JMIR Publications

JMIR Preprints

Advertisement

Journal Description

JMIR Preprints contains pre-publication/pre-peer-review preprints intended for community review (FAQ: What are Preprints?). For a list of all preprints under public review click here. The NIH and other organizations and societies encourage investigators to use interim research products, such as preprints, to speed the dissemination and enhance the rigor of their work. JMIR Publications facilitates this by allowing its' authors to expose submitted manuscripts on its' preprint server with a simple checkbox when submitting an article, and the preprint server is also open for non-JMIR authors.

With the exception of selected submissions to the JMIR family of journals (where the submitting author opted in for open peer-review, and which are displayed here as well for open peer-review), there is no editor assigning peer-reviewers.

Submissions are open for anybody to peer-review. Once two peer-review reports of reasonable quality have been received, we will send these peer-review reports to the author, and may offer transfer to a partner journal, which has its own editor or editorial board.

The submission fee for that partner journal (if any) will be waived, and transfer of the peer-review reports may mean that the paper does not have to be re-reviewed. Authors will receive a notification when the manuscript has enough reviewers, and at that time can decide if they want to pursue publication in a partner journal.

If authors want to have the paper only considered/forwarded to specific journals, e.g. JMIR, PLOS, PEERJ, BMJ Open, Nature Communications etc) after peer-review, please specify this in the cover letter. Simply rank the journals and we will offer the peer-reviewed manuscript to these editors in the order of your ranking.

If authors do NOT wish to have the preprint considered in a partner journal (or a specific journal), this should be noted in the cover letter.

JMIR Preprints accepts manuscripts at no costs and without any formatting requirements (but if you intend the submission to be published eventually by a specific journal, it is of advantage to follow their instructions for authors). Authors may even take a WebCite snapshot of a blog post or "grey" online report. However, if the manuscript is already peer-reviewed and formally published elsewhere, please do NOT submit it here (this is a preprint server, not a postprint server!).

 

Recent Articles:

  • Image credit: Research to Action www.researchtoaction.org/reviewing-peer-review/ - shared by AJC ajcann.wordpress.com on FlickR https://www.flickr.com/photos/ajc1/6735929719/in/faves-14231445@N00/, licensed under Creative Commons Attribution-ShareAlike 2.0 https://creativecommons.org/licenses/by-sa/2.0/

    Peer-Review 2.0: Welcome to JMIR Preprints, an Open Peer-Review Marketplace for Scholarly Manuscripts

    Authors List:

    Abstract:

    JMIR Preprints is a preprint server and "manuscript marketplace" with manuscripts that are intended for community review. Great manuscripts may be snatched up by participating journals which will make offers for publication.There are two pathways for manuscripts to appear here: 1) a submission to a JMIR or partner journal, where the author has checked the "open peer-review" checkbox, 2) Direct submissions to the preprint server. For the latter, there is no editor assigning peer-reviewers, so authors are encouraged to nominate as many reviewers as possible, and set the setting to "open peer-review". Nominated peer-reviewers should be arms-length. It will also help to tweet about your submission or posting it on your homepage. For pathway 2, once a sufficient number of reviews has been received (and they are reasonably positive), the manuscript and peer-review reports may be transferred to a partner journal (e.g. JMIR, i-JMR, JMIR Res Protoc, or other journals from participating publishers), whose editor may offer formal publication if the peer-review reports are addressed. The submission fee for that partner journal (if any) will be waived, and transfer of the peer-review reports may mean that the paper does not have to be re-reviewed. Authors will receive a notification when the manuscript has enough reviewers, and at that time can decide if they want to pursue publication in a partner journal. For pathway 2, if authors do not wish to have the preprint considered in a partner journal (or a specific journal), this should be noted in the cover letter. Also, note if you want to have the paper only considered/forwarded to specific journals, e.g. JMIR, PLOS, PEERJ, BMJ Open, Nature Communications etc), please specify this in the cover letter. Manuscripts can be in any format. However, an abstract is required in all cases. We highly recommend to have the references in JMIR format (include a PMID) as then our system will automatically assign reviewers based on the references.

Citing this Article

Right click to copy or hit: ctrl+c (cmd+c on mac)

Latest Submissions Open for Peer-Review:

View All Open Peer Review Articles
  • Assessing therapeutic alliance in the context of m-health interventions for mental health problems

    From: Journal of Medical Internet Research

    Date Submitted: Oct 4, 2017

    Open Peer Review Period: Oct 4, 2017 - Nov 29, 2017

    Background: There are a variety of digital health interventions (DHIs) in the form of smartphone apps, with a growing proportion of these aimed at improving mental health. This is an important develop...

    Background: There are a variety of digital health interventions (DHIs) in the form of smartphone apps, with a growing proportion of these aimed at improving mental health. This is an important development, enabling people access to support as and when needed without having to overcome the stigma many people experience in accessing routine mental health services. If we are to evaluate m-health apps and advance scientific understanding in this field, we also need tools to help us understand in what ways m-health interventions are or are not effective. The concept of therapeutic alliance (TA), a measure of the quality of the relationship between a healthcare provider and a service user, is a key factor in explaining the effects of face-to-face mental health interventions. To date, the concept of TA in relation to m-health interventions has received little attention. Objective: This study presents the first attempt to: i) explore service users’ views of the concept of ‘relationship’ within m-health mental health interventions; and ii) adapt a well validated face-to-face measure of TA, the Agnew Relationship Measure (ARM), for use with m-health interventions. Methods: Our methodology involved three stages. In stage one, we interviewed nine mental health service users about the concept of TA in the context of a DHI and derived key themes from interview transcripts using thematic analysis. In stage two, we used a combination of rating scales and open-ended questions and elicited views from fourteen service users and ten mental health staff about the content and face validity of a version of the ARM which replaced the word ‘therapist’ with the word ‘app’. In stage three, we used the findings from stages one and two to adapt the measure with the support of a decision-making algorithm about which items to drop, retain or adapt. Results: Findings suggest that service users do identify relationship concepts when thinking about m-health interventions, including forming a bond with an app and the ability to be open with an app. However, there were key differences between relationships with health professionals and relationships with apps, such as apps not being as tailored and responsive to each person’s unique needs and apps not being capable of portraying uniquely human-like qualities such as friendliness, collaboration and agreement. Conclusions: We present an m-health version of the ARM, the m-ARM, which has good face and content validity. We encourage researchers to include this easy to use administer tool in DHI studies to develop further data about its psychometric properties and advance our understanding of the efficacy of m-health interventions and the TA in the context of DHIs.

  • Comparative Analysis of Health Information Reporting Discrepancies Between Internet Media and Scientific Articles

    From: JMIR Preprints

    Date Submitted: Sep 15, 2017

    Open Peer Review Period: Sep 17, 2017 - Sep 2, 2018

    Background: Dietary supplements are the most used complementary and alternative health modality in the U.S., and omega-3 supplements continue to be the most popularly used non-vitamin/non-mineral supp...

    Background: Dietary supplements are the most used complementary and alternative health modality in the U.S., and omega-3 supplements continue to be the most popularly used non-vitamin/non-mineral supplements by adults. Supplement users report that they obtain health guidance from internet media resources, but there is question as to whether or not these resources provide the necessary evidence to guide health decisions. Current evidence suggests that there is a mistranslation occurring somewhere between researchers and the media. Objective: We conducted a comparative cross-sectional analysis to identify areas of discordance created when science is translated from the lab to online news media. Methods: A Google news search provided our convenience sample of 40 omega-3 supplement based media reports stratified by the years 2009-2012. Media reports (n = 17) were compared to the corresponding scientific article for content. Report and article content was extracted using commonly accepted reporting guideline domains, and domains were then compared to detect underlying omissions or mistranslations in reporting. Mean scores for all of the scientific articles and media reports were assessed for each domain. Results: Scientific articles generally maintained a mean close to complete (0.85) for each reporting domain. Media reports were far more likely to report potential caveats and warnings for consumers with a mean domain for Caveat reporting of 0.88, (95%CI[0.72, 1.0]). Conclusions: There are inherent differences in the intended audience, structure, and goals in scientific and media communications. These differences should be explored further, and consumers should be made aware of them. Additional considerations for balanced reporting and reader accessibility are also necessary to take into account, and are explored further in this analysis.

  • Worker preferences for a mental health App in male-dominated industries: A Participatory Study

    From: Journal of Medical Internet Research

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 23, 2017 - Nov 18, 2017

    Background: Men are less likely to seek help for mental health problems possibly due to stigma imposed by cultural masculine norms. These tendencies may be amplified within male-dominated workplaces s...

    Background: Men are less likely to seek help for mental health problems possibly due to stigma imposed by cultural masculine norms. These tendencies may be amplified within male-dominated workplaces such as the emergency services, or transport industries. Mobile apps present a promising way to provide access to mental health support. However, little is known about the kinds of technologies men would be willing to engage with in their workplace, and no App can work if people do not engage with it. Objective: The goal of this participatory user research study was to explore the perceptions, preferences, and ideas of workers in male-dominated workplaces in order to define requirements for a mental health app that would be engaging and effective at improving psychological well-being. Methods: Workers from male-dominated workplaces in rural, suburban, and urban locations, took part in participatory workshops designed to elicit their perspectives and preferences for mental health support and the design of an app for mental health. Participants generated a number of artifacts (including draft screen designs and promotional material) designed to reify their perceptions, tacit knowledge, and ideas. Results: A total of 60 workers aged 26-65 years (92% male) from male-dominated workplaces in rural (27%), suburban (23%) and urban (50%) locations participated in one of six workshops resulting in 49 unique feature ideas and 81 participant-generated artifacts. Thematic analysis resulted in a set of feature, language, and style preferences, as well as characteristics considered important by participants for a mental health app. The term “mental health” was highly stigmatized and disliked by participants. Tools including a mood tracker, self-assessment and “mood boost” tool were highly valued and App characteristics such as the brevity of interactions, minimal on-screen text and a solutions-oriented approach were considered essential by participants. Conclusions: Future mental health smartphone applications targeting workers in male-dominated workplaces need to balance the preferences of users with the demands of evidence-based intervention. In addition to informing the development of mental health apps for workers in male-dominated industries, these findings may also provide insights towards mental health technologies for men more generally, and for others in high-stigma environments.

  • An mHealth Platform for Supporting Clinical Data Integration in Augmentative and Alternative Communication Service Delivery

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 23, 2017 - Nov 18, 2017

    Background: The recent trend of increasing healthcare costs in the United States is likely not sustainable. To make healthcare more economically sustainable, attention must be directed towards improvi...

    Background: The recent trend of increasing healthcare costs in the United States is likely not sustainable. To make healthcare more economically sustainable, attention must be directed towards improving the quality while simultaneously reducing the cost of healthcare. One of the recommended approaches to providing better care at a lower cost is to build high quality data collection and reporting systems, which support healthcare professionals in making optimal clinical decisions based on solid, extensive evidence. Objective: This project sought to develop an integrated mHealth Augmentative and Alternative Communication (AAC) platform consisting of an AAC mobile app and a web-based clinician portal for supporting evidence-based clinical service delivery. Methods: A questionnaire and an interview study were used to collect clinicians’ ideas regarding what constitutes their desired “clinically relevant” data. In response, a web portal was designed by combining mobile and web technologies with AAC intervention to create an integrated platform for supporting data collection, integration, and reporting. Finally, a usability study was conducted with healthcare professionals. Results: A web-based portal was created and integrated with a tablet-based AAC mobile app and data analysis procedures. In the usability study, all participants agreed that the integrated platform provides the ability to collect comprehensive clinical evidence, automatically analyze collected data in real time, and generate clinically relevant performance measures through an easily accessible web portal. Conclusions: The integrated platform offers a better approach for clinical data reporting and analytics. Additionally, the platform streamlines the workflow of AAC clinical service delivery.

  • To share or not to share? Examining perspectives on privacy, trust, and data sharing in web-based and mobile research among a large nationwide sample of men who have sex with men

    From: Journal of Medical Internet Research

    Date Submitted: Sep 28, 2017

    Open Peer Review Period: Oct 2, 2017 - Nov 27, 2017

    Background: Research is increasingly relying on online and mobile technologies, and this is particularly true among historically hard-to-reach populations such as gay, bisexual, and other men who have...

    Background: Research is increasingly relying on online and mobile technologies, and this is particularly true among historically hard-to-reach populations such as gay, bisexual, and other men who have sex with men (GBMSM). Despite this, very little empirical data have been published on participant perspectives about issues such as privacy, trust, and data sharing. Objective: Data from an online sample of 11,032 GBMSM in the United States were analyzed to examine trust and perspectives on privacy and data sharing within online and mobile research. Methods: Participants were recruited via a social networking site or sexual networking app to complete an anonymous online survey. We conducted a series of repeated measures analyses adjusted for between-person factors to examine differences in: (1) trust for guarding personal information across different venues (e.g., online research conducted by a university, an online search engine); (2) privacy concerns about twelve different types by data activity (i.e., collection by app owners, anonymous selling to third parties, and anonymous sharing with researchers); and (3) willingness to share twelve different types of data with researchers. Due to the large sample size, we primarily report measures of effect size as evidence of clinical significance. Results: Online research was rated highest with regards to trust and was different from online and mobile technology companies, such as app owners and search engines, by magnitudes of effect that were moderate (partial-η2 = 0.06) to large (partial-η2 = 0.11). Responding separately about twelve different types of data, participants expressed more concerns regarding anonymously selling data to third-party partners (Mdn = 7.6) and fewer concerns about the data being collected by the app owners (Mdn = 5.8) or shared anonymously with researchers (Mdn = 4.6); differences were small-to-moderate in size (partial-η2 = 0.01, partal-η2 = 0.03). Participants were most willing to share public profile information (e.g., age) with researchers and least willing to share device usage information (e.g., other apps installed); the comparisons were small-to-moderate in size (partial-η2 = 0.03). Conclusions: Participants reported high levels of trust in online and mobile research, which is noteworthy given recent high profile cases of corporate and government data security breaches. Researchers and ethical boards should keep up with technological shifts to maintain the ability to guard privacy and confidentiality and maintain trust. Relatedly, there was substantial variability in privacy concerns about and willingness to share different types of data, suggesting the need to gain consent for data sharing on a specific rather than broad basis. Finally, we saw evidence of a privacy paradox whereby participants expressed privacy concerns about the very types of data-related activities they have likely already permitted via the terms of the apps and sites they use regularly.

  • Predicting Sexual Behaviors among Homeless Young Adults using Ecological Momentary Assessment: Results of Project Youth EMA

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 21, 2017

    Open Peer Review Period: Sep 29, 2017 - Nov 24, 2017

    Background: Homeless youth continue to be disproportionately affected by HIV compared to their housed peers with prevalence rates as high as 13%. Yet, HIV prevention in this high-risk population has o...

    Background: Homeless youth continue to be disproportionately affected by HIV compared to their housed peers with prevalence rates as high as 13%. Yet, HIV prevention in this high-risk population has only been marginally effective. Objective: The aim of this study was to determine whether EMA data can be used to develop a predictive model of sexual risk among homeless youth. Methods: Homeless youth 18-24 years old were recruited from a drop-in center in Houston, TX between August, 2015 and May, 2016. All participants received a study-issued smartphone that prompted brief Ecological Momentary Assessments (EMAs) 5 times a day for 21 days. EMA items assessed near real-time sexual behaviors, cognitions, stress, affect, environmental factors, and environmental circumstances. Results: Participants (N=66) were predominantly male (64%) and Black (66%) with a median age of 20 years old. The mean number of EMAs completed by each participant was 45 observations (i.e., 13 daily and 33.6 random EMAs). Of the 70% of participants who were sexually active during the study, condomless sex was reported in 102 incidences or in 75% of sexual intercourse incidences. In total, 38 (58%) participants reported engaging in any high risk sexual behaviors within the data collection period including condomless sex (53%), having multiple sexual partners in the same day (26%), trading sex (16%), or sharing needles while injecting drugs (3%). Of those, 71% had engaged in more than one of the risk behaviors during the study. The predictive model was based on observations from 66 subjects over 811 days and included 137 cases of sexual intercourse and included sexual orientation, race, mental health, drug use, and sexual urge as predictors in the parsimonious GLMM selected on the basis of the Akaike information criterion (AIC). The estimated odds ratios were notable for same day drug use (OR = 2.17, p < .001) and sexual urge (OR = 1.44, p < 0.01). Performance of the risk estimator was satisfactory, as indicated by the value of 0.834 for the area under the ROC curve [1]. Conclusions: Real-time EMA data can be used to predict sexual intercourse among a sample of high risk, predominately unsheltered homeless youth. Sexual urge and drug use account for increased odds of engaging in sexual activity on any given day. Interventions targeting sexual urge and drug use may help address high rates of HIV risk behaviors among this population.

  • Towards impactful collaborations on Computing and Mental Health

    From: Journal of Medical Internet Research

    Date Submitted: Sep 26, 2017

    Open Peer Review Period: Sep 27, 2017 - Nov 22, 2017

    We describe an initiative to bring mental health researchers, computer scientists, human-computer interaction researchers and other communities together to address the challenges of the global mental...

    We describe an initiative to bring mental health researchers, computer scientists, human-computer interaction researchers and other communities together to address the challenges of the global mental health epidemic. Two face-to-face events and one special issue of the Journal of Medical Internet Research were organized. The works presented in these events and publication reflect key current state of the art research in this interdisciplinary collaboration. A summary description of the special issue articles is presented and contextualized in order to present a picture of the most recent research. In addition, we describe a series of collaborative activities held during the 2nd Symposium and where the community identified five challenges and their possible solutions.

  • The co-production of a theory-based digital resource for unpaid carers: the Care Companion

    From: Journal of Medical Internet Research

    Date Submitted: Sep 23, 2017

    Open Peer Review Period: Sep 25, 2017 - Nov 20, 2017

    Background: Family and other unpaid carers are crucial to supporting the growing population of older people that are living outside residential care with frailty and co-morbidities. The burden associ...

    Background: Family and other unpaid carers are crucial to supporting the growing population of older people that are living outside residential care with frailty and co-morbidities. The burden associated with caring affects carers’ wellbeing, so limiting the sustainability of such care. There is a need for accessible, flexible and responsive interventions that promote carers’ coping and resilience, and so support maintenance of the health, wellbeing and independence of the cared for person. Objective: This study aimed to co-produce a digital program for carers to support effective use of information and other online resources. Its overlapping stages comprised: understanding the ways in which online interventions may address challenges faced by carers; identifying target behaviours for the intervention; identifying intervention components; and developing the intervention prototype. Methods: The study was informed by person-based theories of co-production, and involved substantial patient and public involvement together with input from a range of key stakeholders. It drew on the Behaviour Change Wheel framework to support a systematic focus on behavioural issues relevant to caring. It comprised scoping literature reviews, interviews and focus groups with carers and organisational stakeholders, and an agile, lean approach to IT development. Qualitative data was analysed using a thematic approach. Results: Four behavioural challenges were identified: burden of care lack of knowledge, self-efficacy and lack of time. Local health and social care services for carers were only being accessed by a minority of carers. Carers appreciated the potential value of online resources, but described difficulty identifying reliable information at times of need. Key aspects of behaviour change relevant to addressing these challenges were education (increasing knowledge and understanding), enablement (increasing means and reducing barriers for undertaking caring roles) and persuasion (changing beliefs and encouraging action towards active use of the intervention). In collaboration with carers, this was used to define requirements for the program. A resources library was created to link to websites, online guidance, video and other material that addressed condition-specific and generic information. Each resource was classified according to a taxonomy itemising over 30 different sub-categories of need under the headings Care Needs (of the cared-for person), General information and advice, and Sustaining the Carer. In addition, features, such as a journal and mood monitor, were incorporated to address other enablement challenges. The need for proactive, personalised prompts emerged; the program regularly prompts the carer to re-visit and update their profile which, together with their previous use of the intervention, drives notifications about resources and actions that may be of value. Conclusions: The “person-based” approach has allowed an in-depth understanding of the biopsychosocial context of carers to inform the production of an engaging, relevant, applicable and feasible online intervention. User acceptance and feasibility testing is currently underway.

  • Lamotrigine therapy for bipolar depression: Analysis of self-reported patient data

    From: JMIR Mental Health

    Date Submitted: Sep 23, 2017

    Open Peer Review Period: Sep 24, 2017 - Nov 19, 2017

    Lamotrigine is an anticonvulsant used for the treatment of bipolar disorder, especially for depressive episodes. A randomized placebo controlled trial was conducted and self-reported mood scores were...

    Lamotrigine is an anticonvulsant used for the treatment of bipolar disorder, especially for depressive episodes. A randomized placebo controlled trial was conducted and self-reported mood scores were collected over a period of 52 weeks. Different features were computed from the weekly time series produced by each subject. The coefficient of variation (σ/μ) and detrended fluctuation analysis scaling exponent (α), a measure of scaling and long-range persistence (long memory) in time series, were selected as having the most explanatory power. Data from patients taking lamotrigine show a general decrease in depression score in comparison to the patients taking placebo. The time series of lamotrigine patients tend to be rougher than the placebo group. A classifier was built and, based on the two chosen metrics, we are able to achieve a classification accuracy of more than 60% in predicting the treatment mode.

  • Applying Persuasive Design Techniques to Change Data Entry Behaviour in Primary Care

    From: Journal of Medical Internet Research

    Date Submitted: Nov 4, 2017

    Open Peer Review Period: Nov 6, 2017 - Jan 1, 2018

    Background: Persuasive design (PD) is an approach that seeks to change the behaviours of users by using design and social influence. In primary care, clinician behaviours and attitudes are important p...

    Background: Persuasive design (PD) is an approach that seeks to change the behaviours of users by using design and social influence. In primary care, clinician behaviours and attitudes are important precursors to structured data entry, and there is an impact on overall data quality. This research hypothesizes that PD could change data entry behaviours in clinicians and improve data quality. Objective: Our objective was to use PD principles to change clinician data-entry behaviours in a primary care environment and to increase data quality within a registry system. Methods: We performed a detailed systems analysis of the data-entry task by using cognitive work analysis (CWA). We used the results of this analysis with the Persuasive Systems Design (PSD) framework to describe the persuasion context. We identified several PD principles to be introduced in a new summary screen, which became part of the data entry workflow. As part of our experimental design, we defined three data quality measures (same-day entry, record completeness, and data validity) to measure changes in data quality and entry behaviour. We measured the impacts of the new screen with a paired pre/post t-test and generated XmR charts to contextualize the results. Results: 53 users were shown the new screen during their data entry over the course of 10 weeks. Based on a pre-post analysis, the new summary screen successfully encouraged users to enter more of their data on the same day as their encounter. The percentage of same-day entries increased by 10.34% (P < 0.001). During the first month of the new screen, users compensated by sacrificing aspects of data completeness, before returning to normal in the second month. Improvements to record validity were marginal over the study period (P = 0.045). Statistical process control techniques allowed us to study the XmR charts to contextualize our results and understand trends throughout the study period. Conclusions: By conducting a detailed systems analysis and introducing new PD elements into a data entry system, we demonstrated it was possible to change data-entry behavior and influence data quality in a reporting system. The results show that using PD concepts may be effective at influencing data entry behaviours in clinicians. There may be opportunities to continue improving this approach, and further work is required to perfect and test additional designs. Persuasive design is a viable approach to encourage clinician user change and could support better data capture in the field of medical informatics.

  • Designing for Clinical Change: Creating an Intervention to Implement New Statin Guidelines in a Primary Care Clinic

    From: Journal of Medical Internet Research

    Date Submitted: Sep 25, 2017

    Open Peer Review Period: Sep 25, 2017 - Nov 20, 2017

    Background: Recent clinical practice guidelines from major national organizations, including a joint United States Department of Veterans Affairs and Department of Defense (VA/DoD) committee, have sub...

    Background: Recent clinical practice guidelines from major national organizations, including a joint United States Department of Veterans Affairs and Department of Defense (VA/DoD) committee, have substantially changed recommendations for the use of the cholesterol-lowering statin medications after years of relative stability. Because statin medications are among the most commonly prescribed treatments in the United States, any change to their use may have significant implications for patients and providers alike. Prior research has shown that effective implementation interventions should be both user-centered and specifically chosen to address identified barriers. Objective: To identify potential determinants of provider uptake of the new statin guidelines and to use that information to tailor a coordinated and streamlined local quality improvement intervention focused on statin prescribing. Methods: We employed user-centered design principles to guide the development and testing of a multi-component guideline implementation intervention to improve statin prescribing. This paper describes the intervention development process whereby semi-structured qualitative interviews with providers were conducted to 1) illuminate the values, workflows, and subjective needs and preferences of providers and 2) elicit feedback on intervention prototypes developed to align with and support the use of the VA/DoD guidelines. Our aim was to use this information to design a local quality improvement intervention focused on statin prescribing that was tailored to the needs of primary care providers at our facility. Cabana’s Clinical Practice Guidelines Framework for Improvement and Nielsen’s Usability Heuristics were used to guide the analysis of data obtained in the intervention development process. Results: Semi-structured qualitative interviews were conducted with 15 primary care Patient Aligned Care Team (PACT) professionals (13 physicians and two clinical pharmacists) at a single VA medical center (VAMC). Findings highlight that providers were generally comfortable with the paradigm shift to risk-based guidelines, but less clear on the need for the VA/DoD guidelines in specific. Providers preferred a clinical decision support tool that helped them calculate patient risk and guide their care without limiting autonomy. They were less comfortable with risk communication and performance measurement systems that do not account for shared decision making. When possible, we incorporated their recommendations into the intervention. Conclusions: By combining qualitative methods and user-centered design principles, we were able to inform the design of a multicomponent guideline implementation intervention to better address the needs and preferences of providers, including clear and direct language, logical decision prompts including an option to dismiss a clinical decision support tool, and logical ordering of feedback information. Additionally, this process allowed us to identify future design considerations for quality improvement interventions.

  • Cross-cultural adaptation and translation of a text-based mCessation programme in Samoa

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 25, 2017

    Open Peer Review Period: Sep 25, 2017 - Nov 20, 2017

    Background: Background Samoa faces a persistent high prevalence of adult tobacco use and few existing cessation support services. Mobile phones are ubiquitous, generally affordable and mobile literac...

    Background: Background Samoa faces a persistent high prevalence of adult tobacco use and few existing cessation support services. Mobile phones are ubiquitous, generally affordable and mobile literacy is relatively high. A text message smoking cessation programme (mCessation) designed in New Zealand was adapted for use in Samoa to assist national objectives to reduce tobacco use. Objective: To describe the process of adapting the content and delivery of a mCessation programme for a middle income Pacific country. Methods: Focus groups were conducted with smokers and ex-smokers to explore the context for tobacco use and preferences for text based messages. A post-intervention focus group was conducted after participants received text messages for one week. Frequent, face to face meetings with the primary partner (Ministry of Health Samoa) and key stakeholders were conducted from the outset of the project. Participatory feedback and collaboration from stakeholders became an integral part of the cultural adaptation and translation of the programme. Detailed document analyses were included as part of a formal evaluation of the initiative to explore the core determinants of success for adapting the programme to the Samoan cultural context. Results: The text messages evolved significantly following an iterative process of consultation, in situ testing, revision and retesting to arrive at an acceptable country-specific version of the mCessation programme. The text messages retained in the final set remain consistent with the theory of behaviour change but reflect both linguistic and cultural nuances appropriate for Samoa. Adapting messages requires simultaneous multilevel processes including complex high-level engagement between the team and stakeholders alongside crafting precise content for (character limited) messages. Conclusions: Receiving cessation support messages via a mobile phone show promise and appear to be an acceptable and accessible mode of delivery for tobacco cessation, particularly in the absence of alternative support. Adapting a text based programme in Samoa requires fastidious attention to nuances of culture, language and socio-political structures in-country.

  • A Theory-Based Web Survey on Psychosocial Factors in Health Professionals’ Intention to Use a Decision Aid for Down Syndrome Screening

    From: Journal of Medical Internet Research

    Date Submitted: Sep 25, 2017

    Open Peer Review Period: Sep 25, 2017 - Nov 20, 2017

    Background: Health professionals are expected to engage pregnant women in decisions about prenatal screening tests for Down syndrome. The use of patient decision aids fosters shared decision making, b...

    Background: Health professionals are expected to engage pregnant women in decisions about prenatal screening tests for Down syndrome. The use of patient decision aids fosters shared decision making, but they are rarely used in this context. Objective: We sought to identify factors influencing health professionals’ intention to use a DA during a prenatal visit for decisions about Down syndrome screening. Methods: We conducted cross-sectional quantitative study using a theory-based survey of midwives, family physicians and obstetricians/gynecologists in the province of Quebec (Canada) using a web panel. From December 18th, 2015 to October 4th, 2016, we recruited health professionals. Eligibility criteria were: a) involved in prenatal care; b) family physicians, midwives, obstetrician-gynecologists or interns in these professions; and c) working in the province of Quebec. Participants watched a video depicting the use of a DA during a prenatal consultation with a health professional, a pregnant woman and her partner, and then answered a questionnaire based on an extended version of the Theory of Planned Behavior (TPB). The questionnaire assessed eight psychosocial constructs (attitude, anticipated regret, subjective norm, self-identity, moral norm, descriptive norm, self-efficacy and perceived control), seven related sets of behavioral beliefs (advantages, disadvantages, emotions, sources of encouragement or discouragement, incentives, facilitators and barriers) as well as sociodemographic data. We performed descriptive, bivariate, and multiple linear regression analyses to identify the factors influencing professionals’ intention to use a DA. Results: Among 330 health professionals who completed the survey, 310 met the inclusion criteria: 171 family physicians (55%), 105 obstetrician-gynecologists (34%), and 34 midwives (11%). Of these, 251 were female (81%) and the mean age of participants was 39.6 ± 11.5 years. In decreasing order of importance, socio-cognitive factors influencing participants’ intention to use a DA for Down syndrome prenatal screening were: 1) self-identity (β=0.325, P<0.0001), 2) attitude (β=0.297, P<0.0001), 3) moral norm (β=0.288, P<0.0001), 4) descriptive norm (β=0.166, P<0.0001), and 5) anticipated regret (β=0.099, P=0.0026). Underlying attitudinal beliefs of participating health professionals significantly related to intention were that the use of a DA (i) would promote decision making (β = 0.117, 95% CI 0.043, 0.190), (ii) would reassure health professionals (β = 0.100, 95% CI 0.024, 0.175), and (iii) might require more time than planned for the consultation (β = -0.077, 95% CI -0.124, -0.031). Conclusions: Implementation interventions targeting the use of a DA among health professionals for prenatal screening for Down syndrome should include strategies to remind them: a) that this would be expected from someone in their societal role, b) the favorable emotions they will experience from using it, c) that it is likely would be compatible with their moral values, d) that other health professionals use it and that they may regret not using it.

  • Assessing Unmet Information Needs of Breast Cancer Survivors using Text Classification and Retrieval

    From: Journal of Medical Internet Research

    Date Submitted: Sep 27, 2017

    Open Peer Review Period: Sep 27, 2017 - Nov 22, 2017

    Background: Patient education materials given to breast cancer survivors may not be a good fit for their information needs. Needs may change over time, be forgotten, or be misreported, for a variety o...

    Background: Patient education materials given to breast cancer survivors may not be a good fit for their information needs. Needs may change over time, be forgotten, or be misreported, for a variety of reasons. An automated content analysis of survivors' postings to online health forums can identify expressed information needs over a span of time and be repeated regularly at low cost. Identifying these unmet needs can guide improvements to existing education materials and the creation of new resources. Objective: The primary goals of this project are to assess the unmet information needs of breast cancer survivors from their own perspectives and to identify gaps between information needs and current education materials. Methods: This approach employs computational methods for content modeling and supervised text classification to data from online health forums to identify explicit and implicit requests for health-related information. Potential gaps between needs and education materials are identified using techniques from information retrieval. Results: We provide a new taxonomy for the classification of sentences in online health forum data. 260 postings from two online health forums were selected, yielding 4179 sentences for coding. After annotation of data and training alternative one-versus-others classifiers, a random forest-based approach achieved F1 scores from 66% (Other, dataset2) to 90% (Medical, dataset1) on the primary information types. 136 expressions of need were used to generate queries to indexed education materials. Upon examination of the best two pages retrieved for each query, 12% of queries were found to have relevant content by all coders, and 33% were judged to have relevant content by at least one. Conclusions: Text from online health forums can be analyzed effectively using automated methods. Our analysis confirms that breast cancer survivors have many information needs that are not covered by the written documents they typically receive, as our results suggest that at most a third of breast cancer survivors’ questions would be addressed by the materials currently provided to them.

  • Promoting psychological wellbeing at work by reducing stress and improving sleep: results from a mixed methods analysis

    From: Journal of Medical Internet Research

    Date Submitted: Sep 26, 2017

    Open Peer Review Period: Sep 27, 2017 - Nov 22, 2017

    Background: Workplace programs designed to improve the health and psychological wellbeing of employees are becoming more popular. However, there are mixed reports regarding the effectiveness of such p...

    Background: Workplace programs designed to improve the health and psychological wellbeing of employees are becoming more popular. However, there are mixed reports regarding the effectiveness of such programs and little analysis of what makes these programs effective. Objective: This evaluation of a particularly broad, team-based, digital health and wellbeing program uses mixed methods to identify the elements of the program that promote the psychological wellbeing of employees and the characteristics of the participants best served by this program. Methods: Participants in the Virgin Pulse Global Challenge (VPGC) program during the period May-September 2016 were studied. Self-reported stress, sleep quality, productivity and psychological wellbeing data were collected both pre- and post-program. Participant experience data was also collected through an additional survey released after program completion (n=18,674). Text mining of the participant experience data and machine learning methods were used to identify which factors drove successful outcomes. Results: Results for the participants who completed all three of the surveys (8%) indicate that the VPGC program was effective (p<.001) for improving psychological wellbeing (2 = 0.372), sleep quality (2 = 0.298), work-related stress (2 = 0.226) and productivity (2 = 0.109). For the participants who completed only the first two surveys the results were still significant but not as strong. After pre-program psychological wellbeing, improvement in productivity was the most important predictor of post-program psychological wellbeing (2 = 0.245), followed by improvements in sleep (2 = 0.226) and stress (2 = 0.206). Improved colleague connections were less important (2 = 0.114). The Physical Activity module increased the odds of an improvement in connections with colleagues by 38% on average (95% CI 22%, 56%). However, this module was less important for improvements in stress, sleep, productivity and psychological wellbeing than any of the three other program modules (namely, Nutrition, Sleep, and Balance). Text-mining methods were used to identify 25 key topics from participant descriptions of the VPGC program and regression tree models incorporating these topics provided a contextual view of how the program modules and features drove improvements in psychological wellbeing, stress, sleep and productivity. However, there was some indication that the tracking of steps in the Physical Activity module of the program was proving a distraction. In addition, it was found that the effect of the program was not as beneficial for those who showed less engagement with the program in that they failed to complete the participant experience survey. Conclusions: The results suggest that the VPGC program improves stress, sleep, productivity and psychological wellbeing. The complementary use of both qualitative and quantitative survey data in a mixed methods analysis provided rich information that will inform the development of this and other programs designed to improve employee health. Clinical Trial: n.a.

  • Using information and communication technologies and digital health services for self-management support: perceptions of persons with type 2 diabetes treated in Swedish primary health care – A Qualitative Study

    From: Journal of Medical Internet Research

    Date Submitted: Oct 2, 2017

    Open Peer Review Period: Oct 4, 2017 - Nov 29, 2017

    Background: Digital health services are increasing rapidly worldwide. Strategies to involve patient in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance and there is a...

    Background: Digital health services are increasing rapidly worldwide. Strategies to involve patient in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance and there is a need to optimize the delivery of care, such as self-management support. Digitalised solutions have the potential to modify and personalise the way in which people use primary health services, both by increasing access to information and providing other forms of support at a distance. This study is part of a larger project aimed at implementing person-centred interactive self-management support (iSMS) in primary health care. Objective: The aim of this study was to describe perceptions of using information and communication technologies (ICT) and digital health services for self-management support among people with type 2 diabetes treated in Swedish primary healthcare. Methods: This is a report from a qualitative study, based on interviews analysed using content analysis conducted among people diagnosed with T2D. Results: Findings suggest that the participants had mixed feelings regarding the use of digital health services for self-management support. They experienced potentials such as increased involvement, empowerment, and safety, as well as concerns such as ambiguity and uncertainty. Conclusions: Digital health services for self-management are easily accessible and have the potential to reach a wide population. However, targeted training to increase digital skills is required and personalised devices must be adapted and become more person-centred to improve patients´ involvement in their own care.

  • Validity of wireless sensors in measuring surface electromyography and skin temperature: Basis for a novel preventive headache treatment

    From: Journal of Medical Internet Research

    Date Submitted: Sep 28, 2017

    Open Peer Review Period: Sep 28, 2017 - Nov 23, 2017

    Background: The use of wearables and mobile phone applications in medicine is gaining attention. Biofeedback has the potential to exploit the recent advances in mobile health (mHealth), for the treatm...

    Background: The use of wearables and mobile phone applications in medicine is gaining attention. Biofeedback has the potential to exploit the recent advances in mobile health (mHealth), for the treatment of headaches. Objective: The aim of this study was to assess the validity of selected wireless wearable health monitoring sensors (WHMS) for measuring surface electromyography (SEMG) and peripheral skin temperature in combination with a mobile-phone application. This proof of concept will form the basis for developing innovative mHealth delivery of biofeedback treatment among young persons with primary headache. Methods: Sensors fulfilling the following predefined criteria were identified: wireless, small size, low weight, low cost, and simple to use. These sensors were connected to an application and used by 20 healthy volunteers. Validity was assessed through the agreement with simultaneous control measurements made with stationary neurophysiological equipment. The main variables were: (1) trapezius muscle tension during different degrees of voluntary contraction and (2) voluntary increase in finger temperature. Data were statistically analyzed using Bland-Altman plots, intra-class correlation coefficient (ICC), and concordance correlation coefficient (CCC). Results: The application was programmed to receive data from the wireless sensors, process them, and feed them back to the user through a simple interface. Excellent agreement was found for the temperature sensor, regarding increase in temperature (CCC, 0.90; 95% coefficient interval [CI], 0.83–0.97). Excellent to fair agreement was found for the SEMG sensor. The ICC for the average of three repetitions during four different target levels ranged from 0.58 to 0.81. The wireless sensor showed consistency in muscle tension change during moderate muscle activity. Electrocardiography artifacts were avoided through right-sided use of the SEMG sensors. Participants evaluated the setup as usable and tolerable. Conclusions: This study confirmed the validity of wireless WHMS connected to a smartphone for monitoring neurophysiological parameters of relevance for biofeedback therapy.

  • A Neuroimaging Web Services Interface Design as a Cyber Physical System for Medical Imaging and Data Management in Brain Research

    From: Journal of Medical Internet Research

    Date Submitted: Sep 28, 2017

    Open Peer Review Period: Sep 28, 2017 - Nov 23, 2017

    Background: Structural and functional brain images are generated as essential elements for medical experts to study brain anatomy, learn about the different functions of the brain in its normal and pa...

    Background: Structural and functional brain images are generated as essential elements for medical experts to study brain anatomy, learn about the different functions of the brain in its normal and pathology states, provide diagnosis and prevention measures, and tailor treatment plans that are subject specific. These images are typically visually inspected by experts in the field and stored as part of patient’s medical histories. In order to analyze images without any bias, they must be first converted to numeric values representing volumes, surfaces, direction of water movement in the brain, brain activity maps, etc. Many software packages are available to process the images, but they are complex and difficult to use for non-computer experts. The software packages are also hardware intensive, requiring specialized servers. The results obtained after processing varies depending on the native operating system used and its associated software libraries; data processed in one system cannot typically be combined with data on another system. Objective: Neuroimaging Web Services Interface (NWSI) is a series of processing pipelines that is designed to store, process, and share neuroimaging and clinical data, aimed at fulfilling the need of the neuroimaging community for a common platform to process and store their neuroimaging data. Methods: NWSI was developed based on Drupal 7, with feedback from experts in the field of Alzheimer’s disease and Epilepsy. The repository accepts raw images, such as MRI, PET, DTI, and fMRI. The images are processed using existing and custom software packages. The output is then stored as image files, tabulated files, and MySQL data tables. The system, made up of a series of interconnected servers, is password protected, and is securely accessible through a HIPPA compliant web interface from anywhere in the world. The webserver allows (1) visualization of results by embedding interactive visual analysis of multi-faceted neuroimaging data, and (2) downloading tabulated data results for further processing. Several forms are also available on the interface to capture demographic and clinical data (e.g., diagnoses and neuropsychological test scores). Results: The system has been piloted using data and researchers from the 1Florida Alzheimer’s disease Research Center (ADRC), Baptist Health South Florida, and Nicklaus Children's Hospital. All results were obtained using our processing servers in order to maintain data validity and consistency. The design is responsive and scalable. The processing pipeline starts from a FreeSurfer reconstruction of T1-weighted MRI images. The FreeSurfer and regional Standardized Uptake Value ratio (SUVR) calculations have been validated using ADNI input images and results are posted at LONI (Laboratory of Neuro Imaging) data archive. Conclusions: To our knowledge there is no validated web-based system offering all the services that NWSI offers. The intent of NWSI is to create a tool for clinicians and researchers with keen interest on multimodal neuroimaging but who do not necessarily have the time and/or the required expertise in image processing, computing, and data management resources.

  • How is “tinnitus” is represented in the United Sates newspaper media and social media?

    From: Journal of Medical Internet Research

    Date Submitted: Sep 27, 2017

    Open Peer Review Period: Sep 27, 2017 - Nov 22, 2017

    Background: When people with health conditions start to manage their health issues, one aspect that determines what they do with the information involves what they obtain through various sources (e.g....

    Background: When people with health conditions start to manage their health issues, one aspect that determines what they do with the information involves what they obtain through various sources (e.g., news media, social media, health professionals, friends and family). The information they gather helps form their opinions, and will also to some degree influence their attitudes towards managing the condition. Objective: The current study was aimed at understanding how “tinnitus” is represented in the United Sates newspaper media and in social media (specifically Facebook pages) using text pattern analysis. Methods: This was a cross-sectional study based upon secondary analyses of publicly available data. The two data sets (i.e., text corpuses) analyzed in this study were generated from: (1) U.S. newspaper media during 1980-2017 (downloaded from the database U.S. Major Dailies by ProQuest); and (2) Facebook pages during 2010-2016. The text corpuses were analyzed using the Iramuteq software using cluster analysis and Chi square tests. Results: The newspaper data set had 432 texts (i.e., articles). The cluster analysis resulted in five clusters, which were named as follows: (1) brain stimulation (26.2%); (2) symptoms (13.5%); (3) coping (19.8%); (4) social support (24.2%); and (5) treatment innovation (16.4%). A time series analysis of clusters indicated a change in the pattern of information presented in newspaper media during 1980-2017 (e.g., more emphasis on cluster 5, focusing on treatment inventions). The Facebook data set had 1,569 texts. The cluster analysis resulted in five clusters, which were named as: (1) diagnosis (21.9%); (2) cause (4.1%); (3) research and development (13.6%); (4) social support (18.8%); (5) challenges (11.1%); (6) symptoms (21.4%); and (7) coping (9.2%). A time series analysis of clusters indicated no change in information presented in Facebook pages on tinnitus during 2011-2016. Conclusions: The study highlights the specific aspects about tinnitus that the U.S. newspaper media and social media (i.e., Facebook pages) focuses on, and also how these aspects change over time. These findings can help clinicians to better understand the presupposition that tinnitus patients have, and may also help clinicians in tailoring specific messages during clinical consultations and rehabilitation. More importantly, the findings can help public health experts and health communication experts in tailoring health information about tinnitus in order to promote self-management, as well as assisting in appropriate choices of treatment for tinnitus sufferers. Clinical Trial: NA

  • Web-based versus usual care and other formats of decision aids to support prostate cancer screening decision: systematic review and meta-analysis

    From: Journal of Medical Internet Research

    Date Submitted: Sep 27, 2017

    Open Peer Review Period: Sep 28, 2017 - Nov 23, 2017

    Background: Prostate cancer is a leading cause of cancer among men. Screening for prostate cancer is a controversial issue. Thus, many experts in the field have defended the use of shared decision mak...

    Background: Prostate cancer is a leading cause of cancer among men. Screening for prostate cancer is a controversial issue. Thus, many experts in the field have defended the use of shared decision making using validated decision aids, which can be presented in different formats (written, multimedia, web). Recent studies have concluded that decision aids improve knowledge and reduce decisional conflict. Objective: This meta-analysis aimed to investigate the impact of using web-based decision aids to support men's prostate cancer screening decisions in comparison with usual care and other formats of decision aids. Methods: Pubmed, CINAHL, PsychINFO, and Cochrane Database of Systematic Reviews databases up until November 2016 were searched. The review identified randomised controlled trials, which assessed web-based decision aids for men making a prostate cancer screening decision and reported quality of decision-making outcomes. Two reviewers independently screened citations for inclusion criteria, extracted data, and assessed risk of bias. Using a random-effects model, meta-analyses were conducted pooling results using mean differences (MD), standardized mean differences (SMD), and relative risks (RR). Results: Of 2406 unique citations, seven randomised controlled trials met the inclusion criteria. For risk of bias, selective outcome reporting and partipant/personnel blinding were mostly rated as unclear due to inadequate reporting. Based on seven items, two studies had high risk of bias for one item. Compared to the usual care, web-based decision aids increased knowledge (SMD 0.46; 95% confidence interval [CI] 0.18‒0.75), reduced decisional conflict (MD -7.07%; 95% CI -9.44 ‒ [-]4.71), and reduced the practitioner control role in the decision-making process (RR 0.50; 95% CI 0.31‒0.81). Web-based decision aid compared to printed decision aids yielded no differences in knowledge, decisional conflict, and participation in decision or screening behaviours. Compared to video decision aids, web-based decision aids showed lower average knowledge scores (SMD -0.50; 95% CI -0.88‒[-]0.12) and a slight decrease in prostate-specific antigen (PSA) screening (RR 1.12; 95% CI 1.01‒1.25). Conclusions: According to the present analysis, web-based decision aids performed similarly to alternative formats (printed, video) for the assessed decision-quality outcomes. The low cost, readiness, availability, and anonymity of the worldwide web can be an advantage for increasing access to decision aids that support prostate cancer screening decision among men.

  • Framework of remote postprocedural monitoring of patients undergoing Transcatheter Aortic Valve Replacement

    From: JMIR Cardio

    Date Submitted: Sep 28, 2017

    Open Peer Review Period: Sep 29, 2017 - Nov 24, 2017

    Background: The postprocedural trajectory of patients undergoing transcatheter aortic valve replacement (TAVR) involves in-hospital monitoring of potential cardiac rhythm or conduction disorders and o...

    Background: The postprocedural trajectory of patients undergoing transcatheter aortic valve replacement (TAVR) involves in-hospital monitoring of potential cardiac rhythm or conduction disorders and other complications. Recent advances in telemonitoring technologies create opportunities to monitor the electrocardiogram (ECG) and vital signs remotely, facilitating redesign of follow-up trajectories. Objective: This study aimed to outline a potential set-up of telemonitoring after TAVR. Methods: A multidisciplinary team systematically framed the envisioned telemonitoring scenario according to the iPACT (intentions, People, Activities, Context, Technology) and FICS (Functionality, Interaction, Content, Services) method and identified corresponding technical requirements. Results: In the envisioned scenario agreed upon by the expert team, a wearable sensor system is used to continuously transmit the ECG and contextual data to a central monitoring unit, allowing remote follow-up of ECG abnormalities and physical deteriorations. Telemonitoring is suggested as an alternative or supplement to current in-hospital monitoring after TAVR, enabling early hospital dismissal in eligible patients and accessible follow-up prolongation. Together, this approach aims to improve rehabilitation, enhance patient comfort, optimize hospital capacity usage, and reduce overall costs. Required technical components include continuous data acquisition, real-time data transfer, privacy-ensured storage, sophisticated event detection, and user-friendly interfaces. Conclusions: The suggested telemonitoring set-up involves a new approach of patient follow-up that could bring durable solutions for the growing scarcities in healthcare and for improving healthcare quality. To further explore the potential and feasibility of post-TAVR telemonitoring, evaluation of the overall effects and impact on patient outcome and safety, social, ethical, legal, organizational, and financial factors is desired.

  • Evaluating the effectiveness of real-time patient experience feedback: a systematic review

    From: Journal of Medical Internet Research

    Date Submitted: Sep 28, 2017

    Open Peer Review Period: Sep 29, 2017 - Nov 24, 2017

    Background: One of the essential elements of a strategic approach to improving patents’ experience is to measure and report on patients’ experiences in real-time, to assess progress and identify n...

    Background: One of the essential elements of a strategic approach to improving patents’ experience is to measure and report on patients’ experiences in real-time, to assess progress and identify new opportunities for improving performance. Real-time feedback (RTF) is increasingly being collected or collated using digital technology, however, there remains a gap in the literature with regard to the effectiveness of these digital real-time feedback modes. Objective: The aim of this review was to assess the effectiveness of real-time patient experience feedback. Methods: The following databases were systematically searched to identify articles which used digital systems to collect, collate or disseminate RTF: the Cochrane Librbary, Global Health, Health Management Information Consortium, MEDLINE, EMBASE, PsycINFO, Web of Science and CINAHL. Google Scholar and Grey Literature was also utilised. Studies were assessed on their effectiveness using a Digital Maturity Framework, based on four domains; capacity/resource, usage, interoperability and impact. A total score of four indicated the highest level of digital maturity. Results: Of the 13 eligible studies, none had digital systems that were deemed to be of the highest level of maturity. Three (23.1%) studies achieved a score of 3, three (23.1%) a score of 2, three (23.1%) a score of 1, and four (30.7%) achieved a score of 0. Seven (53.8%) studies demonstrated capacity/resource, and 8 (61.5%) demonstrated impact. No articles demonstrated interoperability in their digital systems. Implementation of digital systems showed acceptable response rates and positive views from patients and staff. Conclusions: Digitally enabled RTF has been chronically under-reviewed. Given the potential benefits, healthcare services should be mindful of the need to ensure digital maturity when implementing RTF. As failure to deliver across the digital maturity continuum may lead to ineffective RTF thwarting improvement efforts.

  • Electronic collection of multilingual patient reported outcomes across Europe

    From: Journal of Medical Internet Research

    Date Submitted: Sep 28, 2017

    Open Peer Review Period: Sep 29, 2017 - Nov 24, 2017

    Background: The interoperability between information systems in healthcare is still an issue despite of the large number of institutions seeking solutions. One of the most commonly accepted ones is th...

    Background: The interoperability between information systems in healthcare is still an issue despite of the large number of institutions seeking solutions. One of the most commonly accepted ones is the use of standards. Patient reported outcomes (PROs), information provided directly by the patient, improve patient diagnosis and treatment, and their translations may be used to treat international patients. Electronic systems and especially mobile devices provide a great opportunity for the collection of PROs. These systems are normally study oriented and therefore single language, not scalable and not interoperable. Objective: To demonstrate the feasibility of an open standard based electronic PRO system in a multilingual and multi-centre context. Methods: MoPat was developed using Java 8 and jQuery Mobile 1.4.5. The system was evaluated in the context of the European dermatology project “PruNet”, which aimed to unify the assessment of itch in routine dermatological care in Europe. Clinicians and patients participating in the PruNet study were interviewed and the user acceptance of MoPat was assessed. Results: MoPat’s initial implementation was enhanced with multilingual capabilities and is now able to perform surveys in several languages and collect the results in a single one. 26 clinicians and 495 patients from 8 European clinical centres participated in a satisfaction survey, resulting in a high acceptance of the system by both groups. The age of the patients not willing to further use MoPat was, in average, considerably higher than the ones willing to use the system. Conclusions: This study represents the first use of an electronic PRO system for the collection of multilingual PROs in an international multi-centre setting. MoPat has been evaluated by both clinicians and patients in the context of a European dermatological study resulting in a high user acceptance. The system will be further developed in order to include new features such as patient’s follow up outside of the clinical setting.

  • Perspectives of nurses toward Telehealth Efficacy and Quality of Health Care

    From: Journal of Medical Internet Research

    Date Submitted: Sep 28, 2017

    Open Peer Review Period: Sep 29, 2017 - Nov 24, 2017

    Background: Telehealth nursing, or the delivery, management, and coordination of nursing care services, provided via telecommunications technology, is one of the methods of delivering health care to p...

    Background: Telehealth nursing, or the delivery, management, and coordination of nursing care services, provided via telecommunications technology, is one of the methods of delivering health care to patients in the USA. It is important to assess the service quality of the involved medical fields as well as the telehealth nursing process .The role of telehealth nursing and related technology toward patient care needs to be justified and established. Objective: The primary objective of this study is to examine whether telehealth technology impacts the perceived level of internal service quality, delivered by nurses, within a telehealth organization. To address this research goal, the notion of telehealth nursing service quality is empirically tested and validated with a survey instrument. Methods: Data was collected based on interview questions inquiring about facilitators and inhibitors to telehealth nursing service quality (TNSQ). A survey to measure telehealth nursing service quality based on the SERVQUAL instrument was completed by adjusting descriptions of the original instrument to suit the context. Follow up interviews were conducted to validate questions on the revised instrument. Results: The findings of this survey research were positive, based on mean differences between expectations and perceptions of telehealth nursing service quality. This indicates satisfaction with TNSQ and also indicates that quality of the service is higher than what the respondents expect. The Wilcoxon signed-ranks test using the p-value for the test, which is 0.35, did not show a statistically significant change between the median differences of perception and expectation. The total number of respondents was 13. Results indicate that overall perceived service quality is a positive value (0.05332).This means the perceptions of the level of service, is slightly higher than what they expect, indicating there is satisfaction with telehealth nursing service quality. Conclusions: The responses to the interview questions and data gathered from the survey showed overall satisfaction with TNSQ. The SERVQUAL instrument was a good framework to assess TNSQ. In a nutshell, the study highlighted how the telehealth process provides daily monitoring of patient health, leading to the benefits of immediate feedback for patients, family, and caregivers as well as convenience of scheduling.

  • Recommendations for the Development of a Mobile HIV-Prevention Intervention for Men Who Have Sex with Men and Hijras in India

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 29, 2017

    Open Peer Review Period: Oct 2, 2017 - Nov 27, 2017

    Background: As Internet and smartphone use expands in India, there is an opportunity to develop mobile health (mHealth) interventions for marginalized populations, including men who have sex with men...

    Background: As Internet and smartphone use expands in India, there is an opportunity to develop mobile health (mHealth) interventions for marginalized populations, including men who have sex with men (MSM) and hijras/transgender women, hesitant to access traditional healthcare systems. Objective: The purpose of this study was to determine if an mHealth intervention was acceptable to MSM and hijras living in Mumbai, and if so, what features would be used. Methods: Data from four focus groups with MSM and interviews with four hijras, ten healthcare providers, and eight mHealth developers were thematically analyzed. Results: Once the need for an mHealth intervention was confirmed, comments about features were organized into three themes: content, usability, and retention. Content subthemes included providing sex education for younger community members, providing information about STIs, and providing information and social support for persons living with HIV. Usability subthemes included presenting content using pictures; using videos to present stories of role models; using push notifications for testing, appointment, and medication reminders; using geo-location to link to just-in-time services; and using telemedicine to increase access to healthcare providers and community services. Five retention subthemes included keeping it fun, using gaming mechanics, developing content in regional languages, protecting confidentiality, and linking to social networking apps. Conclusions: These findings may help inform mHealth development in India.

  • Zika Virus and Sexual Transmission: A Twitter-Based Study

    From: Journal of Medical Internet Research

    Date Submitted: Oct 17, 2017

    Open Peer Review Period: Oct 18, 2017 - Dec 13, 2017

    Background: Zika virus emerged in Latin America in 2015, leading the WHO to declare the epidemic a public health emergency of international concern. Although it is primarily a vector-borne disease, se...

    Background: Zika virus emerged in Latin America in 2015, leading the WHO to declare the epidemic a public health emergency of international concern. Although it is primarily a vector-borne disease, sexual transmission is also possible and has been emphasized in public health recommendations and media coverage. Hence, sexual transmission of Zika may provide important insights into how the public perceive Zika and how health information is shared in social media. Objective: This is an exploratory qualitative research study that aims at describing the discourses around sexual transmission of Zika virus on Twitter during the beginning of the public health emergency of international concern. We also aim to analyze the relationship between information shared in traditional media and Twitter. Methods: We retrieved tweets and linked URLs that contained references to sexual transmission of Zika posted from January 1, 2016, to March 1, 2016. We restricted our search to tweets in English, French, Portuguese, and Spanish. We manually categorized the content of the tweets posted during peaks of Twitter activity and accessed the websites linked to the tweets in order to identify major themes in the textual and graphic content of these websites. Results: We retrieved 37,992 tweets (18,912 in English, 13,799 in Spanish, 3,280 in Portuguese, and 2,001 in French) and three peaks of Twitter activity (February 5, 24, and 27, 2016). The first peak was seen only in Portuguese (412 tweets) and followed the discovery of live Zika particles in saliva. Most tweets had humorous content (55.3%) or were disseminating information (32.0%), and only 19.6% contained an embedded URL. The second peak was seen in English, French, and Spanish (5,514 tweets total) and was associated with the investigation of 14 cases of sexual transmission of Zika in the US. Tweets were emotionally neutral and served the purpose of disseminating information (>94%). The third peak, in all languages (5,182 tweets total), followed the identification of a case of sexually-transmitted Zika in France. Again, tweets were emotionally neutral and disseminated information (>93%). Across all peaks, URLs contained in the tweets contained content predominantly produced by traditional media outlets and represented a technicized speech; Images in these tweets depicted the public health response of the epidemic and emphasized mosquitoes (57.8%), public health authorities (19.0%), and laboratory settings (16.0%). Images of the victims of Zika were not common (16.6%). Conclusions: Early in the Zika epidemic, tweets that mentioned sexual transmission of the disease were predominantly driven by traditional media, and largely reproduced the technical discourse of international news agencies. The technical discourse de-politicizes the health crisis created by Zika virus in a moment when a heated debate about reproductive justice and abortion was taking place in Latin America.

  • Online Lectures in Undergraduate Medical Education: A Scoping Review

    From: JMIR Medical Education

    Date Submitted: Oct 3, 2017

    Open Peer Review Period: Oct 4, 2017 - Nov 29, 2017

    Background: The adoption of the flipped classroom in undergraduate medical education (UME) calls on students to learn from various self-paced tools – including online lectures – before attending i...

    Background: The adoption of the flipped classroom in undergraduate medical education (UME) calls on students to learn from various self-paced tools – including online lectures – before attending in-class sessions. Hence, the design of online lectures merits special attention, given that applying multimedia design principles has been shown to enhance learning outcomes. Objective: To understand how online lectures have been integrated into medical school curricula, and whether published literature employs well-accepted principles of multimedia design. Methods: This scoping review followed the methodology outlined by Arksey and O'Malley (2005). MEDLINE, PsycINFO, Education Source, Francis, and ProQuest were searched to find articles from 2006 to 2016 related to online lecture use in UME. Results: 45 articles met inclusion criteria. Online lectures are used in preclinical and clinical years, covering basic sciences, clinical medicine, and clinical skills. The use of multimedia design principles is seldom reported. Almost all studies describe high student satisfaction and improvement on knowledge tests following online lecture use. Conclusions: Integration of online lectures into UME is well-received by students and appears to improve learning outcomes. Future studies should apply established multimedia design principles to the development of online lectures to maximize their educational potential.

  • Mobile Spirometry: A case report of effective screening for COPD in a rural area

    From: Journal of Medical Internet Research

    Date Submitted: Oct 3, 2017

    Open Peer Review Period: Oct 5, 2017 - Nov 30, 2017

    Chronic Obstructive Pulmonary Disease (COPD) is a multidimensional debilitating disease that affects nearly 210 million individuals and is classified as the fifth leading cause of death worldwide....

    Chronic Obstructive Pulmonary Disease (COPD) is a multidimensional debilitating disease that affects nearly 210 million individuals and is classified as the fifth leading cause of death worldwide. Despite advancements in management, the disease is still frequently underdiagnosed and undertreated [1]. To identify patients at risk for COPD, spirometry is used as a basis for diagnosis [2]. Despite initiation of federal COPD outreach programs, the cost endured directly or indirectly to a patient remains high. According to the ERS, the annual costs of healthcare and lost productivity due to COPD are estimated as €48.4 billion, of which €23.3 billion constitute direct costs and €25.1 indirect costs [3]. The average annual cost per case for COPD in the EU is € 2104 (direct - €1013; indirect - €1091) [3]. In late-diagnosis of COPD, direct medical costs were higher by an average of $3,671 per patient in 2 years and $2,489 in one year prior to initial diagnosis of COPD compared to controls [4]. We investigated the effects associated with using MySpiroo, with a dedicated mobile application in a medical screening event, conducted for inhabitants of Przezmark, a village in Pomorskie province in northern Poland, with minimal access to healthcare nearby.

  • Online assessment of the usual diet: a validity and reproducibility study of a new short food frequency questionnaire in an adult population

    From: Journal of Medical Internet Research

    Date Submitted: Oct 5, 2017

    Open Peer Review Period: Oct 5, 2017 - Nov 30, 2017

    Background: Available dietary questionnaires to assess the habitual diet are timely, costly, or not adapted to the modern diet; thus there is a need to develop a short food frequency e-Questionnaire (...

    Background: Available dietary questionnaires to assess the habitual diet are timely, costly, or not adapted to the modern diet; thus there is a need to develop a short food frequency e-Questionnaire (SFFeQ) adapted to Western countries diets, to properly estimate energy and macronutrient intakes and rank individuals according to food and nutrient intakes. Objective: The aim of the study was to evaluate the validity and reproducibility of a 30-minute and 44-item SFFeQ in a sample of adults from the general population. Methods: A sample of French adults was recruited through social media and an advertising campaign. A total of 223 volunteers completed the SFFeQ twice, at a one-year interval, and were included in the reproducibility study. During that interval, 92 participants also completed three to six 24-hour recalls and were included in the validity study. Main nutrient and dietary intakes were computed. The level of agreement between the two methods was evaluated for nutrient and food group intakes using classification into quintiles of daily intake, correlation coefficients and Bland-Altman plots. Results: Regarding validity, correlation coefficients ranged from 0.09 to 0.88 (unadjusted correlation coefficients, median: 0.48) and 0.02 to 0.68 (de-attenuated and energy adjusted correlation coefficients, median: 0.50) for food group and nutrient intakes, respectively. The median proportion of subjects classified into the same or adjacent quintile was 73% and 66% for food and nutrient intakes, respectively. Bland-Altman plots showed good agreement across the range of intakes. Regarding reproducibility, intraclass correlation coefficients ranged from 0.33 to 0.72 (median: 0.60) and 0.55 to 0.73 (median: 0.64), for food and nutrient intakes, respectively. Conclusions: The SFFeQ showed acceptable validity and reproducibility in a sample of adults. It appears valid to rank individuals based on their food and nutrient intakes. The SFFeQ is a promising and low-cost tool that can now be used in large-scale online epidemiological studies or in clinical routine and could be integrated in evidence-based smartphone apps for assessing diet components.

  • Quality Evaluation of HPV Vaccine Online Educational Interventions for Clinicians

    From: JMIR Cancer

    Date Submitted: Oct 4, 2017

    Open Peer Review Period: Oct 9, 2017 - Dec 4, 2017

    Background: HPV vaccination rates fall far short of Healthy People 2020 objective. Missed clinical opportunities for clinicians to recommended and administer the HPV vaccine is a leading factor for lo...

    Background: HPV vaccination rates fall far short of Healthy People 2020 objective. Missed clinical opportunities for clinicians to recommended and administer the HPV vaccine is a leading factor for low HPV vaccination rates. Many online HPV vaccine educational interventions for clinicians have been created to promote vaccination recommendations. Yet, evaluation of leading online HPV vaccine educational interventions is critically important for guiding efforts to promote clinician recommendations for HPV vaccination. Objective: The study’s aims were to expand previous research by: systematically identifying HPV vaccine online educational interventions developed for clinicians, and evaluating the quality of these online educational interventions based on access, content, design, user evaluation, interactivity, and use of theory/models to create the interventions. Methods: Current HPV vaccine online educational interventions were systematically identified from search engines (Google), continuing medical education search engines, health department websites, and professional organization websites. Inclusion criteria included online educational programs or interventions that were created for clinicians (clinician was defined as an individual qualified to deliver healthcare services, such as physicians, clinical nurses, and school nurses, to patients 9 to 26 years of age), provided information about the HPV vaccine, provided information about increasing vaccination rates, and had current continuing education credits available. The interventions’ content and usability were analyzed on six key indicators: access, content, design, evaluation, interactivity, and theory/models. Results: A total of 21 interventions were identified. Based on the evaluation indicators, 33.3% (n = 7) were webinars, 33.3% (n = 7) were videos/lectures, and 33.3% (n=7) were other (e.g., text articles, website modules). Seventeen interventions identified the purpose of the intervention. Twelve interventions provided the date that the information had been updated, and only seven were updated within the last six months. Of the 21 interventions, 14 (66.7%) provided the users/participants with the opportunity to provide feedback on the intervention. Five interventions provided an interactive component. None of the educational interventions explicitly stated a theory or model used to develop the intervention. Conclusions: This analysis provides evidence needed to develop online HPV vaccine educational interventions based on health education and design principles and to guide refining existing interventions, designed to increase strong and consistent HPV vaccination recommendations by clinicians.

  • The rise and rise of pregnancy apps: advances, issues, gaps

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 5, 2017

    Open Peer Review Period: Oct 5, 2017 - Nov 30, 2017

    Background: Pregnancy apps are a booming global industry, with most pregnant women in developed countries now using them. From the perspective of health care and health information provision, this is...

    Background: Pregnancy apps are a booming global industry, with most pregnant women in developed countries now using them. From the perspective of health care and health information provision, this is both encouraging and unsettling; the demand indicates a clear direction for the development of future resources, but it also underscores the importance of processes ensuring access, reliability and quality control. Objective: This review provides an overview of current literature on pregnancy apps with the aim of describing: the ways in which apps and mhealth initiatives are used by women in general and those of a culturally and linguistically diverse (CALD) background; the utility and quality of information provided; and areas where more research, development and oversight are needed. Methods: A narrative review methodology was chosen for the study. Inclusion criteria were papers focussed on pregnancy app and mhealth usage and/or evaluation, and uptake among culturally and linguistically diverse populations. The date range of relevant identified publications was 2009 to 2017. Electronic searches were conducted using Pubmed and Google Scholar, with the addition of manual searches of reference lists. Results: We found that pregnancy apps are principally used to access pregnancy health and fetal development information. Data storage capability, interactive features/personalised tools, and social media features are also popular app features sought by women. There is evidence of lower rates of pregnancy app uptake among lower-income women and among those who do not speak English as a first language. Preliminary evidence indicates that a combination of technological, health literacy and/or language issues, may result in less accessibility by these groups, however further investigation is required. The small body of literature examining the effectiveness of mhealth initiatives for improving the understanding of pregnancy concepts and health outcomes is positive. A significant limitation of the health app industry in general is the lack of regulation in a commercially dominated field, making it difficult for users to assess the reliability of information being presented. Health professionals and users alike indicate a preference for pregnancy apps that are relevant to their local health care context and come from a trusted source.There is evidence of a need for greater health professional and institutional engagement in app development, as well as awareness of and guidance for women’s use of these resources. Conclusions: This is the first review of pregnancy app use, types of information provided and features preferred by pregnancy women in general and those of a CALD background. It indicates the demand for accessibility to accurate information that is relevant to the users’ community and their associated health services. Given the popularity of pregnancy apps, there is a huge potential for such apps to be used for the provision of accurate, evidence-based health information and it is hoped this review will inform their future development.

  • The Role of Person-Generated Health Data in Simulated Rehabilitation for Stroke: A Literature Review

    From: Journal of Medical Internet Research

    Date Submitted: Oct 13, 2017

    Open Peer Review Period: Oct 14, 2017 - Dec 9, 2017

    Background: Person- or patient-generated health data (PGHD) are health, wellness and clinical data that people generate, record and analyse for themselves. There is potential for PGHD to improve the e...

    Background: Person- or patient-generated health data (PGHD) are health, wellness and clinical data that people generate, record and analyse for themselves. There is potential for PGHD to improve the efficiency and effectiveness of simulated rehabilitation technologies for stroke. Objective: This review attempts to understand to what extent Kinect-based Stroke Rehabilitation Systems (K-SRS) have utilised PGHD, and to what benefit. Methods: The review is conducted in two parts. Part 1 is an overview of PGHD-related content in existing systematic literature reviews of K-SRS. Part 2 reviews original research papers with a specific focus on PGHD utilisation. Results: Part 1 showed that previous reviews focused on technical effectiveness of K-SRS, with some attention on clinical effectiveness. None of those reviews reported on home-based implementation, nor on PGHD utilisation. Part 2 showed that there is a gap in understanding how PGHD utilisation may affect patients using K-SRS, as well as a lack of patient participation in the design of such systems. Conclusions: This paper calls specifically for further studies of K-SRS - and more generally for studies of technologies that allow patients to generate their own health data - to pay more attention to how patients’ own use of their data may influence their care processes and outcomes. Future studies which trial the effectiveness of K-SRS outside the clinic should also explore how patients and carers use PGHD in home rehabilitation programs.

  • A computer-based Driving in Dementia Decision Tool with mail support: A cluster randomized controlled trial

    From: Journal of Medical Internet Research

    Date Submitted: Oct 16, 2017

    Open Peer Review Period: Oct 17, 2017 - Dec 12, 2017

    Background: Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia, and deciding when to report to transportation admi...

    Background: Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia, and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports. Objective: To assess whether a Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment (MCI) to transportation administrators. Methods: Design: Parallel-group cluster non-blinded randomized controlled trial of a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system, activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or MCI to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from Sept 9, 2014 to Jan 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm. Results: Sixty-nine participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used the DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with the DD-DT recommendation did not differ between the intervention and the control groups (50% vs. 49%; Z=-0.19, P = .85). Two variables predicted algorithm-based reporting: caregiver concern (OR 5.8, 95% CI 2.5-13.6, P <.001) and abnormal clock drawing (OR 6.1, 95% CI 3.1-11.8, P <.001). Conclusions: Based on this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influence physicians to report patients with mild dementia or MCI to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians. Clinical Trial: NCT02036099

  • Are Turkish University Students Text-Message Dependent?Validity and Reliability of Turkish Self-Perception of Text-Message Dependency Scale

    From: Journal of Medical Internet Research

    Date Submitted: Oct 17, 2017

    Open Peer Review Period: Oct 18, 2017 - Dec 13, 2017

    Background: Text messaging is a fast and efficient means of communication among people. Text messaging (especially via SMS, Facebook, Twitter, Whatsapp) is quite common in developed and developing cou...

    Background: Text messaging is a fast and efficient means of communication among people. Text messaging (especially via SMS, Facebook, Twitter, Whatsapp) is quite common in developed and developing countries. Objective: We aimed to do validity and reliability of Self-perception of Text-message Dependency Scale among Turkish university students and show their text-message dependency level Methods: Between January 2016 and March 2016, Self-perception of Text-message Dependency Scale were administered to 221 students selected with a simple random selection method, from the Faculty of Social Sciences of Çankırı Karatekin University along with a sociodemographic data form. Internal reliability coefficient (Chronbach α), Pearson correlation analysis, confirmatory factor analysis, and goodness of fit indexes were calculated. P<0.05 is considered significant. Results: The mean age of the participants was 21 ± 1.72. The Internal Consistency Coefficient of the self-perception of text-message dependency scale was found to be Cronbach α 0.85. GFI=1, CFI=1, NFI=1, RMSEA=0,000. The total item correlation (rit) is between 0.329 and 0.663, indicating that the construct validity is strong.The theoretical model proposed by Igarashi et al. consists of 3 latent variables (factors) that are influenced by extroversion and neuroticism: 1) excessive use of messaging, 2) relationship maintenance, and 3) emotional reactions (5). These factors have an impact on the psychological or behavioral patterns by affecting the frequency of message writing. Conclusions: In our study, the internal reliability and goodness of fit indexes values were similar to the original study inciting that the Message Dependence Perception Scale can reliably be used in Turkey.

  • Digital access in working age and older adults and their carers attending psychiatry outpatient clinics

    From: JMIR Mental Health

    Date Submitted: Oct 6, 2017

    Open Peer Review Period: Oct 8, 2017 - Dec 3, 2017

    Background: Background: It has been suggested that improving access to mental health services, supporting self-management and increasing clinical productivity can be achieved through the delivery of...

    Background: Background: It has been suggested that improving access to mental health services, supporting self-management and increasing clinical productivity can be achieved through the delivery of technology-enabled care via personal mobile and internet-based services, but there is little evidence available about whether working age and older adults with mental health problems or their carers have access to these technologies, or their confidence with these technologies. Objective: To ascertain the prevalence and range of devices used to access the internet in patients and carers attending general and older adult psychiatry outpatient services, and their confidence in using these technologies. Methods: We conducted an anonymous survey of 77 patients and carers from a general psychiatry and old age psychiatry clinic to determine rates of internet access and device ownership, and attitudes to technology enabled care. Results: We found high levels of internet access and confidence in using the internet in working age adults, their carers, and older adult carers but not in older adult patients. Smartphone usage predominated in working age adults and their carers. Older adult carers were more likely to use desktop or laptop computers. In our sample, tablets were the least popular form factor. Conclusions: Access rates and uptake of internet based services have the potential to be high in working age adults and their carers, but are likely to be significantly lower among older adult patients attending psychiatry clinics. Applications designed for tablets are likely to have low uptake. All groups identified appointment reminders as likely to be beneficial.

  • Exploring digital health use, opinions and needs of university students

    From: Journal of Medical Internet Research

    Date Submitted: Nov 4, 2017

    Open Peer Review Period: Nov 6, 2017 - Jan 1, 2018

    Background: University students have easy access to the Internet and new technologies, thus representing a potentially very important target of digital health interventions. Up to today, surveys have...

    Background: University students have easy access to the Internet and new technologies, thus representing a potentially very important target of digital health interventions. Up to today, surveys have explored mainly students’ use of the Internet for health-information seeking. Since digital health is rising and evolving exponentially, updated data on its use are needed, concerning not only Internet-based but also new mobile-based tools. Objective: To investigate the pace and direction of university students’ appraisal of the Internet and new technologies for health and well-being with the aim to shed some light on the perspectives of digital health for this population group. Methods: This field survey was conducted from March to April 2017. An informed consent form and a paper questionnaire were given to students aged 18-24 years in four university campuses of the Bordeaux area in France. The survey was formulated in four sections: (1) sociodemographic characteristics, (2) information about general use of the Internet and new technologies, (3) information about specific use of digital health, and (4) data on opinions about evolution and consequences of digital health. Data were analyzed using descriptive statistics and tests of independence to define associations. Results: A total of 507 students completed the questionnaire. Our sample was representative of all students in Bordeaux in terms of gender and field of study. Regarding personal characteristics, 59.6% (302/507) of participants were females, 35.7% (181/507) studying Life and Health Sciences, 43.3% (220/507) attending the first year of study, 74.7% (379/507) declaring being in relatively good physical health, and 76.1% (386/507) declaring being in relatively good mental health. Only 3.9% (20/507) of students had a wearable device, but one third of them (175/507) had at least one health smartphone application, mostly for self-monitoring physical activity (42.1%) and sleep (10.3%). Almost all students (94.8%, 481/507) had searched for health-related information online at least once in the last 12 months. The most sought health-related topics were nutrition (63.9%), illness and pain (60.6%) and stress, anxiety and depression (47.9%). Participants who used digital health more frequently were likely to be female, attending the first year, studying Literature and Social Sciences, and reporting good general and mental health. Students considered institution-based digital health tools as trustworthy and reliable. Conclusions: By describing the current use and opinions of digital health among students, we can better anticipate their needs and expectations, and tailor future digital health interventions on students’ characteristics (e.g. by gender or field of study). Our results suggest that digital health tools (from websites to mobile applications) should be mainly developed and promoted by institutions and official entities in order to respond to students’ need for high-quality health-related information and support. Clinical Trial: No trial registration number required.

  • Effectiveness of new media interventions on glycemic control in patients with type 2 diabetes: a meta-analysis of randomized controlled trials

    From: Journal of Medical Internet Research

    Date Submitted: Oct 14, 2017

    Open Peer Review Period: Oct 16, 2017 - Dec 11, 2017

    Background: New media has become a hot area of research for several years. Given its rapid development and increasing coverage worldwide, new media seems to offer a promising option to ameliorate huge...

    Background: New media has become a hot area of research for several years. Given its rapid development and increasing coverage worldwide, new media seems to offer a promising option to ameliorate huge burdens brought by type 2 diabetes mellitus. However, studies conducted by different researchers came out with contradictory results on new media’s effect in glycemic control. Objective: This meta-analysis aims to summarize currently available evidence and evaluate the overall impact of new media interventions on glycemic management of type 2 diabetic patients. Methods: A systematic literature search was performed in Pubmed, ScienceDirect and Web of Science. Randomized controlled trials that used glycosylated hemoglobin values as the outcome measure of glycemic control were considered. Risk of bias and publication bias were evaluated. Results: Of the 471 articles, 28 were included in meta-analysis and results indicated that compared with usual care, new media interventions significantly reduced HbA1c levels with a pooled weighted mean difference of -0.314% (95% CI [-0.39, -0.24], P < .001). Subgroup analyses revealed that intervention duration > 3 months and ≤ 6 months yielded optimal performance (WMD -0.47%, 95% CI [-0.63, -0.30], P < .001). Web-based interventions were substantially superior to mobile-based interventions in glycemic control (mobile only: WMD -0.23%, 95% CI [-0.40, -0.06], P = .009; web only: WMD -0.51%, 95% CI [-0.68, -0.34], P < .001). Furthermore, interventions with automated feedbacks had advantages over interventions with factitious feedbacks and studies with online educational contents were more effective in glycemic control. Assessment revealed low risk of bias. Conclusions: In conclusion, utilization of new media interventions is beneficial to patients with type 2 diabetes and taking full advantage of new media may substantially reduce the incidence of complications and improve quality of life. Clinical Trial: This meta-analysis was registered at PROSPERO and the registration number is CRD42017058032.

  • Fitspiration on social media: a qualitative study exploring young people’s experiences of following healthy lifestyle material

    From: Journal of Medical Internet Research

    Date Submitted: Oct 10, 2017

    Open Peer Review Period: Oct 11, 2017 - Dec 6, 2017

    Background: Social media use has become ubiquitous in the lives of many people, especially young adults. A popular recent trend emerging on social media is that of posting and following ‘Fitspiratio...

    Background: Social media use has become ubiquitous in the lives of many people, especially young adults. A popular recent trend emerging on social media is that of posting and following ‘Fitspirational’ content - material that purports to motivate and showcase healthy lifestyle habits, particularly relating to exercise and diet. There is very limited existing literature on how engaging with this type of content influences people’s psychological and physical heath. Initial studies have focused on concerns over potential negative effects on psychological wellbeing including body image, self-esteem and eating disorders. Objective: We aimed to address a gap in the literature for exploratory research on this topic from the perspective of users. We used a qualitative approach to explore how people experience viewing Fitspiration on social media including why and how they engage with this material and how they perceive that it affects their thoughts, emotions, behaviour and health. Methods: We recruited 20 young adults (14 females, 6 males, aged 18-25) who self-declared themselves to be Fitspiration followers to participate in either focus groups or individual interviews. We asked detailed, open-ended questions about their motivations for following Fitspiration, experiences of viewing this content and its perceived impact. We used inductive thematic analysis to derive themes that represented common and salient features of the data set. Results: Four main themes were developed: 1) A tool with the potential to support healthy living, 2) Unrealistic, untrustworthy content, 3) Negative effects on emotional wellbeing, and 4) Vulnerability and protective factors. Following Fitspirational posts on social media can provide young people with knowledge and motivation that may support healthy lifestyle behaviours. However, a range of harms also appeared to arise from Fitspiration viewing ranging from minor annoyances and frustrations to more meaningful negative effects on psychological & physical health. These negative effects seemed to persist despite individuals acknowledging that the material can be unrealistic, and believing that they are personally equipped to minimise harms to themselves. Conclusions: This study suggests that Fitspiration on social media can be attractive and compelling for young people but appears to bring about negative as well as positive effects. Future research should aim to confirm the scale and intensity of positive and negative effects and investigate ways of harnessing desirable outcomes and minimising undesirable outcomes.

  • Using fitness trackers and smart watches to measure physical activity in research. A review of consumer wrist worn wearables.

    From: Journal of Medical Internet Research

    Date Submitted: Nov 17, 2017

    Open Peer Review Period: Nov 18, 2017 - Nov 25, 2017

    Background: New fitness trackers and smart watches are released to the consumer market every year. These devices are equipped with different sensors, algorithms, and accompanying mobile applications....

    Background: New fitness trackers and smart watches are released to the consumer market every year. These devices are equipped with different sensors, algorithms, and accompanying mobile applications. With recent advances in mobile sensor technology, privately collected physical activity data can be used as an addition to existing methods for health data collection in research. Furthermore, data collected from these devices have possible applications in patient diagnostics and treatment. With an increasing number of diverse brands, there is a need for an overview of device sensor support, as well as device applicability in research projects. Objective: The objective of this review is to examine the availability of wrist-worn fitness wearables and analyze availability of relevant fitness sensors from 2011 to 2017. Furthermore, the review is designed to assess brand usage in research projects, compare common brands in terms of developer access to collected health data, and features to consider when deciding which brand to use in future research. Methods: We searched for devices and brand names in six wearable device databases. For each brand, we identified additional devices on official brand web sites. The search was limited to wrist-worn fitness wearables with accelerometers, for which we mapped brand, release year and supported sensors relevant for fitness tracking. In addition, we conducted a MEDLINE and ClinicalTrials.gov search to determine brand usage in research projects. Finally, we reviewed developer accessibility to the health data collected by identified brands. Results: We identified 423 unique devices from 132 different brands. Forty-three percent of brands released only one device. Introduction of new brands peaked in 2014, and the highest number of new devices was introduced in 2015. Sensor support increased every year and, in addition to the accelerometer, a photoplethysmograph, for estimating heart rate, was the most common sensor. Out of the brands currently available, the five most often used in research projects are Fitbit, Garmin, Misfit, Apple and Polar. Fitbit is used in twice as many validation studies as any other brands, and is registered in ClinicalTrials.org-studies ten times as often as other brands. Conclusions: The wearable landscape is in constant change. New devices and brands are released every year, promising improved measurements and user experience. At the same time, other brands disappear from the consumer marked for various reasons. Advances in device quality offer new opportunities for researches. However, only a few well-established brands are frequently used in research projects, and even less has been thoroughly validated.

  • Online Consumer Ratings of Healthcare Providers Differ Across Specialties: A Tool to Calculate Specialty-Specific Rankings

    From: Journal of Medical Internet Research

    Date Submitted: Oct 10, 2017

    Open Peer Review Period: Oct 11, 2017 - Dec 6, 2017

    Background: Healthcare consumers are increasingly using online ratings to select providers, but interpretation of ratings is difficult due to the lack of established benchmarks for scoring. Objective:...

    Background: Healthcare consumers are increasingly using online ratings to select providers, but interpretation of ratings is difficult due to the lack of established benchmarks for scoring. Objective: To determine whether distributions of consumer ratings differ across specialties and to provide specialty-specific data to assist consumers and clinicians in interpreting ratings Methods: We sampled 212,933 healthcare providers rated on the Healthgrades consumer ratings website, representing 29 medical specialties (n=128,678), 15 surgical specialties (n=72,531), and 6 allied health professions (n=11,724). We created boxplots depicting distributions and tested the normality of overall patient satisfaction scores. We then determined specialty-specific percentile rank for scores across groupings of specialties and individual specialties. Results: Allied health providers had higher median overall satisfaction scores (4.5, IQR 4.0, 5.0) than physicians in medical specialties (4.0, IQR 3.3, 4.5) and surgical specialties (4.2, IQR 3.6, 4.6) (p<.001). Overall satisfaction scores were highly left skewed for all specialties but skewness was greatest among allied health providers (-1.23, 95% CI -1.280, -1.181), followed by surgical (-0.77, 95% CI -0.787, -0.755) and medical specialties (-0.64 95% CI -0.648, -0.628). Percentile ranks for overall satisfaction scores varied across groupings of specialties and individual specialties; percentile ranks for scores of 2 (0.7%, 3%, 0.8%), 3 (6%, 17%, 8%), 4 (23%, 50%, 37%), and 5 (64%, 90%, 87%) differed for allied health, medical, and surgical specialties, respectively. Conclusions: Online consumer ratings of healthcare providers are highly left skewed, fall within narrow ranges, and differ by specialty, which precludes meaningful interpretation by healthcare consumers. Specialty-specific percentile ranks may help consumers more meaningfully assess online physician ratings.

  • Weight loss efficacy of a novel mobile Diabetes Prevention Program delivery platform with human coaching: 65-week observational follow-up

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 11, 2017

    Open Peer Review Period: Oct 13, 2017 - Dec 8, 2017

    Background: Previously, results from a 24-week Diabetes Prevention Program (DPP) fully mobile pilot intervention were published. Objective: This study extends previous findings to evaluate weight los...

    Background: Previously, results from a 24-week Diabetes Prevention Program (DPP) fully mobile pilot intervention were published. Objective: This study extends previous findings to evaluate weight loss efficacy of core (up to week 16) and maintenance (post-core weeks) DPP interventions at 65 weeks from baseline. Methods: Originally, forty-three overweight or obese adult participants with a diagnosis of prediabetes signed-up to receive a 24-week virtual diabetes prevention program with human coaching through a mobile platform. At 65 weeks, this study evaluates weight loss and engagement in maintenance participants by means of paired t-tests, and backward multiple linear regression to examine predictors of weight loss. Results: At 65 weeks, mean weight loss was 6.15% in starters who read 1 or more lessons per week on 4 or more core weeks, 7.36% in completers who read 9 or more lessons per week on core weeks, and 8.98% in maintenance completers who did any action in post-core weeks (all P < .001). Participants were highly engaged with 80% of the sample completing 9 lessons or more and 68% completing the maintenance phase. In-app actions related to self-monitoring significantly predicted weight loss. Conclusions: In comparison to eHealth programs, this study shows that a fully mobile DPP is just as, if not more, effective in producing transformative weight loss. A fully mobile DPP intervention resulted in significant weight loss and high engagement during the maintenance phase, providing evidence for long-term potential as an alternative to in-person DPP by removing many of the barriers associated with in-person and other forms of virtual DPP.

  • Novel Approach to Cluster Patient Generated Data into Actionable Topics.

    From: JMIR Medical Informatics

    Date Submitted: Oct 11, 2017

    Open Peer Review Period: Oct 13, 2017 - Dec 8, 2017

    The increasing use of social media and mobile health applications has generated new opportunities for health care consumers to share information about their health and wellbeing. Information shared t...

    The increasing use of social media and mobile health applications has generated new opportunities for health care consumers to share information about their health and wellbeing. Information shared through social media contains not only medical information but also valuable information about how the survivors manage disease and recovery in the context of daily life. The aim of the present study is to explore methods for analyzing forum posts of breast cancer patients to discover the “hidden” aspects of disease management and recovery. An open source software MALLET was used to reduce the postings to categories with similar content. Qualitative analysis of the categorization and statistical analyses confirmed clinical significance of the results.

  • MIROR, An automated modular MRI clinical decision support system: an application in paediatric cancer diagnosis

    From: JMIR Medical Informatics

    Date Submitted: Oct 25, 2017

    Open Peer Review Period: Oct 26, 2017 - Dec 21, 2017

    Background: Advances in magnetic resonance imaging (MRI) and the introduction of clinical decision support systems has underlined the need for an analysis tool to extract and analyse relevant informat...

    Background: Advances in magnetic resonance imaging (MRI) and the introduction of clinical decision support systems has underlined the need for an analysis tool to extract and analyse relevant information from MRI data to aid decision-making, prevent errors and enhance health care. Objective: The aim of this study was to design and develop a modular Medical Image Region of interest analysis tool and Repository (MIROR) for automatic processing, classification, evaluation and representation of advanced MRI data. Methods: The clinical decision support system was developed and evaluated for diffusion-weighted imaging of body tumours in children (cohort of 48 children, with 37 malignant and 11 benign tumours). Mevislab software and Python have been used for development of MIROR. Regions of interests were drawn around benign and malignant body tumours on different diffusion parametric maps and extracted information was used to discriminate the malignant from benign tumours. Results: Using MIROR, the various histogram parameters derived for each tumour case when compared with the information in the repository, provided additional information for tumour characterization and facilitated the discrimination between benign and malignant tumours. Clinical decision support system cross validation showed high sensitivity and specificity in discriminating between these tumour groups for various histogram parameters, 100 % for kurtosis and entropy 85% and 78% respectively over all parameters. Conclusions: MIROR as a diagnostic tool and repository allowed the interpretation and analysis of MRI images to be more accessible and comprehensive for clinicians. It aims to increase clinicians’ skillset by introducing newer techniques and up-to-date findings to their repertoire and make information from previous cases available to aid decision-making. The modular-based format of the tool allowed integration of analyses which are not readily available clinically and streamlines future developments. Clinical Trial: N/A

  • Technology and Social Media Use among Patients Enrolled in Outpatient Addiction Treatment Programs

    From: Journal of Medical Internet Research

    Date Submitted: Oct 13, 2017

    Open Peer Review Period: Oct 14, 2017 - Dec 9, 2017

    Background: Substance use disorder research and practice have not yet taken advantage of emerging changes in communication patterns. While internet and social media use is widespread in the general...

    Background: Substance use disorder research and practice have not yet taken advantage of emerging changes in communication patterns. While internet and social media use is widespread in the general population, little is known about how these mediums are used in substance use disorder treatment. Objective: This paper aims to provide data on patients with substance use disorders prevalence of smartphone ownership, patterns of use of multiple digital platforms (social media, internet, computer, and mobile applications), and interest in the use of these platforms to monitor personal recovery. Methods: We conducted a cross-sectional survey of patients in four intensive outpatient substance use disorder treatment facilities in Philadelphia, PA, USA. Logistic regressions were used to examine associations among variables. Results: Survey participants (N= 259) were mostly male (73%), African American (63%), with annual incomes < $10,000 (62%), and averaged 39 years of age. The vast majority of participants (94%) owned a cellphone and about 64% owned a smartphone, of whom 80% accessed the internet mainly through their smartphone. There were no significant differences in age, gender, ethnicity or SES by computer usage, internet usage, number of times participants changed their phone, type of cellphone contract, or whether participants had unlimited calling plans. The sample was grouped into 3 age groups (Millennials, Generation Xers and Baby Boomers. The rates of having a social media account differed across these three age groups with significant differences between Baby Boomers and both GenXers and Millennials (p<0.0001 in each case). Among participants with a social media account (73.6%), most (76%) reported using it daily and nearly all (98%) used Facebook. Nearly half of participants (47%) reported viewing content on social media that triggered substance cravings and an equal percentage reported being exposed to recovery information on social media. There was a significant difference in rates of reporting viewing recovery information on social media across the three age groups with Baby Boomers reporting higher rates than Millennials (p<0.001). The majority of respondents (70%) said they would prefer to use a relapse prevention app on their phone or receive SMS relapse prevention text messages (72%) and 49% expressed an interest in receiving support by allowing social media accounts to be monitored as a relapse prevention technique. Conclusions: This is the first and largest study to date examining the online behavior and preferences regarding technology-based substance use disorder treatment interventions in a population of patients enrolled in community outpatient treatment programs. Patients were generally receptive to using relapse prevention apps and text messaging interventions and a substantial proportion support social media surveillance tools. The design of technology-based interventions remains a challenge, however, as many participants have monthly telephone plans, which may limit continuity, and most do not have a smartphone. Clinical Trial: N/A

  • Uncovering a role for electronic personal health records (PHRs) in reducing disparities in sexually transmitted infection rates: A mixed-methods study among students at a predominantly Black university

    From: Journal of Medical Internet Research

    Date Submitted: Oct 21, 2017

    Open Peer Review Period: Oct 22, 2017 - Dec 17, 2017

    Background: Young Black adults continue to bear an overwhelming proportion of the United States sexually transmitted infection (STI) burden, including HIV. Several studies on web- and mobile-based (mH...

    Background: Young Black adults continue to bear an overwhelming proportion of the United States sexually transmitted infection (STI) burden, including HIV. Several studies on web- and mobile-based (mHealth) STI interventions have been conducted and are currently ongoing that focus on improving outcomes related to testing, risk communication, reducing stigma, increasing condom use, and improving adherence to biomedical prevention and treatment among men who have sex with men (MSM), substance using, and adolescent populations. The Electronic Sexual Health Information Notification and Education (eSHINE) Study was an exploratory mixed-methods study among students at a historically Black university, exploring perceptions on facilitating STI testing conversations with partners using electronic personal health records (PHRs). Objective: The purpose of this paper is to use eSHINE Study results to describe perceived impacts of PHRs on facilitating risk discussion events. Methods: Focus groups and individual in-depth interviews were conducted on a qualitative research sample (n=35) to explore attitudes and practices related to talking with partners about STI testing and of incorporating PHRs into dyadic discussion events. An online survey was developed to measure qualitative findings on a larger sample of Black students (n=354) and to determine whether any significant differences exist between male and female participants. Results: Multiple contextual barriers were described that inhibit the utility of PHRs for facilitating discussions about STI testing and test results with partners. PHRs were believed to facilitate participants’ ability to initiate conversations and confidence in STI screening information shared by partners. With PHR access, the proportion of online survey participants who reported willingness to discuss STI testing within dyadic partnerships prior to sex increased from 40.4% to 61.0%. Conclusions: Findings suggest that subpopulations of young Black adults having access to PHR may improve both motivation and personal agency for initiating dyadic talks about STI testing. This study builds on mHealth interventions research to suggest that PHRs also offer promise as a STI prevention strategy to reduce health disparities. Future eSHINE Study analyses will determine factors associated with willingness to utilize PHR for delivery of STI results as well as willingness to utilize these results to facilitate risk discussions. Clinical Trial: N/A

  • Qualitative exploration of patient and health professional requirements for an e-health behavioural change intervention to self-manage cardiovascular disease.

    From: Journal of Medical Internet Research

    Date Submitted: Oct 16, 2017

    Open Peer Review Period: Oct 17, 2017 - Dec 12, 2017

    Background: Cardiovascular diseases (CVD) are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation (CR). Uptake of...

    Background: Cardiovascular diseases (CVD) are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation (CR). Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based CR programmes is low, with community-based CR rates and individual long-term exercise maintenance even lower. Home-based CR programs have been shown to be equally effective in clinical and health-related quality of life outcomes, and yet are not readily available. Objective: Given the potential that home-based CR programs have it is important to explore how to appropriately design any such intervention in conjunction with key stakeholders. The aim of the current study was to engage with individuals with cardiovascular disease and other professionals within the health eco-system to 1) understand the personal, social and physical factors that inhibit or promote their capacity to engage with physical activity and 2) explore their technology competencies, needs and wants in relation to an eHealth intervention. Methods: Fifty-four semi-structured interviews were conducted across two countries. Interviews were audiotaped, transcribed verbatim, and analysed using thematic analysis and further mapped onto the COM-B model for future intervention design. Results: Key recommendations included collection of patient data and use of measurements, harnessing hospital based social connections, and advice to utilize a patient-centered approach with personalization and tailoring to facilitate optimal engagement. Barriers to the implementation of PATHway were also explored specifically in relation to physical capability and safety as well as technology readiness. Conclusions: In summary, a multi-faceted, personalisable intervention with an inclusively designed interface was deemed desirable for use among CVD patients both by end-users and key stakeholders. In depth understanding of core needs of the population can aid intervention development and acceptability.

  • Fat Stigma Goes Viral on the Internet: A Systemic Assessment of YouTube Comments Attacking Overweight Men and Women

    From: Journal of Medical Internet Research

    Date Submitted: Oct 14, 2017

    Open Peer Review Period: Oct 14, 2017 - Dec 9, 2017

    Background: On social media including YouTube, a plethora of anonymous verbal attacks against overweight individuals are made and go viral. These comments often accompany negative, misogynist or derog...

    Background: On social media including YouTube, a plethora of anonymous verbal attacks against overweight individuals are made and go viral. These comments often accompany negative, misogynist or derogatory words, which stigmatize the targeted obese individuals. These verbal attacks can cause depressions in obese individuals, which can subsequently promote unhealthy eating behavior (i.e., binge eating) and further weight-gains. To develop an intervention policy and strategies that tackle the anonymous, online verbal attacks, a thorough understanding of what the comments spell out is necessary. Objective: The present study aimed to examine how anonymous users verbally attack or defend overweight individuals in terms of four themes: 1) topic of verbal attack (i.e., what aspect of overweight individuals are verbally attacked), 2) genders of commenters and targeted overweight individuals, 3) intensity of derogation depending on the targeted gender (i.e., the number of swear words used within comments), 4) gender of overweight models in the YouTube videos. Methods: This study content-analyzed YouTube comments which discuss overweight individuals or groups from two videos, titled “Fat Girl Tinder Date” and “Fat Guy Tinder Date.” These two videos were released approximately three weeks prior to the beginning of this study. Thus, these two videos provided an ideal empirical setting (i.e., natural experiment) since these two videos provide the same stories except the gender of the main character. Thus, these two “twin” videos provide avenue through which to analyze discussions of obesity as they organically occurred in a contemporary setting. Three-hundred and twenty comments were sampled from these two videos and analyzed based on an instrument developed for this study. Results: The primary results are four-fold. First, overweight women are attacked for their capacities (e.g, laziness, maturity, etc.) while overweight men are attacked for their hetero-social skills (e.g., rudeness, annoyance, etc.). Second, the majority of commenters who attacked overweight women are male. Third, overweight women receive more swear words than men when targeted. Fourth, the gender of the model in the video attracts the aggressive comments against overweight people made by the commenters of the opposite gender. Conclusions: Our data elucidate a worrying situation where the online world is filled with disinhibited aggressive messages against overweight individuals. More importantly, the patterns of these verbal aggression differ depending on the gender of the overweight model in the YouTube videos. Thus, gender-tailored effective intervention strategies that specifically tackles Internet users’ verbal aggression against these three traits needed to be developed.

  • Well beyond a reminder tool: applying the Behaviour Change Wheel to evaluate how an interactive two-way mHealth intervention improves medication adherence

    From: Journal of Medical Internet Research

    Date Submitted: Oct 17, 2017

    Open Peer Review Period: Oct 18, 2017 - Dec 13, 2017

    Background: Medication adherence is an important, but highly complex set of behaviours, which for life-threatening and infectious diseases like HIV carry critical consequences for individual and publi...

    Background: Medication adherence is an important, but highly complex set of behaviours, which for life-threatening and infectious diseases like HIV carry critical consequences for individual and public health. There is growing evidence that mobile phone text messaging interventions (‘mHealth’) connecting providers with patients positively impact medication adherence, particularly ‘two-way’ engagement platforms that require bidirectional communication versus ‘one-way’, in which responses aren’t mandatory. However, mechanisms of action have not been well defined. The Behaviour Change Wheel (BCW) is a comprehensive framework for behaviour change that includes an all-encompassing model of behaviour known as ‘COM-B’ (Capability Opportunity Motivation – Behaviour) and complemented by a taxonomy of behaviour change techniques. Evaluating mHealth interventions for medication adherence using these tools could provide useful insights that may contribute to optimizing their integration into the health care system and successful scaling-up. Objective: We aim to help address the current knowledge gap regarding how two-way mHealth interventions for medication adherence may work by applying the BCW to characterize WelTel: an interactive digital health outreach platform with robust evidence for improving adherence to antiretroviral therapy (ART). Methods: To characterize how WelTel may promote medication adherence, we applied the BCW in order to systematically (1) generate a ‘behavioural diagnosis’ through mapping known ART adherence barriers onto the COM-B model of behaviour; (2) specify the behaviour change techniques (BCTs) that WelTel delivers; (3) link identified BCTs to corresponding intervention functions of the BCW; and (4) connect these BCTs and interventions functions to respective COM-B influences on behaviour in order to determine potential mechanisms of action. Results: Our evaluation of WelTel using the BCW suggests that most of its impact is delivered primarily through its personalized communication component, in which eight different BCTs were identified and linked with five intervention functions (environmental restructuring, enablement, education, persuasion, training). Its mechanisms of action in promoting ART adherence may involve addressing all COM-B influences on behaviour (physical and psychological capability, physical and social opportunity, reflective and automatic motivation). Conclusions: Systematically unpacking the potential active ingredients of effective interventions facilitates the creation and implementation of more parsimonious, tailored and targeted approaches. Evaluating WelTel using the BCW has provided valuable insights into how and why such interactive two-way mHealth interventions may produce greater impact than one-way in addressing both non-intentional and intentional forms of non-adherence. The application of the BCW for evidence synthesis across mHealth interventions targeting various conditions would contribute to strengthening the knowledge base regarding how they may work to impact medication adherence behaviour.

  • Home-but not Alone- mobile-health application based postnatal educational programme: A descriptive qualitative study

    From: Journal of Medical Internet Research

    Date Submitted: Oct 16, 2017

    Open Peer Review Period: Oct 17, 2017 - Dec 12, 2017

    Background: Postnatal period poses numerous challenges for new parents. Various educational programmes are available to support new parents during this stressful period. However, the usefulness of edu...

    Background: Postnatal period poses numerous challenges for new parents. Various educational programmes are available to support new parents during this stressful period. However, the usefulness of educational programmes needs to be evaluated to ascertain their credibility. Objective: The aim of this descriptive qualitative study is to explore the views of parents to new-born with regard to the content and delivery of a mobile-health application based postnatal educational programme. Methods: A qualitative semi-structured interview guide was used to collect data from the 17 participants who belonged to the intervention group of a randomised controlled trail. The intervention, a four-week-long access to a mobile-health application based educational programme, was evaluated. The interviews were carried out in English and at the participants’ homes. Thematic analysis was used to analyse the data. Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to report the findings. Results: The interviews revealed four main themes: (1) positive features of the mobile-health application, (2) advice from the midwife, (3) experiences gained from using the mobile-health application, and (4) recommendations for the future. The participants evaluated the educational programme to be a good source of information that was tailored to the local context. The different modes of delivery, including audio and video, accentuated the accessibility of information. The parents evaluated that the facilitator of the featured communication platform, a midwife, provided trustworthy advice. Belonging to a virtual community beyond the hospital gave parents the confidence that they were not alone and were supported by other parents and healthcare professionals. Conclusions: The mobile-health application based educational programme effectively supported a multi-ethnic sample of parents during the postnatal period. This signals its potential to be implemented in a wider community of parents in the postnatal period. The effectiveness of the educational programme is a testament of the potential benefits in using telemedicine among new parents postnatally. Resources can also be dedicated towards extending the duration of access to the application beyond one month, and to develop relevant content for parents across the perinatal period. Clinical Trial: ISRCTN99092313

  • Satisfaction with the newly-implemented Electronic System for Integrated Health Information among Pediatricians at a University Hospital

    From: Journal of Medical Internet Research

    Date Submitted: Oct 18, 2017

    Open Peer Review Period: Oct 21, 2017 - Dec 16, 2017

    Background: Electronic Health Records (EHR) are becoming the standard of care in healthcare settings, with their great potentials to reduce operational costs, improve healthcare quality, and patient...

    Background: Electronic Health Records (EHR) are becoming the standard of care in healthcare settings, with their great potentials to reduce operational costs, improve healthcare quality, and patient’s safety. Various factors may influence physicians’ satisfaction, and there is a need to address them according to healthcare workers’ needs in Saudi Arabia. Objective: The objective of this study was to explore factors that may have influenced satisfaction with a newly-implemented EHR system (namely: eSiHi or Electronic System for Integrated Health Information) among Physicians in the Pediatric Department at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia Methods: Methods: A cross-sectional survey was conducted on the physicians of Pediatric Department, KSUMC, between July-August 2015, after two months of launching the EHR system (eSiHi). Results: A total of 150 physicians enrolled in the survey, only (120, 80%) responded to the survey in a timely manner. Tentative analysis of missing values, however, revealed that 112 surveys were complete and suitable for inclusion in the analysis. As such, response rate was 74.6%. 60% of the physicians were males and 40% were females. 27.6% of them were consultants, 43% specialists, followed by 28% who were residents. Almost half of the physicians had no previous experience with Electronic Medical Records (51.8%). 86.7% of the respondents have attended the workshops and the training courses before the implementation of the new EHR system. On average, they rated their satisfaction levels with the EHR (eSiHi) at 5.2 out of 10, and for the usefulness for the patient's care it was rated on average (6.4 out of 10). 82.2% of respondents believed that the EHR improves the Quality of care and reduces errors and 73% of the respondents agreed that EHR's Improve the quality of the clinical practice environment. 55.8% indicated that EHR increased the practice productivity. Conclusions: There is a global and national transition toward an EHR system in the hospitals and the physicians have the willing to support this transition and they appreciate the potential benefits of this system over the paper-based system. In order to increase the like hood of a successful transition, an ongoing technical support must be considere

  • Engaging Vulnerable Patients through Health Information Transparency: How important is reading notes to different patient populations?

    From: Journal of Medical Internet Research

    Date Submitted: Oct 23, 2017

    Open Peer Review Period: Oct 24, 2017 - Dec 19, 2017

    Background: OpenNotes is a national initiative to share clinicians’ visit notes with patients. Studies suggest that transparent notes can improve care, but little is known about their effect on care...

    Background: OpenNotes is a national initiative to share clinicians’ visit notes with patients. Studies suggest that transparent notes can improve care, but little is known about their effect on care for vulnerable populations. Objective: To examine the importance of online visit notes to vulnerable patients. Methods: Patients at an urban academic medical center with an active patient portal account and at least one available ambulatory visit note over the prior year were surveyed during June-Sep 2016. The survey assessed importance of reading notes for: 1) understanding health conditions, 2) feeling informed about care, 3) understanding how patients’ providers are thinking about their medical conditions, 4) remembering the plan of care, and 5) making decisions about care. Response options ranged from 0 to 10. We compared the proportion of patients reporting 9-10 (“extremely important”) for each item across three sociodemographic factors: education level, race/ethnicity, and self-reported health. Results: 6,913/24,722 (28%) patients completed the survey. Non-white patients and those with a high school education or less were more likely to report that notes are “extremely important” for all 5 items than white and more educated respondents, respectively (p< 0.01 for all comparisons). Patients with poorer self-reported health were as or more likely to indicate that notes are "extremely important" for all items. Conclusions: Patients who are non-white, less educated, and sicker each assigned higher importance to reading open notes for several health behaviors than white, highly educated and healthier patients. Some vulnerable patients who use the portal may find OpenNotes especially valuable for understanding their health and engaging in their care. Facilitating access to notes may improve engagement in health care for some vulnerable populations who have historically been more challenging to reach.

  • A Student-Created Wiki for Collaborative Medical Education

    From: JMIR Medical Education

    Date Submitted: Oct 16, 2017

    Open Peer Review Period: Oct 18, 2017 - Dec 13, 2017

    Background: Wiki platform use has potential to improve student learning by improving engagement with course material. A student-created wiki was established to serve as a repository of study tools for...

    Background: Wiki platform use has potential to improve student learning by improving engagement with course material. A student-created wiki was established to serve as a repository of study tools for students in a medical school curriculum. There is a scarcity of information describing student-led creation of wikis in medical education. Objective: To describe the creation of a student-centered wiki, characterize website traffic and evaluate student usage via a short anonymous online survey. Methods: Website analytics were used to track visitation statistics to the Wiki and a survey was distributed to assess ease of use, interest in contributing to the Wiki, and suggestions for improvement. Results: Site traffic data indicated high usage, averaging 316 pageviews per day from July 2011 to March 2013 and 74,317 total user sessions. The average session duration was 2 min 18s. Comparing Fall 2011 to Fall 2012 revealed a large increase in returning visitors (65.7%) and sessions via mobile devices (87.7%). The survey received 164 responses, 88% of whom were aware of the Wiki at the time of the survey. On average, respondents felt that the Wiki was more useful in the pre-clinical years (2.73 ± 1.25) than in the clinical years (1.88 ± 1.12; P < .001). Perceived usefulness correlated with the percent of studying for which the respondent used electronic resources (Spearman’s = 0.414, P < .001). Conclusions: Overall, the Wiki was a highly utilized, though informal part of the curriculum with much room for improvement and future exploration.

  • Development and feasibility testing of internet-delivered Acceptance and Commitment Therapy (iACT) for severe health anxiety

    From: JMIR Mental Health

    Date Submitted: Nov 5, 2017

    Open Peer Review Period: Nov 7, 2017 - Jan 2, 2018

    Background: Severe health anxiety (hypochondriasis), or illness anxiety disorder according to the DSM-5, is characterised by preoccupation with fear of suffering from a serious illness in spite of med...

    Background: Severe health anxiety (hypochondriasis), or illness anxiety disorder according to the DSM-5, is characterised by preoccupation with fear of suffering from a serious illness in spite of medical reassurance. It is a debilitating, prevalent disorder associated with increased health care utilisation. Still, there is a lack of easily accessible specialised treatment for severe health anxiety. Objective: The present paper has two objectives; 1) to describe the development and setup of a new internet-delivered Acceptance and Commitment Therapy (iACT) programme for patients with severe health anxiety using self-referral and a video-based assessment, and 2) to examine the feasibility and potential clinical efficacy of iACT for severe health anxiety. Methods: Fifteen self-referred patients with severe health anxiety were diagnostically assessed by a video-based interview. They received 7 sessions of clinician-supported iACT comprising self-help texts, video clips, audio files and worksheets over 12 weeks. Self-report questionnaires were obtained at baseline, post-treatment and at 3-month follow-up (3MFU). The primary outcome was Whiteley-7 index measuring health anxiety severity. Depressive symptoms, health-related quality of life (HRQoL), life satisfaction and psychological flexibility were also assessed. A within-group design was employed. Means, standard deviations (SD) and effect sizes using the Standardized Response Mean were estimated. Post-treatment interviews were conducted to evaluate the patient experience of the usability and acceptability of the treatment setup and programme. Results: Self-referral and video-based assessment were well received. Most patients 12/15 (80%) completed the treatment, and only one patient dropped out. Post-treatment data were available for almost all patients 14/15 (93%) and 3MFU data for 12/15 (80%). Paired t-tests showed significant improvements on all outcome measures both at post-treatment and 3MFU except on one physical component subscale of HRQoL. Health anxiety symptoms decreased with 33.9 points at 3MFU (95% CI 13.6 to 54.3, t(11) = 3.66, P=0.004) with a large within-group effect size measured by the standardised response mean (SRM=1.06). Conclusions: Treatment adherence and potential efficacy suggest that iACT may be a feasible treatment for health anxiety. The uncontrolled design and small sample size limit the robustness of the findings. Therefore, the findings should be replicated in a randomised controlled trial. Potentially, iACT may increase availability and accessibility of specialised treatment for health anxiety. Clinical Trial: The study was approved by the Danish Data Protection Agency, Central Denmark Region (ID no. 1-16-02-427-14). URL: https://www.datatilsynet.dk/forside/

  • Usability and acceptability of a wearable activity tracker in young adolescents

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 17, 2017

    Open Peer Review Period: Oct 18, 2017 - Dec 13, 2017

    Background: Wearable activity trackers have the potential to be integrated into physical activity interventions, yet little is known about how adolescents use these devices or perceive their acceptabi...

    Background: Wearable activity trackers have the potential to be integrated into physical activity interventions, yet little is known about how adolescents use these devices or perceive their acceptability. Objective: The aim of this study was to examine the acceptability and usability of a wearable activity tracker among adolescents. A secondary aim was to determine adolescents’ awareness and use of the different functions and features in the wearable activity tracker and accompanying app. Methods: Sixty adolescents (aged 13-14 years) in Year 8 from three secondary schools in Melbourne, Australia, were provided with a wrist-worn Fitbit Flex and accompanying app and asked to use it for six weeks. Demographic data (age, sex) were collected via an online survey completed during week 1 of the study. At the conclusion of the 6-week period, all adolescents participated in focus groups that explored their perceptions of the acceptability and usability of the Fitbit Flex, accompanying app, and online Fitbit profile. Qualitative data were analysed using pen profiles, which were constructed from verbatim transcripts. Results: Adolescents typically found the Fitbit Flex easy to use for activity tracking, though greater difficulties were reported for monitoring sleep. The Fitbit Flex was perceived to be useful for tracking daily activity, and adolescents used a range of features and functions available through the device and the app. Barriers to use included the comfort/design of the Fitbit Flex, a lack of specific feedback about activity levels, and the inability to wear the wearable activity tracker for water-based sports. Conclusions: Adolescents reported that the Fitbit Flex was easy to use, and that it was a useful tool for tracking daily activity. A number of functions and features were used, including the devices visual display to track and self-monitor activity, goal-setting in the app, and undertaking challenges against friends. However, several barriers to use were identified, which may impact on sustained use over time. Overall, wearable activity trackers have potential to be integrated into physical activity interventions, but both the functionality and wearability of the monitor should be considered.

  • New-Onset Diabetes Educator to Educate Children and their Caregivers about Diabetes at the Time of Diagnosis: a Pragmatic Trial

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 17, 2017

    Open Peer Review Period: Oct 18, 2017 - Dec 13, 2017

    Background: Background Diabetes self-management education (DSME) is essential at the time of diagnosis. We developed the New Onset Diabetes Educator (NODE), an animation-based educational web applicat...

    Background: Background Diabetes self-management education (DSME) is essential at the time of diagnosis. We developed the New Onset Diabetes Educator (NODE), an animation-based educational web application for Type 1 Diabetes Mellitus patients. Objective: Objective: Our hypothesis is that NODE is a feasible, effective and user-friendly intervention in improving DSME delivery to child/caregiver-dyads at the time of diagnosis. Methods: Methods: We used a pragmatic parallel randomized trial design. Dyads were recruited within 48 hours of diagnosis and randomized into a NODE-enhanced DSME or a standard DSME group. Dyads randomized in the NODE group received the intervention on an iPad before receiving the standard DSME with a nurse educator. The Diabetes Knowledge Test 2 (DKT2) assessed disease-specific knowledge pre- and post-intervention in both groups, and was compared using t-tests. Usability of the NODE mobile health intervention was assessed in the NODE group. Results: Results: We recruited 16 dyads (Mean child age=10.75, SD=3.44). Mean DKT2 scores were 14.25 (SD=4.17) and 18.13 (SD=2.17) pre- and post- intervention in the NODE group, and 15.50 (SD=2.67) and 17.38 (SD=2.26) in the standard DSME group. The effect size was medium (Δ = 0.56). Usability ratings of NODE were excellent. Conclusions: Conclusion: NODE is a feasible mobile health strategy for type 1 diabetes education. It has the potential to be an effective and scalable tool to enhance DSME at time of diagnosis, and consequently, could lead to improved long-term clinical outcomes for patients living with the disease.

  • Validation of a Novel EHR Patient Portal Advance Care Planning Delivery System

    From: Journal of Medical Internet Research

    Date Submitted: Oct 17, 2017

    Open Peer Review Period: Oct 18, 2017 - Dec 13, 2017

    Background: Advanced Care Planning (ACP) allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early ACP in outpatient settings prov...

    Background: Advanced Care Planning (ACP) allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early ACP in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations. Yet, ACP remains rarely delivered due to barriers like provider time constraints and communication complexity. Novel methods, like patient portals, can provide a unique opportunity to conduct ACP pre-visit planning for outpatient care. Objective: Our intervention tested a pre-visit ACP questionnaire sent via secure Electronic Health Record (EHR)-linked patient portal in a real world clinical setting to determine its impact on frequency and quality of ACP. Methods: We conducted a pragmatic trial in 2 sister clinical sites (with similar baseline ACP workflows) with site randomization to electronic pre-visit ACP planning and usual care over a 3-month study period. Baseline chart review at both sites was conducted 1 month prior. 200 patients received intervention and 219 usual care. Chart review was conducted at 1 week and 1 month post-visit to determine the presence and quality of ACP documentation. Results: Intervention patients had a 27% increase in documentation rates and 25.4% higher quality scores compared to usual care. Individuals between 50-60 years of age and active portal users (>10 messages in one year) saw documentation rates increase by 37% and 33.5% respectively at the intervention site. Conclusions: Sending patients a pre-visit questionnaire on their future care preferences yielded improvement in quality and presence of ACP documentation, with highest improvement in active patient portal users and patients aged 50-60. Targeted pre-visit patient portal ACP delivery in these populations can potentially improve the quality of care in these populations.

  • Feasibility, Acceptability, and Potential Efficacy of a Web-Based Physical Activity Intervention for Latina Adolescents: Niñas Saludables

    From: Journal of Medical Internet Research

    Date Submitted: Oct 17, 2017

    Open Peer Review Period: Oct 18, 2017 - Dec 13, 2017

    Background: Physical activity is markedly low in Latina adolescents, yet few physical activity interventions have been attempted in this population. Web-based interventions can incorporate theory-base...

    Background: Physical activity is markedly low in Latina adolescents, yet few physical activity interventions have been attempted in this population. Web-based interventions can incorporate theory-based components, be appealing to adolescents, and have potential for low cost dissemination. Objective: We sought to assess the feasibility, acceptability, and potential efficacy of a web-based physical activity intervention for Latina adolescents in a single-arm pilot trial. Methods: Twenty-one Latina adolescents (age 12-18) who were underactive (<90 minutes/week) participated in a 12-week theory-informed web-based physical activity intervention. Web content was individually tailored based on responses to monthly questionnaires. Feasibility was measured by recruitment, retention, and adherence/engagement, and acceptability was measured by satisfaction. Physical activity was measured at baseline and follow-up using the 7-Day Physical Activity Recall (PAR) Interview and accelerometers. Results: Baseline activity as measured by the 7-Day PAR and accelerometers was 24.7(26.11) and 24.8(38.3) minutes/week, respectively. At 12 weeks, 19 participants (90.5%) returned. Adherence and engagement with materials was low, and 72% of participants indicated they were satisfied with the intervention. Activity at 12 weeks increased by 58.8(11.33) minutes/week measured by the 7-Day PAR (p<0.001). Accelerometer-measured activity did not increase. Activities reported at follow-up were more varied than at baseline, including some measured poorly by accelerometers (e.g. biking, swimming). Participants suggested simplifying the website and incorporating other technologies. Conclusions: Good retention and increases in self-reported activity suggest a promising approach to delivering a physical activity intervention to Latina adolescents. Incorporating other technologies, such as smartphone apps, could make the intervention more engaging, acceptable and effective.

  • Integration of a technology-based mental health screening into routine practices of primary health care services in Peru: The Allillanchu Project

    From: Journal of Medical Internet Research

    Date Submitted: Nov 6, 2017

    Open Peer Review Period: Nov 7, 2017 - Jan 2, 2018

    Background: Despite their high prevalence and significant burden, common mental disorders (CMD) are largely underdiagnosed and undertreated. Objective: The Allillanchu Project aimed to design, develop...

    Background: Despite their high prevalence and significant burden, common mental disorders (CMD) are largely underdiagnosed and undertreated. Objective: The Allillanchu Project aimed to design, develop, and test an intervention to promote early detection, opportune referral and access to treatment of patients with CMD attending public primary health care services in Lima, Peru. Methods: The project had a multi-phase design: formative study, development of intervention components and implementation. The intervention combined three strategies: training of primary health care providers (PHCP), task shifting of CMD detection and referral, and a mHealth component comprising a CMD screening app followed by motivational and reminder SMS to identify at-risk patients. The intervention was routinely implemented by 22 PHCP working in ten public health care services including prenatal control, tuberculosis, chronic diseases and HIV/AIDS clinics. Results: During the 9-week implementation phase, 733 patients were screened by the 22 PHCP during routine consultations. The chronic diseases (49.9%) and prenatal care services (36.7%) had the higher number of screenings. Time constraint and workload were the main barriers to screening, while the use of technology, training and supervision were facilitators. Out of the 733 patients, 21.7% screened positively for CMD and were advised to seek specialized care. During a follow-up interview, 72.4% of positively screened patients reported seeking specialized care and 55.1% stated seeing a specialist. Both patients and PHCP recognized the utility of the screening and identified some key challenges to its wider and successful implementation. Conclusions: The use of a CMD screening app supported by training and supervision is feasible and uncovers a high prevalence of unidentified psychological symptoms in primary care. To increase its sustainability and utility, this procedure can be tailored to the resources and features of each service but need to be incorporated into the routine health care system. The early detection of psychological symptoms by a PHCP within a regular consultation, followed by adequate advice and support, can lead to a significant percentage of patients accessing specialized care and reducing the treatment gap of CMD.

  • Development of a family-based intervention for BRCA carriers and their close biological relatives: Focus groups, feasibility, and usability testing

    From: Journal of Medical Internet Research

    Date Submitted: Oct 18, 2017

    Open Peer Review Period: Oct 21, 2017 - Dec 16, 2017

    Background: Carriers of BRCA mutations are asked to communicate genetic test results to their close biological relatives and advocate for genetic services. This process is highly variable from family...

    Background: Carriers of BRCA mutations are asked to communicate genetic test results to their close biological relatives and advocate for genetic services. This process is highly variable from family to family. Interventions that support communication of genetic test results, coping, and offer decision support in families that harbor a pathogenic variant may contribute to more effective management of hereditary cancer. Objective: This paper describes the development of the Family Gene Toolkit©, a web-based intervention targeting BRCA carriers and untested biological relatives, designed to enhance coping, family communication, and decision-support. Methods: We present findings from focus groups regarding intervention acceptability and participant satisfaction, and findings from a pre-post pilot study with random allocation to a wait listed control group regarding intervention feasibility and usability. Results: The Family Gene Toolkit© was developed by a multidisciplinary team as a psycho-educational and skills-building intervention, including two live webinar sessions and a follow-up phone call guided by a certified genetic counselor and a Master’s prepared oncology nurse. Each live webinar includes two modules (total four modules) presenting information about BRCA mutations, a decision-aid for genetic testing, and two skills-building modules for effective coping and family communication. Participants in focus groups (n=11) were highly satisfied with the intervention, reporting it was useful and illustrative of pertinent issues. From the n=12 dyads recruited in the pre-post pilot study (response rate 23%), completion rate was 71% and 20% for the intervention and wait-listed control group, respectively. Conclusions: Acceptability and satisfaction with the Family Gene Toolkit© is high. Based on usability and feasibility testing, modifications on timing, delivery mode, and recruitment methods are planned. Clinical Trial: NCT02154633

  • Changes in anxiety following participation in BRAVE Self-Help: an open-access online Cognitive-Behaviour Therapy Program for anxiety

    From: Journal of Medical Internet Research

    Date Submitted: Oct 19, 2017

    Open Peer Review Period: Oct 21, 2017 - Dec 16, 2017

    Background: Internet-based CBT (iCBT) for child and adolescent anxiety has demonstrated efficacy in randomized controlled trials, but has not yet been examined when disseminated as a public health int...

    Background: Internet-based CBT (iCBT) for child and adolescent anxiety has demonstrated efficacy in randomized controlled trials, but has not yet been examined when disseminated as a public health intervention. If effective, iCBT programs may offer promise as a first-step, low-intensity intervention that can be easily accessed by young people. Objective: The aim of this study was to examine changes in anxiety severity in young people enrolling in a publicly available online, self-help iCBT program (BRAVE Self-Help). Methods: This study conducted an open trial, involving the analysis of data collected from 1094 children and adolescents aged 7-17 years who presented with elevated anxiety at baseline and commenced the program during the data collection period. The iCBT program was delivered through an open-access portal with no professional support. Anxiety severity was assessed via scores on the Children’s Anxiety Scale, 8-item (CAS-8) at four time points; baseline, Session 4, Session 7 and Session 10. Results: Statistically significant reductions in anxiety were evident across all time points for both children and adolescents. For users who completed 6 or more sessions, there was an average 4-point improvement in CAS-8 scores (d=0.87 for children, d=0.81 for adolescents) indicative of a moderate to large effect size. For participants who completed 9 sessions, 58.3% (95 out of 163) achieved clinically meaningful, and 54.6% (89 out of 163) achieved statistically reliable reductions in anxiety. Conclusions: Substantial and meaningful reductions in anxiety symptoms were achieved by many children and adolescents taking part in a completely open-access and self-directed iCBT program. Online self-help CBT may offer an effective and viable first step for service delivery with children and adolescents with anxiety. Clinical Trial: n/a

  • A new tool for assessing the quality of online health information on the McMaster Optimal Aging Portal

    From: Journal of Medical Internet Research

    Date Submitted: Oct 18, 2017

    Open Peer Review Period: Oct 21, 2017 - Dec 16, 2017

    Background: The McMaster Optimal Aging Portal (the Portal) is a health information website that provides access to online resources about healthy aging that have been pre-appraised for quality. Web re...

    Background: The McMaster Optimal Aging Portal (the Portal) is a health information website that provides access to online resources about healthy aging that have been pre-appraised for quality. Web resource ratings (WRR) are a feature of the Portal which provide a rigorous evaluation of health resources available elsewhere online. In the development phase of the WRR feature, the Portal team aimed to identify a single quality assessment instrument that: a) had been assessed for reliability; b) assessed the quality of the evidence used to create online information; c) had fewer than 15 criteria; and d) were suitable for use by citizen raters. When no single instrument was identified that met the four priority conditions, the Portal team created the web resource rating (WRR) tool, consisting of 13 dichotomous (Y/N) assessment criteria. Objective: This analysis provides an overview of the development process of the WRR tool and the results of two Intraclass Correlation Coefficient (ICC) analyses to assess the reliability of the quality assessment criteria. Methods: Reliability between two raters was assessed using the ICC for each criteria included in the WRR tool at two points in the development process: April 2014 and July 2015. SPSS Statistics 22 software was used for statistical analysis and a one-way random effects model used to report the results. The overall ICC was assessed for the WRR tool as a whole in July 2015, once the final set of criteria were identified. The threshold for retaining criteria for the WRR tool was ICC > 0.60 (‘good’ reliability). Results: Of 10 items assessed for reliability in April 2014, three had an ICC <0.60 (‘good’ reliability). One of these criteria was removed (“minimal scrolling”) and two were retained as priority items. Modifications to the wording of the criteria were made for clarity. Four new items were added that assessed the level of research evidence cited in web resources bringing the total number of items assessed to 13 in July 2015. The total ICC scores of the WRR tool, calculated with a one-way random model has excellent agreement with both single measures (ICC= 0.988; CI 0.982-0.992) and average measures (ICC = 0.994; CI 0.991 – 0.996). Two of the 13 criteria had good ICC scores (ICC 0.600 – 0.740), 11 had excellent ICC scores (ICC >0.750), with six of them having an ICC of 1. These 13 items became the final set of criteria for the WRR tool. Conclusions: The web resource rating (WRR) tool developed for the McMaster Optimal Aging Portal can be recommended as a highly reliable instrument for the assessment of online health information.

  • Towards replicable evaluations of privacy for mobile health apps

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 24, 2017

    Open Peer Review Period: Oct 24, 2017 - Dec 19, 2017

    Background: The increasing sophistication of self-tracking technologies allows individuals to generate significant quantities of timely and accurate data about their lifestyle, biology, and environmen...

    Background: The increasing sophistication of self-tracking technologies allows individuals to generate significant quantities of timely and accurate data about their lifestyle, biology, and environment, which can be used to support health interventions and measure outcomes. However, such user-generated data is often not treated with the sensitivity of other medical data, with data stored and processed by vendors with commercial motivations, such as enabling targeted advertising and making inferences from linked data. As the sensors and applications which enable these technologies continue to become more sophisticated, the privacy implications may become more severe. Methods for systematically identifying and investigating privacy issues in such applications are required, but currently lacking. Objective: In this paper, we introduce a set of heuristics for assessing key privacy characteristics of such services, rooted in US and EU data privacy regulations, and usability best practice from the human-computer interaction literature. By applying these heuristics to existing services, we aim to identify and characterise common privacy issues, and suggest how designers can avoid exposing their users to them. Methods: We conduct an analysis of 64 popular services to determine the extent to which they satisfy various dimensions of privacy captured by the heuristics, including regulatory compliance, suitability of consent processes, and the usability of interfaces for controlling disclosures. We also investigate non-health related self-tracking services, to determine whether the current generation of mobile health applications exhibit stronger privacy protections, or reveal unique weaknesses. Results: We found that the majority of services examined fail to (a) provide users with full access to their own data, (b) acquire sufficient consent, or (c) extend controls over disclosures to third parties. We demonstrate a number of best and worst-practice usability patterns, and make recommendations for how designers can avoid such pitfalls. Conclusions: Our findings are of interest to clinicians looking to incorporate self-tracking technologies into care; privacy researchers for whom we provide a robust and reproducible method for investigating the state of privacy in self-tracking applications; developers of mHealth applications who seek guidance to incorporate best practice into the design of their services; and end-users looking for assurance that services meet their privacy requirements. We provide the documentation and tools needed to replicate our work, allowing the state of privacy in mHealth services to be monitored over time.

  • Long-Term Effectiveness of a Smartphone Application for Improving Healthy Lifestyles in general population in Primary Care: A Randomized Controlled Trial (EVIDENT II study)

    From: Journal of Medical Internet Research

    Date Submitted: Oct 21, 2017

    Open Peer Review Period: Oct 22, 2017 - Dec 17, 2017

    Background: Information and communication technologies are currently one of the supporting elements that may contribute to improving health and changing lifestyles. Objective: To evaluate the long-ter...

    Background: Information and communication technologies are currently one of the supporting elements that may contribute to improving health and changing lifestyles. Objective: To evaluate the long-term effectiveness of adding an app to standardized counselling in order to increase physical activity (PA) and adherence to the Mediterranean diet (MD) and to analyze the effects of app adherence in lifestyles changes. Methods: Randomized, multicenter clinical trial with 12 month-follow up, including 833 participants, recruited by random sampling in six primary Spanish care centers (415 versus 418). Interventions: Counseling on PA and MD was given to both groups by a nurse research. The counseling+app group (IG) received additional training in the use of an app that was designed to promote MD and PA over a 3-month period. Main Outcomes and Measures: PA by accelerometer and the 7-day Physical Activity Recall (PAR) questionnaire and adherence to the MD by an adherence screener questionnaire. We considered adherence to the app to be high when it was used for >60 days. Results: The mean age was 51 years (SD 12) in the IG and 52.3 (SD 12.0) in the counseling only group (CG); females predominated in both groups (60.0% and 64.1%, respectively). PA by accelerometer declined in both groups at 12 months (p for tendency in moderate-vigorous PA [MVPA]=0.146).The subgroup of IG with high app adherence had better behavior than the low adherence subgroup (p for tendency in MVPA=0.001). The PA analyzed by 7-day PAR did not show changes at 12 months in any of the groups (p for tendency=0.245). In MD, an increase in adherence was observed in both groups at 12 months with no differences between them (p for tendency=0.465). In these two cases the group with high app adherence also had better behavior although without reaching significance for the tendency (p >0.05). Conclusions: In subjects with high app adherence, better results in healthy lifestyle improvements were observed. Overall, however, no differences were found between the IG group and CG in PA increase and adherence to the MD in the long-term. Clinical Trial: Clinical Trials.gov Identifier: NCT02016014 (https://clinicaltrials.gov/ct2/show/NCT02016014)

  • Adoption of Stroke Rehabilitation Technologies bu the User Community

    From: JMIR Rehabilitation and Assistive Technologies

    Date Submitted: Oct 19, 2017

    Open Peer Review Period: Oct 21, 2017 - Dec 16, 2017

    Background: Using technology in stroke rehabilitation is attractive. Devices from robots to smart phone apps can help deliver evidence-based levels of practice intensity and automated feedback without...

    Background: Using technology in stroke rehabilitation is attractive. Devices from robots to smart phone apps can help deliver evidence-based levels of practice intensity and automated feedback without additional labour costs. Currently, however, few technologies have been adopted into everyday rehabilitation. Objective: This project aimed to identify the priorities for users (therapists/patients and carers) and generate user centred solutions to enhance technology adoption. Methods: Stakeholders (n=60), including stroke survivors (33%), therapists (33%), carers, technologists and researchers (33%), were invited to attend three workshops facilitated by the Scottish Universities Insight Institute. Workshop 1 was preceded by a survey of stroke survivors and therapists (n=177) to generate an initial list of priorities. Subsequent workshops focused on generating practical solutions to enhance adoption. Results: Twenty-four priorities were generated from the survey, these were reduced to ten, non-ranked, priorities through discussion, consensus activities and voting at workshop 1. These were: access to technologies, ease of use, awareness of available technologies, technologies focused on function, supports self-management, user training, evidence of effectiveness, value for money, knowledgeable staff and performance/progress feedback. Follow-up workshops set out user benefits for walking technologies and provided recommendations for improve technology adoption: an annual exhibition of commercially available and developing technologies, an online consumer-rating website of available technologies and a user network to inspire and test new technologies. Conclusions: The key outcomes from this series of stakeholder workshops provides a starting point for an integrated approach to promoting greater adoption of technologies in stroke rehabilitation. Bringing technology developers and users together to shape future and evaluate current technologies is critical to achieving evidence based stroke rehabilitation Clinical Trial: None

  • Evaluation of a Diabetes Self-Management Program on Type II Diabetes Patients’ Comorbid Illnesses, Healthcare Utilization, and Cost

    From: Journal of Medical Internet Research

    Date Submitted: Oct 31, 2017

    Open Peer Review Period: Oct 31, 2017 - Dec 26, 2017

    Background: An estimated 30.3 million Americans have diabetes mellitus (DM). The US Department of Health and Human Services created national objectives via its Healthy People 2020 initiative to impro...

    Background: An estimated 30.3 million Americans have diabetes mellitus (DM). The US Department of Health and Human Services created national objectives via its Healthy People 2020 initiative to improve the quality-of-life for people who either have, or are at risk, for DM and, hence, lower the personal and national economic burden of this debilitating chronic disease. Diabetes self-management education interventions are a primary focus of this initiative. Objective: To evaluate the impact of the Better Choices Better Health Diabetes (BCBH-D) self-management program on comorbid illness related to DM, healthcare utilization, and cost. Methods: A propensity score matched, two-group, pre-post design was used for this study. Retrospective administrative medical and pharmacy claims data from the HealthCore Integrated Research Environment (HIRE) were used for outcome variables. The Intervention cohort included DM patients who were recruited to a diabetes self-management program offered both on-line and via in-person workshops. Control cohort subjects were identified from the HIRE by at least two diabetes associated claims (ICD-9 250.xx) within two years prior to the program launch date (10/01/2011-09/30/2013), and received usual care but did not participate in BCBH-D. Controls were matched to cases in a 3:1 propensity score match. Outcome measures included pre- and post-intervention all-cause and diabetes-related utilization and costs recorded in the HIRE claims database. Cost outcomes are reported as least squares means. Repeated measures analyses (Generalized Estimating Equation approach) were conducted for utilization, comorbid conditions, and costs. Results: The program participants who were identified in HIRE claims (N=558) were matched to a Control Cohort of 1,669 patients. Following the intervention, the self-management cohort experienced significant reductions in claims for DM associated comorbid conditions, with the post-intervention disease burden being significantly lower (mean 1.78 (SD=1.6)) compared to the Control cohort (mean 2.13 (SD=1.73)); P=.001. Post-intervention all-cause utilization was decreased in the Intervention cohort compared to controls with -40/1000 Emergency department visits vs +70/1000; P=.004 and -2,790 outpatient visits per 1000 vs. -440/1000; P=.001. Unadjusted total all-cause medical cost was decreased by $2,207 in the Intervention cohort compared to a $338 increase in the Controls, P=.001. After adjustment for other variables through structural equation analysis, the direct effect of the BCBH-D was -$815. Conclusions: Patients in the BCBH-D program experienced reduced all-cause healthcare utilization and costs. Direct cost savings were $815. While encouraging, given the complexity of the patient population, further study is needed to cross-validate the results. Clinical Trial: N/A

  • Virtual Reality and Well-being: A systematic review of behaviour change and virtual reality systems.

    From: JMIR Serious Games

    Date Submitted: Oct 20, 2017

    Open Peer Review Period: Oct 21, 2017 - Dec 16, 2017

    Background: E-health interventions are becoming increasingly used in public health. Computer generated environments viewed through virtual reality (VR) have demonstrated endless possibilities to adap...

    Background: E-health interventions are becoming increasingly used in public health. Computer generated environments viewed through virtual reality (VR) have demonstrated endless possibilities to adapt problematic behaviours that affect well-being. VR is no longer unaffordable for individuals, and with smartphone technology able to track movements and project 3D images, VR is now a mobile tool that can be used at work, home or on the move. Objective: This systematic review aims to explore in what context VR can be an applicable tool for the improvement of well-being, what conditions interventions are aimed it and what forms of VR are commonly being used in research. Methods: A systematic review was carried out that included studies whose interventions were relevant to well-being. Thematic analysis was incorporated to find themes that assist us in answering the objectives set out for this review. Several web-based databases were searched for papers that were published between January 2012 and July 2017. Results: 102 studies were identified, they were concerned with areas of anxiety (n = 76), depression/stress (n = 5), addiction (n = 9), eating disorders/body image (n = 10) and sleep disorders (n = 3). In these papers 22 different virtual reality systems were found, the most common VR HMD (Head-Mounted Display) was the eMagin z800 (n=28). VR exposure therapies that incorporated traditional treatments such as cognitive behaviour therapy (CBT) proved to be effective across conditions, particularly for anxiety and post-traumatic stress disorder (PTSD). Cue exposure therapy (CET) reduced addiction cravings and full body images viewed in VR could revolutionise treatment for anorexia. VR has proven itself to be an applicable platform for behaviour change. Conclusions: With reactions to feared stimuli proving effective in VR, increasingly immersive environments that promote positive stimuli combined with health knowledge could prove to be a valuable tool for public health and well-being. The current state of research highlights the importance of the content within VR programs for improved well-being. Future research should look to incorporate more accessible forms of VR

  • Improving prediction of risk of hospital admission in chronic obstructive pulmonary disease: application of machine learning to telemonitoring data

    From: Journal of Medical Internet Research

    Date Submitted: Oct 30, 2017

    Open Peer Review Period: Oct 31, 2017 - Dec 26, 2017

    Background: Telemonitoring of symptoms and physiological signs has been suggested as a means of early detection of exacerbations of chronic obstructive pulmonary disease (COPD) with a view to institut...

    Background: Telemonitoring of symptoms and physiological signs has been suggested as a means of early detection of exacerbations of chronic obstructive pulmonary disease (COPD) with a view to instituting timely treatment. However, current algorithms to identify exacerbations result in frequent false positive results and increased workload. Machine learning, when applied to predictive modelling, can determine patterns of risk factors useful for improving quality of predictions. Objective: To establish if machine learning techniques applied to telemonitoring datasets improve prediction of hospital admissions, decisions to start steroids, and to determine if the addition of weather data further improves such predictions. Methods: We used daily symptoms, physiological measures and medication data, with baseline demography, COPD severity, quality of life, and hospital admissions from a pilot and large randomised controlled trial of telemonitoring in COPD. In addition, we linked weather data from the UK Meteorological Office. We used feature selection and extraction techniques for time-series to construct up to 153 predictive patterns (features) from symptom, medication, and physiological measurements. The resulting variables were used for the construction of predictive models fitted to training sets of patients and compared to common algorithms. Results: We had a mean 363 days of telemonitoring data from 135 patients. The two most practical traditional score-counting algorithms, restricted to cases with complete data resulted in AUC estimates of 0.60 [CI 95% 0.51, 0.69] and 0.58 [0.50, 0.67] for predicting admissions based on a single day’s readings. However, in a real-world scenario allowing for missing data, with greater numbers of patient daily data and hospitalisations (N = 57,150, N+=17), the performance of all the traditional algorithms fell, including those based on two days data. One of the most frequently used algorithms performed no better than chance. Machine learning models demonstrated significant improvements; the best machine learning algorithm based on 57,150 episodes resulted in an aggregated AUC = 0.73 [0.67, 0.79]. Addition of weather data measurements resulted in a negligible improvement in the predictive performance of the best model (AUC = 0.74 [0.69, 0.79]). In order to achieve an 80% true positive rate (sensitivity), the traditional algorithms were associated with an 80% false positive rate: our algorithm halved this rate to approximately 40% (specificity approximately 60%). The machine learning algorithm was moderately superior to the best standard algorithm (AUC = 0.77 [0.74, 0.79] v AUC = 0.66 [0.63, 0.68]) at predicting the need for steroids. Conclusions: The early detection and management of COPD remains an important goal given the huge personal and economic costs of the condition. Machine learning approaches, which can be tailored to an individual’s baseline profile and can learn from experience of the individual patient are superior to existing predictive algorithms show promise in achieving this goal. Clinical Trial: NA

  • Ontology-based cloud computing approach implements on mobile healthcare and management

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 20, 2017

    Open Peer Review Period: Oct 22, 2017 - Dec 17, 2017

    Background: Healthcare involves the maintenance or improvement of health via diagnosis, treatment, and prevention of disease, illness, injury, or other physical and mental impairments. During the past...

    Background: Healthcare involves the maintenance or improvement of health via diagnosis, treatment, and prevention of disease, illness, injury, or other physical and mental impairments. During the past decade, there has been a proliferation of research on health information technology (HIT), which shows that HIT is essential for improving the quality of mobile healthcare and management. Objective: The smart-healthcare industry is a growing market that uses new technologies for the mobile healthcare and management field. The provision of more precise service solutions will allow smart healthcare and management strategies to be deployed in the healthcare industry. Methods: Thus, this study gives theoretical and practical insights into an ontology-based cloud computing approach in the mobile healthcare and management context. Results: Depending on the characteristics of the variable content, these data formats are defined as category data variable and numerical data variable (Table 1). These health evaluation factors also have a threshold value for each factor in Table 2, which determines the health status. Conclusions: This increases the understanding of the creation of value using a cloud computing business model and opens new paths for the development of a business case for healthcare providers.

  • Mobile personalized blood glucose prediction system for patients with gestational diabetes mellitus

    From: JMIR mHealth and uHealth

    Date Submitted: Nov 10, 2017

    Open Peer Review Period: Nov 11, 2017 - Jan 6, 2018

    Background: Personalized blood glucose prediction for diabetes patients is an important goal that is pursued by many researchers worldwide. Despite many proposals for blood glucose prediction algorith...

    Background: Personalized blood glucose prediction for diabetes patients is an important goal that is pursued by many researchers worldwide. Despite many proposals for blood glucose prediction algorithms, only a few projects are dedicated to the development of complete recommender system infrastructures that incorporate blood glucose prediction algorithms for diabetes patients. The development and implementation of such a system aided by mobile technology is of particular interest to patients with gestational diabetes mellitus (GDM), especially considering the significant importance of quickly achieving adequate blood glucose control for these patients in a short period, i.e., during pregnancy, and a typically higher acceptance rate for mHealth solutions for short-to-mid-term usage. Objective: This study was conducted with the objective of developing an infrastructure comprising data processing algorithms, blood glucose prediction models, and an appropriate mobile application for patients’ electronic records management to guide blood glucose prediction-based personalized recommendations for GDM patients. Methods: The prediction results by the models for blood glucose levels one hour after food intake were RMSE: 0.87 mmol/L, MAE: 0.69 mmol/L, and MAPE: 12.8%, which correspond to an adequate prediction accuracy for blood glucose control decisions. Results: The implemented software and methods were used in a clinical study, in which 62 (49 GDM / 13 healthy) participants were involved in a 1-week monitoring trial, in which they used the mobile app to track records on their meals and self-measurements of BG, and CGMS for continuous blood glucose monitoring. The data on 909 food intakes and corresponding postprandial blood glucose curve as well as the set of patients’ characteristics (such as HbA1C, BMI, age, lifestyle parameters etc.) were selected as inputs for the blood glucose prediction model. The model predicting blood glucose levels one hour after food intake showed the result of RMSE 0.87 mmol/L, MAE 0.69 mmol/L, MAPE 12.8%, which corresponds to an adequate prediction accuracy for blood glucose control decisions. Conclusions: A mobile application for collection and processing of relevant data, appropriate software for CGMS signals processing, and blood glucose prediction models were developed for a recommender system. The developed system may help to improve blood glucose control in patients with GDM; this will be the subject of evaluation in a subsequent study. Clinical Trial: АААА-А16-116012210374-0 at rosrid.ru

  • Mobile Technology in E-Learning for Undergraduate Medical Education on Emergent Otorhinolaryngology-Head and Neck Surgery Disorders: A Pilot Randomized Controlled Trial

    From: Journal of Medical Internet Research

    Date Submitted: Nov 13, 2017

    Open Peer Review Period: Nov 13, 2017 - Jan 8, 2018

    Background: The use of mobile technology in e-learning (M-TEL) can add new levels of experience and significantly increase the attractiveness of e-learning in medical education. Whether an innovative...

    Background: The use of mobile technology in e-learning (M-TEL) can add new levels of experience and significantly increase the attractiveness of e-learning in medical education. Whether an innovative interactive e-learning multimedia (IM) module using M-TEL to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders is feasible and efficient in undergraduate medical students is unknown. Objective: The aim of this study was to compare the impact of a novel IM module using M-TEL to a conventional PowerPoint show (PPS) module for emergent ORL-HNS disorders with regards to learning outcomes, satisfaction, and learning experience. Methods: This pilot randomized controlled trial was conducted at an academic teaching hospital and included 24 undergraduate medical students who were novices in ORL-HNS. The cognitive style was determined using the Group Embedded Figures Test. The participants were randomly allocated (1:1) to one of two groups matched by age, sex, and cognitive style: the IM group, and the PPS group. The content for the gamified IM module and the PPS video module was derived from the textbook-based learning material. During the 100-minute learning period, the participants were unblinded to use the IM or PPS courseware on a 7-inch tablet. Pretests and posttests using multiple choice questions to evaluate knowledge and multimedia situational tests to evaluate competence were administered. The global satisfaction scale and AttrakDiff2 learning experience questionnaire were also given to each participant, who also provided feedback about the modules. Data were expressed as median (95% confidence interval [CI]). Results: Overall, the participants had significant gains in knowledge (71% [95% CI, 1–100%], P<.001) and competence (25% [95% CI, 0–33%], P=.007) after 100 minutes of learning. Although there was no significant difference in knowledge gain between the two groups (difference, -24% [95% CI, -75–36%]; P=.55), competence gain was significantly lower in the IM group compared to the PPS group (-41% [95% CI, -67–-20%]; P=.008). However, the IM group had significantly higher scores of satisfaction (difference, 2 [95% CI, 2–4]; P=.01), pragmatic quality (1.7 [95% CI, 0.1–2.7]; P=.03), and hedonic stimulation (1.9 [95% CI, 0.3–3.1]; P=.01) compared with the PPS group. Qualitative feedback indicated that the various games in the IM module attracted the participants’ attention, but that the nonlinearly arranged materials affected their learning. Conclusions: Using M-TEL for undergraduate medical education on emergent ORL-HNS disorders, an IM module seems to be useful for gaining knowledge, but competency may need to occur elsewhere. While the small sample size reduces the statistical power of our results, its design seems to be appropriate to determine the effects of M-TEL using a larger group. Clinical Trial: ClinicalTrials.gov NCT02971735, (http://clinicaltrials.gov/show/NCT02971735)

  • The Mediating Effect of Internet Addiction in the Relationship between Individualism and Cyberbullying

    From: Journal of Medical Internet Research

    Date Submitted: Oct 22, 2017

    Open Peer Review Period: Oct 22, 2017 - Dec 17, 2017

    Background: Among a variety of dynamics that may have an effect in Internet-related behaviors, cultural orientation is particularly important. Previous studies suggest that individualism is a strong d...

    Background: Among a variety of dynamics that may have an effect in Internet-related behaviors, cultural orientation is particularly important. Previous studies suggest that individualism is a strong determinant of aggressive behavior. In addition, findings suggest that vertical individualism may lead to the development of more tolerance for addiction and aggression. Objective: The study aimed to test whether vertical individualism has significant positive effects on cyberbullying and Internet addiction and whether horizontal individualism has significant negative effects on cyberbullying and Internet addiction. A theoretical model was specified to test the relationships among vertical versus horizontal individualism, cyberbullying, and Internet addiction. Methods: A total of 665 college students were selected using convenience sampling method and willingly participated in the study. Participants’ ages ranged from 17 years old to 19 years old (mean age=17.94, SD=1.12). Of the group, 462 were women (69.5 %) and 203 were men (30.5%). Study majors represented are mathematics (n=113, 17%), science (n=102, 15.3%), instructional technology (n=99, 14.9%), psychology (n=98, 14.7%), and others (n=253, 38.1%). Self-report instruments were used to measure vertical/horizontal individualism, cyberbullying, and Internet addiction. Results: Results show significant positive effect of vertical individualism (.10) and significant negative effect of horizontal individualism (-.12) on cyberbullying. In addition, the direct effect of vertical individualism on Internet addiction was significant (.28) but the direct effect of horizontal individualism was not (-.05). Finally, Internet addiction had a significant direct effect on cyberbullying (.39) as well as an intervening effect in the relationship between vertical individualism and cyberbullying. Results also indicate significant gender differences in cultural patterns and Internet addiction. Conclusions: Points raised in the current study should be valuable to researchers and taken into account by practitioners who design and implement prevention or treatment programs in dealing with Internet addiction or cyberbullying.

  • Design and Evaluation of Personalized Motivational Messages by a Virtual Agent that assists in Post-Traumatic Stress Disorder Therapy

    From: Journal of Medical Internet Research

    Date Submitted: Oct 23, 2017

    Open Peer Review Period: Oct 24, 2017 - Dec 19, 2017

    Background: Background E-mental health care systems incorporating virtual agents can play a major role, as barriers to care still prevent some patients from receiving the help they need. To properly...

    Background: Background E-mental health care systems incorporating virtual agents can play a major role, as barriers to care still prevent some patients from receiving the help they need. To properly assist the users of these systems, the virtual agent needs to promote motivation, something which can be done by offering motivational messages. Objective: This paper presents the design and evaluation of a motivational message system for a virtual agent assisting in post-traumatic stress disorder (PTSD) therapy. A database of motivational statements was built with expert (n=13) input on what types of statements to use in what user situation. Using this database, the system generates personalized motivational messages. Methods: To investigate if the motivational message system improves motivation to continue and trust in a good therapy outcome, an online study was performed (n=207). Participants were asked to imagine they were in a certain situation, and received either a personalized motivational message as generated by the system, a general motivational message, or a message without motivation. They were asked how this message changed their motivation and trust, as well as how much they felt being heard by the agent. Results: Overall, receiving a motivational message improved motivation to continue, trust in a good therapy outcome and the feeling of being heard by the agent. Moreover, this feeling of being heard was further improved if the motivational message was personalized to the user’s situation. This personalization was also shown to be important in those situations where the symptoms were getting worse. In these situations, personalized messages outperformed general messages both in terms of motivation to continue and trust in a good therapy outcome. Conclusions: Based on expert’s input, a personalized motivational message system was developed, which can improve motivation and trust in PTSD therapy. Given the confrontational nature of PTSD therapy, this system has the potential to make an important difference. As both motivation and trust play an important role in many other e-mental health systems as well, personalized motivational message systems such as these can be very valuable.

  • Barriers and facilitators when implementing online monitoring and management as a substitution for traditional outpatient care in children with asthma

    From: Journal of Medical Internet Research

    Date Submitted: Nov 7, 2017

    Open Peer Review Period: Nov 8, 2017 - Jan 3, 2018

    Background: Despite their potential benefits many eHealth innovations studied in major studies fail to integrate into organizational routines and implementation of these innovations remains problemati...

    Background: Despite their potential benefits many eHealth innovations studied in major studies fail to integrate into organizational routines and implementation of these innovations remains problematic. Objective: The purpose of this study was to describe health care professionals’ self-identified perceived barriers and facilitators for the implementation of a web-based portal to monitor asthmatic children online as a substitution for routine outpatient care. Also, we assessed patient (and/or their parents) satisfaction with this eHealth innovation. Methods: Between April and November 2015, 76 healthcare professionals were recruited to participate. During a period of six months, participants received three questionnaires to identify factors that facilitate or impede the use of this eHealth innovation. Questionnaires for patients (and/or parents) were sent once after a period of 6 months. Results: perceived barriers included concerns about the lack of structural financial reimbursement for online monitoring, lack of integration of this eHealth innovation with electronic medical records, the burden of web-based portal use on clinician workload and altered patient-professional relationship (due to fewer face-to-face contacts). Major perceived facilitators included enthusiastic and active initiators, a positive attitude of professionals towards eHealth, the possibility to tailor care to the individual patient (so-called ‘personalized eHealth’) and to easily deliver care according to current guidelines by using the virtual asthma clinic (VAC) and long-term profit and efficiency. Conclusions: Implementation of an eHealth innovation is complex, dynamic and influenced by multiple factors at the levels of the innovation itself, individual professionals, patients, social context, organizational context and economic and political context. Understanding and defining the barriers and facilitators that influence the context appears to be important for successful implementation and sustainability of eHealth innovations.

  • Prescription and use of inhaled medication in patients with asthma and COPD: Baseline-data of an adherence-Intervention-study

    From: Journal of Medical Internet Research

    Date Submitted: Oct 27, 2017

    Open Peer Review Period: Oct 27, 2017 - Dec 22, 2017

    Background: In Swiss adults, prevalence of asthma and COPD is around 7%. To date, asthma and COPD are not curable but treatable respiratory diseases. The burden of each disease among patients is high...

    Background: In Swiss adults, prevalence of asthma and COPD is around 7%. To date, asthma and COPD are not curable but treatable respiratory diseases. The burden of each disease among patients is high and people affected are frequently hospitalised due to exacerbations. This is associated with accelerated lung function decline, increased mortality and reduced health-related quality of life (HRQoL). However, there are numerous reasons for the lack of disease control in asthma and COPD patients. It is repeatedly associated with non-adherence to guidelines regarding treatment recommendation on the part of the health care provider and with poor inhalation technique and/or non-adherence to the prescribed treatment plan by the patient. Objective: This study aims at presenting data on compliance in accordance with current treatment guidelines. Moreover, we provide baseline data on inhaler application and its impact on quality of life and symptom control in a typical population with chronic lung disease from the Adherence-Trial. Methods: For this cross-sectional analysis, 169 in- and out-patients with asthma and COPD were recruited. Correct application of inhaler devices was tested using pre-defined checklists. Quality of life and symptom control were investigated using COPD Assessment Test (CAT) and Asthma Control Test (ACT). Spirometry was used to measure forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Results: Overall, correct inhalation technique ranged from 55% to 100% depending on the type of inhaler. 112 participants (68%) participants were treated according to global guidelines. COPD patients with incorrect device application had a higher CAT sum score compared to those with a correct device application (P=.02). Moreover, COPD patients with incorrect device application had more often cough (P=.03) and were more breathless while walking up hills or one flight of stairs (P=.02). While there was no significance found in asthma patients, COPD patients who used their devices correctly had a significantly better mean FEV1% predicted at baseline compared to those who applied their devices incorrectly (P=.04). Conclusions: Regular and comprehensive training of correct an inhalation technique is recommended in patients with chronic lung disease, in particular COPD. Correct inhalation of prescribed medication is associated with improved health status and lung function. These findings should encourage physicians and pharmacists to provide instructions on correct inhalation technique and to re-evaluate the patients’ inhalation technique on a regular basis. Clinical Trial: Trial registration: ClinicalTrials.gov: NCT02386722

  • Development and validity of physiotherapy questionnaires: An app with the main musculoskeletal assessment questionnaires

    From: JMIR Rehabilitation and Assistive Technologies

    Date Submitted: Oct 23, 2017

    Open Peer Review Period: Oct 24, 2017 - Dec 19, 2017

    Background: Patient-reported outcomes (PROs) translate subjective outcomes into objective data that can be quantified and analyzed. Nevertheless, the use of PROs in their traditional paper format is n...

    Background: Patient-reported outcomes (PROs) translate subjective outcomes into objective data that can be quantified and analyzed. Nevertheless, the use of PROs in their traditional paper format is not practical for clinical practice due to limitations associated with the analysis and management of the data. To address the need for a viable way to group and utilize the main functioning assessment tools in the field of musculoskeletal disorders, a physiotherapy questionnaires (PQ) app was developed. Objective: This study aims to explain the development of the PQ app, to validate it using two questionnaires, and to analyze whether participants prefer to use the app or the paper version of the questionnaires. Methods: In the first stage, the PQ app for an Android operational system was developed. In the second stage, the aim was to select questionnaires that were most often used in musculoskeletal clinical practice and research. The Foot and Ankle Outcome Score (FAOS) and American Orthopaedic Foot and Ankle Society (AOFAS) questionnaires were selected to validate the PQ. 50 participants completed the paper and app versions of the AOFAS and 50 completed the FAOS. The study’s outcomes were the correlation of the data between the paper and app versions as well as the preference of the participants between the two versions. Results: The PQ was approved by the experts after the adaptations of the layout for mobile phones and a total of 18 questionnaires were included in the app. Moreover, the app allows the generation of PDF and Excel files with the patients' data. In regards to validity, the mean of the total scores of the FAOS were 91.54% ± 8.86 for the paper version and 91.74% ± 9.20 for the app. There was no statistically significant difference in the means of the total scores or the subscales (P=.11-.94). The mean total scores for the AOFAS were 93.94 ± 8.47 for the paper version and 93.96 ± 8.48 for the app. No statistically significant difference was found for the total scores for the AOFAS or the subscales (P=1.00). The PQ app showed excellent agreement with the paper version of the FAOS, with an ICC value of .98 for the total score (CI 95%, 0.98–0.99) which was also found for the AOFAS with the ICC for the total score of .99 (IC 95%, 0.98–0.99). In regards to compliance, 72% of the participants in the FAOS and 94% in the AOFAS opted for the application as their preferred version. Conclusions: The PQ app showed validity and high levels of compliance for the FAOS and AOFAS, which means that it is not inferior to the paper version of these two questionnaires, thus confirming its viability and feasibility for use in clinical practice.

  • Modeling and Predicting European Physicians’ eHealth Usage Outcomes: A Multidimensional Approach from a Survey of 9,196 General Practitioners

    From: Journal of Medical Internet Research

    Date Submitted: Oct 24, 2017

    Open Peer Review Period: Oct 24, 2017 - Dec 19, 2017

    Background: In the shared healthcare model that eHealth proposes, the literature has noted the need to use more advanced methods and models to evaluate physicians’ eHealth usage outcomes. Objective:...

    Background: In the shared healthcare model that eHealth proposes, the literature has noted the need to use more advanced methods and models to evaluate physicians’ eHealth usage outcomes. Objective: The goal of our study was to design and evaluate a predictive multidimensional model of European general practitioners’ eHealth usage outcomes. Methods: We used data from a 2012-2013 survey of a sample of 9,196 European general practitioners. We proposed and tested two composite indicators of eHealth usage outcomes (internal practices [IP] and practices with patients [PP]) by means of two-stage structural equation modeling with latent variables and measurement errors. Logistic regression (odds ratios, OR) to model the predictors of eHealth usage outcomes indicators was performed using independent variables corresponding to sociodemographic circumstances, attitudes towards ICT impact, and working conditions. Results: The dimensions with more explanatory power of eHealth usage outcomes in internal practices were ICT usage, electronic health records_data, electronic health records_decision support systems, personal health records and Telehealth. In contrast, the eHealth usage outcomes in practices with patients were only explained by the composite indicator of eHealth usage outcomes in the internal practices and by Telehealth usage. For 54.8% (5,035/9,196) and for 55.8% (5,133/9,196) of European general practitioners, the eHealth usage outcomes in internal practices and in practices with patients were more favorable (greater than the mean). European general practitioners who were female (IP OR 1.15, 95% CI 1.10–1.20; PP OR 1.19, 95% CI 1.14–1.24) and younger –aged < 35 years (IP OR 1.14, 95% CI 1.02–1.26; PP OR 1.32, 95% CI 1.13–1.54) and aged 36-45 years (IP OR 1.16, 95% CI 1.06–1.28; PP OR 1.21, 95% CI 1.10–1.33) – had a higher propensity towards favorable eHealth usage outcomes in internal practices (IP) and in practices with patients (PP). European general practitioners who positively valued the effect of ICT on their personal work processes (IP OR 5.30, 95% CI 4.73–5.93; PP OR 4.83, 95% CI 4.32–5.40), teamwork processes (IP OR 4.19, 95% CI 3.78–4.65; PP OR 3.38, 95% CI 3.05–3.74) and relations with patients (IP OR 3.97, 95% CI 3.60–4.37; PP OR 6.02, 95% CI 5.43–6.67) showed a high propensity towards the favorable results of eHealth uses (IP and PP). European general practitioners who had used 2.0 applications in their personal lives frequently (IP OR 1.77, 95% CI 1.60–1.97; PP OR 1.94, 95% CI 1.74–2.15) or occasionally (IP OR 1.16, 95% CI 1.06–1.28; PP OR 1.19, 95% CI 1.08–1.31) also had a high propensity towards favorable eHealth usage outcomes. Self-employed European general practitioners (IP OR 1.33, 95% CI 1.22–1.45; PP OR 1.10, 95% CI 1.03–1.28) also showed more favorable results in eHealth usage. Lastly, general practitioners who reported that the number of patients treated had remained constant (IP OR 1.08, 95% CI 1.01–1.17) or had increased in the last two years (PP OR 1.12, 95% CI 1.03–1.22) had a greater predisposition towards favorable eHealth usage outcomes. Conclusions: We provide new evidence of predictors (sociodemographic issues, attitudes towards ICT impacts, and working conditions) explaining favorable eHealth usage outcomes. The results highlight the need to develop more specific policies for general practitioners’ eHealth usage to address different realities. Clinical Trial: NONE

  • E-Health as the Next Generation Obstetric Care: a Review of the Literature

    From: JMIR mHealth and uHealth

    Date Submitted: Nov 2, 2017

    Open Peer Review Period: Nov 3, 2017 - Dec 29, 2017

    Rapid development in digital technology has provided healthcare with numerous devices, systems and services to support daily care by e-health. In the reproductive age, women are particularly frequent...

    Rapid development in digital technology has provided healthcare with numerous devices, systems and services to support daily care by e-health. In the reproductive age, women are particularly frequent users of Internet, social media and smartphone apps. This makes the obstetric patient a prime candidate for e-health supported health care. This review describes the current state of affairs on e-health developments in obstetrical care. We evaluate the effect on healthcare quality, discuss legal and privacy barriers and identify possibilities for future directions. Several studies show that e-health applications in gestational diabetes and mental health are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression and web-based cognitive behavioral therapy. A number of applications and exercise programs show a direction towards less gestational weight gain, increase in step count and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable the shift from hospital-centered to patient-centered care. This active involvement of patients to their health has been widely acknowledged to improve commitment to treatment and thus health outcomes. In general, the combination of increased patient empowerment and home pregnancy care could lead to more efficiency and reduction of costs. E-health will continue to grow and this will not be limited to the obstetric department. We accentuate the need for evidence for health outcomes, patient satisfaction and the impact on costs of the possibilities of e-health interventions in obstetric care. The link between this specific group of patients and their digital mindset cannot be ignored.

  • HIV Cure Goes Viral: An Analysis of HIV Cure #Hashtags from Twitter Around the Mississippi Baby Announcement

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 25, 2017

    Open Peer Review Period: Oct 26, 2017 - Dec 21, 2017

    Background: On 3 March 2013, an announcement was made concerning the possible functional HIV cure of the “Mississippi baby” at the Conference on Retroviruses and Opportunistic Infections (CROI) in...

    Background: On 3 March 2013, an announcement was made concerning the possible functional HIV cure of the “Mississippi baby” at the Conference on Retroviruses and Opportunistic Infections (CROI) in Atlanta, Georgia, USA. Immediately following this announcement, word spread across traditional media outlets, and social media platforms such as Twitter, rousing tremendous public excitement. Objective: The purpose of this study was to examine the frequency, content, and sentiment of HIV cure-related messages (tweets/retweets) on Twitter around the HIV “cure” Mississippi baby announcement on the 3 of March 2013. Methods: We obtained a dataset containing all HIV cure messages between 13 January and 16 May 2013 and conducted qualitative analyses on a 1,111-message sample. Results: A sharp increase (2,786%) in HIV cure-related messages occurred immediately following the announcement. However, this sharp increase only lasted approximately 19 days. Out of our sample of 1,111 messages most were from individuals (68.1%) or news organizations (18.3%), including the single most retweeted post from the BBC (20,047 retweets). 36.6% of these messages were coded as opinion/commentary and 26.7% were coded as news. The proportion of messages with neutral sentiment increased (42.5% to 53.9%; P = 0.003 while the proportion of those with negative sentiment decreased (15.6% to 9.2%; P = 0.01. Conclusions: The Mississippi baby announcement substantially increased HIV cure-related social media messages. Tweets from individuals dominated this platform; messages from public health agencies were relatively under-represented. The increased public attention garnered after the announcement was short-lived. Similar surges in public attention following future HIV cure breakthrough announcements may offer opportunities to reduce negative perceptions of HIV and improve community engagement.

  • Mobile Diabetes Intervention Study: A Mixed Methods Analysis of Patient Engagement and Impact on Blood Glucose

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 25, 2017

    Open Peer Review Period: Oct 28, 2017 - Dec 23, 2017

    Background: Successful treatment of diabetes includes patient self-management behaviors to prevent or delay complications and co-morbid diseases. On the basis of findings from large clinical trials an...

    Background: Successful treatment of diabetes includes patient self-management behaviors to prevent or delay complications and co-morbid diseases. On the basis of findings from large clinical trials and professional guidelines, diabetes education programs and health providers prescribe daily regimens of glucose monitoring, healthy eating, stress management, medication adherence, and physical activity. Consistent, long-term commitment to regimens is challenging. Mobile health is increasingly being used to assist patients with lifestyle changes and self-management behaviors between provider visits. The effectiveness of mobile health to improve diabetes outcomes depends on patient engagement with a technology, content, or interactions with providers. In the current analyses, we aimed to identify patient engagement themes in diabetes messaging with diabetes providers and to determine if differences in engagement in the Mobile Diabetes Intervention Study (MDIS) influenced changes in gm/dL HbA1c over a one-year treatment period (1.9% absolute decrease in the parent study). Objective: N/A Methods: In the primary MDIS study, 163 patients were enrolled into one of three mobile intervention groups or a usual care control group, based on their physician cluster randomization assignment. The control group received care from their physicians as usual. Participants in each intervention group had access to a patient portal where they could record monitoring values for blood glucose, blood pressure, medication changes or other self-management information, while also assigned to varying levels of physician access to patient data. Intervention participants could choose to send and receive messages to assigned Certified Diabetes Educators (CDEs) with questions or updates through the secure web portal. For this secondary analysis, patient engagement was measured using qualitative methods to identify self-care themes in 4,109 patient messages. Mixed methods were used to determine the impact of patient engagement on change in HbA1c over one year. Results: Self-care behavior themes that received the highest engagement for participants (n=107) were glucose monitoring (70.1%), medication management (66.4%), and reducing risks (66.4%). The average number of messages sent per patient were highest for glucose monitoring (9.2 ± 14.0) and healthy eating (6.9 ± 13.2). Compared to sending no messages, sending any messages about glucose monitoring (P=.03) or medication (P=.01) led to a decrease in HbA1c of 0.62% and 0.72%, respectively. Sending any messages about healthy eating, glucose monitoring, or medication combined led to a decrease in HbA1c of 0.54% compared to not sending messages in these themes (P=.045). Conclusions: The findings from this study help validate the efficacy of the mobile diabetes intervention. The next step is to determine differences between patients who engage in mobile interventions from those who do not engage and to identify methods to enhance patient engagement.

  • Depression is predicted by emotional instability on Facebook, but by reduced emotion variability on Twitter

    From: Journal of Medical Internet Research

    Date Submitted: Oct 25, 2017

    Open Peer Review Period: Oct 26, 2017 - Dec 21, 2017

    Background: Frequent expression of negative emotion words on social media has been linked to depression. However, metrics have relied on average values, not dynamic measures of emotional volatility. O...

    Background: Frequent expression of negative emotion words on social media has been linked to depression. However, metrics have relied on average values, not dynamic measures of emotional volatility. Objective: This study reports on the associations between depression severity and the variability (time-unstructured) and instability (time-structured) in emotion word expression on Facebook and Twitter across status updates. Methods: Status updates and depression severity ratings of 29 Facebook users and 49 Twitter users were collected through the app MoodPrism. The average proportion of positive and negative emotion words used, within-person variability, and instability were computed. Results: Negative emotion word instability was a significant predictor of greater depression severity on Facebook (rs(29) =.44, p = .017, 95% CI [.09, .69]), even after controlling for the average proportion of negative emotion words used (partial rs(26)= .51, p = .006) and within-person variability (partial rs(26) = .49, p = .009). A different pattern emerged on Twitter where greater negative emotion word variability indicated lower depression severity (rs(49) = -.34, p = .011, 95% CI [-.58, .09]). Differences between Facebook and Twitter users in their emotion word patterns and psychological characteristics were explored. Conclusions: The findings suggest that negative emotion word instability may be a simple yet sensitive measure of time-structured variability useful when screening for depression through social media, though this may only be the case for Facebook.

  • Examining the Complexity of Patient-Outpatient Care Team Secure Message Communication

    From: Journal of Medical Internet Research

    Date Submitted: Oct 25, 2017

    Open Peer Review Period: Oct 26, 2017 - Dec 21, 2017

    Background: The value of secure messaging in streamlining routine patient care activities is generally agreed upon. However, the differences in how patients use secure messaging, including for communi...

    Background: The value of secure messaging in streamlining routine patient care activities is generally agreed upon. However, the differences in how patients use secure messaging, including for communicating both routine and non-routine issues, and the implications of these differences in use are less well understood. Objective: The purpose of this study is to examine secure messaging use to extend current knowledge of how this tool is being used in outpatient care settings and generate new research questions to improve our understanding of the role of secure messaging in the patient-provider communication toolbox. Methods: We conducted an in-depth qualitative analysis of secure message threads in 12 Department of Veteran Affairs outpatient clinics in south Texas. We analyzed 70 secure message threads with a total of 179 unique communications between patients and their outpatient teams for patterns in communication and secure message content. Theories from information systems and complexity science in organizations were used to explain our observations. Results: Analysis identified content relating to three main themes: 1) information management, 2) uncertainty management, and 3) patient safety and engagement risks/opportunities. Within these themes, we identified two sub-categories of information management (information exchange and problem solving), two sub-categories of uncertainty management (relationship building and sensemaking) and three sub-categories of patient safety and engagement risks/opportunities (unresolved issues, tone mismatch and urgent medical issues). Secure messages were most often used to communicate routine issues (e.g. information exchange, problem solving). However, the presence of sub-categories pertaining to non-routine issues (e.g. relationship building, sensemaking, tone mismatch, urgent, unresolved) requires attention, particularly in terms of the improvement opportunities for outpatient care settings using secure messaging. Conclusions: Patients use secure messaging for both routine and non-routine purposes. Our analysis sheds light on potentially new patient safety concerns, particularly if communicating via secure messaging is deemed ill-suited to address some of the more complex issues patients are raising via secure messaging technologies. As an asynchronous communication information system operated by patients and providers often characterized as having significant differences in knowledge, experience and expectations, justification for its use beyond routine purposes is limited – yet it occurs, presenting a multifaceted dilemma for health care organizations. Secure messaging use in outpatient care settings may be more nuanced, and thus more challenging to understand and manage than previously recognized. New information system designs that acknowledge the use of secure messaging for non-routine and complex health topics are needed.

  • Higher efficacy ratings for self-medication with psychedelics than offered treatment for psychopathologies

    From: Journal of Medical Internet Research

    Date Submitted: Oct 26, 2017

    Open Peer Review Period: Oct 27, 2017 - Dec 22, 2017

    Background: A substantial number of people worldwide suffer from mental health problems during their lifetime. Current first-line treatments are not efficacious for a considerable number of patients a...

    Background: A substantial number of people worldwide suffer from mental health problems during their lifetime. Current first-line treatments are not efficacious for a considerable number of patients and the need for alternative treatments is high. Recent scientific studies suggest that psychedelic drugs have high therapeutic potential for a variety of difficult to treat mental disorders. Objective: To the best of our knowledge the present survey study is the first to assess the tendency of psychedelic users to self-medicate with psychedelics and to compare the efficacy of self-administered psychedelics to treat their disorder, and the treatment offered by a medical professional. Methods: In total 2319 (47.4%) participants completed the survey of which 1967 consented and were 18 years or older. The mean (±SD) age of this final set was 25.9 (8.7); 78.7% were males, 19.9% females, and 1.3% classified themselves as ‘other’. Results: Almost half of the final set (45.7%) indicated to have suffered or to be currently suffering from a mental disorder; 77.5% of those were diagnosed by a medical professional. In 92.5% of the diagnosed cases some kind of treatment was offered; 77.3% of them searched for treatments outside a medical professional’s recommendation and 15% of those had used or were using psychedelics to treat or cure symptoms. Self-administered psychedelic treatment had a higher likelihood of being efficacious, with higher symptoms reduction and larger quality of life improvement compared to treatment offered by a medical professional. Conclusions: Lifetime prevalence of psychopathologies in the current sample of psychedelic drug users seemed to be higher than in the general population. Self-medication with psychedelics was not highly frequent, though when it occurred it was rated as significantly more effective as treatment offered by a medical professional. Current findings support research exploring the potential of psychedelics in the treatment of psychopathologies. Clinical Trial: na

  • Beyond the trial: A systematic review of uptake and engagement with digital self-help interventions for depression, anxiety or mood as implemented

    From: Journal of Medical Internet Research

    Date Submitted: Oct 26, 2017

    Open Peer Review Period: Oct 27, 2017 - Dec 22, 2017

    Background: Digital self-help interventions (including online or computerized programs and apps) for common mental health issues have been shown to be appealing, engaging, and effective in randomized...

    Background: Digital self-help interventions (including online or computerized programs and apps) for common mental health issues have been shown to be appealing, engaging, and effective in randomized controlled trials. They show potential for improving access to therapy and, potentially, for improving population mental health. However, real world use may differ from that in research settings and implementation data are seldom reported. Objective: We aimed to review peer-reviewed articles reporting user uptake and engagement from implemented pure self-help (unguided) digital interventions for depression, anxiety, or for the enhancement of mood. Methods: We conducted a systematic search of the Scopus, Embase, MEDLINE, and PsychINFO databases for studies reporting user uptake or engagement from the implementation of digital self-help interventions for the treatment or prevention of depression or anxiety, or the enhancement of mood, from 2002 to 2017. Database searches were supplemented by screening citations and the reference lists of included articles; and, screening the titles of articles published in Internet Interventions, Journal of Medical Internet Research (JMIR), and JMIR Mental Health since their inception. Data were extracted for measures indicating the number of registrations or downloads, ‘at least minimal use’, ‘indicators of moderate use’ and completion or ‘sustained use’. Results: After the removal of duplicates, 970 papers were identified, of which 10 met the inclusion criteria. Hand-searching identified one additional article. The included articles reported on seven publically available interventions. There was little consistency in the indicators reported. The number of registrants or downloads ranged widely, from 8 to over 40,000 per month. Of users who registered for or downloaded the intervention, between 21% and 88% engaged in at least minimal use (generally used the intervention at least once or completed one module or one assessment). There was little consistency in measures of moderate use: four studies reported that 10% to 39% of users completed between 40% and 60% of modular programs, while 7% to 42% of those who downloaded apps were still using them after four weeks in the three papers which reported this metric. Completion of all modules or the last assessment was reported for three programs and ranged from 0.5% to 19.5%. The percentage of users who continued to use apps after 6 weeks or more was reported for two apps or suites of apps and ranged from 3.5% to 28.6%. Conclusions: Available data suggest that uptake and engagement vary widely across the handful of digital self-help apps and programs which have reported this. Implementation data should be routinely gathered and reported in order to facilitate opportunities for improved ‘real world’ uptake and engagement, arguably among the major challenges in digital health. Clinical Trial: NA

  • The effectiveness of a computer-tailored e-learning program for practice nurses to improve their adherence to smoking cessation counseling guidelines: a randomized controlled trial

    From: Journal of Medical Internet Research

    Date Submitted: Oct 27, 2017

    Open Peer Review Period: Oct 27, 2017 - Dec 22, 2017

    Background: Improving practice nurses’ adherence to smoking cessation counseling guidelines will benefit the quality of smoking cessation care and will potentially lead to higher smoking abstinence...

    Background: Improving practice nurses’ adherence to smoking cessation counseling guidelines will benefit the quality of smoking cessation care and will potentially lead to higher smoking abstinence rates. However, support programs to aid practice nurses in improving their guideline uptake and adherence do not exist yet. Objective: To assess the effects of a novel computer-tailored e-learning program on practice nurses’ smoking cessation guideline adherence. Methods: A web-based randomized controlled trial was conducted in which an intervention group (N = 147) with full access to the e-learning program for six months was compared to a control group (N = 122) without access. Data collection was fully automated at baseline and six-month follow-up via online questionnaires, assessing practice nurses’ demographics, work-related factors, potential behavioral predictors based on the I-Change model and guideline adherence. Practice nurses also completed counseling checklists to retrieve self-reported counseling activities for each consultation with a smoker (N = 1,175). To assess the program’s effectiveness in improving practice nurses’ guideline adherence (i.e. overall adherence and adherence to individual counseling guideline steps), mixed linear and logistic regression analyses were conducted, thus accommodating for the smokers being nested within practice nurses. Potential effect moderation by work-related factors and behavioral predictors was also examined. Results: After six months, 121 practice nurses in the intervention group (43.4%) and 103 in the control group (36.9%) completed the follow-up questionnaire. Mixed linear regression analysis revealed that counseling experience moderated the program’s effect on practice nurses’ overall guideline adherence (β = 0.610; 95% CI 0.132 – 1.089; P = .013), indicating a positive program effect on adherence for practice nurses with a more than average level of counseling experience. Mixed logistic regression analyses regarding adherence to individual guideline steps revealed a trend towards moderating effects of baseline levels of behavioral predictors and counseling experience. More specifically, for practice nurses with less favorable scores on behavioral predictors (e.g. low baseline self-efficacy) and high levels of counseling experience the program significantly increased adherence. Conclusions: Results from our randomized controlled trial showed that among practice nurses with more than average counseling experience the e-learning program resulted in significantly better smoking cessation guideline adherence. Experienced practice nurses might have been better able to translate the content of our e-learning program into practically applicable counseling strategies compared to less experienced colleagues. Less favorable baseline levels of behavioral predictors among practice nurses possibly contributed to this effect, as there was more room for improvement by consulting the tailored content of the e-learning program. To further substantiate the effectiveness of e-learning programs on guideline adherence by healthcare professionals, it is important to assess how to support a wider range of healthcare professionals. Clinical Trial: No medical ethical clearance for this study was needed according to the Medical Ethics Committee Atrium-Orbis-Zuyd (14-N-17). The study is registered with the Dutch Trial Register (NTR4436).

  • Understanding User Reactions and Interactions with an Internet-Based Intervention for Tinnitus Self-Management: Mixed-Methods Process Evaluation

    From: Journal of Medical Internet Research

    Date Submitted: Oct 30, 2017

    Open Peer Review Period: Oct 30, 2017 - Dec 25, 2017

    Background: Tinnitus is a common symptom that can affect an individual’s quality of life, requiring psychological support that is not readily accessible. Internet-based interventions have the potent...

    Background: Tinnitus is a common symptom that can affect an individual’s quality of life, requiring psychological support that is not readily accessible. Internet-based interventions have the potential to reduce the disparity in access to psychological support that people with tinnitus currently experience. One example is the Tinnitus E-Programme, which was developed in the UK to support self-management in people with tinnitus. Although freely available online, it had not been formally evaluated. Objective: To carry out a process evaluation to explore past, current, and new users’ reactions and interactions with the Tinnitus E-Programme. Methods: Study 1 used an online survey to gather past and current users’ reactions to and interactions with the intervention (n=27). Study 2 used interviews and a relaxation log to explore this aim with new users and assess how well they were able to implement the skills they learned during the intervention in their everyday lives (n=13). Findings were triangulated to develop an in-depth understanding of the intervention’s mechanisms of impact and identify any implementation or contextual factors that strengthen or impede its delivery and functioning. Results: Generally, users expressed positive views of the Tinnitus E-Programme content and design features. Users particularly valued the education about tinnitus and its management, and relaxation skills training, whereas reactions and usage of the self-monitoring tools, online support forum, and therapist support were mixed. Implementation was limited by instances of poor usability and accessibility, user engagement, and adherence to relaxation goals. Users’ perceptions of the intervention’s credibility and relevance, and beliefs regarding the intervention’s negative impact on their tinnitus influenced their engagement with the intervention. Users in both studies identified several benefits gained from the intervention, including functional and emotional management; self-efficacy for managing and coping with tinnitus; understanding tinnitus and its management; social support; and acceptance of tinnitus. Conclusions: Findings suggest that acceptability was high among the target group but also highlighted some areas for improvement. These findings will be used to inform further development work.

  • A Community Based Participatory Approach to Training Young Adults to Design and Implement a Social Marketing Framed Lifestyle Intervention on their College Campus

    From: Journal of Medical Internet Research

    Date Submitted: Oct 26, 2017

    Open Peer Review Period: Oct 27, 2017 - Dec 22, 2017

    Background: Using a Community-Based Participatory Research (CBPR) approach may increase the likelihood of relevance and acceptability of the designed intervention, especially on a college campus. Furt...

    Background: Using a Community-Based Participatory Research (CBPR) approach may increase the likelihood of relevance and acceptability of the designed intervention, especially on a college campus. Furthermore, recruiting and training college students to design and implement a social marketing framed healthy lifestyle intervention for their peers will allow the intervention to be tailored to the needs of the campus Objective: To describe the process of training college students to develop a campus-based, social marketing health promotion intervention Methods: Four universities recruited current college students (18+ y.o.) to develop a social marketing and environmental intervention (SMEI), which was completed during a 16-week semester course. Researchers and Extension professionals trained students to design 24 weeks of intervention events that would be implemented the upcoming year. Results: Seventy-eight students enrolled in the study and SMEI course among the four intervention states (FL=30, SD=8, TN=13, WV=27); students were predominately Caucasian (65.8%), females (84.0%), and sophomore status in college (64.9%). Throughout the semester, students assessed their campus environments, set priorities, and developed weekly events and resources needed to implement the intervention on their campuses. By the end of the semester, the students had designed 24 weeks of intervention events focusing on nutrition/food/diet, physical activity, stress management, sleep, and time management. SMEI students designed interactive events, advertisements, artwork, and social media posts for the intervention. These events and resources were catalogued into a digital toolkit of instructions and activities for each week of intervention events. Conclusions: Training students to be social marketing and environmental interventionists via the CBPR process allows for the development of an intervention that stems from grass roots efforts and is tailored to the acceptability and needs of their peers. Clinical Trial: This study was prospectively registered in October 2016 on clinicaltrials.gov, NCT 02941497.

  • Why clinicians don’t report adverse drug events: A qualitative study

    From: Journal of Medical Internet Research

    Date Submitted: Oct 30, 2017

    Open Peer Review Period: Oct 31, 2017 - Dec 26, 2017

    Background: Adverse drug events (ADEs) are unintended and harmful events related to medications. ADE outcomes are important for patients, quality improvement, drug safety research, and post-marketing...

    Background: Adverse drug events (ADEs) are unintended and harmful events related to medications. ADE outcomes are important for patients, quality improvement, drug safety research, and post-marketing surveillance; yet they are vastly underreported. Objective: Our objectives were to identify barriers to ADE documentation and factors contributing to underreporting. Methods: This qualitative study was conducted in one ambulatory centre and three hospitals in British Columbia between March 2014 and December 2016. We completed workplace observations and focus groups with family, hospitalist and emergency physicians, and hospital and community pharmacists. We analyzed field notes by coding and iteratively analyzing our data to identify emerging concepts, generate thematic and event summaries, and create workflow diagrams. Clinicians validated emerging concepts by applying them to cases from their clinical practice. Results: We completed 238 hours of observations during which clinicians investigated 65 suspect ADEs. The observed events were often complex and diagnosed over time, requiring the input of multiple providers. Providers documented ADEs in charts to support continuity-of-care, but never reported them to external agencies. Providers faced time constraints, and reporting would have required duplication of documentation. Conclusions: Existing reporting systems are not suited to capture the complex nature of ADEs nor adapted to workflow, and simply not used by frontline clinicians. Systems that are integrated into electronic medical records (EMRs), make use of existing data to avoid duplication of documentation, and generate alerts to improve safety may address the shortcomings of existing systems, and generate robust ADE data as a byproduct of safer care.

  • An mHealth Intervention to Improve Young Gay and Bisexual Men’s Sexual, Behavioral, and Mental Health in a Structurally Stigmatizing National Context

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 26, 2017

    Open Peer Review Period: Oct 27, 2017 - Dec 22, 2017

    Background: Young gay and bisexual men (YGBM) in Eastern European countries like Romania face high stigma and discrimination, including in healthcare. Increasing HIV transmission is a concern given in...

    Background: Young gay and bisexual men (YGBM) in Eastern European countries like Romania face high stigma and discrimination, including in healthcare. Increasing HIV transmission is a concern given inadequate prevention, travel to high-prevalence countries, and popularity of sexual networking technologies. Objective: An efficacious mobile health (mHealth) HIV-prevention intervention created in the United States was adapted and pilot-tested in Romania to reduce YGBM’s HIV risk. Methods: After an intervention formative phase, 43 YGBM (M age = 23.2, SD=3.6) who reported condomless sex with a male partner and at least five days of heavy drinking in the past three months were enrolled and completed up to eight 60-minute counseling sessions based on motivational interviewing and cognitive behavioral skills training with trained counselors. Pre-post intervention assessments of sexual (e.g., HIV-risk behavior), behavioral (e.g., alcohol use), and mental health (e.g., depression) outcomes were conducted to evaluate intervention impact. Results: From baseline to follow-up, participants reported significant: 1) increases in HIV-related knowledge (M=4.6 vs. M=4.8, P < 0.001) and recent HIV testing (M=2.8 vs. M=3.3, P < 0.05); 2) reductions in heavy alcohol consumption (M=12.8 vs. M=6.9, P < 0.01), and 3) increases in self-efficacy of condom use (M=3.3 vs. M=4.0, P < 0.01). Participants also reported significant reductions in depression symptoms (M=1.5 vs. M=1.0, P < 0.01). Conclusions: This first mHealth HIV risk-reduction pilot intervention for YGBM in Eastern Europe indicated preliminary efficacy and strong acceptability and feasibility. This mobile prevention tool lends itself to broad dissemination pending future efficacy testing, especially in contexts where stigma keeps GBM out of reach of affirmative health interventions.

  • The use and effects of ehealth tools for patient self-monitoring and reporting of outcomes following medication use: A systematic review

    From: Journal of Medical Internet Research

    Date Submitted: Nov 2, 2017

    Open Peer Review Period: Nov 3, 2017 - Dec 29, 2017

    Background: eHealth tools are becoming increasingly popular for helping patients self-manage chronic conditions. Little research has examined the effect of ehealth tools for patient self-reporting on...

    Background: eHealth tools are becoming increasingly popular for helping patients self-manage chronic conditions. Little research has examined the effect of ehealth tools for patient self-reporting on medication management. This review aims to determine whether ehealth tools featuring patient self-reporting of symptoms, adverse effects and drug therapy problems are effective at prompting medication changes and improving patient outcomes. Objective: The primary objective is to determine how patient self-reporting of symptoms and adverse effects via ehealth tools influences medication use and changes made to medications. Secondary objectives are to investigate how patient use of ehealth tools influences identification of adverse events, patient self-management of disease and self-efficacy, medication use behaviour, medication reconciliation and recommendations for drug changes, changes in patient signs and symptoms, health services utilization, quality of life, and patient satisfaction with health care. Methods: MEDLINE, EMBASE and CINAHL were searched from Jan 1, 2000 through to January 4, 2016. References were also searched. Title, abstract and full text review, as well as data abstraction and risk of bias assessment were performed in duplicate. Due to high heterogeneity, results were not meta-analyzed, and instead presented as a narrative synthesis. Results: 13 studies, including 10 randomized controlled trials (RCTs) and 3 single-arm cohort studies were included, from which 10 unique ehealth tools were identified. Here six of seven RCTs found improvement in patient symptoms following ehealth tool use, especially in adolescent asthma patients. Four of six RCTs reported that ehealth tools may have potential to initiate changes to medications based on patient self-reports. Two of four RCTs showed that ehealth tools may improve patient self-efficacy and self-management of chronic disease. Little or no evidence was found to support the effectiveness of ehealth tools at improving medication recommendations and reconciliation by clinicians, medication-use behaviour, health service utilization, quality of life, or patient satisfaction. eHealth tools with multifaceted functionalities and those allowing direct patient-provider communication may be more effective at improving patient self-management and self-efficacy. Conclusions: Initial evidence showing ehealth tools may improve patient symptoms and lead to medication changes is promising. Patients generally found ehealth tools useful in improving communication with health care providers. Implementation issues such as poor patient engagement and poor clinician workflow integration were identified. More high-quality research is needed to explore how ehealth tools can be used to effectively manage use of medications to improve patient outcomes.

  • TaskExchange: Facilitating online collaboration in evidence synthesis

    From: Journal of Medical Internet Research

    Date Submitted: Oct 26, 2017

    Open Peer Review Period: Oct 27, 2017 - Dec 22, 2017

    Background: The conduct and publication of scientific research is increasingly open and collaborative. There is growing interest in online platforms that can effectively enable global, multidisciplina...

    Background: The conduct and publication of scientific research is increasingly open and collaborative. There is growing interest in online platforms that can effectively enable global, multidisciplinary scientific teams, and create networks of scientists in areas of shared research interest. Designed to facilitate online collaboration in research evidence synthesis, TaskExchange highlights the potential of these kinds of platforms. Objective: This paper describes the development, growth and future for TaskExchange, an online platform facilitating collaboration in research evidence synthesis. Methods: The original aim for the development of TaskExchange was to create a platform that connected people who needed help with their Cochrane Systematic Reviews (rigorous syntheses of health research) with people who had the time and expertise to help. The scope of TaskExchange has now been expanded to include other evidence synthesis tasks, including guideline development. The development of TaskExchange was undertaken in four agile development phases with substantial user engagement. In each phase, software was iteratively deployed as it was developed and tested, enabling close cycles of development and refinement. Results: TaskExchange enables users to browse and search tasks and members by key word or nested filters, post and respond to tasks, sign up to notification emails and acknowledge the work of TaskExchange members. The pilot platform has been open access since August 2016, has almost 1500 members and has hosted more than 400 tasks, covering a wide range of research synthesis-related tasks. Response rates are consistently over 70% and user feedback has been positive. Conclusions: TaskExchange demonstrates the potential for new technologies to support online collaboration in health research. Development of a relatively simple platform for peer-to-peer exchange has provided opportunities for systematic reviewers to get their reviews completed more quickly, and provides an effective pathway for people to join the global health evidence community.

  • Empirical Study of Wearable and Social App in Social Care

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 27, 2017

    Open Peer Review Period: Oct 28, 2017 - Dec 23, 2017

    Background: The amount of mobile self-tracking devices connected to the web has exploded in today’s society. With these mobile wearables related to Web 2.0 apps and social media has followed new way...

    Background: The amount of mobile self-tracking devices connected to the web has exploded in today’s society. With these mobile wearables related to Web 2.0 apps and social media has followed new ways of monitoring, measuring, representing and sharing experiences of the human body. New opportunities related to health, and new areas of implementation for professionals have appeared. One identified area that can benefit from mHealth technologies is social work. Objective: There are still few publications presenting experiences of applying wearables and social apps in social work. To contribute to this area it was started a research project targeting wearables and social apps for youths in need of social care. The project was framed by the overarching questions: What improved physical and sleeping effects did the youths and the professional staff experience as a result of using the wearables and the social apps? Methods: To answer the question a field study was performed were wearables and social apps were tried out and studied in the context of vulnerable youths in need of social care, living at a Swedish municipalities care and accommodation home. Results: : The study confirmed earlier reported mHealth research results claiming that instant graphical feedback, sharing information, and being part in social community can have positive impact on life style changes. In addition, the present study identified that the most important factor for positive health related life style changes for youths was the establishment of own long-term goals. The professional social workers identified that the studied wearable and social app could function as a valuable counseling tool opening up for life style talks that otherwise were hard to accomplish. Conclusions: This study demonstrate how wearables and social apps can help vulnerable youths to change bad life style patterns, and also suggests that they can be used as counseling tools for professionals in social work.

  • Serious games in the context of people with cognitive disabilities: a case study

    From: JMIR Serious Games

    Date Submitted: Oct 27, 2017

    Open Peer Review Period: Oct 28, 2017 - Dec 23, 2017

    Background: While traditional video games provide amusement, with the advent of serious games (SG), it has raised the potential and the results that can be achieved from the games, these artifacts, wh...

    Background: While traditional video games provide amusement, with the advent of serious games (SG), it has raised the potential and the results that can be achieved from the games, these artifacts, whose main differentials are the fact that they are naturally playful and motivators. While in the 1990s, the games aimed only at entertainment, nowadays teaching and learning combine with entertainment and become the main goals to be achieved through the SG. A strong example of SG application is for motivation and help in the formal or special teaching-learning process acting as a pedagogical tool. In this sense, the following question arises: What are the characteristics and interface resources considered adequate to compose the interface of a serious game that have educational objectives directed to people with Williams-Beuren Syndrome? Here's the motivation guide for this article. Objective: Elementary mathematics education for people with Williams Syndrome Methods: An exploratory and descriptive study,using qualitative and quantitative approaches. Results: The results portfolio obtained from the WBS user experience assessment presents the confidence rectangle within the "desirable" quadrant. This is what a project program is, since scientifically this is one of the biggest difficulties reported by unlock authors, it is not possible to teach content and maintain playfulness. Conclusions: The prototype of the game here called SoundMath, was intended to meet a demand for learning elementary arithmetic for people with WBS, from a playful and immersive process. Through the results of the evaluations carried out, this work provides relevant information that can encourage the development of this game, as well as help companies in the educational segment, and contribute to the improvement of the quality of the applications targeted to this type of public. Other important point to be highlighted from this work is with regard to the social aspect that this work encompasses, because it is the development of a solution applied to a daily problem of this public. But we did not just develop; we decided to go beyond and document the entire process of engineering and gamification, based on data obtained throughout this study of design and design of a serious educational game prototype that contained in its layout the ideal characteristics to mediate a teaching-learning process from its use, as well as document and outline a methodological process that may serve as the basis for further studies. Thus, we believe that the results and reflections raised from this study may, in the future, broaden the knowledge about the design of serious games for people with cognitive disabilities. The prototype of the game here called SoundMath, was intended to meet a demand for learning elementary arithmetic for people with WBS, from a playful and immersive process. Through the results of the evaluations carried out, this work provides relevant information that can encourage the development of this game, as well as help companies in the educational segment, and contribute to the improvement of the quality of the applications targeted to this type of public. Other important point to be highlighted from this work is with regard to the social aspect that this work encompasses, because it is the development of a solution applied to a daily problem of this public.

  • The Development and Testing of an mHealth Smartphone Application to Measure Risky Driving Behavior

    From: Journal of Medical Internet Research

    Date Submitted: Oct 31, 2017

    Open Peer Review Period: Oct 31, 2017 - Dec 26, 2017

    Background: Naturalistic driving studies (NDS), designed to assess driving behavior and outcomes objectively, are conducted by equipping vehicles with dedicated instrumentation (e.g., accelerometers,...

    Background: Naturalistic driving studies (NDS), designed to assess driving behavior and outcomes objectively, are conducted by equipping vehicles with dedicated instrumentation (e.g., accelerometers, gyroscopes, GPS, and cameras) that provide continuous recording of acceleration, location, videos, and still images for eventual retrieval and analyses. However, this research is limited by the cost of equipment installation; management and storage of the large amounts of data collected; and data reduction, coding and analyses. Modern smartphone technology includes accelerometers built into phones, and the vast, global proliferation of smart phones could provide a possible low-cost alternative for assessing kinematic risky driving (KRD). Objective: We evaluated an in-house developed iPhone application (gForce) for detecting elevated g-force events by comparing the iPhone linear acceleration measurements with corresponding acceleration measurements obtained with both a custom Android application and the in-vehicle miniDAS data acquisition system (DAS, Virginia Tech Transportation Institute). Methods: The iPhone and Android devices were dashboard-mounted in a vehicle equipped with the DAS instrumentation. The experimental protocol consisted of driving maneuvers on a test track, such as, cornering, braking, and turning, performed at different acceleration levels (i.e., mild, moderate, or hard). The iPhone gForce application recorded linear acceleration (i.e., gravity corrected). Whereas, the Android application recorded gravity-corrected and -uncorrected acceleration measurements, and the DAS device recorded gravity-uncorrected acceleration measurements. Lateral and longitudinal acceleration measures were compared. Results: The correlation coefficients between the iPhone and DAS acceleration measurements were slightly lower compared to the correlation coefficients between the Android and DAS, possibly due to the gravity correction on the iPhone. Averaging the correlation coefficients for all maneuvers, the longitudinal and lateral acceleration measurements between iPhone and DAS were rlng = 0.79 and rlat = 0.81, respectively, while the corresponding acceleration measurements between Android and DAS were rlng = 0.91 and rlat = 0.96. The correlation coefficients between lateral accelerations on all three devices were higher than with the corresponding longitudinal accelerations for most maneuvers. Conclusions: The gForce iPhone application reliably assessed elevated g-force events compared to the Android and DAS. Collectively, the gForce application and iPhone platform have the potential to serve as feature-rich, inexpensive, scalable, and open-source tool for assessment of kinematic risky driving events, with potential for research and feedback forms of intervention.

  • Information Technology-Assisted Treatment Planning and Performance Assessment For Severe Thalassemia Care in a resource-limited setting

    From: Journal of Medical Internet Research

    Date Submitted: Oct 27, 2017

    Open Peer Review Period: Oct 28, 2017 - Dec 23, 2017

    Background: Successful models of information and communication technology (ICT) applied to cost-effective delivery of quality care in low- and middle-income countries (LMIC) are an increasing necessit...

    Background: Successful models of information and communication technology (ICT) applied to cost-effective delivery of quality care in low- and middle-income countries (LMIC) are an increasing necessity. Severe thalassemia (ST) is one of the most common life-threatening non-communicable diseases of children globally. Objective: To study the impact of ICT on quality of care for ST patients in LMIC. Methods: A total of 1110 patients with ST from 5 centers in India were followed over a one-year period. The impact of consistent use of a web-based application platform designed to assist comprehensive management of ST (ThalcareTM) on key indicators of quality of care such as minimum (pre-transfusion) hemoglobin, serum ferritin, liver size and spleen size was assessed. Results: For four centers, the improvement in mean pre-transfusion hemoglobin level was statistically very significant (P<0.001). Four out of five centers achieved reduction in mean ferritin levels with two displaying a highly significant drop in ferritin (P=0.003 and P=0.0002). One of the five centers did not record liver and spleen size on palpation, but out of the remaining 4 centers, 2 witnessed a strongly significant drop in liver and spleen size (P <0.01), 1 witnessed moderate drop (P= 0.05 for liver P =0.03 for spleen size) while the fourth witnessed a moderately increase in liver size (P =0.08) and insignificant change in spleen size (P=0.12). Conclusions: Implementation of Computer-Assisted Treatment Planning and Performance Assessment positively impacted on indices reflecting effective delivery of care to patients suffering from ST in LMIC consistently.

  • Assessment of MCQs in MBBS program in college of Medicine, King Khalid University Abha

    From: JMIR Medical Education

    Date Submitted: Oct 28, 2017

    Open Peer Review Period: Oct 31, 2017 - Dec 26, 2017

    Background: Multiple choice questions represent one of the commonest methods of assessment in medical education. They believed to be reliable and efficient. Their quality depends on good item construc...

    Background: Multiple choice questions represent one of the commonest methods of assessment in medical education. They believed to be reliable and efficient. Their quality depends on good item construction. Item analysis is used to assess their quality by computing difficulty index, discrimination index, distractor efficiency and test reliability. Objective: The aim of this study was to evaluate the quality of MCQs used in the college of medicine, King Khalid University, Saudi Arabia. Methods: Cross sectional Study design. Item analysis data of 21 MCQs exams were collected. Values for difficulty index, discrimination index, distractor efficiency and reliability coefficient were entered in MS excel 2010. Descriptive statistic parameters were computed. Results: Twenty one tests were analyzed. Overall, 7% of the items among all the tests were difficult, 35% were easy and 58% were acceptable. The mean difficulty of all the tests was in the acceptable range of 0.3-0.85. Items with acceptable discrimination index among all tests were 39%-98%. Negatively discriminating items were identified in all tests except one. All distractors were functioning in 5%-48%. The mean functioning distractors ranged from 0.77 to 2.25. The KR-20 scores lie between 0.47 and 0.97. Conclusions: Overall, the quality of the items and tests was found to be acceptable. Some items were identified to be problematic and need to be revised. The quality of few tests of specific courses was questionable. These tests need to be revised and steps taken to improve this situation.

  • The Rise and Need for Mobile Apps for Maternal and Child Health Care in China- a survey based on App markets

    From: Journal of Medical Internet Research

    Date Submitted: Oct 31, 2017

    Open Peer Review Period: Oct 31, 2017 - Dec 26, 2017

    Background: The mobile health (mHealth) services are booming in maternal and child health (MCH) in China, due to the expansion of e-health and the introduction of the ‘two child policy’ Countless...

    Background: The mobile health (mHealth) services are booming in maternal and child health (MCH) in China, due to the expansion of e-health and the introduction of the ‘two child policy’ Countless MCH apps can be found in computer stores, but the exact number, downloads and functional features of such apps are not clear. Objective: To explore the use of MCH apps in Android and iOS app stores and describe the key functional features of the most popular ones with the purpose of providing insight for further research and development of MCH mobile health products. Methods: The researchers searched the three most popular Android app stores (Tencent MyApp, Baidu Mobile Assistant and 360 Mobile Assistant) and the iTunes App Store in China. All apps on family planning (contraception and preparing for pregnancy), pregnancy and perinatal care, neonatal care and health, and development for children under 6 years were counted. Any apps focusing on MCH product marketing, children's songs, animation and games were excluded from the study. The 50 most used apps in each of the Android and iTunes stores (78 de-duplicated apps in total) were downloaded for in-depth analysis. Results: A total of 5276 Android apps and 877 iOS apps were identified for MCH care. Of the 78 most popular ones, 43 (55.1%) apps focused on only one stage of MCH care, mainly targeting child care (25 apps) and pre-pregnancy (11 apps), while 35 (44.9%) apps covered two or more stages, with most of these (32 apps) related to both pregnancy and child care. The functions mostly covered by the popular apps were health education/promotion, communication, data collection and management, diary, reminder and counseling. Among the functions of ‘data collection and management’, the researchers found 47 independent tools, including pregnancy preparation, fetal heart monitoring, blood glucose and blood pressure monitoring, as well as some that prompted an action, such as visiting the doctor. A few apps were equipped with external devices (n=3) or cellphone-based measurement technology (n=1). No app was found having intelligent decision-support functions to support disease management such as gestational diabetes and pregnancy-induced hypertension. Only a small amount of apps (n=5) had a web connection with hospital information systems to support appointment scheduling, payments, hospital service guidance or to check on laboratory test results. Conclusions: There are thousands of MCH apps on the China market. The most popular apps tend to cover both pregnancy and child care, or child care or pre-pregnancy separately. They are usually equipped with various functions and tools. However, internet of things, intelligent decision-support and docking with existing hospital information systems are still being developed and need more research.

  • Internet and Social Media Access Among Youth Experiencing Homelessness

    From: Journal of Medical Internet Research

    Date Submitted: Oct 30, 2017

    Open Peer Review Period: Oct 31, 2017 - Dec 26, 2017

    Background: Youth experiencing homelessness are at risk for a variety of adverse outcomes. Given the widespread use of internet and social media, these new technologies may be used to address their ne...

    Background: Youth experiencing homelessness are at risk for a variety of adverse outcomes. Given the widespread use of internet and social media, these new technologies may be used to address their needs and for outreach purposes. However, little is known about how this group uses these resources. Objective: This study investigated how homeless adolescents use these technologies for general and health related purposes, whether the scope of their use changes with housing status, and their interest in a website dedicated to youth experiencing homelessness. Methods: A convenience sample of youth ages 18-21 were recruited from a youth specific homeless shelter. All participants completed a 47-item survey, with 10 individuals completing a semi-structured interview. Descriptive statistics, exact testing, and GEE modeling was performed for quantitative data analysis. Interviews were transcribed verbatim, and NVivo 10 was employed to facilitate double coding and thematic analysis. Results: 87 participants completed the survey with a mean age of 19.4 ±1.1 years. 56.3% accessed the internet at least once/day, with 86.1% accessing once/week. Access to a smartphone was associated with a 2.76 greater odds of getting online, and was the most frequently used device (65.5% of participants). While experiencing homelessness, subjects were less likely to access the internet at least once a day (79.3% vs. 56.3%, P < .001), spend more than 2 hours/day on the internet (56.3% vs. 24.1%, P < 0.001), use social media (97.0% vs. 85.1%, P = .006), and have access to a smartphone (85.1% vs. 65.5%, P = .006). Ten participants completed the semi-structured interview. Several themes were identified including, (1) changes in internet behaviors while experiencing homelessness, (2) health status as a major concern and reason for internet use, and (3) interest in a website dedicated to youth experiencing homelessness. While experiencing homelessness, participants indicated their behaviors were more goal oriented and less focused on leisure or entertainment activities. Conclusions: While homeless youth experience changes in the frequency, amount of time, and specific uses of the internet and social media, study participants were able to access the internet regularly. The internet was used to search health related topics. Given the importance of smartphones in accessing the internet, mobile-optimized websites may be an effective method for reach this group.

  • Potential application of connected tuberculosis diagnostics for real-time surveillance of drug resistant TB transmission

    From: JMIR Medical Informatics

    Date Submitted: Nov 1, 2017

    Open Peer Review Period: Nov 2, 2017 - Dec 28, 2017

    Background: Tuberculosis (TB) is the top killer infectious disease in the world, and yet the surveillance of this disease is still paper-based. Drug resistant TB is an urgent public health crisis, and...

    Background: Tuberculosis (TB) is the top killer infectious disease in the world, and yet the surveillance of this disease is still paper-based. Drug resistant TB is an urgent public health crisis, and the World Health Organization has endorsed since 2010 a series of rapid diagnostic tests (RDTs) that allowed rapid detection of drug resistant strains and produced large volumes of data. In parallel, most high burden countries have adopted connectivity solutions that allow linking of diagnostics, real-time capture and shared repository of these test results. However, these connected diagnostics and readily available test results are not utilised to their full capacity as we have yet to capitalize on fully understanding the relationship between test results and specific rpoB mutations to elucidate its potential application on real-time surveillance. Objective: We aimed to validate and analyse RDT data in detail, and propose the potential use of connected diagnostics and associated test results for real-time evaluation of RR-TB transmission. Methods: From the Belgian Coordinated Collections of Microorganisms at the Institute of Tropical Medicine, 107 RR-TB strains harbouring 34 unique rpoB mutations, including 30 within the Rifampicin Resistance Determining Region, were selected. These strains were subjected to XpertMTB/RIF (Cepheid), GenoTypeMTBDRplusv2.0 (Hain LifeScience GmbH), and GenoscholarNTM+MDRTBII (Nipro), the results of which were validated against the strains’ available rpoB gene sequences. The reproducibility of the results was determined, and the probe reactions were analysed and visualised, and proposed for potential use in evaluating transmission. Results: TB diagnostic test results, particularly the RDT probe reactions detected the majority of RRDR mutations tested, although a few critical discrepancies between observed probe reactions and manufacturer claims were found. Based on published frequencies of probe reactions and RRDR mutations, we found specific probe reactions with high potential use in transmission studies namely XpertMTB/RIF probes A, Bdelayed, C, Edelayed; GenotypeMTBDRplusv2.0 WT2, WT5, WT6; and GenoscholarNTM+MDRTBII S1, S3. Additionally, inspection of probe reactions of disputed mutations may potentially resolve discordance between genotypic and phenotypic test results. Conclusions: We propose a novel approach for potential real-time detection of RR-TB transmission through fully utilizing connected TB diagnostics and shared repository of test results. To our knowledge, this is the first pragmatic and scalable work in response to the consensus of world-renowned TB experts in 2016 on the potential of diagnostic connectivity for accelerated efforts toward TB elimination. This is evidenced by the ability of our proposed approach to facilitate comparison of probe reactions between and among different RDTs used in the same setting. Integrating this proposed approach as a plug-in module to a connectivity platform will increase usefulness of connected TB diagnostics for RR-TB outbreak detection through real-time investigation of suspected RR-TB transmission cases based on epidemiological linking.

  • Increasing Physical Activity in Mothers Using Video Exercise Groups and Exercise Mobile Apps: A Randomized Controlled Trial

    From: Journal of Medical Internet Research

    Date Submitted: Nov 13, 2017

    Open Peer Review Period: Nov 14, 2017 - Jan 9, 2018

    Background: Women significantly decrease their activity levels in the transition to motherhood. Digital health technologies are low cost, scalable, and can provide an effective delivery mechanism for...

    Background: Women significantly decrease their activity levels in the transition to motherhood. Digital health technologies are low cost, scalable, and can provide an effective delivery mechanism for behavior change. This is the first study that examines the use of videoconferencing and mobile apps to create exercise groups for mothers. Objective: We tested the feasibility, acceptability, and effectiveness of an individually adaptive and socially supportive physical activity intervention incorporating videoconferencing and mobile apps in mothers. Methods: The Moms Online Video Exercise (MOVE) Study was an 8-week, two-armed, web-based randomized trial comparing the effectiveness of a group exercise intervention to a waitlist control. Healthy mothers with at least one child under age 12 were recruited online, through Facebook and email listservs. Intervention participants joined exercise groups using videoconferencing (Google Hangouts) every weekday morning and exercised together in real time guided by exercise mobile apps (e.g. Nike+, Sworkit, etc.) of their choosing. Waitlist control participants had access to the list of recommended mobile apps and an invitation to join an exercise group after an 8-week period. The main outcomes assessed were self-reported moderate, vigorous, and moderate-to-vigorous physical activity (MVPA) minutes per week in aggregate and stratified by whether women met Centers for Disease Control and Prevention (CDC) guidelines for sufficient aerobic activity at baseline. Outcomes were measured through self-assessed online questionnaires at baseline and 8 weeks. Results: The intervention was effective at increasing exercise for inactive women, and proved to be feasible and acceptable to all participants. 64 women were randomized, 30 to intervention and 34 to control. Women attended 2.8 sessions per week. There was a strong, but not statistically significant, trend toward increasing moderate and vigorous minutes of physical activity for all women. As hypothesized, women in the pre-specified strata who were inactive at baseline (n=51) significantly increased their activity by an average of 56 MVPA minutes per week more in the intervention group (95% CI: 10.8, 100.7, P=.02). A corresponding statistically significant net increase of 21 (95% CI: 5.2, 36.8, P=.01) minutes of vigorous activity drove the difference in increased MVPA minutes for this stratum of inactive women. Inactive women in the intervention group reported promising reductions in depression, a statistically significant net decrease in their depression score, -4.1 (95% CI: -7.3, -0.8, P=.02).  Conclusions: We found that a group exercise intervention using videoconferencing and mobile apps was a feasible and acceptable way to deliver a physical activity intervention to mothers with young children. The intervention significantly increased physical activity in inactive mothers. Further studies are needed to better establish how long these changes in physical activity can be maintained and whether these findings can be reproduced in a more diverse population. Clinical Trial: ClinicalTrials.gov NCT02805140

  • What Predicts Patients’ Adoption of Mobile Health Services in China?

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 31, 2017

    Open Peer Review Period: Nov 2, 2017 - Dec 28, 2017

    Background: With the increasing concern of Healthy China and the development of information technology, mobile health enables patients access health information and interacting with doctors anytime an...

    Background: With the increasing concern of Healthy China and the development of information technology, mobile health enables patients access health information and interacting with doctors anytime and anywhere. Since the success of mobile health would depend on the adoption of patients, examining patients’ willingness to use it is considered critical. Objective: This study aims to explore the determinants of mobile health services adoption among Chinese patients by an extended TAM with trust and perceived risk. Methods: We conducted a questionnaire-based survey in three large Chinese hospitals, and analyzed the data with structural equation model. Results: The results reveal that the proposed model fits well. Specifically, trust, perceived usefulness and perceived ease of use positively correlate with mobile health services adoption. While, privacy risk and performance risk negatively correlate with the patients’ trust and adoption intention toward mobile health. In addition, age and chronic condition of patients could predict their trust level and adoption intention towards mobile health respectively. Conclusions: We conclude that TAM works for the context of mobile health adoption in general, though the significance has declined. Supplementary to technical factors, trust and perceived risk are critical in explaining mobile health services adoption among Chinese patients.

  • Perceptions of adolescents with cancer related to a pain management app and its evaluation: A qualitative study nested within a multicenter pilot feasibility study

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 31, 2017

    Open Peer Review Period: Oct 31, 2017 - Dec 26, 2017

    Background: Pain in adolescents with cancer is common and negatively impacts health-related quality of life (HRQL). The Pain Squad+ smartphone app, capable of providing adolescents with real-time pain...

    Background: Pain in adolescents with cancer is common and negatively impacts health-related quality of life (HRQL). The Pain Squad+ smartphone app, capable of providing adolescents with real-time pain management support, was developed to enhance pain management using a phased approach (i.e., systematic review, consensus conference and vetting, iterative usability testing cycles). A 28-day Pain Squad+ pilot was conducted with 40 adolescents with cancer to evaluate the feasibility of implementing the app in a future clinical trial and to obtain estimates of treatment effect. Objective: We aimed to elucidate the perceptions of adolescents with cancer to determine the acceptability, perceived helpfulness of Pain Squad+, suggestions for app improvement, and satisfaction with the pilot study protocol. Methods: Post-pilot study participation, telephone-based semi-structured, and audio-recorded exit interviews were conducted with 20 adolescents with cancer (12-18 years). All interviews were transcribed and independently coded by two study team members. Content analysis was conducted to identify data categories and overarching themes. Results: Five major themes comprising multiple categories and codes emerged. These themes focused on the acceptability of the intervention and the study to adolescents, the perceived active ingredients of the intervention, the suitability of the intervention to adolescents’ lives, and recommendations for intervention improvement. Conclusions: Overall, Pain Squad+ and the pilot study protocol were acceptable to adolescents with cancer. Suggestions for intervention and study improvements will be incorporated into the design of a future randomized clinical trial aimed at assessing the effectiveness of Pain Squad+ on adolescent with cancer health outcomes. Clinical Trial: NCT02901834 ClinicalTrials.gov

  • Exploring pitfalls of online consumer health information use and potential preventive strategies: A qualitative study

    From: Journal of Medical Internet Research

    Date Submitted: Nov 2, 2017

    Open Peer Review Period: Nov 2, 2017 - Dec 28, 2017

    Background: There has been an exponential increase in the general population's usage of the Internet, and of information accessibility; the current demand for online consumer health information (OCHI)...

    Background: There has been an exponential increase in the general population's usage of the Internet, and of information accessibility; the current demand for online consumer health information (OCHI) is unprecedented. In North America, more than 70% of adults have used the internet regularly to search for information in 2014, particularly OCHI. There are multiple studies on Internet access and usage, quality of information, and information needs. However, there is a limited number of studies that examine information use and subsequent outcomes. Moreover, few studies explored negative outcomes in detail or from different perspectives, and none examined how these negative outcomes could be prevented or reduced. Objective: To describe negative outcomes associated with OCHI use in primary care, and identify potential preventive strategies from consumers’, health practitioners’ and health librarians’ perspectives. Methods: A two-stage interpretive qualitative study. In the first stage, we recruited, through a social media survey, a purposeful sample of 19 OCHI users who had experienced negative outcomes associated with OCHI. We conducted semi-structured interviews, and performed a deductive-inductive thematic analysis on the transcribed verbatim. The results also informed the creation of vignettes that were used in the next stage. In the second stage, we interviewed a convenient sample of 10 key informants: seven health practitioners (three family physicians, two nurses, and two pharmacists), and three health librarians. With the support of the vignettes, we asked participants to elaborate on (a) their experience with patients who have used OCHI and experienced negative outcomes, and (b) what strategies they suggest to prevent these outcomes. We performed a deductive-inductive thematic analysis on the transcribed verbatim. Results: We found that negative outcomes of OCHI may occur at three levels: internal (such as increased worrying), interpersonal (such as a tension in the patient-clinician relationship), and service-related (such as postponing a clinical encounter). Participants also proposed three types of strategies to prevent the occurrence of these negative outcomes, namely: providing consumers with reliable OCHI, educating consumers on how to assess OCHI websites, and helping consumers present and discuss the OCHI they find with a health professional in their social network or a librarian for instance. Conclusions: We examined negative outcomes associated with using OCHI from five complementary perspectives. We conceptualized the results using a comprehensive and meaningful new construct: OCHI use-related tension. This construct has three dimensions (three inter-dependant levels): internal, interpersonal, and service-related tensions. Future research can focus on the implementation and effectiveness of the proposed strategies, which might contribute to prevent and decrease these tensions.

  • Designing an Intensive Care Unit Visualization Dashboard: An Integrative Literature Review

    From: Journal of Medical Internet Research

    Date Submitted: Nov 1, 2017

    Open Peer Review Period: Nov 1, 2017 - Dec 27, 2017

    Background: Intensive Care Units (ICUs) in the United States admit more than 5.7 million people each year. The ICU level of care helps people with life-threatening illness or injuries and involves cl...

    Background: Intensive Care Units (ICUs) in the United States admit more than 5.7 million people each year. The ICU level of care helps people with life-threatening illness or injuries and involves close, constant attention by a team of specially-trained health care providers. Delay between condition onset and implementation of necessary interventions can dramatically impact the prognosis of patients with life-threatening diagnoses. Evidence supports a connection between information overload and medical errors. A tool that improves display and retrieval of key clinical information has great potential to benefit patient outcomes. The purpose of this review is to synthesize research on the use of visualization dashboards in health care. Objective: The purpose of conducting this literature review is to synthesize previous research on the use of visualization dashboards. A review of the existing literature on this subject can be used to identify gaps in prior research and to inform further research efforts on this topic. Ultimately, this evidence can be used to guide the development, testing, and implementation of a new solution to optimize the visualization of clinical information, reduce clinician cognitive overload, and improve patient outcomes. Methods: Articles were included if they addressed the development, testing, implementation, or use of a visualization dashboard solution in a health care setting. An initial search was conducted of literature on dashboards only in the intensive care unit setting, but there were not many articles found that met the inclusion criteria. A secondary follow-up search was conducted to broaden the results to any health care setting. The initial and follow-up searches returned a total of 17 articles that were analyzed for this literature review. Results: Visualization dashboard solutions decrease time spent on data gathering, difficulty of data gathering process, cognitive load, time to task completion, errors, and improve situation awareness, compliance with evidence-based safety guidelines, usability, and navigation. Conclusions: Researchers can build on the findings, strengths, and limitations of the work identified in this literature review to bolster development, testing, and implementation of novel visualization dashboard solutions. Due to the relatively few studies conducted in this area, there is plenty of room for researchers to test their solutions and add significantly to the field of knowledge on this subject.

  • Development of a Comprehensive Mobile Care System for Patients with Advanced Gastrointestinal Cancer: The Life Manager App

    From: JMIR mHealth and uHealth

    Date Submitted: Nov 8, 2017

    Open Peer Review Period: Nov 9, 2017 - Jan 4, 2018

    Background: Chemotherapy is the most common treatment plan for individuals with advanced cancer. Although this treatment improves the survival of patients, their quality of life is still poor because...

    Background: Chemotherapy is the most common treatment plan for individuals with advanced cancer. Although this treatment improves the survival of patients, their quality of life is still poor because of its adverse effects. Mobile health applications (apps) have emerged as an alternative in managing this condition. However, only few apps have self-monitoring features, and they are not standardized and validated by health experts. Objective: This study aimed to develop a comprehensive mobile care system with self-monitoring features that can be useful in providing information and facilitating communication in patients with advanced cancer. Methods: In this context, the establishment of a comprehensive mobile health management system was divided into three steps. First, the service scope was set up, and the measurement tools were standardized. Second, the service flow of the mobile care system was organized. Third, the mobile app (Life Manager) was developed. Results: The general services can be used for the management of chemotherapy side effect, nutrition, and rehabilitation. To effectively identify patient symptoms using the mobile app, we used the modified PROCTCAE (Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events) questionnaire to determine the patients’ condition. To measure the clinical effect of the mobile app, the following survey tools were used: PGSGA (Scored Patient-Generated Subjective Global Assessment), distress, EORTC-QLQ (European Organisation for Research and Treatment of Cancer - Quality-of-Life questionnaire), IPAQ-SF (International Physical Activity Questionnaire-short form), LARS score (Low anterior resection syndrome score), and measurement of satisfaction. The service protocol is based on the medical information that is communicated by a patient to a medical provider in the hospital. A patient can enter a question or information anytime and anywhere using the app service, and they can obtain real-time and accurate health information from medical personnel based on clinical evidence. Healthcare providers meet the participants in person to explain the online research service process and the use of the daily-life app with a wearable device in person. Online programs are established based on the patient’s initial information, such as results of physical examination and laboratory tests and health domain. The main themes of the application are: To-do-list, Health information, and In-app-chat service. When a patient logs into the app, the “To-do-list” theme first appears on the screen. The patient can check the “Daily tasks” on this screen. The common contents of the health information consist of drug explanation, general side effects, and countermeasures against the side effects of chemotherapy. Using the “In-app-chat service” the patient can communicate with experts anytime and anywhere. The wearable device that is linked to the app via Bluetooth can measure performed activities. Conclusions: In terms of service flow, a clinical evidence-based care system was established, which can provide high-quality care and run both offline and online. In terms of life-manager app development, a mobile health app with multidisciplinary effects for patients with advanced gastrointestinal cancer patients was created.

  • The Relationship between Internet Health Information and Patient Compliance based on Trust: an Empirical Study

    From: Journal of Medical Internet Research

    Date Submitted: Nov 8, 2017

    Open Peer Review Period: Nov 8, 2017 - Jan 3, 2018

    Background: The Internet has become a major means of acquiring health information due to the increasing demand for health information and the development of the Internet. However, Internet health info...

    Background: The Internet has become a major means of acquiring health information due to the increasing demand for health information and the development of the Internet. However, Internet health information is of mixed quality and may therefore significantly affects health-related behaviour and decisions. The trust of patients in their physicians may potentially change because of health information obtained from the Internet, thereby affecting their compliance to medical diagnoses and treatment. Hence, it is significant to discuss the relationship between Internet health information and patient compliance from the perspective of trust. Objective: This study aimed to discuss the relationship between Internet health information and patient compliance from the dimensions of quality and source through theoretical principle (i.e. cognition- and affect-based trust) and empirical study. Methods: An online survey involving 375 participants from 28 cities in China was conducted to assess the research model, which included two independent variables (i.e. Internet health information quality and source of Internet health information), two mediator variables (i.e. cognition- and affect-based trust) and one dependent variable (i.e. patient compliance). All variables were measured using multiple-item scales from previously validated instruments. The scales’ reliability and validity were analysed, demographic analysis was performed and hypotheses were tested using structural equation modelling (SEM). Results: The questionnaire response was 89.6%, and the reliability and validity was acceptable (Cronbach’s α = .950 > .700, KMO = .907 > .700, P < .001). This study indicated that the quality and source of Internet health information impacted cognition- and affect-based trust, consequently, patient compliance. In addition, Internet health information source also directly affected patient compliance, and the Internet health information quality was more important than the source of information. Furthermore, cognition- and affect-based trust had significant positive impacts on patient compliance, and cognition-based trust had a significant impact on affect-based trust. Unexpectedly, a nonsignificant relationship between source of Internet health information and affect-based trust was found. Conclusions: The Internet health information quality plays a more important role than the source of information in impacting patient trust, consequently, patient compliance. Therefore, patient compliance should be improved by strengthening the management of Internet health information quality and urging physicians to focus on health websites, and acquire health information from these websites to understand the information accessed by patients and enrich their knowledge structure to show their specialization and reliability in their interaction with patients. Cognition- and affect-based trust directly impact patient compliance. Therefore, physicians can communicate with patients through health websites to allow patients to acquire health information from physicians online and establish cognition-based trust in advance. Furthermore, physicians should focus on providing care and respect for patients and foster a safe atmosphere in which patients can express themselves sufficiently.

  • Consensus on quality indicators of postgraduate medical e-learning: a Delphi study

    From: JMIR Medical Education

    Date Submitted: Nov 8, 2017

    Open Peer Review Period: Nov 8, 2017 - Jan 3, 2018

    Background: The progressive use of e-learning in postgraduate medical education calls for proper quality indicators. Currently many evaluation tools exist. However, these are diversely used and their...

    Background: The progressive use of e-learning in postgraduate medical education calls for proper quality indicators. Currently many evaluation tools exist. However, these are diversely used and their empirical foundation is often lacking. Objective: We aimed to identify an empirically founded set of quality indicators to set the bar for “good enough” e-learning. Methods: We performed a Delphi procedure with a group of 13 international education experts and 10 experienced users of e-learning. The questionnaire started with 57 items. These items were the result of a previous literature review and focus group study performed with experts and users. We used a Rate of Agreement (RoA) of less than two thirds resulted in its rejection. Results: In the first round, 37 items of the 57 were accepted as important, there was no consensus on 20, and 15 new items were added by the participants. In the second round, we added the comments of the first round to the items on which there was no consensus, and added the 15 new items. After this round, a total of 72 items were questioned and of these, 37 items were accepted and 35 were rejected due to lack of consensus. Conclusions: This study provides a list of 37 items which can form the basis of an evaluation tool to evaluate postgraduate medical e-learning. This is the first time that quality indicators for postgraduate medical e-learning have been defined and validated. The next step is to create and validate an e-learning evaluation tool from these items.

  • The impact of low back pain clinical trials measured by the Altmetric score: an analysis of 200 articles

    From: Journal of Medical Internet Research

    Date Submitted: Nov 8, 2017

    Open Peer Review Period: Nov 9, 2017 - Jan 4, 2018

    Background: There is interest from authors and publishers in sharing the results of their studies over the internet in order to increase their readership. In this way, articles tend to be discussed an...

    Background: There is interest from authors and publishers in sharing the results of their studies over the internet in order to increase their readership. In this way, articles tend to be discussed and the impact of these articles tends to be increased. In order to measure this type of impact a new score (named Altmetric) was created. Altmetric aims to understand the individual impact of each article through the attention attracted online. Objective: The primary objective of this study was to analyze potential factors related with with the publishing journal and the publishing trial that could be associated with Altmetric scores on a random sample of low back pain randomised controlled trials. The secondary objective of this study was to describe the characteristics of these trials and their Altmetric scores. Methods: We searched for all low back pain randomised controlled trials indexed on the Physiotherapy Evidence Database (www.pedro.org.au) published between 2010 and 2015. A total of 200 articles were randomly selected. We extracted data related to the publishing trial, the publishing journal, methodological quality of the trials (measured by the 0-10 item PEDro scale) and total and individual scores of Altmetric mentioned and Altmetric reader. Multivariate regression models and descriptive statistics were used to present statistical analysis. Results: A total of four variables were associated with Altmetric mentioned score: impact factor (β= 3.4 points), number of years since publication (β= -4.9), number of citations divided by years since publication (β= 5.2 points) and descriptive title (β= -29.4 points). Only one independent variable was associated with Altmetric reader score: number of citations divided by years since publication (β= 10.1 points, 95% CI (7.74 to 12.46)). Descriptive statistics showed that the majority of articles were published in English, with a descriptive title and published in open access journals endorsing the CONSORT statement. Conclusions: Researchers should preferrably select high impact factor journals for submission and use declarative or interrogative titles, as these factors are likely to increase the visibility of their studies in social media.

  • Reducing ‘Misses’ and ‘Near Misses’ Related to Multitasking on the Electronic Health Record

    From: Journal of Medical Internet Research

    Date Submitted: Nov 8, 2017

    Open Peer Review Period: Nov 9, 2017 - Jan 4, 2018

    Background: Clinician use of electronic health record systems (EHRs) while multitasking may increase risks of errors, but silent EHR use may lower patient satisfaction. Delaying EHR use until after vi...

    Background: Clinician use of electronic health record systems (EHRs) while multitasking may increase risks of errors, but silent EHR use may lower patient satisfaction. Delaying EHR use until after visits may increase clinicians’ EHR workload, stress, and burnout. Objective: To describes perspectives of clinicians, educators, administrators, and researchers about “misses” and “near misses” due to clinician multitasking while using EHRs. Methods: This observational study is a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during two workshops and one interactive lecture about how challenges and strategies for relationship-centered communication during clinician EHR use. We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes. Results: All workshop participants shared stories of “misses” or “near misses” in EHR ordering and documentation or patient-clinician communication, wondering about “misses we don’t even know about.” Risk factors included: computer position, EHR usability, note content/style, information overload, problematic workflows, systems issues, provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR “misses” included: clinician transparency when needing silent EHR use (e.g., prescribing), narrating EHR use, patient activation during EHR use, adapting visit organization and workflow, improving EHR design, and improving team support and systems. Conclusions: CME participants shared numerous stories of multitasking-related errors and near misses in EHR tasks and communication, but brainstormed diverse strategies for using EHRs safely while preserving patient relationships.

  • Diabetes specific formulae versus standard formulae as enteral nutrition to treat hyperglycaemia in critically ill patients: study protocol for a randomised controlled feasibility trial

    From: JMIR Research Protocols

    Date Submitted: Nov 9, 2017

    Open Peer Review Period: Nov 11, 2017 - Nov 25, 2017

    Introduction: During critical illness hyperglycaemia is prevalent and is associated with adverse outcomes. While treating hyperglycaemia with insulin reduces morbidity and mortality, it increases glyc...

    Introduction: During critical illness hyperglycaemia is prevalent and is associated with adverse outcomes. While treating hyperglycaemia with insulin reduces morbidity and mortality, it increases glycaemic variability and hypoglycaemia risk, both of which have been associated with an increase in mortality. Therefore other interventions which improve glycaemic control, without these complications should be explored. Nutrition forms part of standard care, but the carbohydrate load of these formulations has the potential to exacerbate hyperglycaemia. Specific diabetic-formulae with a lesser proportion of carbohydrate are available, and these formulae are postulated to limit glycaemic excursions and reduce patients’ requirements for exogenous insulin. Methods: The primary outcome of this prospective, blinded, single centre, randomised controlled trial is to determine whether a diabetes specific formula reduces exogenous insulin administration. Key secondary outcomes include the feasibility of study processes as well as glycaemic variability. Critically ill patients will be eligible if insulin is administered whilst receiving exclusively liquid enteral nutrition. Participants will be randomised to receive a control formula, or a diabetes specific, low glycaemic index, low in carbohydrate study formula. Additionally, a third group of patients will receive a second diabetes specific, low glycaemic index study formula, as part of a sub-study to evaluate its effect on biomarkers. This intervention group (n=12) will form part of recruitment to a nested cohort study with blood and urine samples collected at randomisation and 48 hours later for the first 12 participants in each group with a secondary objective of exploring the metabolic implications of a change in nutrition formula. Data on relevant medication and infusions, nutrition provision and glucose control will be collected to a maximum of 48 hours post randomisation. Baseline patient characteristics and anthropometric measures will be recorded. A 28 day phone follow up will explore weight and appetite changes as well as blood glucose control pre and post ICU discharge. Results: Recruitment is currently underway. Discussion: This feasibility study of the effect of diabetes specific formulae on the administration of insulin in critically ill patients and will inform the design of a larger, multi-centre trial.

  • Effect of a TiF4 varnish in the prevention and treatment of caries lesions in permanent teeth of children living in a fluoridated region: protocol of randomized controlled clinical trial

    From: JMIR Research Protocols

    Date Submitted: Nov 9, 2017

    Open Peer Review Period: Nov 11, 2017 - Nov 25, 2017

    Background: Titanium tetrafluoride (TiF4) has became of great interest again due to new formulations that have shown to be more effective against tooth demineralization than NaF formulations in vitro...

    Background: Titanium tetrafluoride (TiF4) has became of great interest again due to new formulations that have shown to be more effective against tooth demineralization than NaF formulations in vitro and in situ. Objective: To evaluate the effect of 4% TiF4 varnish compared to a commercial 5% NaF varnish on the prevention of caries lesions and the treatment of non-cavitated enamel caries lesions in permanent teeth of children living in fluoridated area. Methods: This randomized, controlled, parallel and single blind clinical trial involves 63 children, 6-7 years old, living in Bauru-SP/Brazil. Children were selected according to their caries activity (presence of at least 1 tooth with score Nyvad 1) and randomly divided into the following treatments: 4% TiF4 varnish (2.45 % F-, pH 1, FGM); 5% NaF varnish (2.26% F, pH 5, Duraphat®, Colgate) and control (placebo varnish, pH 5, FGM). The varnishes were applied on all permanent teeth, once a week for 4 weeks and they will be reapplied only once after 6 and 12 months of the beginning of the study. Two calibrated examiners carry out the clinical examination (ICDAS and Nyvad indexes, kappa> 0.8) at baseline (before the first application), after the 1st, 6th, 12th and 18th month. Furthermore, quantitative fluorescence changes are measured using QLF. The degree of patient satisfaction with the treatment is also computed. The data will be submitted to statistical analysis (p<0.05). Results: This ongoing study is funded by the Brazilian funding agencies (FAPESP- 2015/14149-1 and CNPq- 401313/2016-6). We expect to confirm the efficacy of TiF4 compared to NaF varnish on the prevention and treatment of caries lesions. The subjects are under 1 month evaluation and the dropout was about 8.3%. No differences between the treatments were detected at the 1st month. Conclusions: If our hypothesis is confirmed, TiF4 varnish can be marketed and applied at individual level and in community programs to control dental caries. Clinical Trial: The Brazilian Clinical Trials Registry – ReBEC (Number: RBR-5VWJ4Y).

  • Analyzing the Adherence of a Mobile App to Follow up Tobacco-Quitting Patients

    From: JMIR mHealth and uHealth

    Date Submitted: Nov 9, 2017

    Open Peer Review Period: Nov 9, 2017 - Jan 4, 2018

    Background: Tobacco smoking is a major risk factor for a wide range of respiratory and circulatory diseases in active and passive smokers. Well-designed campaigns are raising awareness to the problem...

    Background: Tobacco smoking is a major risk factor for a wide range of respiratory and circulatory diseases in active and passive smokers. Well-designed campaigns are raising awareness to the problem and an increasing number of smokers seek medical assistance to quit their habit. In this context, there is the need to develop mHealth Apps that assist and manage large smoke quitting programs in efficient and economic ways. Objective: To analyse and evaluate the results of using a mobile application (TControl) on a smoking cessation program. Methods: Analysis of 197 patients were we wanted to find out the effectiveness of the application on decreasing the number of relapses and the success cases of patients using it. Results: Actually, the difference between using TControl or not have been the number of relapses which is way lower than not using it, and it could considerably retain more patients on the treatment than the conventional treatment. Conclusions: TControl was designed and successfully implemented in the context of an anti-smoking treatment in a public hospital in Catalunya, Spain. TControl can be successfully deployed in medical centers to keep track of smoke-quitting patients.

  • Design and Implementation of a Decision Support System to Enhance Self-Management of Low Back Pain: Concept and Approach of the selfBACK Project

    From: JMIR Research Protocols

    Date Submitted: Nov 9, 2017

    Open Peer Review Period: Nov 10, 2017 - Nov 24, 2017

    Background: Low back pain (LBP) is a leading cause of disability worldwide. Most patients seen in primary care with LBP have non-specific LBP, that is, pain with an unknown pathoanatomical cause. Self...

    Background: Low back pain (LBP) is a leading cause of disability worldwide. Most patients seen in primary care with LBP have non-specific LBP, that is, pain with an unknown pathoanatomical cause. Self-management in the form of physical activity and strength/flexibility exercises along with patient education constitute the core components in the management of non-specific LBP. However, adherence to a self-management program is challenging for most patients, especially without feedback and reinforcement. Here we outline a protocol for the design and implementation of a decision support system (DSS) - selfBACK - to be used by the patient him/herself to promote self-management of LBP. Objective: The main objective of the selfBACK project is to improve self-management of non-specific LBP in order to prevent chronicity, recurrence and pain-related disability. This is achieved by utilising computer technology to develop personalised self-management plans based on individual patient data. Methods: The decision support is conveyed to the patient via a smartphone app in the form of advice for self-management. Cased-based reasoning (CBR), a technology that utilizes knowledge about previous patient cases along with data about the current patient case, is used to tailor the advice to the current patient. This enables a patient-centred intervention based on what has – and what has not – been successful in previous patient cases. The data source for the CBR system comprises initial patient data collected by a web-based questionnaire, weekly patient reports (e.g., symptom progression), and a physical activity-detecting wristband. The effectiveness of the selfBACK DSS will be evaluated in a multi-national randomised controlled trial (RCT), targeting care-seeking patients with non-specific LBP. A process evaluation will be carried out as an integral part of the RCT to document the implementation and patient experiences with selfBACK. Results: The selfBACK project was launched in January 2016 and runs until the end of 2020. The final version of the selfBACK DSS will be complete in 2018. The RCT will commence in February 2019 with pain-related disability at 9 months as primary outcome. Results for the trial will be reported according to the CONSORT statement and the extended CONSORT E-HEALTH checklist. Exploitation of the results will be ongoing throughout the project period based on a business plan developed by the selfBACK consortium. Discussion: Tailored digital support has been proposed as a promising approach to improve self-management of chronic disease. However, tailoring self-management advice according to the needs, motivation, symptoms, and progress of individual patients is a challenging task. Here we outline a protocol for the design, implementation and evaluation of a stand-alone DSS based on CBR technology with the potential to improve self-management of non-specific LBP. Conclusions: The selfBACK project will provide learning regarding the implementation and effectiveness of an app-based DSS for patients with non-specific LBP.

  • Attention Bias in Individuals with Addictive Disorders: A Systematic Review Protocol

    From: JMIR Research Protocols

    Date Submitted: Nov 10, 2017

    Open Peer Review Period: Nov 11, 2017 - Nov 25, 2017

    To date, there has been a good number of studies looking at attention bias in substance use disorders and evaluating the efficacy of attentional bias modification paradigms for addictive disorders. To...

    To date, there has been a good number of studies looking at attention bias in substance use disorders and evaluating the efficacy of attentional bias modification paradigms for addictive disorders. To date, there have been more research examining attentional bias and determining the effectiveness of attention bias modification in other addictive disorders, such as that of opiate use disorder, cannabis use disorder as well as amphetamine or stimulant use disorder. This includes a combination of cross-sectional studies, case-control studies as well as randomised trials. The primary aim of the current systematic review is to synthesise the current evidence with regards to attentional bias amongst the following addictive disorders, that of opioid use, cannabis use and stimulant use disorders. While there have been several meta-analysis and prior review, there has yet to be any reviews that aim to primarily demonstrate that attention bias is present in these disorders and could be subjected to manipulation. This is important as attention bias could potentially be a target for psychological interventions. It is the secondary aim of the current review to determine the efficacy of attentional bias modification interventions for these disorders, in the aspects of attentional bias reduction, cravings score and addiction outcomes, such as whether attention bias modification was a predictor of relapse. This would be correlated with the methodology that is being utilised in attentional bias assessment and modification that of Stroop test or Visual probe task. To achieve the aims of this review, the authors will undertake a systematic review to synthesise the existing evidence for the presence of attentional bias in the disorders mentioned above, and to determine the clinical efficacy of attentional bias modification. The studies will be selected by independent assessors and screened against the inclusion and exclusion criteria. A risk of bias assessment will be conducted in the assessment of the quality of the included studies. A meta-analytical review will be conducted to determine the effect size of attention bias modification interventions for opioid use, cannabis use and stimulant use disorders if there are sufficient studies. The findings from the current review have clinical implications. As discussed previously, the dual process theory of addiction suggests that aside from cognitive control processes being responsible for the lapse and relapse amongst individuals with substance disorders, automatic processes do have a role. The findings from the current review will help guide further psychological interventions that seek to help individuals maintain their abstinence and minimise the risk of relapse.

  • Severely burdened individuals do not need to be excluded from internet-based mobile-supported stress management: effect modifiers of treatment outcomes from three randomized controlled trials

    From: Journal of Medical Internet Research

    Date Submitted: Nov 11, 2017

    Open Peer Review Period: Nov 11, 2017 - Jan 6, 2018

    Background: Although internet-based mobile-supported stress management interventions (iSMIs) may be a promising strategy to reach employees suffering from high chronic stress, it remains unknown wheth...

    Background: Although internet-based mobile-supported stress management interventions (iSMIs) may be a promising strategy to reach employees suffering from high chronic stress, it remains unknown whether participants with high symptom severity of depression or anxiety also profit, or should be excluded from iSMIs. Objective: The study aimed to evaluate the efficacy of iSMIs in subgroups with high symptom severity. Methods: Data from three randomized controlled trials (RCTs; N=791) were pooled to identify effect modifiers, and to evaluate efficacy in subgroups with different levels of initial symptom severity. The outcomes perceived stress (PSS), depressive (CES-D) and anxiety (HADS) symptom severity were assessed at baseline, 7-week post-treatment, and 6-month follow-up. In multiple moderation analyses (MMAs) potential moderators were tested in predicting differences in change of outcome. Through simple slope analyses efficacy of the iSMI was compared in subgroups with low, moderate and severe initial symptomology based on means and standard deviations of the study population. Results: Individuals with high stress (PSS≥30), depression (CES-D≥33), anxiety (HADS≥15) and emotional exhaustion (MBI≥5.6) profited significantly from the intervention with great reductions of stress (dpost=[0.86-1.16], dFU=[0.93-1.35]), depression (dpost=[0.69-1.08], dFU=[0.91-1.19]), and anxiety (dpost=[0.79-1.19], dFU=[1.06-1.21]), and effects were sustained at 6-month follow-up. Symptom severity moderated treatment outcomes, as individuals with higher symptom severity at baseline profited significantly more from the intervention than individuals with lower symptom severity. Conclusions: Highly burdened individuals benefit greatly from iSMIs and should, therefore, not be excluded from participation. Clinical Trial: German clinical trial registry DRKS00005112, DRKS00005384, DRKS00004749 (https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_DE.do)

  • Medical students views

    From: JMIR Medical Education

    Date Submitted: Nov 12, 2017

    Open Peer Review Period: Nov 13, 2017 - Jan 8, 2018

    Background: The importance of assessment in the educational process is well emphasized in medical education. The system of continuous assessment (CA) used in the College of medicine, KKU can be descri...

    Background: The importance of assessment in the educational process is well emphasized in medical education. The system of continuous assessment (CA) used in the College of medicine, KKU can be described as frequent summative assessments in each course since there was no regular feedback. The CA adopted carries 50% of the total marks. Achievement of students in CA is critical to their pass or failure of any course. Excessive use of summative assessment was identified as problematic by some research work. But, at the same time a single terminal summative assessment is not recommended. The objective of this study was to examine the relation between each of gender, feedback and students' perception of learning with performance in CA. Objective: To get the views of medical students about their performance in continuous assessment and the factors affecting the continuous assessment. Methods: The target population of this study was the 4th, 5th and 6th year students of the college of medicine, KKU. Non-probability convenience sampling was used aiming at 25% - 30% of the total. A correlational design was adopted. A structured self-administered questionnaire was developed. This was based on four constructs: performance on CA: 3 items, feedback: 6 items, students' perception of learning: 12 items and gender. A 5-point Likert scale was used ranging from strongly agree to strongly disagree to the stated statements in the instrument. The questionnaire was validated before use. Pearson’s correlation coefficient (r) was computed using SPSS. P value of <0.05 was considered significant. Results: This is a cross sectional study . The total number of respondents was 128 with 58% of them males and 42% females. The computed r for the perception of learning with performance in CA was .741 and for feedback with performance in CA was .766. This clearly indicated a significant positive correlation between them. Gender had no significant correlation with performance in CA. Although profound evidence does exist on the positive effect of CA on academic performance and motivation of students, this effect seems to be dependent on how the assessment system is used. In one experimental study, it was found that CA had positive effect on students' academic performance, learning and satisfaction compared to summative assessment. On the other hand, when continuous assessment was done in form of frequent summative assessment, the positive effect was lost and in fact a negative effect was evident Conclusions: The respondents viewed their perception of learning and feedback strongly and positively correlated with their performance in CA, while gender had no significant correlation.

  • Remote patient monitoring and telemedicine in neonatal and pediatric settings: A scoping literature review

    From: Journal of Medical Internet Research

    Date Submitted: Nov 13, 2017

    Open Peer Review Period: Nov 13, 2017 - Jan 8, 2018

    Background: Telemedicine and telehealth solutions are emerging rapidly in healthcare, and have the potential to decrease costs for insurers, providers and patients in various settings. Pediatric popu...

    Background: Telemedicine and telehealth solutions are emerging rapidly in healthcare, and have the potential to decrease costs for insurers, providers and patients in various settings. Pediatric populations that require specialty care, are disadvantaged socially or economically, or have chronic health conditions will greatly benefit from results of studies utilizing telemedicine technologies. This paper examines the emerging trends within pediatric populations as part of a systematic literature review and provides a scoping review of the type, extent, and quantity of research available. Objective: This paper aims to examine the role of remote patient monitoring and telemedicine in neonatal and pediatric settings. Findings can be used to identify strengths, weaknesses, and gaps in the field. The identification of gaps will allow for interventions or research to improve healthcare quality and costs. Methods: A systematic literature review is being conducted in order to gather an adequate amount of relevant research for telehealth in pediatric populations. The fields of remote patient monitoring and telemedicine are not yet very well established by the healthcare services sector and definitions vary across healthcare systems, and thus the terms are not always defined similarly throughout the literature. Three databases were scoped for information for this specific review, and 56 articles are included so far Results: Three major telemedicine trends emerged from the review of 45 relevant papers: remote patient monitoring, teleconsultation, and monitoring patients within the hospital, but without contact, thus decreasing likelihood of infection or other adverse health effects. Conclusions: While the current telemedicine approaches show promise, limited conditions studied and small sample sizes affect generalizability, therefore warranting further research. The information presented can inform healthcare providers of the most widely implemented, studied, and effective forms of telemedicine for patients and their families, and the telemedicine initiatives that are most cost efficient for health systems. While the focus of this review is to summarize some telehealth applications in pediatrics, there are also research studies presented which can inform providers of the importance of data sharing of remote monitoring data between hospitals. Further reports will be developed to inform health systems as the systematic literature review continues.

  • The Evaluation of Two Mobile Health Applications in the Context of Smoking Cessation: A Longitudinal Qualitative Study

    From: Journal of Medical Internet Research

    Date Submitted: Nov 15, 2017

    Open Peer Review Period: Nov 15, 2017 - Jan 10, 2018

    Background: mHealth (mobile health) applications can offer a number of benefits for users, representing a feasible and acceptable means of administering health interventions, such as Cognitive Behavio...

    Background: mHealth (mobile health) applications can offer a number of benefits for users, representing a feasible and acceptable means of administering health interventions, such as Cognitive Behavioural Therapy (CBT). CBT is commonly used in the treatment of mental health conditions, where it has a strong evidence base, suggesting that it represents an effective method to elicit health behaviour change. Importantly, CBT has shown to be effective in smoking cessation, whereby smoking-related costs to the NHS were estimated to be £2.6bn in 2015. Whilst the evidence base for computerised CBT in mental health is strong, there is limited literature on its use in smoking cessation. This, combined with the cost-effectiveness of mHealth interventions, advocates a need for research into the effectiveness of CBT-based smoking cessation applications. Objective: The objective of this study is to investigate the impact of two mHealth applications, one CBT-based application, Quit Genius (QG), and one non-CBT-based application, NHS SmokeFree (SF), in promoting positive behaviour change with respect to smoking cessation. Methods: A qualitative short-term longitudinal study was conducted, using a sample of 29 smokers allocated to one of the two applications, QG or SF. Each user underwent two one-to-one semi-structured interviews, one week apart. From the primary data collected, thematic analysis was carried out and themes were identified. Results: Results indicated that QG generally led to a perceptional change in participants’ smoking behaviour and increased confidence in their ability to quit, thus eliciting greater effects than SF on their positive behaviour change, after one week of use. A greater proportion of participants using QG compared to SF reported smoking fewer cigarettes per day (QG 53% vs SF 14%, p<.05). QG participants were similarly more likely to recommend the application compared to SF (73% vs 36%, p<.05) and participants stated a higher likelihood to continue using QG compared to SF (67% vs 36%, p <.05). Conclusions: The findings support the use of CBT in the context of mHealth applications as an effective smoking cessation tool. mHealth applications must be well-developed, preferably with an underlying behavioural change mechanism, to promote positive health behaviour change. Digital CBT thus has the potential to become a powerful tool in overcoming current healthcare challenges. Future research is required to focus on the effect of greater personalisation on measures of behavioural change, and on understanding the psychological barriers to the adoption of new mHealth solutions.

  • Public Perception Analysis of Tweets during the 2015 Measles Outbreak Using a Neural Network Model

    From: Journal of Medical Internet Research

    Date Submitted: Nov 14, 2017

    Open Peer Review Period: Nov 14, 2017 - Jan 9, 2018

    Background: Timely understanding of public perceptions allows public health agencies to provide up-to-date responses to health crises such as infectious diseases outbreaks. Social media such as Twitte...

    Background: Timely understanding of public perceptions allows public health agencies to provide up-to-date responses to health crises such as infectious diseases outbreaks. Social media such as Twitter provides an unprecedented way for the prompt assessment of the large-scale public response. Objective: This study has two aims: 1) to develop a scheme for a comprehensive public perception analysis of a measles outbreak from Twitter data; 2) to demonstrate the superiority of the neural network-based approach (compared with conventional machine-learning methods) on measles outbreak-related tweets classification tasks with a relatively small and highly unbalanced gold standard training set. Methods: We first designed a comprehensive scheme for the analysis of public perception of measles based on tweets, including three dimensions: Discussion themes, Emotions expressed, and Attitude toward vaccination. All 1,154,156 tweets containing the word “measles” posted between December 1st, 2014 and April 30th, 2015 were purchased and downloaded from DiscoverText.com. Two expert annotators curated a gold standard of 1,151 (approximately 1% of all the tweets) tweets based on the three-dimensional scheme. Next, a tweet classification system based convolutional neural network (CNN) was developed. We compared the performance of the CNN model to that of four conventional machine-learning models. We also compared the performances of two word embeddings: (1) Stanford GloVe embedding trained on billions of tweets in general domain and (2) measles-specific embedding trained on our 1 million measles related tweets. Results: Cohen’s Kappa inter-coder reliability values for the annotation were: 0.781, 0.723, and 0.796 on three dimensions. Class distributions in the gold standard were highly unbalanced for all dimensions. The CNN model with measles-specific embedding and Stanford GloVe embedding performed significantly better on all classification tasks than K-nearest Neighbors, Naïve Bayes, Support Vector Machines, or Random Forest. Detailed comparison between Support Vector Machines and CNN model with two tweet embeddings showed that the major contributor to the overall superiority of the CNN models is the significant improvement on recall, especially for those classes with low occurrence. The CNN model with Stanford GloVe embedding achieved the best performance overall, while the CNN model with measles-specific tweet embedding achieved better performance for some classes with lower abundance. Conclusions: Compared to conventional machine-learning methods, our CNN models showed superiority on measles related tweet classification tasks with a relatively small and highly unbalanced gold standard. Our proposed scheme and neural network based tweets classification system could be used for the analysis of tweets about other infectious diseases such as influenza and Ebola.

  • Project Swerve: A protocol for a randomized control trial of a brief intervention to increase HIV testing among substance using young men who have sex with men

    From: JMIR Research Protocols

    Date Submitted: Nov 14, 2017

    Open Peer Review Period: Nov 17, 2017 - Dec 1, 2017

    Background: Young men who have sex with men (YMSM) and transgender people (TG) in the Detroit Metro Area (DMA) are the only risk group for whom HIV and STI incidence has increased since 2000, with HIV...

    Background: Young men who have sex with men (YMSM) and transgender people (TG) in the Detroit Metro Area (DMA) are the only risk group for whom HIV and STI incidence has increased since 2000, with HIV incidence nearly doubling among youth [1,2]. Substance use (including alcohol) is relatively frequent among YMSM and TG, and creates barriers to the optimal delivery of HIV prevention and care services [3-6]. Standard HIV Counseling, Testing, and Referral (CTR) is limited in providing strategies to identify and address substance use. Hence, in its current form, CTR may not be serving the prevention needs of substance-using YMSM and TG. Brief counseling interventions, grounded in principles of motivational interviewing, may offer a mechanism to meet the HIV prevention and care needs of substance-using YMSM and TG [7-15]. Objective: The prospective, four-arm factorial randomized control trial (RCT) aims to examine the efficacy of a Motivational Interviewing-based substance use brief intervention (SUBI) on participants’ substance use and engagement in HIV prevention. Methods: The research implements a prospective RCT (Project SWERVE) of 600 YMSM and TG recruited both online and in person. Eligible participants 1) are between the ages of 15-25, 2) live in the Detroit Metro Area (DMA), 3) self-identify as a man or transgender man or woman, 4) have had sexual contact with a man in the six months prior to enrollment, 5) self-report binge drinking or any substance use in the three months prior to enrollment, and 6) self-report an unknown or negative HIV status upon enrollment. Participants are randomized to receive, 3-months apart starting at baseline, two individual sessions. Sessions are CTR-only, SUBI-only, CTR followed by SUBI, or SUBI followed by CTR. Results: Project SWERVE was launched in April 2017 and enrollment is on-going. Conclusions: Incorporating a substance use brief intervention that utilizes the principles of motivational interviewing into HIV counseling, testing, and referral provides an opportunity to tailor counseling services for YMSM and TG to address additional client barriers to HIV and STI testing. Clinical Trial: ClinicalTrials.gov (NCT02945436); University of Michigan Institutional Review Board (HUM00105125)

  • Evaluation of technology-based peer-support intervention program for preventing postnatal depression: A randomized controlled trial

    From: JMIR Research Protocols

    Date Submitted: Nov 14, 2017

    Open Peer Review Period: Nov 14, 2017 - Nov 28, 2017

    Background: Multiple international agencies, including the World Health Organization (WHO) and the International Monetary Fund (IMF), have emphasized the importance of maternal mental health for optim...

    Background: Multiple international agencies, including the World Health Organization (WHO) and the International Monetary Fund (IMF), have emphasized the importance of maternal mental health for optimal child health and development. Adequate social support is vital for the most vulnerable to postpartum mood disorders. Hence, an urgent need for sustainable social support programs to aid mothers ease into their new parenting role exists. Objective: This study aims to examine the effectiveness of technology-based Peer-Support Intervention Program (PIP) among mothers at risk for postnatal depression in the early postpartum period. Methods: A randomized controlled two-group pre-test and repeated post-test experimental design will be used. The study will recruit 118 mothers from the postnatal wards of a tertiary public hospital in Singapore. Eligible mothers will be randomly allocated to receive either PIP or routine perinatal care from the hospital. Peer volunteers will be mothers who have experienced self-reported depression and will be receiving face-to-face training to support new mothers at risk of depression. Outcome measures include postnatal depression, anxiety, loneliness, and social support. Data will be collected at immediate postnatal period (day of discharge from the hospital), at fourth week, and twelfth week post-childbirth. Results: The recruitment and training of peer support volunteers (N = 20) ended in June 2017, while recruitment of study participants commenced in July 2017 and is still ongoing. The current recruitment for new mothers stands at 73 with 36 in the control group and 37 in the intervention group. Data collection is projected to be completed by May 2018. Conclusions: This study will identify a potentially effective and clinically useful method to prevent postnatal depression in new mothers, which is the top cause of maternal morbidity. Receiving social support from others who share similar experiences may enhance the positive parenting experiences of mothers, which in turn can improve the psychosocial well-being of the mothers, tighten mother child bond, and enhance overall family dynamics for mothers and infants. Clinical Trial: ISRCTN14864807

  • Internet based interventions for problem gambling: A scoping review.

    From: JMIR Rehabilitation and Assistive Technologies

    Date Submitted: Nov 14, 2017

    Open Peer Review Period: Nov 14, 2017 - Jan 9, 2018

    Background: The rate of treatment seeking for problem gambling has been demonstrated to be low across several research environments. This is in part due to the systemic barriers that would be treatmen...

    Background: The rate of treatment seeking for problem gambling has been demonstrated to be low across several research environments. This is in part due to the systemic barriers that would be treatment seekers face to accessing traditional face-to-face treatment. Making problem gambling treatment resources available through the Internet is one way to reduce the impact of those systemic barriers. The use of Internet based resources to address problem gambling has been growing and a field of research evaluating it has developed as well. However, there has been little done to examine this growing field of research as a whole. Objective: To collect and evaluate research on the use of Internet based intervention for problem gambling in order to provide an understanding of the current state of the field. A secondary objective of this study is to outline the advantages and challenges that are associated with addressing problem gambling using Internet based resources. Methods: A scoping review was performed of five peer-reviewed research data bases (PsychINFO, CINAHL, Medline, Social Science Abstracts and Scopus) and three grey literature databases (MedEdPortal, Proquest: dissertations and Opengrey). Article inclusion required to have been published in the last ten years (2007-2017), include an intervention for problem gambling, and involve the use of the Internet to deliver that intervention. Results: A total of 21 articles were found that met the review requirements. Studies were found from several different areas with particularly strong representation for Australia and New Zealand, and Scandinavia. Cognitive behavioural therapy was the most common form of Internet based intervention. Internet based interventions we generally shown to be effective by the collected research in reducing problem gambling scores and gambling behaviours. Stated advantages include lower feelings of stigma, greater flexibility in time of treatment, and ease of access to relevant information. Stated disadvantages include ethical concerns related to clients in crisis and confidentiality, a lack of rapport in the client-provider relationship, and high rates of attrition. Conclusions: Internet based interventions are a promising direction for treatment and prevention of problem gambling, particularly in reducing barrier to accessing professional help. The state of the current literature is sparse and more research is needed in directly comparing Internet based interventions and their traditional counterparts.

  • #Depressed: A Tumblr Pilot Intervention Study

    From: JMIR Research Protocols

    Date Submitted: Nov 14, 2017

    Open Peer Review Period: Nov 14, 2017 - Nov 28, 2017

    Background: Adolescents and young adults (AYAs) frequently post depression symptom references on social media; previous studies show positive associations between depression posts and self-reported de...

    Background: Adolescents and young adults (AYAs) frequently post depression symptom references on social media; previous studies show positive associations between depression posts and self-reported depression symptoms. Depression is common among AYAs and this population often experiences many barriers to mental health care. Thus, social media may be a new resource to identify, recruit and intervene with AYAs at risk for depression. Objective: The purpose of this pilot study was to test a social media intervention on Tumblr. We used social media to identify and recruit participants, and to deliver the intervention resource of online depression resources. Methods: This randomized pilot intervention identified Tumblr users age 15-23 who posted about depression using the search term “#depress”. Eligible participants were recruited via Tumblr messages; consented participants completed depression surveys and were then randomized to intervention of online mental health resources delivered via a Tumblr message, control participants did not receive resources. Post-intervention surveys assessed resource access and usefulness, and control groups were asked whether they would have liked to receive resources. Analyses included t-tests. Results: A total of 25 participants met eligibility, they were age 17.5 (SD=1.9) and 65.4% female with average PHQ-9 of 17.5 (SD=5.4). Among the 11 intervention participants, 36.3% reported accessing intervention resources and 63.6% felt the intervention was an acceptable approach. Only 28.6% of control group participants reported that receiving resources online would be acceptable. Participants of both groups suggested anonymity, supportiveness and ease of use as important characteristics in an online depression resource. Conclusions: The intervention was appropriately targeted to AYA at risk for depression, and recruitment via Tumblr was feasible. Most participants in the intervention group felt the social media approach was acceptable, and about a third utilized the online resources. Participants who had not experienced the intervention were less likely to find it acceptable. Future studies should explore this approach in larger samples. Social media may be an appropriate platform for online depression interventions for AYAs.

  • Ethical Challenges in Consumer Digital Psychotherapy

    From: JMIR Mental Health

    Date Submitted: Nov 14, 2017

    Open Peer Review Period: Nov 15, 2017 - Jan 10, 2018

    This article focuses on the ethical challenges presented by digital psychotherapy services that are direct-to-consumer and do not involve oversight by a professional mental health provider. These serv...

    This article focuses on the ethical challenges presented by digital psychotherapy services that are direct-to-consumer and do not involve oversight by a professional mental health provider. These services include apps that connect users to peer counseling and counseling steered by artificial intelligence and conversational agents. These services can potentially assist in improving access to mental health care for the many people would otherwise not have the resources or ability to connect with a therapist. However, the lack of adequate regulation in this area exacerbates concerns over how safety, privacy, liability, and other ethical obligations to protect a client are addressed by these services. In the traditional therapeutic relationship, there are ethical obligations that serve to protect the interests of the client and provide warnings. In contrast, in a direct-to-consumer therapy app, there are not clear lines of accountability or associated ethical obligations to protect the user seeking mental health services. There is a need for increased oversight of direct-to-consumer non-professional psychotherapy services to better protect the consumer.

  • What are the impacts of urban agriculture on the determinants of health? A scoping review protocol

    From: JMIR Research Protocols

    Date Submitted: Nov 15, 2017

    Open Peer Review Period: Nov 16, 2017 - Nov 30, 2017

    Background: Since the 1990s, urban agriculture (AU) has contributed to improving food security in low- and middle- income countries. Now, it is implemented as a multifunctional intervention that can i...

    Background: Since the 1990s, urban agriculture (AU) has contributed to improving food security in low- and middle- income countries. Now, it is implemented as a multifunctional intervention that can influence a various determinants of health (e.g. food security, social relationships). However, studies of interest are from several research disciplines, use a wide range of methods, and show results that are sometimes inconsistent. There are no current studies that have been conducted to summarize conclusions of the overall effects of UA on health and its determinants. The objective of this protocol is to develop a research strategy for a scoping review that characterizes studies of beneficial and adverse impacts of UA on health and its determinants in a wide range of disciplines. Methods: Initially, with the help of a library specialist, a list of publications will be obtained through a systematic search of seven electronic bibliographic databases (PubMed, Embase®, MEDLINE® (Embase®), CINAHL Plus with full text, Academic Search Premier (EBSCO host), CAB Abstract (Ovid), and Web of Science). Secondly, a three-step screening by two independent reviewers will lead to a list of relevant publications that meet eligibility and inclusion criteria. Finally, data on the bibliography, type of participants, type of study, results of study, and countries will be extracted from included articles and analyzed to be presented in a peer-reviewed article. Discussion: This is an original study that seeks to integrate beneficial and adverse effects of UA on health at different level of influence (individuals, households, and community) in order to facilitate a better understanding of UA impacts. This protocol is a first of its kind and is expected to lead to a characterization of UA impacts based on sociodemographic profiles of participants and income levels of the studied countries. This will be relevant for policy makers and UA practitioners. The findings are expected to identify research gaps that will inform needs for UA research in specific fields (e.g. mental health), among certain population groups (e.g. adults) or within different economic contexts (e.g., low-, middle- or high-income countries?).

  • The SAGE-SR: Item Development and Initial Validation of a DSM-5 and SCID-based Self-report Behavioral Health Assessment for Differential Diagnosis

    From: Journal of Medical Internet Research

    Date Submitted: Nov 15, 2017

    Open Peer Review Period: Nov 15, 2017 - Nov 23, 2017

    Background: The Structured Clinical Interview for DSM (SCID) is considered the gold standard assessment for accurate and reliable psychiatric diagnoses; however, due to its length, complexity, and the...

    Background: The Structured Clinical Interview for DSM (SCID) is considered the gold standard assessment for accurate and reliable psychiatric diagnoses; however, due to its length, complexity, and the training required, the SCID is rarely used outside of research. Objective: This paper describes the development and initial validation of a web-based, self-report screening instrument (the SAGE-SR) based on the DSM-5 and the SCID-5-Clinician Version (CV) that is intended to make accurate, broad-based behavioral health diagnostic screening more accessible within clinical care. Methods: In the first phase, study staff drafted approximately 1200 self-report items representing the individual granular symptoms in the diagnostic criteria for the eight primary SCID-CV modules. An expert panel iteratively reviewed, rated, critiqued, and revised items. In the second phase, the resulting items were iteratively administered and revised through three rounds of cognitive interviewing with community mental health center participants. In the first two rounds, the SCID was also administered to participants for direct comparison between the Likert self-report and SCID responses. In the third phase, a second expert panel evaluated the final pool of items from cognitive interviewing and criteria in the DSM-5 to construct the SAGE-SR, a computerized adaptive instrument with a screener section from which additional follow-up questions could be administered to refine the differential diagnoses. The SAGE-SR was administered to healthy controls as well as outpatient mental health clinic clients to assess test duration and test-retest reliability. Cut-off scores for screening into follow-up diagnostic sections were evaluated. Criteria for inclusion of diagnoses in the differential diagnosis were developed. Results: In the first phase, the expert panel reduced the initial 1200 test items to 664 items that panel members agreed collectively represented the SCID items from the 8 targeted modules and covered DSM criteria for each of 13 diagnostic categories. These 664 items were iteratively submitted to three rounds of cognitive interviewing with 50 community mental health center participants; the expert panel reviewed session summaries and agreed upon a final set of 661 clear and concise self-report items representing the desired criteria in the DSM-5. The SAGE-SR constructed from this item pool took an average of 14 minutes to complete in a non-clinical sample versus 24 minutes in a clinical sample. Responses to individual items can be combined to generate DSM criteria endorsements and differential diagnoses, as well as provide indices of individual symptom severity. Preliminary measures of test-retest reliability in a small, non-clinical sample were promising, with good to excellent reliability for screener items in 11 of the 13 diagnostic screening modules (ICC or kappa coefficients ranging from .60-.90), with mania achieving fair test-retest reliability (ICC =.50) and other substance use endorsed too infrequently for analysis. Conclusions: The SAGE-SR is a computerized adaptive self-report instrument designed to provide rigorous differential diagnostic information to clinicians.

  • A Pilot Trial of a Healthy Body Image Intervention Delivered to Young Women Via Facebook Groups: Engagement and Acceptability

    From: JMIR Research Protocols

    Date Submitted: Nov 17, 2017

    Open Peer Review Period: Nov 18, 2017 - Dec 2, 2017

    Background: There is increasing interest in using social media sites such as Facebook to deliver health interventions so as to expose people to content while they are engaging in their usual social me...

    Background: There is increasing interest in using social media sites such as Facebook to deliver health interventions so as to expose people to content while they are engaging in their usual social media habit. This formative intervention development study is novel in describing a preliminary test of using the secret group feature of Facebook to deliver a behavioral intervention targeting users of indoor tanning beds to reduce their risk of skin cancer. Intervention content was designed to challenge two constructs associated with indoor tanning, unhealthy body image beliefs and promote positive body image, through the use of dissonance-inducing content. Objective: To evaluate engagement with and acceptability of using a secret Facebook group to deliver a healthy body image intervention to young women engaged in indoor tanning. Methods: Seventeen young women completed a baseline survey and joined a secret Facebook group with intervention content delivered via daily posts for 4 weeks. Engagement data was extracted and acceptability was measured via a follow-up survey. Results: The study had a high retention rate (94%, 16 participants). On average, posts were viewed by 91% of participants, liked by 35%, and commented on by 26%. The average comment rate was highest (65%) for posts that elicited comments by directly posing questions or discussion topics to the group. Average intervention acceptability ratings were highly positive and participants reported feeling connected to the group and its topic. Average rates of past 1-month indoor tanning reported following the intervention were lower than the baseline rate (p = 0.08, Cohen’s d= 0.47). Conclusions: This study is novel in demonstrating participant engagement with and acceptability of using Facebook secret groups to deliver a dissonance-inducing intervention approach that utilizes group-based discussions related to body image. The study is also unique within the field of skin cancer prevention by demonstrating the potential value of delivering an indoor tanning intervention within an interactive social media format. The findings suggest that Facebook metrics of intervention post engagement (i.e., likes and comments) may vary based on post types and that designing specifically labeled discussion posts may be helpful for soliciting engagement as well as challenging beliefs. Clinical Trial: We did not register this trial as it was a formative/pilot/feasibility trial, which is consistent with the policy described in the JMIR trial registry guidelines (https://jmir.zendesk.com/hc/en-us/articles/115001389307).

  • Study design for the Prediction of Cognitive Recovery After Stroke (PROCRAS) study: a role for new brain MRI modalities in daily clinical practice?

    From: JMIR Research Protocols

    Date Submitted: Nov 16, 2017

    Open Peer Review Period: Nov 16, 2017 - Nov 30, 2017

    Abstract Rationale Cognitive impairment is common after acute ischemic stroke, affecting up to 75% of patients. About half of them will show recovery, whereas the others will remain cognitively impa...

    Abstract Rationale Cognitive impairment is common after acute ischemic stroke, affecting up to 75% of patients. About half of them will show recovery, whereas the others will remain cognitively impaired or deteriorate. It is difficult to predict these different cognitive outcomes. Aim We aim to investigate whether diffusion tensor imaging (DTI) based measures of brain connectivity predict cognitive recovery after one year in addition to patient characteristics and stroke severity. A specific premise of the PROCRAS study is that it is conducted in a daily practice setting. Methods and design The PROCRAS study is a prospective, mono-center cohort study, conducted in a large teaching hospital in the Netherlands. 350 patients suffering from an ischemic stroke who screen positive for cognitive impairment on the Montreal Cognitive Assessment (MoCA < 26) in the acute stage, will undergo a 3T-MRI with a diffusion-weighted sequence and a neuropsychological assessment. Patients will be classified as being unimpaired, as having a mild vascular cognitive disorder or as having a major vascular cognitive disorder. One year after stroke patients will undergo follow-up neuropsychological assessment. Study Outcomes The primary endpoint is recovery of cognitive function one year after stroke in patients with a confirmed post-stroke cognitive disorder. The secondary endpoint is deterioration of cognitive function in the first year after stroke. Discussion The PROCRAS study will show the additional predictive value of DTI based measures of brain connectivity for cognitive outcome at one year in patients with a post-stroke cognitive disorder in a daily clinical practice setting.

  • Stigma and its association with glycemic control and hypoglycemia in adolescents and young adults with type 1 diabetes, a cross-sectional study

    From: Journal of Medical Internet Research

    Date Submitted: Nov 16, 2017

    Open Peer Review Period: Nov 16, 2017 - Jan 11, 2018

    Background: In type 1 diabetes, qualitative studies indicate that visibility of diabetes supplies, self-care, and hypoglycaemia symptoms are associated with stigma and suboptimal management. This may...

    Background: In type 1 diabetes, qualitative studies indicate that visibility of diabetes supplies, self-care, and hypoglycaemia symptoms are associated with stigma and suboptimal management. This may be particularly salient in youth who face concurrent challenges such as establishing autonomy and vocational choices. Objective: To estimate stigma prevalence in youth (14-24 years) with type 1 diabetes and associations with glycemic control. Methods: Participants, recruited largely through social media, were asked to complete an online survey and mail in capillary blood samples for A1C measurement. The primary definition of stigma required endorsement of one or more of three stigma-specific items of the Barriers to Diabetes Adherence questionnaire. These addressed avoidance of diabetes management with friends present, difficulty telling others about diabetes diagnosis, and embarrassment in performing diabetes care with others present. Poor glycemic control was defined as A1C >9% (i.e., >75 mmol/mol; measured value when available, else self-report) and/or ≥1 severe hypoglycemic episode in the previous year (reported requiring assistance from someone else during the episode). Stigma prevalence was computed (95% confidence intervals, CI) and associations with glycemic control evaluated (multivariate logistic regression models). Results: Among the 380 respondents, stigma prevalence was 65.5% (95% CI 60.7-70.3). Stigma was associated with a two-fold higher odds of poor glycemic control overall (OR 2.25, 95% CI 1.33-3.80; adjusted for age, sex, type of treatment). There were specific associations with both A1C >9% (75 mmol/mol; OR 3.05, 95% CI 1.36-6.86) and severe hypoglycemia in the previous year (OR 1.86, 95% CI 1.05-3.31). Conclusions: There is a high prevalence of stigma in youth with type 1 diabetes that is associated with both high A1C and severe hypoglycemia. Targeted strategies to address stigma are needed. Clinical Trial: linicalTrials.gov NCT02796248

  • How might digital technology augment chronic illness management among Black men? A commentary.

    From: Journal of Medical Internet Research

    Date Submitted: Nov 16, 2017

    Open Peer Review Period: Nov 16, 2017 - Jan 11, 2018

    Health disparities associated with chronic illness experiences of Black men demonstrate widespread systematic failures to meet an urgent need. Well-established social and behavioral determinants that...

    Health disparities associated with chronic illness experiences of Black men demonstrate widespread systematic failures to meet an urgent need. Well-established social and behavioral determinants that have led to health disparities among Black men, include racism, discrimination, and stress. While advocacy work that includes community-engagement and tailoring health promotion strategies have shown local impact, evidence shows the gaps are increasing. We suspect that failure to reduce current disparities may be due to conventional public health interventions and programs; therefore, we submit that innovative interventions, ones that embrace digital technologies and their ability to harness naturally occurring social networks within groups, like Black men, have particular importance and deserve attention. This commentary characterizes the current literature on chronic illness among Black men as well as health interventions that use digital technology, to build a case for expanding research in this area to reduce the overwhelming burden of chronic illness among Black men.

  • Acceptability and feasibility of using mobile technology to improve bone-related lifestyle risk factors in young women with low bone mineral density: a pilot study

    From: Journal of Medical Internet Research

    Date Submitted: Nov 16, 2017

    Open Peer Review Period: Nov 17, 2017 - Jan 12, 2018

    Background: Poor bone health in adolescent and young females is a growing concern. Given the widespread use of smartphones in this population, mobile health (mHealth) interventions may help improve li...

    Background: Poor bone health in adolescent and young females is a growing concern. Given the widespread use of smartphones in this population, mobile health (mHealth) interventions may help improve lifestyle behaviours related to bone health in young women. Objective: To determine the effectiveness and feasibility of a mHealth intervention called “Tap4Bone” in improving lifestyle behaviours associated with the risk of osteoporosis in young women. Methods: The mHealth intervention comprised the use of mobile phone apps, short messaging service (SMS) and web emails to encourage lifestyle behaviour changes. The education group received osteoporosis prevention education leaflets. Changes in bone-health-related lifestyle behaviours namely, exercise, smoking and calcium intake were assessed. Users’ experiences and acceptance of the app were collected through focus group interviews. Results: A total of 35 were randomised to either the smartphone (intervention n =18) or education (control n = 17) group. All participants from the mHealth intervention group started taking calcium supplements after commencing the study, compared to fewer in the education control group (100.0% vs 44.4%, P < .001). Though there were trends towards improvement in sports activity and smoking behaviours in the mHealth intervention group, compared to the education group, these were not statistically significant. Approximately 70% of the sample said they would use a mobile phone app in future to improve their bone health. Conclusions: The Tap4Bone mHealth intervention was widely accepted by users and more effective than traditional education at encouraging calcium supplement intake to support bone health in young women.

  • Preferences for Health Information Technologies among U.S. Adults: Findings from the Health Information National Trends Survey

    From: Journal of Medical Internet Research

    Date Submitted: Nov 16, 2017

    Open Peer Review Period: Nov 17, 2017 - Jan 12, 2018

    Background: Emerging health technologies are increasingly being used in health care for communication, data collection, patient monitoring, education, and to facilitate adherence to chronic disease ma...

    Background: Emerging health technologies are increasingly being used in health care for communication, data collection, patient monitoring, education, and to facilitate adherence to chronic disease management. However, there is also lack of studies on differences in preference for using information exchange technologies between chronic and non-chronic disease patients and factors affecting these differences. Objective: The purpose of this paper is to understand preferences and interests in use of technology for information exchange among a nationally representative sample of adults with and without chronic disease conditions and to assess whether these preferences differ according to varying demographic variables. Methods: We utilized data from the 2021 and 2014 iteration of the Health Information National Trends Study (HINTS, N=7307). We modeled negative responses using multiple logistic regressions adjusting for relevant covariates to identify independent factors associated with lowers odds of using health information technology and therefore identify targets for awareness. Analyses were weighted for the US population and adjusted for the sociodemographic variables of age, gender, race and US census region. Results: Analysis included 7,307 participants (weighted population 230,993,888) and 3,529 participants of this sample (weighted population of 90,748,995) reported CVD, diabetes, or hypertension. In the unadjusted models, individuals with Diabetes/CVD/Hypertension were more likely to report using email to exchange medical information with their provider (Odds Ratio [OR] 1.431; 95% Confidence Interval [95% CI] 1.113, 1.838) and less likely to not use any of the technology in health information exchange (OR 0.778; 95% CI 0.618, 0.979). In unadjusted model, additional significant odds ratio values are observed. However, after adjustment, all relationships regarding use and interest in exchanging information with the provider were no longer significant. As a next step, we looked at adjusted odds ratios for demographic variables. Individuals above 65 years old (OR 2.32; 95% CI 1.55, 3.49) and Hispanics (OR 1.95; 95% CI 1.26, 3.01) were less likely to report using email to exchange medical information with their provider. Minorities were less likely to indicate they had no interest in exchanging general health tips with a provider electronically ((Hispanics OR 0.55; 95% CI 0.34, 0.88), (Non-Hispanic Blacks OR 0.36; 95% CI 0.23, 0.56), (Asians OR 0.33; 95% CI 0.16-0.70)). Conclusions: Health information technology related interventions; particularly design of m-health technologies should focus more on demographic factors including race, age and region than chronic disease status to increase likelihood of use. Future research is needed to understand and explore more patient friendly use and design of m-health applications which can be utilized by variety of age, race or education/ health literacy groups efficiently to further bridge the gap in communication between patients and their provider.

  • More Stamina: designing a gamified mHealth fatigue management solution for persons with Multiple Sclerosis

    From: JMIR mHealth and uHealth

    Date Submitted: Nov 17, 2017

    Open Peer Review Period: Nov 17, 2017 - Nov 25, 2017

    Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their...

    Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change. To be effective, mHealth solutions need to be designed to specifically meet the intended audience needs. User-centered design (UCD) is a design philosophy that proposes placing end-users’ needs and characteristics in the center of software design and development and involving users early in the different phases of the software life cycle. There is a current gap in mHealth apps for persons with MS which presents an interesting area to explore. Objective: The purpose of this study is to describe the design and evaluation process of a gamified mHealth solution for behavioral change in persons with MS using user-centered design. Methods: Building on previous work of our team where we identified needs, barriers and facilitators for mHealth apps for persons with MS; we followed UCD to iteratively design and evaluate a mobile application prototype aimed to help persons with MS self-manage their fatigue. Design decisions were evidence-driven and guided by behavioral change models. Usability was assessed through inspection methods using Nielsen’s heuristic evaluation. Results: The mHealth solution More Stamina was designed. It is a task organization tool designed to help persons with MS manage their energy to minimize the impact of fatigue in their day to day life. The tool acts as a to-do list where users can input tasks in a simple manner and assign Stamina Credits, a representation of perceived effort, to the task to help energy management and energy profiling. The app also features personalization and positive feedback. The design process gave way to relevant lessons to the design of a gamified behavioral change mHealth application like the importance of metaphors in concept design, negotiate requirements with the behavioral change models constructs, and tailoring of gamified experiences among others. Several usability problems were discovered during heuristic evaluation and guided the iterative design of our solution. Conclusions: In this paper, we designed an application targeted for helping persons with MS in their fatigue management needs. We illustrate how user-centered design can help in designing mobile health applications, and the benefits and challenges that designers might face when using this approach. We followed a design through research process where user requirements were obtained considering stakeholders’ perspectives and the available scientific literature; design decisions were driven by evidence and behavioral change models resulting in an application targeted for helping persons with MS in their fatigue management needs.

  • QuAliV, a patient portal integrating patient-reported outcome measures into routine HIV care in Aquitaine, France: Formative Research Study Protocol

    From: JMIR Research Protocols

    Date Submitted: Nov 17, 2017

    Open Peer Review Period: Nov 17, 2017 - Dec 1, 2017

    Background: Effective antiretroviral therapy has greatly reduced human immunodeficiency virus (HIV) related morbidity and mortality, dramatically changing the demographics of the population of people...

    Background: Effective antiretroviral therapy has greatly reduced human immunodeficiency virus (HIV) related morbidity and mortality, dramatically changing the demographics of the population of people living with HIV (PLHIV). The majority of PLHIV in France are well cared for insofar as their HIV infection is concerned but remain at risk for age-associated comorbidities. Their long-term, potentially complex, and growing care needs make the routine, longitudinal assessment of health-related quality of life and its determinants of relevance in the current treatment era. Objective: We describe the development of a web-based patient portal for PLHIV linked to patients’ electronic medical records and designed to promote better patient-physician communication and ultimately quality of care (both patient satisfaction and health outcomes). Methods: Participants who meet the eligibility criteria will be invited to engage with the web-based patient portal and provided with the information necessary to create a personal patient account. They will then be able to access the patient portal and complete a set of standardized validated questionnaires covering health-related quality of life and its potential social, behavioral and psychological determinants. The information provided via questionnaires will be presented in a summary format for clinicians together with their HIV care history. Results: The prototype of the patient portal will be finalized and the first two formative research phases of the study [pre-testing, usability testing, and pilot testing] will be conducted from December 2017 to March 2018. We describe the iterative processes planned to ensure that the proposed patient portal is ready for formal pilot testing, referred to herein as Phases 1a and 1b. We also describe the planned pilot testing designed to evaluate the use and acceptability of the portal from the patients’ perspective (Phase 2). Conclusions: The underlying information technology solution, ARPEGE®, has being developed in house. Should the feasibility study presented here yield promising results, the panel of services provided via the proposed portal could ultimately be expanded and used to experiment health promoting interventions in aging PLHIV in hospital-based care or adapted for use in other patient populations.

  • End-user and expert perspectives on the acceptability of a tailored, self-guided smartphone app-based intervention for depression.

    From: JMIR mHealth and uHealth

    Date Submitted: Nov 17, 2017

    Open Peer Review Period: Nov 18, 2017 - Jan 13, 2018

    Background: Despite the growing number of mental health apps available for smartphones, acceptability of these from the perspectives of end-users or healthcare experts has rarely been reported. Usabil...

    Background: Despite the growing number of mental health apps available for smartphones, acceptability of these from the perspectives of end-users or healthcare experts has rarely been reported. Usability information is vital, particularly for self-guided mHealth interventions, as navigability and quality of content is likely to impact participant engagement and treatment compliance. Objective: The overall aim of the present study was to conduct a usability evaluation of a personalized, self-guided app-based intervention for depression. Methods: Participants were administered the System Usability Scale and open-ended questions as part of a semi-structured interview. There were 15 participants from three groups: (1) individuals with clinical depression who were the target audience for the app; (2) mental health professionals; and (3) researchers who specialize in the area of eHealth interventions and/or depression research. Results: The end-user group rated the app highly, both in quantitative and qualitative assessments. The two expert groups highlighted the self-monitoring features, and range of established psychological treatment options (such as behavioral activation and cognitive restructuring), but had concerns that the amount and layout of content may be difficult for end-users to navigate in a self-directed fashion. The end-user data did not confirm these concerns. Conclusions: Encouraging participant engagement via self-monitoring and feedback, as well as personalized messaging may be a viable way to maintain participation in self-guided interventions. Further evaluation is necessary to determine whether levels of engagement with these features enhance treatment effects.

Advertisement