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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!).

 

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    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.

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Latest Submissions Open for Peer-Review:

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  • Title: Patient reported measures for person-centred coordinated care: a comparative domain map and online compendium for supporting policy development and implementation.

    From: Journal of Medical Internet Research

    Date Submitted: Sep 28, 2017

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

    Background: Patient Reported Measure (PRM) questionnaires were originally used in research to measure outcomes of intervention studies. They have now evolved into a diverse family of tools measuring a...

    Background: Patient Reported Measure (PRM) questionnaires were originally used in research to measure outcomes of intervention studies. They have now evolved into a diverse family of tools measuring a range of constructs including quality of life (QoL) and experiences of care. Current health and social care policy increasingly advocates their use for embedding the patient voice into service redesign through new models of care such as Person Centred Coordinated Care (P3C). If chosen carefully and used efficiently, these tools can help improve care delivery through a variety of novel ways, including system-level feedback for healthcare management and commissioning. Support and guidance on how to use these tools would be critical to achieve these goals. Objective: To develop evidence based guidance and support for the use of P3C-PRMs in health and social care policy through: 1) identification of PRMs that can be used to enhance the development of P3C; 2) mapping P3C-PRMs against an existing model of domains of P3C; and 3) integration and organisation of the information in a user-friendly online database. Methods: A pragmatic approach was used for the systematic identification of candidate P3C-PRMs, which aimed at balancing comprehensiveness and feasibility. This utilised a number of resources, including existing compendiums, published and grey literature (using a flexible search strategy) and stakeholder engagement (which included guidance for relevant clinical areas). A subset of those candidate measures (meeting pre-specified eligibility criteria) were then mapped against a theoretical model of P3C, facilitating classification of the construct being measured and the subsequent generation of shortlists for: 1) generic P3C measures, 2) specific aspects of P3C (e.g. “communication” or “decision making”), in addition to 3) condition specific measures (e.g. diabetes, cancer, stroke etc.) in priority areas as highlighted by stakeholders. Results: In total, 328 P3C-PRMs were identified, which were used to populate a freely available online database (“the compendium”). 63 of these P3C-PRMs met eligibility criteria for shortlisting and were classified according to their measurement constructs and mapped against the theoretical P3C model. We identified tools with the best coverage of P3C, thereby providing evidence of their content validity as outcome measures for new models of care. Transitions and medications were two areas currently poorly covered by existing measures All the information is currently available at a user-friendly online portal (p3c.org.uk), which includes all relevant information on each measure such as the constructs targeted, links to relevant literature, item lists of the mapped measures, in addition to shortlists according to relevant constructs. Conclusions: A detailed compendium of P3C-PRMs has been developed using a pragmatic systematic approach supported by stakeholder engagement. Our user-friendly suite of tools is designed to act as a portal to the world of PRMs for P3C, and have utility for a broad audience, including (but not limited to) healthcare commissioners, managers, and researchers.

  • 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.

  • Evaluation of a smartphone-based intervention to increase parents’ knowledge about the MMR vaccination and their psychological empowerment: A mixed method approach.

    From: Journal of Medical Internet Research

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 21, 2017 - Nov 16, 2017

    Background: There is mixed evidence on the effectiveness of vaccination-related interventions. A major limitation of most interventions is that they lack a rigorous evaluative assessment which is part...

    Background: There is mixed evidence on the effectiveness of vaccination-related interventions. A major limitation of most interventions is that they lack a rigorous evaluative assessment which is partly due to the fact that, over the last two decades, randomized controlled trials have been increasingly considered as the only proof of the effectiveness of an intervention and, consequently, as the most important instrument in deciding whether to adopt an intervention or not. Objective: The aim of this study is to evaluate two smartphone-based interventions aimed at increasing parents’ knowledge of the MMR vaccination (through elements of gamification) and their psychological empowerment (through the use of narratives), respectively. The two interventions were part of a randomized controlled trial. Methods: We conducted two studies with the RCT participants: an online survey aimed at assessing their rating of the tool regarding a number of qualities, such as usability and usefulness, and qualitative telephone interviews to explore participants’ experiences with the application. Results: The results of the survey showed that participants receiving the knowledge intervention (alone or together with the empowerment one) liked the app significantly better compared to the group that only received the empowerment intervention. Parents receiving the empowerment intervention complained that they did not receive useful information but were only invited to make an informed, autonomous MMR vaccination decision. Conclusions: The results suggest that empowering efforts should always be accompanied by the provision of factual information. Using a narrative format that promotes parents’ identification can be an appropriate strategy, but it should be employed together with the presentation of more points of views and notions regarding, for instance, the risks and benefits of the vaccination at the same time.

  • Level of Evidence in ICT for Alzheimer’s Disease: A Systematic Literature Review

    From: JMIR Biomedical Engineering

    Date Submitted: Oct 12, 2017

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

    Background: Alzheimer’s Disease (AD) is one of the top ten leading causes of death and only one that cannot be completely prevented or cured in the United States. The cost on AD is high: the total p...

    Background: Alzheimer’s Disease (AD) is one of the top ten leading causes of death and only one that cannot be completely prevented or cured in the United States. The cost on AD is high: the total payments for health care, long-term care and hospice are estimated to be $236 billion, and these could rise to more than 1$ trillion by 2050. Objective: By performing the systematic literature review of information and communications technologies on AD, we aimed to identify the level of evidence in this field by focusing on the following five items: 1) purposes when ICT was utilized on AD, 2) types of conducted studies, 3) characteristics of the target populations in the previous studies, 4) types of methods used in the previous studies, and 5) benefits for the patients, caregivers, and physicians. Methods: We performed four rounds: database selection, keyword search, screening with inclusion criteria, and screening the full-text to identify previous studies. The databases we used were PubMed, SCOPUS, PSYCINFO, Web of Science (WoS), and CINAHL. We used the following two concepts that answer to our research questions when creating combinations of keywords: Alzheimer’s disease and information and communication technologies. Results: We found sixteen articles published between 2010 May and 2016 January, which corresponded to each individual study. The findings of the systematic literature review were arranged and assessed with six categories: purposes of using ICT, study design, devices, evaluation, target population, methods, and benefits of research. Conclusions: The main contribution of our study was to identify the level of evidence in this field with the following themes: purposes, types of studies, types of ICT, evaluation criteria, target population, methods, and benefits. Such contribution guides other researchers interested in this field to perform more effective research and devise ICT tools for ADs.

  • Personal Healthcare Management: Assessing the Relationship With Chronic Disease Prevalence

    From: Journal of Medical Internet Research

    Date Submitted: Sep 19, 2017

    Open Peer Review Period: Sep 20, 2017 - Nov 15, 2017

    Background: The use of personal healthcare management (PHM) is increasing rapidly within the U.S. due to implementation of health technology across the healthcare continuum and increased regulatory re...

    Background: The use of personal healthcare management (PHM) is increasing rapidly within the U.S. due to implementation of health technology across the healthcare continuum and increased regulatory requirements for healthcare professionals and organizations promoting the use of PHM, particularly the use of messaging, online scheduling, and online requests for prescription renewals. Limited research has been conducted comparing PHM use across groups based upon chronic condition. Objective: The purpose of this research is to describe the overall utilization of PHM and compare individual characteristics associated with PHM in groups with no reported chronic conditions, with one chronic condition and with two or more such conditions. Methods: Datasets drawn from the National Health Interview Series were analyzed using multiple logistic regression to determine the level of PHM use in relation to demographic, socioeconomic, or health-related factors. Data from 47,814 individuals were analyzed using logistic regression. Results: Approximately 12 percent of respondents reported using PHM, but higher rates of use were reported by individuals with higher levels of education and income. The overall rate of PHM remained stable between 2009 and 2014, despite increased focus on the promotion of patient engagement initiatives. Demographic factors predictive of PHM use were younger, non-Hispanic, and people who lived in the western region of the United States were the most likely to use PHM. There were also differences in PHM use based upon socioeconomic factors. Respondents with college level education were over 2.5 times more likely to use PHM than respondents without college level education. Health related factors were also predictive of PHM use. Individuals with health insurance and a usual place for healthcare were more likely to use PHM than individuals with no health insurance and no usual place for healthcare. Individuals reporting a single chronic condition or multiple chronic conditions reported slightly higher levels of PHM use than individuals reporting no chronic condition. Individuals with no chronic conditions who did not experience barriers to accessing healthcare were more likely to use PHM than individuals with one or more chronic conditions. Conclusions: The findings of this study illustrated the disparities in PHM use based upon a number of chronic conditions, and that multiple factors influence the use of PHM, including economics and education. These findings provide evidence of the challenge associated with engaging patients through the use of electronic health information as the healthcare industry continues to evolve.

  • Privacy-preserving logistic regression based on homomorphic encryption

    From: Journal of Medical Internet Research

    Date Submitted: Aug 22, 2017

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

    Background: Learning a model without accessing raw data has been an intriguing idea to security and machine learning researchers for years. In an ideal setting, we want to encrypt sensitive data to st...

    Background: Learning a model without accessing raw data has been an intriguing idea to security and machine learning researchers for years. In an ideal setting, we want to encrypt sensitive data to store them on a commercial cloud and run analysis without ever decrypting the data to preserve the privacy. Homomorphic encryption technique is a perfect match for secure data outsourcing but it is a very challenging task to support real-world machine learning tasks. Existing framework can only handle simplified cases with low-degree polynomials such as linear means classifier and linear discriminative analysis. Objective: The aim of this study is to give a practical support to the mainstream learning models (e.g., logistic regression). Methods: We innovated on: (1) a novel homomorphic encryption scheme optimized for real numbers computation, (2) the least squares approximation of the logistic function for accuracy and efficiency (i.e., reduce computation cost), and (3) new packing and parallelization techniques. Results: Using real world datasets, we evaluated the performance of our model and demonstrated its feasibility in speed and memory consumption. For example, it took about 114 minutes to obtain the model parameter from homomorphically encrypted training model of Edinburgh dataset. In addition, it could give quite correct predictions on the testing dataset. Conclusions: We present the first homomorphically encrypted logistic regression model based on the critical observation that a precision loss of classification models is sufficiently small so that the decision plan stays still.

  • Cultural and contextual adaptation of an eHealth intervention: Adaptation framework and protocol for Horyzons-Canada

    From: JMIR Research Protocols

    Date Submitted: Oct 12, 2017

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

    Background: eHealth interventions have the potential to address challenges related to access, service engagement, and continuity of care in the delivery of mental health services. However, the initial...

    Background: eHealth interventions have the potential to address challenges related to access, service engagement, and continuity of care in the delivery of mental health services. However, the initial development and evaluation of such interventions can require substantive amounts of financial and human resource investments to bring them to scale. Therefore, it may be warranted to increase policy, services, and research attention on eHealth platforms that have the potential to be adapted for use across settings. Yet, limited attention has been placed on the methods and processes for adapting eHealth interventions to improve their applicability across cultural, geographical, and contextual boundaries. Objective: In this paper, we describe an adaptation framework and protocol to adapt an eHealth intervention designed to promote recovery and prevent relapses in youth receiving specialized services for first-episode psychosis. The online platform, called Horyzons, was originally developed and tested in Australia and is being prepared for a wider evaluation in Canada. Methods: Service users and service providers from two specialized early intervention programs for first-episode psychosis located in different provinces will explore a beta-version of the eHealth intervention through focus group discussions and extended personal explorations to identify the need for, and content of contextual and cultural adaptations. An iterative consultation process will then take place with service providers and users to develop and assess platform adaptations in preparation for a pilot study with a live version of the platform. Results: Data collection has been completed August 2017 and analysis is in process. Conclusions: This protocol contributes to an important gap in the literature pertaining to the specific principles, methods and steps involved in conducting a systematic reflection and change process in scaling up the evaluation of eHealth interventions across a diverse range of healthcare settings. Clinical Trial: N/A

  • Usage of a Digital Health Workplace Intervention based on Socioeconomic Environment and Race: Is there a Digital Divide?

    From: Journal of Medical Internet Research

    Date Submitted: Aug 28, 2017

    Open Peer Review Period: Aug 29, 2017 - Oct 24, 2017

    Background: Digital health tools have been associated with improvement of cardiovascular (CVD) risk factors and outcomes; however, the differential use of these technologies among various ethnic and e...

    Background: Digital health tools have been associated with improvement of cardiovascular (CVD) risk factors and outcomes; however, the differential use of these technologies among various ethnic and economic classes in not well known. Objective: To identify the effect of socioeconomic environment of usage of a digital health intervention. Methods: We analyzed usage of a previously-validated workplace digital health tool in association with a change in intermediate markers of CVD over the course of one year in 26,188 participants of a work health program across 81 organizations in 42 states between 2011 and 2014. Baseline demographic data for participants included age, sex, race, home zip code, weight, height, blood pressure, glucose, lipids, and HbA1c which was then obtained in 90 day increments for up to one year. Using publicly available data from the American Community Survey, we obtained the median income for each zip code as a marker for socioeconomic status via median household income. DHI usage was analyzed based on socioeconomic status as well as age, gender, and race. Results: The cohort was found to represent a wide sample of socioeconomic environments from a median income of $11,000 to $171,000. As a whole, doubling of income was associated with 7.6% increase in log-in frequency. However, there were marked differences between races. Blacks showed a 40.5% increase and Hispanics showed a 57.8% increase in use with a doubling of income, compared to 3% for Caucasians. Conclusions: The current study demonstrated that socioeconomic data confirms no relevant relationship between socioeconomic environment and DHI usage for Whites. However, a strong relationship is present for Black and Hispanic cohorts. Thus, socioeconomic environment plays a prominent role only in minority groups that represent a high-risk group for cardiovascular disease. This identifies a need for digital health applications that are effective in these high risk groups. Clinical Trial: Retrospective analysis, no trial number

  • Needs and perspectives of patients with asthma and chronic obstructive pulmonary disease on patient web portals: a focus group study

    From: Journal of Medical Internet Research

    Date Submitted: Aug 24, 2017

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

    Background: As accessibility to the internet has increased in society, many healthcare organizations have developed patient web portals. These portals can provide a range of self-management options to...

    Background: As accessibility to the internet has increased in society, many healthcare organizations have developed patient web portals. These portals can provide a range of self-management options to improve patient access. However, the available evidence suggests that they are used inefficiently and that they do not benefit patients with low health literacy. Asthma and chronic obstructive pulmonary disease (COPD) are common chronic diseases that require ongoing self-management. Moreover, patients with COPD are typically older and have lower health literacy. Objective: We aimed to obtain and present an overview of patients’ perspectives of patient web portals to facilitate the development of a portal that better meets the needs of patients with asthma and COPD. Methods: We performed a focus group study using semi-structured interviews in three patient groups from the north of the Netherlands who were recruited through the Dutch Lung Foundation. Each group met three times for two hours each, with one week between meetings. Data were analyzed with coding software and patient descriptors were analyzed with nonparametric tests. The consolidated criteria for reporting qualitative research were followed when conducting the study. Results: We included 29 patients (55% male, mean age 65 years) with large variation in internet experience: some patients hardly used the internet, whereas others were daily uses. In general, patients were positive about having access to a patient web portal, considering access to personal medical records to be the most important option, though only after discussion with their physician. A medication overview was also considered a useful option. It was expressed that communication between healthcare professionals could be improved if patients could use the patient web portal to share information with their healthcare professionals. However, participants were worried about the language and usability of portals, so it was recommended that language should be adapted to the patient level. Another concern was that disease monitoring through online questionnaire use would only be useful if the results were discussed with healthcare professionals. Conclusions: Participants were positive about patient web portals and considered them a logical step. Today, most patients tend to be better educated and to have internet access, while also being more assertive and better informed about their disease. A patient web portal could support these patients. Our participants also provided practical suggestions for implementation in current and future patient web portal developments. The next step will be to develop a portal based on these recommendations and to assess whether it meets the needs of patients and healthcare providers. Clinical Trial: According to the medical ethics committee of the University Medical Center Groningen, this study did not fall under the Medical Research Involving Human Subjects Act.

  • My Doctor Sister, My Nutrition Sister: Feasibility, acceptability and compliance with an integrated package of nutrition counselling and unconditional cash transfers on a mobile platform to improve maternal and child nutrition

    From: Journal of Medical Internet Research

    Date Submitted: Aug 25, 2017

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

    Background: Inappropriate feeding practices, inadequate nutrition knowledge and insufficient access to food are major risk factors for maternal and child under nutrition. There is evidence to suggest...

    Background: Inappropriate feeding practices, inadequate nutrition knowledge and insufficient access to food are major risk factors for maternal and child under nutrition. There is evidence to suggest that the combination of cash transfer and nutrition education improves child growth. However, it will require cost effective delivery platform to achieve the complete coverage of these interventions in the population Objective: This study aims to assess feasibility, acceptability and the compliance of an intervention package of voice messaging, direct counselling, and un-conditional cash transfers all on a mobile platform for changing perceptions on nutrition during pregnancy and the first year of the child’s life. Methods: We conducted a mixed method pilot study. We recruited 340 women. The women were either pregnant or lactating. The intervention consisted of an unconditional cash transfer combined with nutrition counselling both delivered on a mobile platform. The participants received BDT 787 per month and were given a mobile phone. The nutrition message and counselling were delivered by voice message and conversations with a counsellor from a call centre. We carried out cross sectional surveys at base line and end line, focus group discussion and in-depth interviews with participants and their family members. Results: The poor rural women were interested both in voice messages and direct counselling. Most women reported that they had no problem in operating the mobile phones and listen to the voice messages. There were also able to interact freely with the counsellor. Charging of the mobile handsets posed some challenges. Less than 50% households had electricity at home. However almost all families, which did not have electricity at home were able to find a solution. They either charged their mobiles at their neighbour’s house or at a market place. No major barriers were identified with the use of mobile banking for cash transfers. Regarding the use of cash, our study reported that one of the highest priorities for poor families was purchasing food. Conclusions: The use of mobile platform for cash transfer and nutrition counselling is a feasible and acceptable strategy and has the potential to be used in large-scale programs to improve maternal and child nutrition.

  • Using Reddit to recruit hard-to-reach study populations

    From: Journal of Medical Internet Research

    Date Submitted: Aug 29, 2017

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

    Background: Social media websites (e.g., Facebook and Twitter) have been used to recruit hard-to-reach populations for research. One hard-to-reach population is women who are refused reproductive heal...

    Background: Social media websites (e.g., Facebook and Twitter) have been used to recruit hard-to-reach populations for research. One hard-to-reach population is women who are refused reproductive health care due to a provider’s moral or ethical beliefs. Objective: To test methods for recruiting a hard-to-reach population into qualitative research via Reddit, a social news aggregation and discussion site. Methods: We employed two recruitment methods: 1) recruitment posts on applicable subreddits (pages dedicated to specific topics) and 2) private messaging Reddit users who had previously posted about being denied this care. Results: For the first approach, we posted recruitment messages 13 times on 6 subreddits at various times during a five-month interval. This method yielded no interviews. For the second approach, we used key words in Reddit’s search function, which revealed posts from 13 potentially-eligible women. After messaging the women, three completed the interview. Conclusions: Social media websites (e.g., Facebook and Twitter) have been used to recruit hard-to-reach populations for research. One hard-to-reach population is women who are refused reproductive health care due to a provider’s moral or ethical beliefs.

  • Preferences for online information material for low back pain – a semi-structured interview study of people consulting general practice (Part of the ADVIN Back Trial)

    From: Journal of Medical Internet Research

    Date Submitted: Aug 25, 2017

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

    Background: Information on self-management, including addressing people’s fears and concerns, are core aspects of managing patients with low back pain (LBP). Web applications with patient informatio...

    Background: Information on self-management, including addressing people’s fears and concerns, are core aspects of managing patients with low back pain (LBP). Web applications with patient information may be used to extend the consultation and encourage self-management outside of the consultation room. It is, however, important to identify the end users’ needs and preferences in order to maximise acceptance. Objective: The aim of this study was to identify preferences for the content, design, and functionality of a web application with evidence-based information and advice for people with LBP. Methods: This is a phenomenological qualitative study. Adults who had consulted their general practitioner because of LBP within the past 14 days were included. Each participated in a semi-structured interview, which was audiotaped and transcribed for text condensation. Interviews were conducted at the participant’s home by two interviewers. Participants also completed a questionnaire with information about age, gender, Internet usage, interest in searching new knowledge, LBP-related function, and pain. Results: We conducted fifteen 45-minute interviews. Participants had a median age of 40 (range, 22-68) years and reported a median disability of 7 points (range, 0-18) using the 23-item Roland Morris Disability Questionnaire. Participants reported that online information should be easy to find and easy to read, should not be overloaded with information, and should be easily overviewed. They found existing online information confusing, often difficult to comprehend, and not relevant for them, and they questioned the motives driving most hosting companies/organisations. The Patient Handbook, a Danish government-funded website that provides information to Danes about health, was mentioned as a trustworthy site and a preferred site when searching online for information and advice regarding LBP. Conclusions: This study identified important issues to consider when developing and supplementing existing general practice treatment with online information and advice to patients with LBP. Development of a web application should consider patient input, and developers should carefully address the following domains: readability, customisation, design, credibility, and usability.

  • Combining fitness trackers with motivational interviewing and mutual support to increase physical activity in adolescent/parent dyads

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 5, 2017

    Open Peer Review Period: Sep 7, 2017 - Nov 2, 2017

    Background: An essential component of any effective adolescent weight management program is physical activity (PA). The growing field of health technology provides potential solutions for addressing c...

    Background: An essential component of any effective adolescent weight management program is physical activity (PA). The growing field of health technology provides potential solutions for addressing chronic health issues and lifestyle change, such as adolescent obesity. Activity trackers, used in conjunction with smart phone apps, can engage, motivate, and foster support, among users while simultaneously providing feedback on their PA progress. Objective: To evaluate the effect of a 10 week pilot study utilizing smartphone-enabled activity tracker data to tailor motivation, goal setting on physical activity (PA) for overweight/obese adolescents and their parents. Methods: Eligible adolescents, ages 13-16 with BMI >85th percentile, and one of their parents were queried as to behaviors, barriers to change, perceptions about exercise and health pre- and post-intervention. We captured daily step count and active minutes via fitness trackers. Staff made phone calls to dyads at weeks 1, 2, 4, 8 post enrollment to set daily personalized step count/active minutes goals based upon their prior data, age specific Center for Disease Control and Prevention (CDC) goals. Dyad correlations were evaluated using the non-parametric Spearman rank order correlations. Results: 9 parent adolescent dyads were enrolled. Mean adolescent age was 15 years (range 14-16) (4 female/5 male); mean parent age was 47 years (range 36-66). On average, adolescents met their personalized daily step count goals 35% (11-62%) of the days they wore their trackers; parents did so 40% (3-68%) of the days they wore their tracker. Adolescents met their active minute goals 56% (27-85%) of the days they wore their tracker; parents did 83% (52-97%) of the days. Parent and adolescent success was strongly correlated: step count r=0.36, P=.001, active minutes r=0.30, P=.007. Parental age was inversely correlated with step count success (r=-0.78, P=.01). Conclusions: Our findings that parent-adolescent dyads have highly correlated physical activity success rates suggest that further investment in family-centered weight management strategies merit consideration by policy makers, insurers, and health care providers.

  • Psychosocial assessment using telehealth in adolescent and young adults with cancer: A randomised pilot study

    From: JMIR Mental Health

    Date Submitted: Sep 1, 2017

    Open Peer Review Period: Sep 3, 2017 - Oct 29, 2017

    Background: Adolescent and young adults (AYAs) with cancer are at increased risk of psychosocial difficulties relative to their healthy peers. Current models of in-patient face-to-face psychosocial ca...

    Background: Adolescent and young adults (AYAs) with cancer are at increased risk of psychosocial difficulties relative to their healthy peers. Current models of in-patient face-to-face psychosocial care, whilst essential, may limit the capacity for clinicians to provide timely and personalised assessment and intervention to AYAs who are unable to attend due to barriers such as time, logistics, distance to travel and stigma. Telehealth offers a promising alternative towards increasing access to the provision of evidence-based psychosocial assessment and treatment for AYAs with cancer. Objective: This partially-randomised patient-preference pilot study aimed to examine the feasibility and acceptability of providing psychosocial assessment via telehealth to AYAs currently receiving treatment for cancer, relative to face-to-face delivery. Methods: Patients were eligible if they were: between the ages of 15-25; currently receiving treatment; had sufficient English; and were medically stable. Patients were recruited from oncology clinics/wards, and allocated to receive a psychosocial assessment (AYA Oncology Psychosocial Assessment Measure) with a clinical psychologist or social worker via face-to-face or telehealth modalities using a partially-randomised patient preference model. Patients completed a pre- and post-assessment questionnaire including validated and purposely designed feasibility and acceptability indices (YSQ, Treatment Credibility and Expectations Questionnaire, WAI) and measures of psychosocial wellbeing (K10, Peds-QL-AYA, AYA Oncology Screening Tool). Clinicians also completed a post-assessment questionnaire rating their impressions of the acceptability and feasibility of the intervention delivery via each modality. Results: Patients were recruited from three hospitals in Australia. Of 29 patients approached, 23 consented to participate (response rate = 79%). Participants were randomised to either the telehealth (n=8; 35%; mean age=16.50 years [range=15-23]; females=4 [50%]) or face-to-face (n=11; 62%; mean age=17 years [range=15-22]; females=8 [72.70%]) conditions. Four participants were withdrawn due to logistical/medical complications (attrition rate = 17.4%). The majority 6/8 (75%) of participants in the telehealth group used their own computer/iPad with minor technical difficulties occurring in 3/8 (37.5%) of assessments. Participants from both groups rated high working alliance (WAI: median patient response in the telehealth group = 74 [range: 59-84] and face to face group = 63 [range: 51-84]) and reported positive beliefs regarding the credibility and expectations of their treatment group. Post-assessment preferences between face-to-face or online modalities varied. The majority of patients in the telehealth group (5/8, 63%) reported no preference, whilst 6/11 (55%) in the face-to-face group reported a preference for the face-to-face modality. Conclusions: This study demonstrated that telehealth was acceptable, patient comfort was comparable across modalities, and no significant technological barriers were experienced. Despite this, patients varied in their preferred interview modality, highlighting the need to tailor treatment to patient preference and circumstance. Clinical Trial: ACTRN12614001142628, http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12614001142628&isBasic=True

  • Associations of eHealth Literacy with Health Services Utilization among College Students

    From: Journal of Medical Internet Research

    Date Submitted: Sep 7, 2017

    Open Peer Review Period: Sep 9, 2017 - Nov 4, 2017

    Background: eHealth literacy has become an important topic in the health field and related fields. Studies have found that individuals with higher eHealth literacy are more likely to use preventive ca...

    Background: eHealth literacy has become an important topic in the health field and related fields. Studies have found that individuals with higher eHealth literacy are more likely to use preventive care services and to have effective interactions with their physician. In addition, previous studies have shown that there is a gender difference in the utilization of physician access and outpatient services. Nevertheless, few studies have explored the associations among gender, eHealth literacy, and various determinants of health services utilization among college students. Moreover, there is a lack of studies that focus on the three levels of eHealth literacy as predictors of health services utilization. Objective: To investigate the associations among gender, eHealth literacy, and health services utilization. Methods: The eHealth Literacy Scale is a 12-item instrument designed to measure college students’ functional, interactive, and critical eHealth literacy. The Health Services Utilization Scale is a 10-item instrument developed to measure four dimensions of health services utilization by college students. A nationally representative sample of 489 valid college students in Taiwan was surveyed. We then conducted a multiple regression analysis to examine the associations among gender, eHealth literacy, and health services utilization. Results: The study found that being female negatively predicted the purpose dimension of health services utilization (t484=-2.85, P<0.01). Moreover, critical (t484=2.98-4.23, P<0.01) and interactive eHealth literacy (t484=2.43-2.89, P<0.05) predicted 3 of the health services utilization dimensions, and functional eHealth literacy predicted only the purpose dimension (t484=-2.63, P<0.01). Conclusions: This study found that participants with high interactive and critical eHealth literacy are more likely to utilize various determinants of health services. Moreover, it found that participants with low functional or high interactive eHealth literacy might have a short time interval for visiting a doctor and that females are less likely to seek preventive, illness-related and custodial care

  • Using Mobile Health Gamification to Facilitate Cognitive-Behavioral Therapy Skills Practice in Child Anxiety Treatment

    From: Journal of Medical Internet Research

    Date Submitted: Sep 5, 2017

    Open Peer Review Period: Sep 6, 2017 - Nov 1, 2017

    Background: Cognitive Behavioral Therapy (CBT) is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40-50%) do not show a significant reduction in symptoms and...

    Background: Cognitive Behavioral Therapy (CBT) is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40-50%) do not show a significant reduction in symptoms and/or full recovery from primary anxiety diagnoses. Children may fail to improve because they do not fully understand or apply the skills learned in the clinic to their daily lives. Homework is routinely assigned in CBT with the goal of generalizing skills beyond the therapy session in clinic. Many children however, are likely to struggle with homework completion. This can occur for a variety of reasons, including a lack of motivation, forgetfulness, and a lack of CBT skills understanding. Mobile health (mHealth) gamification provides a potential solution to improve CBT efficacy by delivering more engaging and interactive strategies to facilitate CBT skills practice in everyday lives (in vivo). Objective: The goal of this project was to redesign an existing mHealth system called SmartCAT so as to increase user engagement, retention, and learning facilitation by integrating gamification techniques and interactive features. Furthermore, this project sought to evaluate the utility of SmartCAT in open clinical trial, and also to assess the effectiveness of gamification in improving user engagement and retention throughout post-treatment. Methods: We redesigned our existing SmartCAT system consisting of a smartphone app and an integrated clinician portal. The app contains: (1) a series of interactive activities to reinforce skill understanding, (2) an in vivo skills coach that cues the participant to use CBT skills during real-world emotional experiences, (3) a home challenge module to encourage home-based exposure techniques, (4) a digital reward system that contains digital points and trophies, and (5) a therapist-patient messaging interface. Therapists used the portal connected to the app to setup required activities for each session, receive or send messages, manage participant rewards and challenges, and view data and figures summarizing the app usage. The system was implemented as an adjunctive component to Brief CBT (BCBT) in an open clinical trial. To evaluate the effectiveness of gamification, we compared the app usage data at post-treatment with the existing version of SmartCAT without gamification. Results: Gamified SmartCAT was used frequently throughout treatment. On average, patients spent 35.59 minutes on the app (SD=64.18) completing 13.00 activities between each therapy session (SD=12.61). At the .10 significance level, the app usage of the gamified system (Median=68.00) was higher than that of the existing version (Median=37.00), U=76.00, P<.01. The amount of time spent on the gamified system (Median=173.15) was significantly different from that of the existing version (Median=120.73), U=173.00, P=.06. Conclusions: The gamified system showed good acceptability, usefulness, and engagement among anxious children receiving BCBT treatment. Integrating an mHealth gamification platform within treatment for anxious children seems to increase involvement in shorter treatment, and thus has the potential to increase involvement in full-length treatment.

  • The effects of a guided computer-based health information search on hypertensive seniors’ decision self-efficacy levels: a quasi-experimental design.

    From: Journal of Medical Internet Research

    Date Submitted: Sep 6, 2017

    Open Peer Review Period: Sep 8, 2017 - Nov 3, 2017

    Background: Patients’ engagement in healthcare decision making is constituted by at least two behaviors: health information seeking and active involvement in medical decisions. Previous research rep...

    Background: Patients’ engagement in healthcare decision making is constituted by at least two behaviors: health information seeking and active involvement in medical decisions. Previous research reported that older adults desire a lot of information but want to participate in decision making to a lesser degree. However, there is only limited evidence on the effect of health information preference and consultation on seniors’ perceived confidence in making an informed choice (i.e., decision self-efficacy). Objective: The goal of this study was to contribute to a better understanding of the role desire for health information has for older patients. More specifically, it tested whether decision self-efficacy increases as a function of information consultation. Additionally, the study allowed insights into the sources senior patients prefer to consult. Methods: A sample of 101 senior citizens (aged 60 or older) with a high blood pressure condition in the Italian-speaking part of Switzerland answered a questionnaire before and after an informational intervention was applied. The intervention consisted of offering additional information on hypertension from five different sources and of providing the information the participant desired. Preference for receiving this information was the major independent variable. The main outcome measure was decision self-efficacy (assessed at baseline and posttest). Analyses of co-variance were conducted to detect differences between and within who desired additional hypertensive related contents (intervention group) and ‘information avoidant’ profiles (control group). Results: Healthcare professionals firmly remain the preferred and most trusted source of health information for senior patients. The second most consulted source was the Internet. However, among the total sample the Internet obtained the lowest credibility score. A significant increase in decision self-efficacy occurred to seniors consulting further information compared to avoidant profiles (F(1,93) = 28.25; P<.001). Conclusions: Engaging in a guided computer-based health information consultation is a helpful activity to ultimately increase hypertensive senior patients’ perceived confidence in making treatment decisions.

  • Development of Just-in-time Adaptive Intervention for Insomnia: Usability Study

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 5, 2017

    Open Peer Review Period: Sep 7, 2017 - Nov 2, 2017

    Background: Healthy sleep is a fundamental component of physical and brain health. Insomnia, however, is a prevalent sleep disorder that compromises functioning, productivity, and health. Therefore, d...

    Background: Healthy sleep is a fundamental component of physical and brain health. Insomnia, however, is a prevalent sleep disorder that compromises functioning, productivity, and health. Therefore, developing efficient treatment delivery methods for insomnia can have significant societal and personal health impacts. Cognitive behavioral therapy for insomnia (CBTI) is the recommended first-line treatment of insomnia but access is currently limited for patients, since treatment must occur in specialty sleep clinics, which suffer from an insufficient number of trained clinicians. Smartphone-based interventions offer a promising means for improving the delivery of CBTI. Furthermore, novel features such as real-time monitoring and assessment, personalization, dynamic adaptations of the intervention, and context awareness can enhance treatment personalization and effectiveness, and reduce associated costs. Ultimately, this “Just in Time Adaptive Intervention” (JITAI) for insomnia—an intervention approach that is acceptable to patients and clinicians, and is based on mobile health (mHealth) platform and tools—can significantly improve patient access and clinician delivery of evidence-based insomnia treatments. Objective: This study aims to develop and assess the usability of a JITAI application platform called iREST (“interactive Resilience Enhancing Sleep Tactics”) for use in behavioral insomnia interventions. iREST can be used by both patients and clinicians. Methods: The development of iREST was based on the interactive and incremental (IID) software development model. Requirement analysis was based on the case study’s description, workflow and needs, clinician inputs, and a previously conducted BBTI military study/implementation of the JITAI architecture. To evaluate the usability of the iREST mHealth tool, a pilot usability study was conducted. Additionally, this study explores the feasibility of using an off-the-shelf wearable device to supplement the subjective assessment of patient sleep patterns. Results: The iREST app was developed from the mobile logical architecture of JITAI. It consists of a cross-platform smartphone app, a clinician portal, and secure 2-way communications platform between the app and the portal. The usability study comprised 19 Active Duty Service Members (ADSM) and Veterans between the ages of 18 and 60. Descriptive statistics based on in-app questionnaires indicate that on average, 12 (mean=12.23, SD=8.96) unique devices accessed the clinician portal per day for more than two years, while the app was rated as “highly usable”, achieving a mean System Usability Score (SUS) score of 85.74 (SD =12.37), which translates to an adjective rating of “Excellent”. The participants also gave high scores on “ease of use and learnability” with an average score of 4.33 (SD=0.65) on a scale of 1 to 5. Conclusions: iREST provides a feasible platform for the implementation of JITAI in mHealth-based and remote intervention settings. The system was rated highly usable and its cross-platformness made it readily implemented within the heavily segregated smartphone market. The use of wearables to track sleep is promising; yet the accuracy of this technology needs further improvement. Ultimately, iREST demonstrates that mHealth-based JITAI is not only feasible, but also works effectively.

  • Understanding barriers to physicians adopting clinical decision support systems: A Systematic Review

    From: JMIR Medical Informatics

    Date Submitted: Sep 6, 2017

    Open Peer Review Period: Sep 8, 2017 - Nov 3, 2017

    Background: The purpose of this paper was to conduct an analytical review and task analysis of CDSS re-search, and to develop a new framework for CDSS design in order to achieve user acceptance. Objec...

    Background: The purpose of this paper was to conduct an analytical review and task analysis of CDSS re-search, and to develop a new framework for CDSS design in order to achieve user acceptance. Objective: This paper tackles a critical issue modern healthcare systems namely, the adoption of Health Informatics Technologies (HIT). The paper provides a comprehensive literature review of the current status quo of Clinical Decision Support Systems adoption, the barriers to adoption from users stand point, and proposes novel solutions to current gaps in order to the enhancement of healthcare delivery and execution. Methods: A literature review of CDSS papers was conducted with a focus on user acceptance. In order to gain a greater understanding of the problems associated with CDSS, we conducted a task analysis to identify and describe the goals, user input, system output, knowledge requirements, and constraints from two different perspectives. Results: Based on the literature review, findings are characterized by whether user acceptance was favorable and unfavorable for clinical guidelines, reminders, and diagnostic CDSS. We propose two models: 1) the User Acceptance and System Adaptation Design (UASAD) model which includes optimizing CDSS design based on user needs/expectations and 2) the Input-Process-Output-Engage (IPOE) model which reveals to users the processes the govern CDSS outputs. Conclusions: CDSS have the capacity to decrease medical errors and improve patient outcomes. However, current CDSS designs do not consistently show such improvements. We hypothesized that the incorporation of the proposed models will improve user acceptance to support beneficial impacts of CDSS adoption. Ultimately, if a user does not accept technology this not only poses a threat to the use of the technology but can also pose a threat to the health and wellbeing of patients.

  • A smartphone app (BlueIce) for young people (aged 12-17) who self-harm: An Open Phase 1 Trial

    From: Journal of Medical Internet Research

    Date Submitted: Sep 8, 2017

    Open Peer Review Period: Sep 11, 2017 - Nov 6, 2017

    Background: Recent years have seen a significant increase in the availability of smart phone apps for mental health problems. Despite their proliferation few have been specifically developed for young...

    Background: Recent years have seen a significant increase in the availability of smart phone apps for mental health problems. Despite their proliferation few have been specifically developed for young people and almost none have been subject to any form of evaluation. Objective: Our aim was to undertake a preliminary evaluation of a mobile app (BlueIce), co-produced with young people, designed to help young people manage distress and urges to self-harm. We explored app acceptability and safety as well as changes in self-harm and pre-post changes on standardized measures of depression, anxiety and behaviour. Methods: We undertook an open trial where we recruited young people aged 12 to 17 attending specialist child and adolescent mental health services (CAMHS) who were currently, or had a history of self-harm. Eligible participants were assessed at baseline and then given BlueIce. They were assessed 2 weeks later (post familiarisation) and again at 12 weeks (post-use). Standardised measures of depression, anxiety and general behaviour were completed alongside self-reports of self-harm, app helpfulness and safety. Results: Of the 54 young people assessed for eligibility, 44 began the study and completed baseline assessments. Post-familiarization interviews were conducted with 40 participants and 33 completed post-use assessments. BlueIce was highly acceptable to clinicians and young people. There were no adverse events during the course of the study and young people did not feel that BlueIce increased their urge to self-harm. Almost three-quarters of those who had recently self-harmed reported reductions in self-harm after using BlueIce for 12 weeks. There was a significant difference on symptoms of depression (P =.043) and on symptoms of anxiety (P =.001) at post-use compared to baseline. There was no statistically significant change in behaviour other than on the emotional sub-scale of the SDQ (P =.007). Conclusions: Although our study has limitations our findings are encouraging and suggest that BlueIce, used alongside a traditional CAMHS face to face intervention, can help young people manage their emotional distress and urges to self-harm. Clinical Trial: N/A

  • Just in time information and feedback (JITIF) on antibiotics use for village doctors in rural Anhui, China: A randomize controlled trial

    From: Journal of Medical Internet Research

    Date Submitted: Sep 8, 2017

    Open Peer Review Period: Sep 11, 2017 - Nov 6, 2017

    Background: Excessive antibiotics use is very common worldwide especially in rural China and various measures have been used in curbing the problem but showed only marginal effects. Objective: This st...

    Background: Excessive antibiotics use is very common worldwide especially in rural China and various measures have been used in curbing the problem but showed only marginal effects. Objective: This study tested an innovative intervention which provided just in time information and feedback (JITIF) to village doctors on care of common infectious diseases. Methods: The “information” component of JITIF consisted of a set of theory or evidence- based ingredients including operation guideline, public commitment, and takeaway information; while the “feedback” component tells each participating doctor about his/her performance scores and percentages of antibiotic prescriptions. These ingredients were incorporated together in a synergetic way via a web-based aid (WBA). Evaluation of JITIF adopted a randomized controlled trial (RCT) design involving 24 village clinics randomized into equal control and intervention arms. Measures used included changes between baseline and endpoint (1 year after baseline) in terms of: percentages of patients with symptomatic respiratory or gastrointestinal tract infections (RTIs/GTIs) being prescribed antibiotics; delivery of essential service procedures; patients’ beliefs and knowledge about antibiotics and infection prevention. Two researchers worked as a group in collecting the data at each site clinic. One performed non-participative observation of the service process; while the other, structured exit interview about patients beliefs and knowledge. Data analysis consisted mainly: a) descriptive estimations of beliefs/knowledge, practice of indicative procedures and use of antibiotics at baseline and endpoint and for intervention and control groups; and b) Chi-square tests for the differences between these groups. Results: A total of 1048 patients completed the evaluation, including 532 at baseline (intervention=269, control=263) and 516 at endpoint (intervention=262, control=254). Patients diagnosed with RTIs and GTIs accounted for 407(76.5%) and 125(23.5%) respectively at baseline and 417(80.8%) and 99(19.2%) at endpoint. JITIF resulted in substantial improvement in delivery of essential service procedures (2.6% to 24.8% at baseline on both arms and at endpoint on the control arm versus 88.5% to 95.0% at endpoint on the intervention arm, P<0.05), beliefs favoring rational antibiotics use (11.5% to 39.8% at baseline on both arms and at endpoint on the control arm versus 19.8% to 62.6% at endpoint on the intervention arm, P<0.05) and knowledge about side-effects of antibiotics (35.7% on the control arm versus 73.7% on the intervention arm, p<0.05), measures for managing/preventing RTIs (39.1% versus 66.7%, p<0.05), and measures for managing/preventing GTIs (46.8% versus 69.2%, p<0.05). It also reduced antibiotics prescription (from 88.8% to 62.3%, p<0.05) and this decrease was consistent for RTIs (87.1% versus 64.3%, p<0.05) and GTIs (94.7% versus 52.4%, p<0.05). Conclusions: JITIF is effective in controlling antibiotics prescription at least in the short term, and may provide a low-cost and sustainable solution to the widespread excessive use of antibiotic in rural China. Clinical Trial: Not applicable

  • Academic leagues: a concept created on Brazilian medicals schools

    From: JMIR Medical Education

    Date Submitted: Sep 10, 2017

    Open Peer Review Period: Sep 13, 2017 - Nov 8, 2017

    Background: The Brazilian academic leagues are small groups of medical students that are growing on medical education. Objective: Present the concept of Brazilian academic leagues and synthesize the e...

    Background: The Brazilian academic leagues are small groups of medical students that are growing on medical education. Objective: Present the concept of Brazilian academic leagues and synthesize the experiences published in scientific journals. Methods: Was performed a survey bibliographic databases, with subsequent exclusion of items not related to the theme, repeated or without free access. It was included studies that contained reports of an individual experience of an academic league. Results: Was found 29 articles on total, and analyzed 15 experience reports. They have been described 7 reports of Medicine, 4 reports from other areas and 4 multidisciplinary reports. So, there is a gradual increase in the debate on the subject, although most of it is still in the form of experience reports. Conclusions: There is great variability in the reported academic leagues, although most of them have regular meetings with theoretical discussions, participate in scientific events, as listeners, speakers and leading academic papers. Many leagues have extension activities, with activities in the community in various segments.

  • How healthcare professionals evaluate a digital intervention to improve medication adherence: a qualitative exploratory study

    From: Journal of Medical Internet Research

    Date Submitted: Sep 12, 2017

    Open Peer Review Period: Sep 13, 2017 - Nov 8, 2017

    Background: For many chronic diseases, medication non-adherence poses a serious and hard-to-tackle problem. eHealth applications that foster patient engagement and shared decision making may be a nove...

    Background: For many chronic diseases, medication non-adherence poses a serious and hard-to-tackle problem. eHealth applications that foster patient engagement and shared decision making may be a novel approach to improve medication adherence. Objective: The aim of this study was to investigate the perspective of healthcare professionals regarding a new developed digital application, aimed to improve medication adherence. Familial hypercholesterolemia (FH) was chosen as a case example. Methods: A web-based prototype of the eHealth application (called ‘MIK’) was co-designed with patients and healthcare professionals. After user tests with patients we performed semi-structured interviews and user tests with 12 physicians from six different hospitals to examine how the functionalities offered by ‘MIK’ could assist physicians in their consultation and how they could be integrated in daily clinical practice. Qualitative thematic analysis was used to identify themes that covered physicians’ evaluations. Results: Three themes were identified based on the interview data; 1) Perceived impact on patient-physician collaboration; 2) Perceived impact on patient’s understanding and self-management regarding medication adherence; 3) Perceived impact on clinical decisions and workflow. Conclusions: The eHealth application ‘MIK’ seems to have the potential to improve the consultation between patient and physician in terms of collaboration and patient engagement. The impact of eHealth applications, based on the concept of shared decision making, on improving medication taking behavior and clinical outcomes is yet to be evaluated. Insights will be useful for further development of eHealth applications aimed at improving self-management by means of patient engagement and shared decision making.

  • A bibliometric analysis of physical activity, sedentary behavior and diet related e- & mHealth research

    From: Journal of Medical Internet Research

    Date Submitted: Sep 26, 2017

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

    Background: e- & mHealth approaches to address low physical activity levels, sedentary behavior and unhealthy diets have received significant research attention. However, attempts to systematically ma...

    Background: e- & mHealth approaches to address low physical activity levels, sedentary behavior and unhealthy diets have received significant research attention. However, attempts to systematically map the entirety of the research field are lacking. This gap can be filled with a bibliometric study, where publication-specific data such as citations, journals, authors and keywords are used to provide a systematic overview of a specific field. Such analyses will help researchers better position their work. Objective: To use bibliometric data to provide an overview of the e- & mHealth research field related to physical activity, sedentary behavior and diet. Methods: The Web of Science (WoS) Core Collection was searched to retrieve all, and highly-cited (as defined by WoS), physical activity, sedentary behavior and diet e- & mHealth research papers published in English between January 2000 and 31 December 2016. Retrieved titles were screened for eligibility, using the abstract and full-text where needed. We described publication trends over time; journals, authors and countries of eligible papers; as well as their keywords and subject categories. Citations of eligible papers were compared to those expected based on published data. Additionally, we identified and described “highly-cited papers” of the field (i.e. top ranked 1%). Results: The search identified 4805 hits, of which 1712 (including 42 highly-cited papers) were included in the analyses. Publication output increased on average 26% per year since 2000 with 51% of papers being published between 2014 and 2016. Overall and throughout the years, e- & mHealth papers related to physical activity, sedentary behavior and diet received more citations than expected compared to papers in the same WoS subject categories. The Journal of Medical Internet Research published most papers in the field (n=164, 9.6% of total papers). Papers predominantly originated from high-income countries (96.1%) with the United States being the most prolific country (48.8% of all papers). Most articles were trials, and studied physical activity. Beginning in 2013, research on "Generation 2" technologies (e.g., smartphones, apps, wearables) sharply increased, while research on "Generation 1" (e.g., text messages) technologies increased at a reduced pace. Reviews accounted for 20 of the 42 highly-cited papers (n=19 systematic reviews). Social media, smartphone apps and wearable activity trackers used to encourage physical activity, less sedentary behavior and/or healthy eating were the focus of 14 highly-cited papers. Conclusions: This study highlighted the rapid growth of the e- & mHealth physical activity, sedentary behavior and diet research field, emphasized the sizeable contribution of research from high-income countries and pointed to the increased research interest in "Generation 2" technologies. It is expected that the field will grow and diversify further, and that reviews and research on most recent technologies will continue to strongly impact the field.

  • Team Resilience Training in the Workplace: An E-Learning Adaptation, Measurement Model, and Two Pilot Studies

    From: Journal of Medical Internet Research

    Date Submitted: Sep 13, 2017

    Open Peer Review Period: Sep 16, 2017 - Nov 11, 2017

    Two exploratory and quasi-experimental pilot studies were designed to address four shortcomings in the study of workplace resilience interventions. There is a need: to promote social or team resilienc...

    Two exploratory and quasi-experimental pilot studies were designed to address four shortcomings in the study of workplace resilience interventions. There is a need: to promote social or team resilience; to condense generally longer class-room training into a brief e-learning format; to use known guides for making e-learning programs effective, and for more theoretical precision in designing programs and assessing outcomes. The authors took an established evidence-based program (Team Resilience) and modified it based on these needs. A measurement model distinguishes outcomes that are more proximal (perceptions that the program improved resilience) and more distal (dispositional resilience). Seven hypotheses are advanced to test the model and program efficacy. Two samples (ns = 118, 181) of engineering firms received the online training and provided immediate reactions in a post-test only design. The second sample also included a control condition (n = 201). Findings generally support the model and program efficacy. For example, workplace resilience was greater in the intervention than control group. Other findings suggest social dissemination effects, equal outcomes for employees at different stress levels, and greater benefit for females.

  • Assessing Information Quality in Online Health Social Networks - An Exploratory Investigation of Diabetes-Related Threads

    From: Journal of Medical Internet Research

    Date Submitted: Sep 13, 2017

    Open Peer Review Period: Sep 16, 2017 - Nov 11, 2017

    Background: The number of people turning to online health social networks for health-related information continues to grow. While online support is an important benefit that patients derive from using...

    Background: The number of people turning to online health social networks for health-related information continues to grow. While online support is an important benefit that patients derive from using such forums, patients also seek answers to questions relating to topics such as medication, treatment, and diagnosis. Many prior studies confirm that the health related information available on the Internet and in online health social networks is suspect. Incorrect responses to questions by patients could adversely impact patient safety if patients heed such advice. Objective: The goal of this exploratory study is to investigate the factors that are associated with information quality in online health social networks. These factors can then be used for predicting, monitoring, and warning patients about the extent of misinformation contained in threads in online healthcare social networks. Methods: This quantitative study is based on the analysis of 2,586 posts from 152 threads relating to diabetes mellitus. The data were extracted from a popular online health social network site (OHSNS), and three family medicine board certified physicians evaluated the clinical quality of responses for each thread. Partial least squares (PLS) regression was used to examine the factors. Only threads relating to questions seeking answers regarding medication, diagnosis, and treatment were included in the study. This study excludes threads purely seeking emotional support. Results: Our findings show that the clinical quality of the response is positively associated with the quality of the thread question (completeness P < .001, readability P = .09), the extent of user’s experience with the disease (P = .004), the sentiment within the thread (P = .001), and the proportion of responders with Type-1 diabetes (P < .001). Counter intuitively, the study also found that the quality of the response is negatively associated with the responder’s social network-related measures (likability (P= .001), tenure (P = .003), and activity (P = .047)). The findings suggest that traditional social media measures, such as responders’ “likes”, might mislead users. Conclusions: The results of this exploratory study help to identify factors (also referred to as cues) associated with the response quality of threads in OHSNS. The factors identified in this study could be utilized for developing indicators of information quality to improve patient safety.

  • Lessons learned from the use of a participatory design process to develop digital games addressing airway clearance therapy in children with cystic fibrosis

    From: JMIR Serious Games

    Date Submitted: Sep 14, 2017

    Open Peer Review Period: Sep 16, 2017 - Nov 11, 2017

    Worldwide, between 70,000 to 100,000 individuals are affected with cystic fibrosis. From early childhood, children affected do respiratory exercices to release the mucus stuck in their lungs. This ca...

    Worldwide, between 70,000 to 100,000 individuals are affected with cystic fibrosis. From early childhood, children affected do respiratory exercices to release the mucus stuck in their lungs. This can require many hours daily. Games for health and connected sensors that transform the breath into a signal offer promising avennues to make the treatment more fun. Since 2014, the collective Breathing Games has mobilized game designers, software developers, visual artists, sound composers, children affected and their parents, pulmonologists, and physiotherapists to collectively create prototypes of digital games about cystic fibrosis. These prototypes are released under copyfair licenses so that everyone can build upon them. We present the lessons learned from six game prototypes created through a participatory design process, emphasizing on their strengths and limits. We link this practical experience to a review of litterature about key elements to be included in the design of games for health. The article may benefit researchers and professionals interested in games for health by providing a case study that emerged from the practice, and built a posteriori on scientific methods.

  • The Development of a Mobile Social Networking-Based Relatedness Intervention Condition among Young, First-Time Blood Donors

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 15, 2017

    Open Peer Review Period: Sep 17, 2017 - Nov 12, 2017

    Background: Increasing repeat blood donation behavior is a critical public health goal. According to self-determination theory, the process of developing internal motivation to give blood and an assoc...

    Background: Increasing repeat blood donation behavior is a critical public health goal. According to self-determination theory, the process of developing internal motivation to give blood and an associated self-identity as a blood donor may be promoted by feelings of “relatedness” or connection to other donors, which may be enhanced through social relations and interaction. Objective: The purpose of this report it to describe the development and pilot testing of a social networking-based (Facebook) intervention condition designed to increase feelings of relatedness via virtual social interaction and support. Methods: To develop the intervention condition content, images, text, polls, and videos content was assembled. Ohio University college students (N = 127) rated the content (82 images/text) presented by computer in random order using a scale of one to five on various dimensions of relatedness. Mean ratings were calculated and ANOVA was conducted to assess associations among the dimensions. Based on these results, the relatedness intervention was adapted and evaluated for feasibility, acceptability, and preliminary efficacy among 24 first-time donors, aged 18 to 24, in a 30-day pilot. Paired t-tests were conducted to examine change over time in relatedness and connectedness. Results: The intervention condition developed was acceptable and feasible. Results of the uncontrolled, pre- and post-intervention evaluation revealed that feelings of individual-level relatedness increased significantly after the intervention. Conclusions: By promoting first-time donor relatedness our goal is to enhance internal motivation for donating and the integration of the blood donor identity, thus increasing the likelihood of future repeat donation. Clinical Trial: Clinical Trial Registration: NCT02717338

  • A Case Report of High-risk Multi-Vessel Percutaneous Coronary Intervention Using Impella CP with Severe Mitral Regurgitation

    From: JMIR Cardio

    Date Submitted: Sep 14, 2017

    Open Peer Review Period: Sep 16, 2017 - Nov 11, 2017

    Percutaneous Coronary Intervention (PCI) becomes a high-risk procedure when accompanied by several factors such as low ejection fraction, congestive heart failure, multi-vessel disease and severe mitr...

    Percutaneous Coronary Intervention (PCI) becomes a high-risk procedure when accompanied by several factors such as low ejection fraction, congestive heart failure, multi-vessel disease and severe mitral regurgitation. These factors cause a substantial increase in associated morbidity and mortality. Percutaneous Left Ventricular Assist Devices (pLVAD) assist in betterment of outcomes, in these patients. Here, we present a case documenting the utility of Impella CP, a pLVAD in high risk PCI. Our patient presented with myocardial infarction that was complicated by heart failure and mitral valve abnormality. Coronary angiography reported multi-vessel disease and was deemed unsuitable for surgery due to associated high-risk conditions. Thereafter, PCI was performed on this patient using Impella CP. The procedure was successful with no peri- and post-procedure complications even at 1-year follow-up. Impella CP is a micro-axial pump, which advances blood flow into the aorta from the left ventricle. It is advantageous for being minimally invasive and effective in decreasing end diastolic left ventricular volume. It should be attempted in unstable patients with severe coronary lesions and high-risk mortality with cardiac surgery.

  • Work Smarter or Harder in Healthcare? Investigating Taiwanese Technological Healthcare Innovation

    From: Journal of Medical Internet Research

    Date Submitted: Sep 14, 2017

    Open Peer Review Period: Sep 16, 2017 - Nov 11, 2017

    Background: Background: Technology-based healthcare has been promoted as an effective tool to enable clinicians to work smarter. However, some health stakeholders believe technology will compel users...

    Background: Background: Technology-based healthcare has been promoted as an effective tool to enable clinicians to work smarter. However, some health stakeholders believe technology will compel users to work harder by creating extra work. Objective: Objective: This study investigates how and why e-health has been applied in Taiwan and suggests implications that may inspire other countries facing similar challenges. Methods: Methods: A qualitative methodology was adopted to obtain insightful input from deeper probing. Taiwan was selected as a typical case study given its aging population, advanced technology, and comprehensive healthcare system. This study investigated 38 stakeholders in the healthcare ecosystem through in-depth interviews and focus groups, which provides an open, flexible, and enlightening way to study complex, dynamic, and interactive situations through informal conversation or a more structured, directed discussion. Results: Results: First, respondents indicate that the use of technology can enable seamless patient care and clinical benefits, such as flexibility in time management. Second, the results suggest that a leader’s vision, authority, and management skills might influence success in healthcare innovation. Finally, the results imply that both internal and external organisational governance are highly relevant to implementing technology-based innovation in healthcare. Conclusions: Conclusions: This study provides Taiwanese perspectives on how to intelligently use technology to benefit healthcare and debates the perception that technology prevents human interaction between clinicians and patients.

  • Integrative analysis of the canonical TGFβ-Smad signaling pathway in breast cancer

    From: Journal of Medical Internet Research

    Date Submitted: Sep 15, 2017

    Open Peer Review Period: Sep 17, 2017 - Nov 12, 2017

    Background: Breast cancer deaths are mainly attributed to metastasis, while epithelial to mesenchymal transition (EMT) plays a pivotal role in promoting cancer cell metastasis. EMT is activated by var...

    Background: Breast cancer deaths are mainly attributed to metastasis, while epithelial to mesenchymal transition (EMT) plays a pivotal role in promoting cancer cell metastasis. EMT is activated by various stimuli, resulting in different therapeutic responses. The TGFβ signaling pathway is a canonical driver of EMT, and many molecular drugs are developed to target this pathway. However, the alternations of this pathway in BC remain elusive. Objective: The aim of this study was to investigate the relationship between the canonical TGFβ-Smad signaling pathway and breast cancer pathogenesis. Methods: Herein, we investigated the mutational, transcriptional, epigenetic and post-transcriptional alternations of 14 core members in this pathway through bioinformatics approach by analyses of 56,496 BC patients from various public databases, including COSMIC, Oncomine, DiseaseMeth and Starbase. A protein-protein interaction network was derived from Cytoscape software. Associations of these selected members with relapse free survival (RFS), overall survival (OS), distant metastases free survival (DMFS) and post progression survival (PPS) were performed using the Kaplan-Meier plotter online tool. Results: Our integrated analyses revealed that Smad4 was the most frequently mutated member of the TGFβ-Smad pathway in BC with a mutation frequency of 0.85% (30/3537). The expression levels of TGFβ1, TGFβ3, Smad1, Smad2 and Smad7 were significantly higher, whereas TGFβ2, ALK1, ALK2, ALK5, TGFβR2, Smad3, Smad4, Smad5 and Smad6 were downregulated in BC compared with normal subjects (P<0.001). Evaluation of epigenetic alteration identified that the promoters of ALK1 (P=0.000e+00), ALK2 (P=2.22e-16) and ALK5 (P=1.625e-12) were hypermethylated in 1,274 BC samples. In contrast, Smad2 (P=6.56e-04) was significantly hypomethylated in BC. Although all 14 members had potential diagnostic significances with different prediction power (AUC ranging from 0.788 to 1.00) in various subtypes of BC, only TGFβ3 could predict RFS (HR=0.69, 95% CI [0.62-0.77]), OS (HR=0.69, 95% CI [0.56-0.86]), DMFS (HR=0.8, 95% CI [0.66-0.97]) and PPS (HR=0.76, 95% CI [0.6-0.97]) for patients with BC in an independent manner. Additionally, 11 out of 14 members were associated with RFS in luminal A BC. Conclusions: Our results indicated that TGFβ-Smad pathway core members could serve as novel diagnostic and prognostic biomarkers in BC.

  • The Praise and Price of Pokémon GO -Exploring children’s and parents’ experiences playing Pokémon Go

    From: JMIR Serious Games

    Date Submitted: Sep 19, 2017

    Open Peer Review Period: Sep 19, 2017 - Nov 14, 2017

    Background: Physical activity has multiple health benefits, however, the majority of children around the world do not reach the recommended levels of daily physical activity. Research has shown that t...

    Background: Physical activity has multiple health benefits, however, the majority of children around the world do not reach the recommended levels of daily physical activity. Research has shown that the game Pokémon GO has increased the amount of physical activity and that the game has the potential to reach populations that traditionally have low levels of physical activity. Therefore, there is a need to understand which game components that can promote initial and sustained physical activity. By using a qualitative research approach, it is possible to achieve rich descriptions and enhance a deep understanding of the components promoting physical activity among children in a game like Pokémon GO Objective: Explore children’s and parents’ experiences playing Pokémon GO. Methods: Eight families comprising 13 children (aged 7-12 years) and 9 parents were selected using purposeful sampling. Data collected using focus groups were analyzed using qualitative latent content analysis. Results: Three themes were revealed: Exciting and enjoyable exploration, dangers and disadvantages, and cooperation conquers competition. The first centers around present and possible future aspects of Pokémon GO that promote physical activity. The second focuses on unwanted aspects and specific threats to safety when playing the game. The third shows that cooperation and togetherness is highly valued by the participants and that competition is fun but less important. Conclusions: Components from Pokémon GO might enhance the efficacy of physical activity interventions. Cooperation and exploration are aspects of the game that preferable could be transferred into interventions aiming at promoting children’s physical activity.

  • 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.

  • Barriers and facilitators to patient portal implementation from an organizational perspective: a qualitative study

    From: Journal of Medical Internet Research

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 21, 2017 - Nov 16, 2017

    Background: Patient portals can contribute to patient-centered care and are defined as “an online gateway for patients to gather and share information mostly provided by one health institution”. T...

    Background: Patient portals can contribute to patient-centered care and are defined as “an online gateway for patients to gather and share information mostly provided by one health institution”. The number of patient portals is rising and while portals can have positive effects, its implementation has major impact on the providing health care institutions. Little is known about the organizational factors affecting successful implementation. Knowledge of the specific barriers and facilitators of different stakeholders may be useful for future implementations. Objective: The objective of this study is to identify the barriers and facilitators of patient portal implementation among different stakeholders within the hospital organization. Methods: Purposive sampling was used to select hospitals of different classes. Two university medical centers (UMCs), 3 mid-size hospitals and 2 general hospitals were included. Per hospital three stakeholders were interviewed: 1) medical professionals, 2) managers, and 3) IT employees. Semi-structured interviews were conducted using the model of Grol and Wensing, which describes barriers and facilitators of change in health care practice at six levels: 1) Innovation, 2) Individual professional, 3) Patient, 4) Social Context, 5) Organizational Context, 6) Economic Context. Two researchers independently selected and coded quotes by using this model. Additional factors related to technical and portal characteristics were added by using the model of McGinn et al developed for implementation of electronic health records. Results: In total, we identified 382 quotes and 34 factors. Twenty-five factors were common for all stakeholder groups including 16 barriers and 12 facilitators. Positive factors related to ‘advantage in practice’ were mentioned most frequently, followed by positive ‘attitude’ and ‘motivation to change’. The main barriers were ‘resources’ (eg lack of staff), ‘opinion of colleagues’ (eg negative beliefs) and ‘privacy and security’ (eg strict regulations). Similarities as well as differences were found between stakeholder groups and hospital classes. For example, medical professionals and IT employees considered 'resources' as an essential barrier. However, their perspectives differed regarding 'opinion of colleagues' as this was a major barrier for medical professionals (eg clinicians’ negative attitude), but a facilitator for IT employees (eg implementation can drive a positive change). Conclusions: The model of Grol and Wensing proved to be useful in elicitation and classification of barriers and facilitators to portal implementation. Nevertheless, technical and factors related to portal characteristics (eg 'privacy and security') were missing, and were added from the McGinn model. Barriers and facilitators occurred at various levels and differed between hospital classes and stakeholder groups on several factors (eg 'opinion of colleagues' and 'cost issues'). This underscores the added value of involving multiple stakeholders in portal implementations. The identified set of barriers and facilitators may be useful to make strategic and efficient implementation plans.

  • Developing sustainable and impactful mobile phone HIV testing interventions for Spanish-speaking men who have sex with men in the United States (US): Lessons learned from informative interviews

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 18, 2017

    Open Peer Review Period: Sep 20, 2017 - Nov 15, 2017

    Background: While many gay, bisexual, and other men who have sex with men (MSM) test for HIV at least once in their lifetime, opportunities to improve regular HIV testing, particularly among Hispanic/...

    Background: While many gay, bisexual, and other men who have sex with men (MSM) test for HIV at least once in their lifetime, opportunities to improve regular HIV testing, particularly among Hispanic/Latino MSM, are needed. Many mHealth interventions in development and that include HIV testing have primarily focused on English-speaking white, Black and MSM of other races. To date, no studies have assessed app use, attitudes and motivations for downloading and sustaining use of mobile apps, and preferences with respect to HIV prevention among Spanish-speaking, Hispanic MSM in the U.S. Objective: The primary objectives of this study were to answer the following questions: 1) What features and functions of smartphone apps do Hispanic, Spanish-speaking MSM believe are associated with downloading apps to their smartphones?; 2) What features and functions of smartphone apps are most likely to influence men’s sustained use of apps over time?; and 3) What features and functions do the men prefer in a smartphone app aimed to promote regular testing for HIV? Methods: Interviews (n=15) were conducted with a racially diverse group of sexually active, HIV-negative, Spanish-speaking, Hispanic MSM (Mean age of 32; 40% tested for HIV 6 months ago) in Miami, Florida. Interviews were digitally recorded, transcribed verbatim, translated back to English, and de-identified for analysis. A constant comparison method (i.e., grounded theory coding) was employed to examine and re-examine the themes that emerged from the interviews. Results: Personal interest was the primary reason associated with whether men downloaded an app. Keeping personal information secure, cost, influence by peers and posted reviews, ease of use, and functionality affected whether they downloaded and used the app over time. Men also reported that entertainment value and frequency of updates influenced whether they kept and continued to use an app over time. There were four reasons why participants chose to delete an app: dislike, lack of use, cost, and lack of memory/space. Participants’ also shared their preferences for an app to encourage regular HIV testing by providing feedback on test reminders, tailored testing interval recommendations, HIV test locator, and monitoring of personal sexual behaviors. Conclusions: The features and functions of mobile apps that Spanish-speaking MSM in this study believed were associated with downloading and/or sustained engagement of an app generally reflected the priorities mentioned in an earlier study with English-speaking MSM. However, unlike the earlier study, Spanish-speaking MSM prioritized personal interest in a mobile app and de-emphasized the efficiency of an app to make their lives easier in their decision to download an app to their mobile device. As such, tailoring mobile apps to the language and needs of Spanish-speaking MSM is critical to help appeal to their willingness to download a mobile app. Despite the growing number of HIV prevention apps in development, few are specifically tailored to Spanish-speaking MSM, representing an important gap that should be addressed in future research.

  • Implications of patient portal transparency in oncology: Experiences of patients, oncologists and medical informaticists

    From: Journal of Medical Internet Research

    Date Submitted: Sep 18, 2017

    Open Peer Review Period: Sep 20, 2017 - Nov 15, 2017

    Background: Providing patients with unrestricted access to their electronic medical records through patient portals has impacted patient-provider communication and patients’ personal health knowledg...

    Background: Providing patients with unrestricted access to their electronic medical records through patient portals has impacted patient-provider communication and patients’ personal health knowledge. However, little is known about how patient portals are used in oncology. Objective: We aimed to understand attitudes of the portal’s adoption for oncology and to identify the advantages and disadvantages of using the portal to communicate and view medical information. Methods: In depth semi-structured interviews were conducted with 60 participants: 35 patients, 13 oncologists and 12 medical informaticists. Interviews were recorded, transcribed and thematically analyzed to identify critical incidents and general attitudes encountered by participants. Results: Two primary themes were discovered: 1) implementation practices influence attitudes, in which the decision-making and execution process of introducing portals throughout the hospital did not include the input of oncologists. Lack of oncologists’ involvement led to a lack of knowledge about portal functionality, such as not knowing the time period when test results would be disclosed to patients; 2) perceptions of portals as communication tools varies by user type, meaning that each participant group (patients, oncologists, and medical informaticists) had varied opinions about how the portal should be used to transmit and receive information. Oncologists and medical informaticists had difficulty understanding one another’s culture and communication processes in their fields, while patients had preferences for how they would like to receive communication, but it largely depended upon the type of test being disclosed. Conclusions: The majority of patients (54%) who participated in this study viewed lab results or scan reports via the portal before being contacted by a clinician. Most were relatively comfortable with this manner of disclosure, but still preferred face-to-face or telephone communication. Findings from this study indicate that portal education is needed for both patients and oncologists, especially when portals are implemented across entire health systems since highly specialized areas of medicine may have unique needs and uses. Patient portals in oncology can potentially alter the way diagnoses are delivered and how patients and oncologists communicate. Therefore, communication about the portal should be established during initial consultations so patients can decide whether they want to be informed in such a manner.

  • What do Persons with Multiple Sclerosis need from an mHealth app for Physical Activity? A qualitative exploratory study.

    From: Journal of Medical Internet Research

    Date Submitted: Sep 19, 2017

    Open Peer Review Period: Sep 20, 2017 - Nov 15, 2017

    Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. The most common symptoms are overwhelming fatigue, visual disturbances, altered sensation, cognitive probl...

    Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. The most common symptoms are overwhelming fatigue, visual disturbances, altered sensation, cognitive problems and difficulties with mobility. Evidence suggests that physical activity (PA) helps people with MS stay active and reduces fatigue as well as improving quality of life. The use of mobile apps for health and wellbeing promotion has grown exponentially in recent years. There is currently a gap on mHealth applications for MS and to our knowledge no study has explored persons with MS perspectives to mHealth solutions for PA. Objective: The aim of this study was to: 1) generate insight as to persons with MS specific needs and characteristics for MS mHealth applications for Physical Activity; 2) detect perceived obstacles and facilitators for such mHealth solutions from persons with MS and healthcare professionals; and 3) provide validated MS personas to help further development of mHealth solutions for MS. Methods: A qualitative study was conducted in Kliniken Valens, Switzerland; a clinic specialized in neurological, musculoskeletal, and geriatric rehabilitation. Two series of focus groups, interviews and structured questionnaires took place. One with persons with MS and the other with healthcare professionals who work with MS. Demographic characteristics, satisfaction with life (SWLS), eHealth literacy (eHEALS), and technology use were assessed as well as user needs, barriers, facilitators and desired features for mHealth MS apps. Themes were identified during analysis such as: MS related barriers and facilitators; mHealth Design Considerations and General Motivational Aspects. Information and insights were used to create MS personas for design purposes. Results: A total of 12 persons with MS and 12 healthcare professionals participated in the study, median ages of 43.5 years and 40 respectively. Participants were well educated with an even distribution between genders. Desired features for mHealth applications for persons with MS were: a) activity tracking, b) incentives for completing tasks and objectives, c) customizable goal setting, d) optional sociability and e) game-like attitude among others. Potential barriers to mHealth apps adoption like a) rough on-boarding experiences, b) lack of clear use benefits and c) disruption of the healthcare provider-patient relationship. Potential facilitators were identified such as a) endorsements from experts, b) playfulness and c) tailored to specific persons with MS needs. Four MS personas were developed to provide designers and computer scientists means to help in the creation of future mHealth solutions for MS. Conclusions: The potential of mHealth apps for increasing physical activity in persons with MS holds promise. Allowing for realistic goal setting and positive feedback, while minimizing usability burdens seems to be critical for the adoption of such apps. Fatigue management is especially important in this population so more attention should be focused in that area.

  • Characteristics of Brazilian MSM using apps for sexual encounters: awareness of prevention strategies and willingness to use PrEP

    From: Journal of Medical Internet Research

    Date Submitted: Sep 23, 2017

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

    Background: Geosocial networking (GSN) smartphone applications (apps) are becoming the main venue for sexual encounters among Brazilian men who have sex with men (MSM). To address the increased HIV in...

    Background: Geosocial networking (GSN) smartphone applications (apps) are becoming the main venue for sexual encounters among Brazilian men who have sex with men (MSM). To address the increased HIV incidence in this population, pre-exposure prophylaxis (PrEP) was recently implemented in the Brazilian public health system (SUS) in the context of combined HIV prevention. Objective: This study aimed to describe the characteristics of MSM using GSN apps for sexual encounters, their awareness of prevention strategies and willingness to use PrEP. Methods: Online cross-sectional study conducted in ten Brazilian state capitals from July 1st to July 31st, 2016. The questionnaire was programmed on SurveyGizmo® and advertised in two GSN apps used by MSM to find sexual partners (Hornet and Grindr). Inclusion criteria were ≥18 years-old, cisgender men and HIV negative. Eligible individuals answered questions on demographics, behavior, and knowledge, preferences and willingness to use PrEP, non-occupational post-exposure prophylaxis (nPEP), HIV self-testing (HIVST) and condoms. Logistic regression models were used to assess factors associated with daily oral PrEP willingness. Results: During the study period, 8885 individuals provided consent and started the questionnaire. Of these, 2063 (23.22%) were ineligible, 6822 (76.78%) initiated, and 5065 (57.00%) completed the entire questionnaire and were included in the present analysis. Median age was 30 years (IQR: 25-36), most self-declared as MSM (4991, 98.54%), white (3194, 63.06%), middle income (2148, 42.41%) and had 12 or more years of schooling (3106, 61.36%). The majority of MSM (3363, 66.41%) scored ≥10 points (high risk) on The HIV Incidence Risk for MSM scale, but only 1,083 (21.39%) had a low perceived likelihood of getting HIV in the next year. Daily use of apps for sex was reported by 1798 (35.58%). Most MSM (4488, 85.43%) reported ever testing for HIV and 464 (9.16%) used nPEP in the previous year. PrEP, nPEP and HIVST awareness was reported by 2932 (57.89%), 2907 (57.39%) and 1346 (26.57%), respectively. Half of responders (2653, 52.38%) were willing to use daily oral PrEP, and this was associated with higher number of male sexual partners (adjusted odds ratio [AOR] 1.26,95%CI1.09-1.47), condomless receptive anal intercourse (AOR 1.27, 95%CI1.12-1.44), daily use of apps for sexual encounters (AOR 1.48, 95%CI1.17-1.87), high and unknown perceived likelihood of getting HIV in the next year (AOR 1.72, 95%CI1.47-2.02 and AOR 1.39, 95%CI1.13-1.70), STI diagnosis (AOR 1.25, 95%CI1.03-1.51), PrEP awareness (AOR 1.48, 95%CI1.30-1.70) and not willing to use condoms (AOR 1.16, 95%CI1.00-1.33). Conclusions: Our results evidenced high-risk scores in the studied population suggesting the value for PrEP use. Moreover, those presenting sexual risky behaviors were more willing to use PrEP. Nonetheless, only 58% had heard about this prevention strategy. Efforts to increase awareness of new prevention strategies are needed, and mobile health tools are a promising strategy to reach MSM.

  • 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.

  • Prevalence, demographic correlates, and perceived impacts of use of mobile health applications: a cross-sectional questionnaire study​​

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 21, 2017

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

    Background: The advent of mobile applications (apps) has changed the way people obtain health information and services and advance their understanding of and management strategies for their health. Al...

    Background: The advent of mobile applications (apps) has changed the way people obtain health information and services and advance their understanding of and management strategies for their health. Although many health apps are available, little is known about the prevalence of their use for various health purposes, whether the use is associated with demographic characteristics, and the impacts of the use on health knowledge and management. Objective: This study aimed to examine the prevalence and demographic correlates of use of health apps and the perceived impacts on health knowledge and management. Methods: A cross-sectional questionnaire survey of a random sample of 633 adults living in the community was conducted. Results: A total of 612 (96.7%) participants reported using mobile devices. Of them, 235 (38.4%) reported using multiple types of health apps. The most prevalent health app type was about healthy living information, 32.2%, followed by vital measurement or recording, 13.0%, health and medical reminders, 10.4%, recovery and rehabilitation information, 6.9%, assistance in diagnosis, 4.6%, emergency services, 2.6%, telehealth, 1.8%, and others, 3.1%. Multivariate logistic regression analysis found that those using health apps were more likely to be women and have a higher self-rated social class. Participants with education/culture/academic occupations, that worked in disciplinary forces, and with “others” occupations (e.g., health care, sports, media, social work, etc.) tended to agree that using health apps could increase their health knowledge or improve the effectiveness of health management. Conclusions: We found that the most prevalent types of health apps were ‘healthy living information apps’, ‘vital measurement and record apps’, and ‘health and medical reminders apps’. Results of the study showed that different demographic characteristics including gender, self-rated social class, education level, and occupation may be related to health app use. Since participants’ responses were diverse and they did not gather on a common idea, there were existing uncertainties in ‘whether using health apps could increase personal health knowledge and improve the effectiveness of personal health management’.

  • Making Friends with Doctors in Social Media: The Effect of Doctor-Consumer Interaction on Healthy Behaviors

    From: Journal of Medical Internet Research

    Date Submitted: Sep 21, 2017

    Open Peer Review Period: Sep 22, 2017 - Nov 17, 2017

    Background: Background: Both doctors and consumers have engaged in using social media for health purpose. Social media change traditional one-to-one communication way between doctors and patients to m...

    Background: Background: Both doctors and consumers have engaged in using social media for health purpose. Social media change traditional one-to-one communication way between doctors and patients to many-to-many communication way between doctors and consumers. However, little is known about the effect of doctor-consumer interaction on consumers’ healthy behaviors. Objective: The purpose of this study is to investigate how doctor-consumer interaction in social media affects consumers’ healthy behaviors. Methods: Based on professional-client interaction theory and social cognitive theory, we propose that doctor-consumer interaction can be divided into instrumental interaction and affective interaction. These two types of interaction influence consumers’ healthy behaviors through declarative knowledge, self-efficacy and outcome expectancy. To validate our proposed research model, we employed the survey method and developed corresponding measurement instruments for constructs in our research model. 352 valid answers were collected and partial least square was performed to analyze the data. Results: Instrumental doctor-consumer interaction was found to influence consumers’ declarative knowledge (t=5.763, P <0.001), self-efficacy (t=4.891,P<0.001) and outcome expectancy (t=7.554, P <0.001) significantly, while affective doctor-consumer interaction also impacted consumers’ declarative knowledge (t=4.025, P <0.001), self-efficacy (t=4.775, P <0.001) and outcome expectancy (t=4.855, P <0.001). Meanwhile, consumers’ declarative knowledge (t=3.838, P <0.001), self-efficacy (t=3.824, P <0.001) and outcome expectancy (t=2.985, P <0.01) all significantly affected consumers’ healthy behaviors. Our mediation analysis showed that consumers’ declarative knowledge, self-efficacy and outcome expectancy partially mediated the effect of instrumental interaction on healthy behaviors, while the three mediators fully mediated the effect of affective interaction on healthy behaviors. Conclusions: Compared with many intentional intervention programs, doctor-consumer interaction can be treated as natural cost-effective intervention to promote consumers’ healthy behaviors. Meanwhile, both instrumental and affective interaction should be highlighted for the best interaction results. Declarative knowledge, self-efficacy and outcome expectancy are working mechanisms of doctor-consumer interaction.

  • Is Social Media a Venue for Help-Seeking? Results from a Clinical Sample of Military Veterans with Depression

    From: Journal of Medical Internet Research

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 21, 2017 - Nov 16, 2017

    Background: The media has devoted significant attention to anecdotes of individuals who post messages on Facebook prior to suicide. However, it is unclear to what extent social media is perceived as a...

    Background: The media has devoted significant attention to anecdotes of individuals who post messages on Facebook prior to suicide. However, it is unclear to what extent social media is perceived as a source of help, or how it compares to other sources of potential support for mental health problems. Objective: The objective was to evaluate the degree to which adults with depression use social media for help-seeking, in comparison to other more traditional sources of help. Methods: Cross-sectional self-report survey of 270 adult military veterans with probable major depression. Help-seeking intentions were measured with a modified General Help-Seeking Questionnaire. Facebook users and non-users were compared via t-tests, chi-square, and mixed effects regression models. Associations between types of help-seeking were examined using mixed effects models. Results: The majority of participants were users of social media, primarily Facebook (n=162). Mean overall help-seeking intentions were similar between Facebook users and non-users, even after adjustment for potential confounders. Facebook users were very unlikely to turn to Facebook as a venue for support when experiencing either emotional problems or suicidal thoughts. Compared to help-seeking intentions for Facebook, help-seeking intentions for formal (e.g., psychologists), informal (e.g. friends), or phone help lines sources of support were significantly higher. Results did not substantially change when examining participants who were frequent or active users of Facebook. Conclusions: In its current form, a social media platform such as Facebook is not seen as a venue for seeking help for emotional problems or suicidality among people with major depression in the United States.

  • 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.

  • Development and Formative Evaluation of a Smartphone Application for Smoking Cessation: Crush the Crave

    From: Journal of Medical Internet Research

    Date Submitted: Sep 21, 2017

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

    Background: Emerging evidence supports the use of smartphone apps for smoking cessation. However, there remains a paucity of research describing the design and development processes of mobile health (...

    Background: Emerging evidence supports the use of smartphone apps for smoking cessation. However, there remains a paucity of research describing the design and development processes of mobile health (mHealth) interventions, leaving unanswered questions about how to productively leverage apps for quitting smoking. Objective: This paper describes the process of developing the Crush the Crave (CTC) app for smoking cessation and the results of a formative evaluation of app usage behaviour, as part of a broader program of research that seeks to establish the effectiveness of the CTC app. Methods: The Spiral Technology Action Research (STAR) five-cycle model (listen, plan, do, act, and study) was employed to guide development, implementation, and dissemination of CTC. The approach to development and formative evaluation included focus groups with young adult smokers (n=78), analysis of the content of existing apps, two sessions with content experts, and google analytics to assess user behaviour during a 12-month pilot. Results: LISTEN – focus groups revealed young adult smoker preferences of 1) Positive reinforcement, 2) Personalization, 3) Social support, 4) Quit support, 5) Tracking the behaviour, and 6) Tracking quit benefits. PLAN – Informed by evidence for smoking cessation, young adult preferences, and an assessment of popular cessation apps, content experts produced a mind map and a storyboard describing app content and structure. DO – Focus groups with young adult smokers provided feedback on the first version of the app with opinions on content and suggestions for improvement such as providing alerts, distractions from craving, and improvements to the organization of help information for quitting. ACT – CTC App refinements were made and app content was organized using the four key design components of credibility, task support, dialogue support and social support. CTC was launched April 2013 and piloted from the period July 2013 to June 2014 where 1,987 Android users had 18,567 sessions resulting in 59,384 page views and 89.6% of users returning within the same day to use CTC. STUDY – A pragmatic randomized controlled trial of CTC was launched August 2014 to demonstrate that including mHealth technology as a population-based intervention can help young adult smokers to quit. Conclusions: CTC is one of the first smoking cessation apps designed to meet the needs of young adult smokers. The development was informed by the inclusion of young adults in the design and the systematic application of multiple stakeholder input, scientific evidence, and theory. The STAR model approach was followed from the beginning of intervention development, which should facilitate optimization of mHealth interventions in the future.

  • Web-Based Patient Education in Orthopaedics: A Systematic Review

    From: Journal of Medical Internet Research

    Date Submitted: Sep 21, 2017

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

    Background: Orthopaedic patients frequently use the Internet to find health information. Patient education that is distributed online may form an easy-accessible, time- and cost-effective alternative...

    Background: Orthopaedic patients frequently use the Internet to find health information. Patient education that is distributed online may form an easy-accessible, time- and cost-effective alternative to patient education delivered through traditional channels, such as one-on-one consultations or booklets. However, no systematic evidence for the comparative effectiveness of web-based educational interventions exists. Objective: The objective of this systematic review was to examine the effects of web-based patient education interventions for adult orthopaedic patients and to compare its effectiveness to generic health information websites and traditional forms of patient education. Methods: CINAHL, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, PUBMED, ScienceDirect, Scopus and Web of Science were searched covering the period 1995-2016. Peer-reviewed English and Dutch studies were included if they delivered patient education via the Internet to the adult orthopaedic patient population, and assessed its effects in a controlled or observational trial. Results: A total of 10 trials reported in 14 studies involving 4172 patients were identified. Nine trials provided evidence for increased patients’ knowledge after web-based patient education. Seven trials reported increased satisfaction and good evaluations of web-based patient education. No compelling evidence exists for an effect of web-based patient education on anxiety, health attitudes and behaviour, or clinical outcomes. Conclusions: Web-based patient education may be offered as a time- and cost-effective alternative to current educational interventions when the objective is to improve patients’ knowledge and satisfaction. However, these findings may not be representative for the whole orthopaedic patient population as most reviewed trials included considerably younger, higher-educated, and internet-savvy participants only.

  • The effectiveness of healthcare information technologies: An empirical evaluation of trust, security beliefs, and privacy as determinants of healthcare outcomes.

    From: Journal of Medical Internet Research

    Date Submitted: Sep 21, 2017

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

    Background: The diffusion of health information technologies (HITs) within the healthcare sector continues to grow. However, there is no theory explaining how HITs success influences patient care outc...

    Background: The diffusion of health information technologies (HITs) within the healthcare sector continues to grow. However, there is no theory explaining how HITs success influences patient care outcomes. And the increase in data breaches, HITs success now hinges on the effectiveness of data protection solutions. Yet still, empirical research has only addressed privacy concerns, with little regard for other factors of information assurance. Objective: We study the effectiveness of HITs using the DeLone and McLean IS Success Model (DMISSM)1. We examine the role of information assurance constructs (i.e., information privacy and security beliefs, and trust in health information) as measures of HIT effectiveness. We also investigate the relationships between information assurance and three aspects of system success; electronic medical record (EMR) use, patients’ attitudes towards health information exchange (HIE), and patient care quality. Methods: Using structural equation modeling, we analyze data from a sample of 3,677 cancer patients. We used R software and the Lavaan package to test the hypothesized relationships. Results: Our extension of the DMISSM1 to healthcare was supported. We found that increased privacy concerns reduce the frequency of EMR use, positive attitudes towards HIE, and perceptions of patient care quality. Also, information security beliefs increase EMR use and the positive attitudes towards HIE. Trust in health information had a positive association with attitudes towards HIE, and patient care quality. Trust in health information had no direct effect on EMR use; however, it had an indirect relationship through information privacy concerns. Conclusions: Information trust and information security safeguards increase perceptions of patient care quality. Information privacy concerns reduce EMR use by patients, patients’ positive attitudes towards HIE exchange, and overall patient care quality. Healthcare organizations are encouraged to implement security safeguards for increasing trust and EMR use, reducing privacy concerns, and consequently increasing patient care quality.

  • 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.

  • Extract the Best from a Nursing Home Data Warehouse and Build a Syndromic Surveillance System

    From: JMIR Public Health and Surveillance

    Date Submitted: Sep 22, 2017

    Open Peer Review Period: Oct 6, 2017 - Oct 20, 2017

    Background: New Nursing Homes (NH) data warehouses fed from residents’ medical records open the way for monitoring health elderly population on a daily basis. Elsewhere syndromic surveillance has al...

    Background: New Nursing Homes (NH) data warehouses fed from residents’ medical records open the way for monitoring health elderly population on a daily basis. Elsewhere syndromic surveillance has already shown that professional data can be used for public health (PH) surveillance but not through a long term follow-up of the same cohort. Objective: The goal of this study was to build and assess a national ecological NH PH surveillance system (SS). Methods: Using a national network of 126 NH, an elderly cohort was built. Medical and personal data were extracted from residents’ electronic health records (EHR) and transmitted through internet to a national server in almost real time. Socio-demographic, autonomy and syndromic information were recorded. A set of twenty-six syndromes was defined using pattern matching with the standard query language LIKE operator and a Delphi-like method, through [November 2010 - June 2016]. Early aberration reporting system EARS and Bayes surveillance algorithms of the R surveillance® package were then used to assess this syndromic data against the Sentinelles network data, French epidemics gold-standard, following Centers for Disease and Control (CDC) surveillance system assessment guidelines. Results: By extracting all socio-demographic residents’ data, a cohort of 41 061 elderly was built. EARS_C3 algorithm on NH influenza and acute gastro enteritis AGE syndromic data gave respectively sensitivities of 0.482 and 0.539 and specificities of 0.844 and 0.952 over a 6 year-period, allowing to forecast the last influenza outbreak by more than 2 weeks. Also, assessing influenza and AGE syndromic data quality, precisions through last season epidemic weeks’ peaks (weeks 03-2017 and 01-2017) were of 0.98 and 0.96, whereas through last summer epidemic weeks’ low of 0.95 and 0.92 (week 33-2016). Conclusions: This study confirmed that using the NH medical care transmissions gives a good opportunity to develop a genuine French national PH SS dedicated to the elderly. Access to seniors’ free-text validated health data responds to a PH issue for the surveillance of this fragile population. This database will also make possible new ecological research that will improve prevention, care and rapid response when facing health threats. Clinical Trial: Not applicable

  • 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.

  • 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.

  • Real-time Antiretroviral Therapy Adherence Interventions are Acceptable and Feasible in Rural Uganda: Mixed Methods Findings from a Pilot Randomized Controlled Trial

    From: Journal of Medical Internet Research

    Date Submitted: Oct 15, 2017

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

    Background: Wireless electronic adherence monitors can detect antiretroviral therapy (ART) adherence lapses and trigger interventions in real time, thus potentially avoiding unnecessary HIV viremia. E...

    Background: Wireless electronic adherence monitors can detect antiretroviral therapy (ART) adherence lapses and trigger interventions in real time, thus potentially avoiding unnecessary HIV viremia. Evidence about the acceptability and feasibility of these monitors and associated interventions, however, is limited. Objective: To assess the acceptability and feasibility of real-time adherence monitoring linked to short message service (SMS) reminders and notifications to support adherence amongst individuals living with HIV who are taking ART in rural southwestern Uganda. Methods: Sixty-three individuals living with HIV who are initiating ART were enrolled in a pilot randomized controlled trial exploring the effects of SMS plus real-time adherence monitoring on ART adherence. Participants received a real-time adherence monitor and were randomized to one of the following study arms: (1) scheduled SMS, (2) SMS triggered by missed or delayed doses, or (3) no SMS. SMS notifications were also sent to forty-five patient-identified social supporters for sustained adherence lapses. Qualitative interviews were performed to assess acceptability of this technology. An inductive, content analytic approach framed by the Unified Theory of Acceptance and Use of Technology model was used to analyze qualitative data. Quantitative feasibility data, including device functionality and SMS tracking data, were recorded and summarized descriptively. Results: Participants reported that real-time monitoring intervention linked to SMS reminders and notifications are generally acceptable. The key acceptability factor was perceived usefulness; participants perceived both the monitoring enabled through the device and the SMS reminders as helpful for medication adherence. The intervention was found to be technically feasible as data was obtained from most participants as expected most of the time. Potential feasibility challenges included the impact of the technology on confidentiality, shared phone ownership, usability skills, and availability of electricity. Conclusions: Real-time adherence monitoring integrated with SMS reminders and social support notifications is an acceptable and feasible intervention in a resource limited country. Additional studies are needed in diverse contexts. Clinical Trial: NCT01957865

  • 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.

  • Mobile application of theoretically-based emotion regulation strategies using a wearable sensor: Feasibility and usability among homeless adolescent mothers

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 26, 2017

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

    Background: Many adolescent mothers (AMs) are parenting young children under highly stressful conditions as they are managing first-time parenthood, poverty, lack of housing, school/work demands, and...

    Background: Many adolescent mothers (AMs) are parenting young children under highly stressful conditions as they are managing first-time parenthood, poverty, lack of housing, school/work demands, and challenging peer and familial relationships. Increasing AMs effective emotion regulation strategies using ‘just-in-time’ mobile technology has the potential to potential to intervene at various points in the emotion regulation process to provide support for more adaptive emotional and behavioral regulation during real-life situations. Objective: The goal of this paper is to examine the acceptability, feasibility, use patterns, and mechanisms by which the technology fostered AMs adaptive emotion regulation strategies under real-life conditions. Methods: Participants (N=49) were enrolled in the intervention condition of a randomized controlled pilot study of homeless AMs living in group-based shelters. Intervention activities involved a blended intervention consisting of provider-delivered, in-person intervention sessions and the companion Calm Mom technology. Calm Mom consisted of a mobile app and wrist-worn sensorband for the ambulatory measurement and alerting of increased electrodermal activity (EDA), a physiological measurement of stress. We examined logs of mobile app activity and conducted semi-structured qualitative interviews with a subsample (N= 10) of participants. Qualitative data analysis was guided by the theoretical framework of the intervention and included an analysis of emerging themes and concepts. Results: Participants used one or more elements of the technology on average, 44.11% of days they had the Calm Mom technology (SD = 24.82). Overall, participants indicated that one or more of the elements Calm Mom supported their ability to effectively regulate their emotions in the course of their daily life in ways that were consonant with the intervention’s theoretical model. For many AMs, the app became an integral tool for managing stress. Due to technical challenges, fewer participants received sensorband alerts however, those that received alerts reported high levels of acceptability as the technology helped them to identify their emotions and supported them in engaging in more adaptive behaviors during real-life stressful situations with their children, peers, and family members. Conclusions: Calm Mom is a promising technology for providing theoretically-driven behavioral intervention strategies during real-life stressful moments among a highly vulnerable population. Future research efforts will involve addressing technology challenges and refining tailoring algorithms for implementation in larger scale studies.

  • A confirmatory analysis of the three-factor structure of the eHealth Literacy Scale among magnetic resonance imaging and computed tomography outpatients

    From: JMIR Human Factors

    Date Submitted: Oct 3, 2017

    Open Peer Review Period: Oct 3, 2017 - Oct 17, 2017

    Background: eHealth literacy is needed to effectively engage with online health resources. The 8-item eHealth Literacy Scale (eHEALS) is a common measure of eHealth literacy, and has been suggested to...

    Background: eHealth literacy is needed to effectively engage with online health resources. The 8-item eHealth Literacy Scale (eHEALS) is a common measure of eHealth literacy, and has been suggested to comprise three factors: awareness (2 items), skills (3 items), evaluate (3 items). Objective: This cross-sectional study sought to verify this three factor eHEALS structure among magnetic resonance imaging (MRI) and computed tomography (CT) medical imaging outpatients. Methods: MRI and CT outpatients were recruited consecutively in the waiting room of one major public hospital. Participants self-completed a touchscreen computer survey, assessing their sociodemographic, scan and internet use characteristics. The eHEALS was administered to internet users, and the factor structure was tested using structural equation modelling. Results: Of 405 invited patients, 354 (87.4%) were interested in participating in the study, and of these, 268 (75.7%) were eligible. Two hundred and fifty six eligible participants (95.5%) completed all eHEALS items. All factor loadings were 0.80 and above and statistically significant (P<.001). Two out of three goodness of fit indices were adequate (SRMR = 0.038, CFI = 0.94; RMSEA = 0.16). Item 3 was removed due to its significant correlation with item 2 (LM estimate = 104.02; P<.001), and high loading on two factors (LM estimate = 91.11; P<.001). All three indices of the resulting 7-item model indicated goodness of fit (χ2(11) = 11.32; SRMR = 0.013; CFI = 0.99; RMSEA = 0.01). Conclusions: The three-factor eHEALS structure was supported. Whilst further factorial validation studies are needed, these three scale factors may be used to identify individuals who could benefit from interventions to improve eHealth literacy awareness, skill and evaluation competencies.

  • Obesity prevention in infants using mHealth: key lessons and impact of the Growing healthy program on milk feeding, timing of introduction of solids and infant growth

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 26, 2017

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

    Background: The first year of life is an important window in which to initiate healthy infant feeding practices to promote healthy growth. Interventions delivered by mobile phone (mHealth) provide a...

    Background: The first year of life is an important window in which to initiate healthy infant feeding practices to promote healthy growth. Interventions delivered by mobile phone (mHealth) provide a novel approach for reaching parents, however little is known about the effectiveness of mHealth for child obesity prevention. Objective: The objective of this study was to determine the feasibility and effectiveness of an mHealth obesity prevention intervention in terms of reach, acceptability and impact on key infant feeding outcomes Methods: A quasi-experimental study was conducted with an mHealth intervention group (‘Growing healthy’, GH) and a non-randomized comparison group (‘Baby’s First Food’, BFF). The intervention group received access to a free app and website containing information on infant feeding, sleep and settling, and general support for parents with infants 0-9 months. App generated notifications directed parents to age and feeding specific content within the app. Both groups completed online surveys at three time points: when their infants were less than three months old (T1), six months (T2) and nine months of age (T3). Survival analysis was used to examine duration of any breastfeeding and formula introduction, and cox proportional hazard regression was performed to examine the hazard ratio for ceasing breast feeding between the two groups. Multivariate logistic regression with adjustment for a broad range of child and parental factors was used to compare the exclusive breastfeeding, formula feeding behaviors, and timing of solid introduction between two groups. Mixed effect polynomial regression models were performed to examine the group differences in growth trajectory of BMIz, weight and height from birth to T3. Results: A total of 909 parents initiated the enrollment process for the study and a final sample of 645 parents (GH n=301, BFF n= 344) met the eligibility criteria and were included in the study. The majority of mothers were Australian born and just under half had completed a university education. Retention of participants was high (80%) in both groups. Most parents (84%) downloaded and used the app. There was a high level of satisfaction with the program with 86% reporting that they trusted the information in the app and 85% would recommend it to a friend, however some technical problems were encountered with just over a quarter of parents reporting that the app failed to work at times. There were no significant differences between groups in any of the target behaviors. Growth trajectories of BMIz, weight and height also did not differ between the two groups. Conclusions: An mHealth intervention using a smartphone app to promote healthy infant feeding behaviors is a feasible and acceptable mode for delivering obesity prevention intervention to parents. Learnings from this study will be used to further enhance the program to improve its potential for changing infant feeding behaviors. Future research using randomized controlled design is required to determine the effectiveness of mHealth programs in preventing obesity early in life.

  • Youth Co-design Of A Mobile Phone app to facilitate self-monitoring and management of mood symptoms in young people with major depression, suicidal ideation and self-harm

    From: JMIR Mental Health

    Date Submitted: Sep 26, 2017

    Open Peer Review Period: Sep 26, 2017 - Nov 21, 2017

    Background: Effective treatment of depression in young people is critical given its prevalence, impacts and link to suicide. Clinical practice guidelines point to the need for regular monitoring of de...

    Background: Effective treatment of depression in young people is critical given its prevalence, impacts and link to suicide. Clinical practice guidelines point to the need for regular monitoring of depression symptom severity and the emergence of suicidal ideation, to track treatment progress and guide intervention delivery. Yet, this is seldom integrated in clinical practice. Objective: We aimed to address the gap between guidelines about monitoring and real-world practice by co-designing an app with young people that allows for self-monitoring of mood and communication of this monitoring with a clinician. Methods: We engaged young people aged 18 to 25 who had experienced depression, suicidal ideation and/or self-harm, as well as clinicians in a co-design process. We used a human centred co-design “design studio” methodology where young people designed the features of the app first individually and then as a group. This resulted in a minimal viable product design, represented through low fidelity hand drawn wireframes. Clinicians were engaged throughout the process via focus groups. Results: The app incorporated a mood monitoring feature with innovative design aspects that allowed customisation, and was named a ‘well-being tracker’ in response to the need for a positive approach to this function. Brief personalised interventions designed to support young people in the intervals between face-to-face appointments were embedded in the app and were immediately available via pop-ups generated by a back-end algorithm within the well-being tracker. Issues regarding the safe incorporation of alerts generated by the app into face-to-face clinical services were raised by clinicians (i.e., responding in a timely manner) and will need to be addressed in the full implementation of the app into clinical services. Conclusions: The potential to improve outcomes for young people via technology-based enhancement to interventions is enormous. Enhancing communication between young people and their clinicians about symptoms and treatment progress, and increase access to timely and evidence based interventions are desirable outcomes. To achieve positive outcomes for young people using technology (app) based interventions, it is critical to understand an incorporate, in a meaningful way, the expectations and motivations of both young people and clinicians.

  • Heplink: Integrated Hepatitis C Care: Protocol for a feasibility study in primary care

    From: JMIR Research Protocols

    Date Submitted: Oct 2, 2017

    Open Peer Review Period: Oct 4, 2017 - Oct 18, 2017

    Background: Hepatitis C (HCV) infection is a major cause of chronic liver disease and death. Injecting drug use remains the significant cause of new infections in the European Union, with estimates of...

    Background: Hepatitis C (HCV) infection is a major cause of chronic liver disease and death. Injecting drug use remains the significant cause of new infections in the European Union, with estimates of HCV antibody prevalence among persons who inject drugs (PWID) ranging from 5% to 90% in 29 European countries. In Ireland and the EU, primary care is a key area to focus efforts to enhance HCV diagnosis and treatment among PWID. Objective: The HepLink study aims to improve HCV care outcomes among opiate substitution therapy (OST) patients in general practice by developing an integrated model of HCV care and evaluating its feasibility, acceptability and likely efficacy. Methods: The integrated model of care comprises: education of community practitioners, outreach of a HCV trained nurse into GP practices, and enhanced access of patients to community-based evaluation of their HCV disease (including a novel approach to diagnosis, i.e. Fibroscan). 24 OST prescribing GP practices were recruited from the professional networks/databases of members of the research consortium. Patients were eligible if ≥18 years of age, on OST and attend the practice for any reason during the recruitment period. Baseline data on HCV care processes/outcomes were extracted from the clinical records of participating patients. Results: A substantial proportion of HCV-positive patients on OST in general practice are not engaged with specialist hospital services but qualify for DAA treatment. The Heplink model has the potential to reduce HCV-related morbidity and mortality. Conclusions: This feasibility study will inform clinical practice by providing initial indications as to whether a nurse led integrated model of HCV care is feasible, acceptable, and also effective among problem drug users attending primary care. It will also inform future research on the topic by providing key parameters for the design of a future cluster RCT. Clinical Trial: N/A

  • Self-harm and cyberbullying: a systematic review of the association between cyberbullying and self-harm and suicidal behaviours in children and young people

    From: Journal of Medical Internet Research

    Date Submitted: Sep 29, 2017

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

    Background: Given concerns about bullying via electronic communication in children and young people and its possible contribution to self-harm (SH) we have reviewed the evidence for associations betwe...

    Background: Given concerns about bullying via electronic communication in children and young people and its possible contribution to self-harm (SH) we have reviewed the evidence for associations between cyberbullying involvement and SH or suicidal behaviours (such as suicidal ideation, suicide plans and suicide attempts) in children and young people. Objective: The aim of this study was to systematically review the current evidence examining the association between cyberbullying involvement as victim and/or perpetrator and SH and suicidal behaviours in children and young people (under 25-years), and where possible, to meta-analyse data on the associations. Methods: An electronic literature search was conducted for all studies published between 01/01/1996 and 03/02/2017 across sources including Medline, Cochrane, and PsycINFO. Articles were included if the study examined any association between cyberbullying involvement and SH or suicidal behaviours and reported empirical data in a sample under 25-years of age. Quality of included papers was assessed and data extracted. Meta-analyses of data were conducted. Results: Thirty-one eligible articles from 24 independent studies were included covering a population of 155,471 children and young people. Twenty-five articles (20 independent studies, n = 115,056) identified associations (negative influences) between cybervictimisation and SH/suicidal behaviours or between perpetrating cyberbullying and suicidal behaviours. Three additional articles, in which the cyberbullying, SH or suicidal behaviours measures had been combined with other measures (such as traditional bullying and mental health problems), also showed negative influences (n = 44,526). Three articles showed no significant associations (n = 4,733). Meta-analyses, producing odds ratios (OR) as a summary measure of effect size (e.g. ratio of the odds of cybervictims who have experienced SH versus non-victims who have experienced SH) showed that, compared with non-victims, those who have experienced cybervictimisation were: 2·35 [1·65, 3·34] times as likely to SH; 2·10 [1·73, 2·55] times as likely to exhibit suicidal behaviours; 2·57 [1·69, 3·90] times more likely to attempt suicide; and 2·15 [1·70, 2·71] times more likely to have suicidal thoughts. Cyberbullying perpetrators were 1·21 [1·02, 1·44] times more likely to exhibit suicidal behaviours and 1·23 [1·10, 1·37] times more likely to experience suicidal ideation than non-perpetrators. Conclusions: Victims of cyberbullying are at a greater risk than non-victims of both SH and suicidal behaviours. To a lesser extent, perpetrators of cyberbullying are at risk of suicidal behaviours and suicidal ideation when compared to non-perpetrators. Policymakers and schools should prioritise the inclusion of cyberbullying involvement in programmes to prevent traditional bullying. Type of cyberbullying involvement, frequency, and gender should be assessed in future studies.

  • Estimation of Symptom Severity During Chemotherapy From Passively Sensed Data: An Exploratory Study

    From: Journal of Medical Internet Research

    Date Submitted: Sep 26, 2017

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

    Background: Physical and psychological symptoms are common during chemotherapy for cancer, and real-time monitoring of these symptoms can improve patient outcomes. Sensors embedded in smartphones and...

    Background: Physical and psychological symptoms are common during chemotherapy for cancer, and real-time monitoring of these symptoms can improve patient outcomes. Sensors embedded in smartphones and wearable activity trackers could be potentially useful in monitoring symptoms passively, with minimal patient burden. Objective: The goal of this study was to explore whether passively sensed smartphone and Fitbit data could be used to estimate daily symptom burden during chemotherapy. Methods: A total of 14 patients undergoing chemotherapy for gastrointestinal cancer participated in the 4-week study. Participants carried an Android phone and wore a Fitbit Charge HR device for the duration of the study and also completed daily severity ratings of 12 common symptoms. Symptom severity ratings were summed to create a total symptom burden score for each day, and ratings were centered on individual patient means and categorized into low, average, and high symptom burden days. Results: Across 295 days of data with both symptom and sensor data, a number of smartphone and Fitbit features were correlated with patient-reported symptom burden scores. Using a classifier to estimate symptom burden, we achieved an accuracy of 88.1% for our population model. The subset of features with the best accuracy included sedentary behavior as the most frequent activity, fewer minutes in light physical activity, less variable and average acceleration of the phone, and longer screen-on time/interactions with apps on the phone. Accuracy of individual models ranged from 78.1-100%, and subsets of relevant features varied across participants. Conclusions: Passive sensor data, including smartphone accelerometer and usage and Fitbit-assessed activity and sleep, were strongly related to daily symptom burden during chemotherapy. These findings highlight opportunities for long-term monitoring of cancer patients during chemotherapy with minimal patient burden as well as real-time adaptive interventions aimed at early management of worsening or severe symptoms.

  • 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.

  • Effect on the metabolic biomarkers in schoolchildren, after a comprehensive intervention using electronic media and in-person sessions, to change lifestyles: Community Trial

    From: Journal of Medical Internet Research

    Date Submitted: Sep 27, 2017

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

    Background: Obesity is a chronic low-intensity state of inflammation with metabolic alterations that acquired during childhood, lead to severe illness in adult age. Encouraging healthy eating habits a...

    Background: Obesity is a chronic low-intensity state of inflammation with metabolic alterations that acquired during childhood, lead to severe illness in adult age. Encouraging healthy eating habits and physical activity is the basis for preventing and treating obesity and its complications. Objective: To evaluate how a comprehensive intervention promoting healthy eating habits and physical activities in schools affects children’s metabolic biomarkers. Methods: Out of four Mexico City primary schools in this study, two participated in a 12-month intervention (IG) and the other two were control groups (CG). The intervention had two components: 1) Parents/schoolchildren attended in-person educational sessions promoting healthy eating and physical activity habits and were provided printed information; 2) parents were able to seek information through a Web site; they also received brief, weekly phone texts. Anthropometric measurements and fasting blood samples were taken from both groups of children at baseline and again after 12 months. Results: Regardless of each child's nutritional status at the beginning of the study, the intervention improved metabolic parameters; the IG showed a negative effect on glucose concentrations (-1.83; CI 95% -3.06 to -0.60), LDL-C (-2.59; CI 95% -5.12 to -0.06), insulin (-0.84; CI 95% -1.31 to -0.37) and HOMA-IR (-0.21; CI 95% -0.32 to -0.09) in comparison to the CG. HOMA-IR improved in children who had higher than baseline BMI z-scores. Conclusions: Intervention through multiple components promoting healthier eating and physical activity habits improved the metabolic parameters of the children in the study after one year, regardless of their nutritional status.

  • Evaluating the Impact of Physical Activity Apps and Wearables: An Interdisciplinary Review

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 27, 2017

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

    Background: Many smartphone applications (apps) and wearables have been designed to improve physical activity. However, their rapidly evolving nature and complexity present challenges for evaluating t...

    Background: Many smartphone applications (apps) and wearables have been designed to improve physical activity. However, their rapidly evolving nature and complexity present challenges for evaluating their impact. Traditional methodologies, such as randomised controlled trials (RCTs), can be slow. To keep pace with rapid technological development, evaluations of mobile health technologies must be efficient. Rapid alternative research designs have been proposed, and efficient in-app data collection methods, including in-device sensors and device-generated logs, are available. As well as effectiveness, it is important to measure engagement and acceptability to help explain how and why apps and wearables work. Objective: To first, explore the extent to which evaluations of physical activity apps and wearables: employ rapid research designs; assess engagement and acceptability, as well as effectiveness; and use efficient data collection methods. Second, to describe which dimensions of engagement and acceptability were assessed. Methods: An interdisciplinary scoping review using eight databases from health and computing science disciplines. Studies were included if they measured physical activity and evaluated physical activity apps or wearables that provided sensor-based feedback. Results were analysed using descriptive numerical summaries, Chi squared testing and qualitative thematic analysis. Results: Of 111 studies included, 61 (55.0%) were published between 2015 and 2017. Most (61, 55.0%) were RCTs, and only two studies (1.8%) used rapid research designs: one single case design, one multiphase optimisation strategy (MOST). Other research designs included: 23 (22.5%) repeated measures designs; 11 (9.9%) non-randomised group designs; 10 (9.0%) case studies and four (3.6%) observational studies. Under a third of studies (35/111, 32.0%) investigated effectiveness, engagement and acceptability together. To measure physical activity, most studies (101/111, 90.1%) employed sensors (either in-device [75/111, 67.6%] or external [26/111, 23.4%]). RCTs were more likely to employ external sensors (accelerometers: P=0.005). Studies that assessed engagement (58/111, 52.3%) mostly used device-generated logs (53/58, 91.4%) to measure the frequency, depth, and length of engagement. Studies that assessed acceptability (64/111, 57.7%) most often used questionnaires (42/64, 64.1%) and/or qualitative methods (34/64, 53.1%) to explore appreciation, perceived effectiveness and usefulness, satisfaction, intention to continue use, and social acceptability. Some studies (16/111, 14.4%) assessed dimensions more closely related to usability (i.e. burden of sensor wear and use, interface complexity, and perceived technical performance). Conclusions: The rapid increase of research into the impact of physical activity apps and wearables means that evaluation and reporting guidelines are urgently needed to promote efficiency through the use of rapid research designs, in-device sensors and user-logs to collect effectiveness, engagement and acceptability data, and to facilitate the synthesis of evidence across health and HCI disciplines.

  • How mobile app design impacts user responses to mixed self-tracking outcomes: Exploring the role of spatial distance for hedonic editing

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 26, 2017

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

    Background: Goal-setting or goal-monitoring features are among the most common behavioral change techniques employed in contemporary self-tracking apps. For these techniques to be effective, it is rel...

    Background: Goal-setting or goal-monitoring features are among the most common behavioral change techniques employed in contemporary self-tracking apps. For these techniques to be effective, it is relevant to understand how the visual presentation of goal-related outcomes employed in the app design affects users’ responses to their self-tracking outcomes in order to produce health behavior intentions and to accordingly increase a self-tracking app’s impact. Objective: Transferring principles of hedonic editing originally from the field of economics to the context of self-tracking, this study investigated whether a spatially close (vs. distant) presentation of mixed positive and negative self-tracking outcomes from multiple domains (i.e., activity, diet) facilitates the hedonic editing of self-tracking outcomes. Further, this study examined how the opportunity to hedonically edit one’s self-tracking outcome profile relates to users’ future health behavior intentions. Methods: To assess users’ responses to a spatially close (vs. distant) presentation of a mixed gain (vs. mixed loss) self-tracking outcome profile, a randomized 2 x 2 between subjects online experiment with 397 participants (Mage = 27.41, 71.5% female) was conducted in Germany. Results: In the case of a mixed gain (mixed loss) outcome profile, a spatially close (distant) presentation facilitates hedonic editing of one’s self-tracking outcomes, which is indicated by a systematic memory bias, i.e., the underestimation of the negative outcome (P = .064; or the exact recognition of the positive outcome, respectively, P = .039). Further, our results show that when the visual presentation of one’s self-tracking outcomes provides the opportunity for hedonic editing, particularly consumers with a low (vs. high) health motivation produce compensatory health beliefs, which in turn lead to lower health behavior intentions in response to their self-tracking outcomes (index of moderated mediation = .0352; 95% CI = [.0011; .0923]). Conclusions: To the best of our knowledge, this study provides the first evidence how spatial distance employed in a self-tracking app’s visualization of goal outcomes impacts users’ responses to their self-tracked data. This study has implications for the design of self-tracking apps as it provides useful insights on how the presentation of goal outcomes can impact the effectiveness of commonly employed behavioral change techniques in self-tracking apps (i.e., goal setting).

  • 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.

  • Evolution on Cognitive Rehabilitation after Stroke: from Traditional Techniques to Smart and Personalised ICT Home-based Systems

    From: Journal of Medical Internet Research

    Date Submitted: Sep 27, 2017

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

    Background: Neurological patients after stroke usually present cognitive deficits which impose a dependency in their daily living. These deficits mainly affect the performance of some daily activities...

    Background: Neurological patients after stroke usually present cognitive deficits which impose a dependency in their daily living. These deficits mainly affect the performance of some daily activities which can be dangerous if no supervision is provided. For that reason, stroke patients need long-term processes for their cognitive rehabilitation. Considering that classical techniques are focused on acting as a guide, teaching by repetition and they depend on the help of therapists, big efforts are being made to improve current methodologies and get benefits from e-health and web-based architectures to implement ICT systems that achieve reliable, personalized and home-based platforms to increase efficiency and level of attractiveness for patients and carers. Objective: The goal of this work is to provide a wide swept in the practices implemented for the assessment of stroke patients and cognitive rehabilitation. The article puts together traditional methods and the most recent personalised platforms based on ICT technologies and even Internet of Things in order to show the evolution and improvements in the field of cognitive rehabilitation. Methods: A literature review has been distributed to a multidisciplinary team of researchers from engineering, psychology and sport science fields. The systematic review has been focused on scientific published research, other European projects and the most current innovative large-scale initiatives in the area. 3,469 results were managed from the Web of Science, 284 articles from JMIR Publications were obtained and finally, 15 research European projects from CORDIS during the last fifteen years were reviewed for classification and selection regarding their relevance. Results: The analysis of evolution on the techniques gave evidence on the improvements in the implementation of traditional techniques. In that sense, 7 relevant studies on the screening of stroke patients have been presented with 6 additional methods for the analysis of kinematics and 9 works on the execution of goal-oriented activities. Meanwhile, the classical methods to provide cognitive rehabilitation have been classified in the 5 main techniques implemented. Finally, the review has finalised with the selection of 8 different ICT-based approaches found in scientific-technical articles; 9 European projects funded by the European Commission that offer e-health architectures; and other large-scale activities such as smart houses and the initiative City4Age. Conclusions: Stroke is one of the main causes that most negatively affect countries in the socio-economic aspect. The design of new ICT-based systems should provide 4 main features for an efficient and personalised cognitive rehabilitation: support in the execution of complex daily tasks, automatic error detection, home-based performance, and accessibility. Only 33% of the European projects presented fulfilled those requirements at the same time. For this reason, current and future large-scale initiatives focused on e-health and smart environments try to solve this situation by providing more complete and sophisticated platforms.

  • 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

  • The KnOT Study: Knowing Operative Tying

    From: JMIR Medical Education

    Date Submitted: Sep 27, 2017

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

    Background: Medical students lack knowledge about surgical knot tying. Objective: To determine whether viewing a web-based expert knot tying training video, in addition to the standard third year medi...

    Background: Medical students lack knowledge about surgical knot tying. Objective: To determine whether viewing a web-based expert knot tying training video, in addition to the standard third year medical student curriculum, will result in more proficient surgical knot tying. Methods: At the start of their Obstetrics and Gynecology clerkship, 45 students were videotaped tying surgical knots for 2 minutes using a board model. Two blinded Female Pelvic Medicine and Reconstructive Surgery physicians evaluated proficiency with a standard checklist (score range 0-16) and anchored scoring scale (range 0-20); higher numbers represent better skill. Students were then randomized to either (1) expert video or (2) no video. The “video” group was provided unlimited access to an expert knot tying instructional video. At the completion of the clerkship, students were again videotaped and evaluated. Results: At initial evaluation, pre-clerkship cumulative scores (range 0-36) on the standard checklist and anchored scale were not significantly different between the groups (20.3 ± 7.1 versus 20.2 ± 9.2, P=0.90 in the non-video and video group, respectively). Post-clerkship scores improved in both the non-video and video groups (28.4 ± 5.4, P <0.001 versus 28.7 ± 6.5, P <0.01, respectively). Increased knot board practice was significantly correlated with higher post-clerkship scores on the knot tying task, but only in the video group (r=0.47, P <0.05). Conclusions: The addition of a web-based expert instructional video to a standard curriculum, coupled with knot board practice, appears to have a positive impact on medical student knot tying proficiency.

  • What is the quality of publicly available physical activity apps? A review and content analysis

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 5, 2017

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

    Background: Within the new digital health landscape, the rise of health apps creates novel prospects for health promotion. The market is saturated with apps that aim to increase physical activity (PA)...

    Background: Within the new digital health landscape, the rise of health apps creates novel prospects for health promotion. The market is saturated with apps that aim to increase physical activity (PA). Despite the wide distribution and popularity of PA apps, there are limited data on their effectiveness, user experience, and safety of personal data. Objective: The purpose of this review and content analysis was to evaluate the quality of the most popular PA apps on the market using healthcare quality indicators. Methods: The top-ranked 400 free and paid apps from iTunes and Google Play stores were screened. Apps were included if the primary behavior targeted was PA; targeted users were adults; the apps had stand-alone functionality. The apps were downloaded on mobile phones and assessed by two reviewers against the following quality assessment criteria: 1) users’ data privacy and security, 2) presence of Behavioral Change Techniques (BCTs) and quality of the development and evaluation processes, and 3) user ratings and usability. Results: Out of 400 apps, 156 met the inclusion criteria and 65 apps were randomly selected to be downloaded and assessed. Almost 30% apps (19 out of 65) do not have privacy policy. Every app contained at least 1 BCT, with an average number of 7, and a maximum of 13 BCTs. All but 1 app had commercial affiliation, 12 consulted an expert and none reported involving users in the app development. Only 12 of 65 apps had a peer-reviewed study connected to the app. User ratings were high with only a quarter of the ratings falling below 4 stars. The median usability score was “excellent”: 86.3 of out 100 possible. Conclusions: Despite the popularity of PA apps available on the commercial market, there were substantial shortcomings in the areas of data safety and likelihood of effectiveness of the apps assessed. The limited quality of the apps may represent a missed opportunity for PA promotion.

  • 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.

  • Usability Testing of a Mobile Application to Support Caregivers' Tasks at the Patient's Bedside

    From: JMIR mHealth and uHealth

    Date Submitted: Sep 28, 2017

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

    Background: The introduction of clinical information systems (CIS) has increased the amount of clinical documentation. Although this documentation generally improves patient safety, it has become a ti...

    Background: The introduction of clinical information systems (CIS) has increased the amount of clinical documentation. Although this documentation generally improves patient safety, it has become a time-consuming task for nurses, which limits their time with the patient. Based on a user-centered methodology, we have developed a mobile application, named BEDSide Mobility, to support nurses in their daily workflow and to facilitate documentation at the bedside. Objective: The aim of the study was to assess the usability of the BEDSide Mobility app in terms of the navigation and interaction design. Methods: Nurses were asked to complete a scenario reflecting their daily work with patients. Their interactions with the app were captured with eye-tracking glasses and by using the “think aloud” protocol. After completing the tasks, participants filled out the system usability scale questionnaire (SUS). Descriptive statistics were used to summarize task completion rates and the users’ performance. Results: A total of 10 nurses (ages 21-50) participated in the study. Overall, they were satisfied with the navigation, layout and interaction design of the app, with the exception of one user who was unfamiliar with smartphones. The problems identified concerned the ambiguity of some icons and the navigation logic. Conclusions: The participants’ results indicate a good usability, high acceptance and high satisfaction with the developed app.

  • 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.

  • A New Security and Privacy Track in a Health Informatics Graduate Program

    From: JMIR Medical Education

    Date Submitted: Sep 28, 2017

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

    Background: The widespread application of technologies such as Electronic Health Records, mobile health, and telemedicine platforms has made it easy for healthcare providers to collect relevant data a...

    Background: The widespread application of technologies such as Electronic Health Records, mobile health, and telemedicine platforms has made it easy for healthcare providers to collect relevant data and deliver healthcare regimens. While efficacious, these new technologies also pose serious security and privacy challenges. Objective: The training program described herein aims at preparing well-informed health information security and privacy professionals. Methods: A new educational track has been built within a health informatics graduate program. Several existing graduate courses have been enhanced with new security and privacy modules. New labs and seminars have been created and students are being encouraged to participate in research projects and obtain real world experience from industry partners. Students in this track receive both theoretical education and hands-on practice. Evaluations have been performed on this new track by conducting multiple surveys on a sample of students. Results: We have succeeded in creating a new security track and developing pertinent curriculum. The newly created security materials have been implemented in multiple courses. The evaluation indicated that students (N=30) believed that receiving security and privacy training was important for health professionals, the provided security contents were interesting, and having the enhanced security and privacy training in this program was beneficial for their future career. Conclusions: The security and privacy education for health information professionals in this new security track has been significantly enhanced.

  • Exploring the usability of a web-based platform for supporting people with dementia and caregivers

    From: JMIR Research Protocols

    Date Submitted: Oct 5, 2017

    Open Peer Review Period: Oct 5, 2017 - Oct 19, 2017

    Background: The increasing number of people with dementia (PwD) drives research exploring technology interventions to provide effective care for larger populations. In this concept, a web-based platfo...

    Background: The increasing number of people with dementia (PwD) drives research exploring technology interventions to provide effective care for larger populations. In this concept, a web-based platform (CAREGIVERSPRO-MMD, 620911) was designed to i) improve the quality of life for PwD, ii) reduce caregiver burden, iii) reduce the financial costs for care, and to iv) reduce administration time for health and social care professionals. Objective: To evaluate the usability and usefulness of CAREGIVERSPRO-MMD platform for PwD, informal caregivers, health and social care professionals in respect of a wider strategy followed by the project to enhance the user-centred approach. A secondary aim of the study was to collect recommendations for platform improvements from users. Methods: A mixed methods design recruiting PwD (N= 24), caregivers (N= 24) and professionals (N= 10). Participants were asked to rate their satisfaction, the perceived user-friendliness and ease of use of the platform. Testing occurred at baseline and one week after participants used the platform. Qualitative data were gathered for functionalities of the platform users considered unsatisfactory. Results: The platform was useful for the majority of caregivers (90%) and professionals (89%). These user groups also provided positive evaluations for the ease of use (caregivers: 92%, professionals: 97%) and their satisfaction with the platform (caregivers: 79%, professionals: 73%). Ratings from PwD were lower than the other groups for usefulness (57%), ease of use (41%) and overall satisfaction (47%) with the platform (p<.05). Qualitative comments related to both improvements for functionality and the platform interface. Conclusions: Whilst caregivers and professionals were overall satisfied with the platform further adaptations were recommended by PWD. This reiterates the importance of the involvement of end-users in the development of web-based interventions. Recommendations from users in this paper apply for the interface and functionality of a wider range of interventions.

  • Self-swabbing for virological confirmation of influenza like illness (ILI) amongst an internet based cohort in the UK, 2014-5

    From: Journal of Medical Internet Research

    Date Submitted: Sep 29, 2017

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

    Background: Routine influenza surveillance, based on laboratory confirmation of viral infection often fails to estimate a true burden of influenza like illness (ILI) in the community due to the fact t...

    Background: Routine influenza surveillance, based on laboratory confirmation of viral infection often fails to estimate a true burden of influenza like illness (ILI) in the community due to the fact that those suffering from ILI often manage their own symptoms, without visiting a health professional. Internet based surveillance can complement this traditional health-service-based surveillance by measuring symptoms and health behaviour of a population with minimal time delay. Flusurvey, the UK’s largest crowd-sourced platform for surveillance of influenza, collects routine data on over 6,000 voluntary participants and offers real-time estimates of ILI circulation. However, one criticism of this method of surveillance is that it is only able to assess ILI, rather than virologically confirmed influenza. Objective: We designed a pilot to see if it was feasible to ask individuals from the Flusurvey platform to perform a self-swabbing task, and to assess whether they were able to collect samples with a suitable viral content to be able to identify an influenza virus in the laboratory. Methods: Virological swabbing kits were sent to pilot participants, who then monitored their ILI symptoms over the influenza season (2014-5) through the Flusurvey platform. If they reported ILI, they were asked to undertake the self-swabbing exercise, and return the swabs to Public Health England (PHE) laboratory for multiplex PCR testing. Results: The results showed that samples from 18/51 people who reported ILI tested positive for a virological confirmed infection through multiplex PCR testing. Conclusions: This demonstrated proof of concept that it is possible to apply self-swabbing for virological laboratory testing to an online cohort study. This pilot does not have significant numbers to validate whether Flusurvey surveillance does reflect influenza infection in the community, but it highlights that the methodology is feasible and self-swabbing could be expanded to larger online surveillance activities, such as during the initial stages of a pandemic to understand community transmission or to better assess inter-seasonal activity.

  • A systematic and integrated Review of Studies that Evaluate Technology Enhanced Programmes for Healthcare Professionals

    From: Journal of Medical Internet Research

    Date Submitted: Sep 29, 2017

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

    Background: Background: Technology enhanced learning (TEL) programmes are increasingly seen as the way in which education for healthcare professionals can be transformed giving access to effective on...

    Background: Background: Technology enhanced learning (TEL) programmes are increasingly seen as the way in which education for healthcare professionals can be transformed giving access to effective ongoing learning and training even where time or geographical barriers exist. Given the increasing emphasis on this mode of educational support for healthcare practitioners it is vital that we can effectively evaluate and measure impact to ensure that TEL programmes are effective and fit for purpose. This paper examines the existing evidence base for the evaluation of technology enhanced learning programmes for healthcare professionals. Objective: We aimed to undertake a systematic review of the literature relating to evaluation of technology enhanced learning programmes for healthcare professionals and critically appraise the quality of the studies. Methods: This review employed specific search criteria to identify research studies that included evaluation of technology enhanced learning for healthcare professionals. The databases searched included Medline Ovid, CINAHL Plus Advanced, ASSIA, ZETOC, IEE, AMED, ERIC (January 2006 – January 2017). An additional hand search for relevant articles from reference lists was undertaken. Each of the studies identified was critically appraised for quality using the Crowe Critical Appraisal Tool. This produced a percentage total score for each study across specified categories. A proportion of the studies were independently assessed by an additional two reviewers. Results: The review identified 21 studies that met the inclusion criteria. The studies included scored totals across 8 categories within a range of 37% and 97.5 % and average score of 68 %. A number of common themes were identified in relation to the most common types of TEL evaluation evident in the literature and the type of information reported within TEL evaluation studies. Conclusions: Relatively few studies have examined effective evaluation of TEL education for healthcare professionals. Studies often fail to provide sufficient detail to support transferability or direct future TEL healthcare education programmes.

  • A web application to involve patients in the medication reconciliation process: a user-centered usability and usefulness study

    From: Journal of Medical Internet Research

    Date Submitted: Sep 29, 2017

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

    Background: Medication discrepancies consist of unexplained differences between medication lists at different transition points of care; they are a threat to patient safety. These discrepancies can be...

    Background: Medication discrepancies consist of unexplained differences between medication lists at different transition points of care; they are a threat to patient safety. These discrepancies can be solved through medication reconciliation (MedRec), a complex and time-consuming process. Several approaches to optimizing MedRec have been encouraged, including the development of information technology (IT) tools and patient engagement. The SEAMPAT project aims to develop a MedRec IT platform based on two applications (one for the patient, the “patient app”, the other for healthcare professionals), which were developed using a three-iteration user-centered design. The patient app presents the patient with a medication list compiled from different medication resources. Objective: To evaluate the usability and usefulness of the third iteration of the patient app, from the perspective of different categories of users, with the aims of making recommendations for wider use and informing further research. Methods: We performed a four-month user-centered observational study. After a kick-off session, patients, identified through purposive sampling, were invited to use the patient app at home, to update their medication lists whenever required. Quantitative and qualitative data were collected at different time points to evaluate three dimensions of usability (efficiency, satisfaction, and effectiveness), as well as usefulness. Participants completed two questionnaires on satisfaction and usefulness (including the system usability scale, SUS) at the kick-off and the end of the study. Effectiveness was assessed by measuring the completeness and correctness (i.e. medication discrepancies) of the final medication list generated by the patient application. Qualitative data were collected from observations at different time points and from semi-structured interviews at the end of the study. Results: Forty-eight patients agreed to participate and 42 completed the study, of whom 32 connected at least once to the application at home. Sixty-nine percent of patients considered the patient app to be acceptable (SUS Score ≥ 70) and perceived usefulness was high. The medication list was complete for a quarter of the patients and there was a median of two discrepancies per patient. The main causes were technology-related. The qualitative data enabled the identification of several barriers and, thus, of approaches to optimizing usability and usefulness. These relate to both functional (e.g. access, on-screen display, additional functionalities) and non-functional aspects (e.g. patient awareness, concordance between patient and physician) of the application. For future adoption of the tool, it will be important to address these issues. Conclusions: Our findings highlight the importance and value of user-centered usability testing of a patient application implemented in “real-world” conditions. We believe our study also underlines the need to take patients’ points of view into consideration. To achieve adoption and sustained use by patients, the patient app should meet patients’ needs while also efficiently improving the quality of MedRec.

  • 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.

  • Testing Behaviour Change Techniques to encourage primary care physicians to access cancer screening audit and feedback reports: Protocol for a factorial randomized experiment of email content.

    From: JMIR Research Protocols

    Date Submitted: Oct 5, 2017

    Open Peer Review Period: Oct 5, 2017 - Oct 19, 2017

    Background: Cancer Care Ontario’s Screening Activity Report (SAR) is an online audit and feedback tool designed to help primary care physicians in Ontario, Canada identify patients who are overdue f...

    Background: Cancer Care Ontario’s Screening Activity Report (SAR) is an online audit and feedback tool designed to help primary care physicians in Ontario, Canada identify patients who are overdue for cancer screening or have abnormal results requiring follow-up. Use of the SAR is associated with increased screening rates. To encourage SAR use, Cancer Care Ontario sends monthly emails to registered primary care physicians announcing that updated data are available. However, analytics reveal that 50% of email recipients do not open the email and fewer than 7% click the embedded link to log in to their report. Objective: To determine whether rewritten emails result in increased logins. This manuscript describes how different user- and theory-informed messages intended to improve the impact of the monthly emails will be experimentally tested, and how a process evaluation will explore why and how any effects observed were (or were not) achieved. Methods: A user-centered approach was used to rewrite the content of the monthly email, including messages operationalizing three behaviour change techniques: Anticipated Regret, Material Incentive (behaviour), and Problem Solving. A pragmatic, 2x2x2 factorial experiment within a multiphase optimisation strategy (MOST) will test the redesigned emails with an embedded qualitative process evaluation to understand how and why the email(s) may or may not have worked. Trial outcomes will be ascertained using routinely collected administrative data. Physicians will be recruited for semi-structured interviews using convenience and snowball sampling. Results: As of April 2017, 5576 primary care physicians across the province of Ontario, Canada had voluntarily registered for the SAR, and in so doing, signed up to receive the monthly email updates. From May 2017 to August 2017 participants received the re-designed monthly emails with content specific to their allocated experimental condition prompting use of the SAR. We have not yet begun analyses. Conclusions: This study will inform how to communicate effectively with primary care providers by email and identify which behaviour change technique(s) tested are most effective at encouraging engagement with an audit and feedback report. Clinical Trial: The trial is registered on ClinicalTrials.gov (NLM Identifier: NCT03124316).

  • 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.

  • How do patients with major depression use and benefit from smartphone CBT? Content analyses of completed cognitive and behavioral skills exercises with Kokoro-app

    From: Journal of Medical Internet Research

    Date Submitted: Oct 3, 2017

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

    Background: A strong and growing body of evidence has demonstrated effectiveness of cognitive-behavior therapy (CBT), either face-to-face in person or as self-help via internet, for depression. Howeve...

    Background: A strong and growing body of evidence has demonstrated effectiveness of cognitive-behavior therapy (CBT), either face-to-face in person or as self-help via internet, for depression. However CBT is a complex intervention consisting of several putatively effective components and how each component may or may not contribute to the overall effectiveness of CBT is poorly understood. Objective: To investigate how the users of smartphone CBT use and benefit from various components of the program. Methods: This is a secondary analysis from a 9-week, single-blind, randomized controlled trial that has demonstrated effectiveness of adjunctive use of smartphone CBT (Kokoro-app) over antidepressant pharmacotherapy alone among patients with drug-resistant major depressive disorder (total n=164, standardized mean difference in depression severity at week 9=0.40, J Med Internet Res doi:10.2196/jmir.8602). Kokoro-app comprises three cognitive-behavioral skills of self-monitoring, behavioral activation and cognitive restructuring, with corresponding worksheets to fill in. All activities of the participants learning each session of the program and completing each worksheet were uploaded onto Kokoro-web which each patient could use for self-check. We examined what use characteristics differentiated the more successful users of the CBT app from the less successful ones, split at the median of change in depression severity. Results: 81 patients with major depression were allocated to the smartphone CBT. On average, they completed 7.0 (SD=1.4) out of 8 sessions of the program; it took them 10.8 (4.2) days to complete one session, during which they spent 62 (96) minutes on the app. There were no statistically significant differences in the number of sessions completed, time spent for the program or the number of completed self-monitoring worksheets between the beneficiaries and the non-beneficiaries. However, the former completed more behavioral activation tasks, engaged in different types of activities, and also filled in more cognitive restructuring worksheets than the latter. Activities such as “Test-drive a new car,” “Go to a coffee shop after lunch,” or “Call up an old friend” were found to be particularly rewarding. All cognitive-restructuring strategies were found to significantly decrease the distress level, with “What would be your advice to a friend who has a similar problem?” found more helpful than some other strategies. Conclusions: The CBT program offered via smartphone and connected to the remote server is not only effective in alleviating depression but also opens a new avenue in gathering information of what and how each participant may utilize the program. The activities and strategies found useful in this analysis will provide valuable information in brush-ups of the program itself and of mobile health in general. Clinical Trial: Japanese Clinical Trials Registry UMIN CTR 000013693; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000015984

  • Imaging the physiological bases of “hidden” noise-induced hearing loss

    From: JMIR Research Protocols

    Date Submitted: Oct 3, 2017

    Open Peer Review Period: Oct 4, 2017 - Oct 18, 2017

    Background: Rodent studies indicate that noise exposures can be sufficient to cause permanent damage to hair-cell synapses for high-threshold auditory nerve fibres, despite normal threshold sensitivit...

    Background: Rodent studies indicate that noise exposures can be sufficient to cause permanent damage to hair-cell synapses for high-threshold auditory nerve fibres, despite normal threshold sensitivity. These demonstrations of what is commonly known as “hidden hearing loss” have been confirmed in several rodent species, but the implications for human hearing are unclear. Objective: Our Medical Research Council (MRC) funded programme aims to address this unanswered question, by investigating functional consequences of the damage to the human peripheral and central auditory nervous system that results from cumulative lifetime noise exposure. A series of parallel studies focuses on behavioural and neuroimaging techniques for detecting hidden hearing loss in humans. The planned neuroimaging aims to (1) identify central auditory biomarkers associated with hidden hearing loss, (2) investigate if there are any additive contributions from tinnitus or diminished sound tolerance, which are often comorbid with hearing problems, and (3) explore the relation between subcortical functional magnetic resonance imaging (fMRI) measures and the auditory brainstem response (ABR). Methods: Individuals aged 25 to 40 years with pure tone hearing thresholds ≤ 20 dB HL over the range 500 Hz to 8 kHz and no contraindications for MRI or signs of ear disease will be recruited into the study. Lifetime noise exposure will be estimated using an in-depth structured interview. Auditory responses throughout the central auditory system will be recorded using ABR and fMRI. Analyses will focus predominantly on correlations between lifetime noise exposure and auditory response characteristics. Results: This article reports the study protocol. No results are yet available. Conclusions: This challenging and comprehensive study will have the potential to impact diagnostic procedures for hidden hearing loss, enabling early identification of noise-induced auditory damage via the detection of changes in central auditory processing. Consequently, this will generate the opportunity to give personalised advice regarding provision of ear defence and monitoring of further damage, thus reducing the incidence of noise-induced hearing loss.

  • The Physical Activity by Technology Help (PATH) Trial’s Protocol: Using an Alexa-Based Intelligent Agent for Patient Coaching

    From: JMIR Research Protocols

    Date Submitted: Oct 2, 2017

    Open Peer Review Period: Oct 4, 2017 - Oct 18, 2017

    Background: Physical activity has established health benefits, but motivation and adherence remain challenging. Objective: We designed and launched a three-arm randomized trial to test artificial inte...

    Background: Physical activity has established health benefits, but motivation and adherence remain challenging. Objective: We designed and launched a three-arm randomized trial to test artificial intelligence technology solutions to increase daily physical activity in cancer survivors. Methods: A single-center, three-arm randomized clinical trial with an allocation ration of 1:1:1: (A) control, in which participants were provided written materials about the benefits of physical activity; (B) participant received daily motivation from an fully automated, data-driven algorithmic text message via mobile phone (Coachtext®); and (C) participants were provided with an in-home on demand autonomous Intelligent Agent using data driven Interactive Digital Voice Assist on the Amazon Alexa/Echo (MyCoach®). Results: The study runs for 5 weeks, a one-week run-in to establish baseline, followed by 4 weeks of intervention. Data for study outcomes is collected automatically through a wearable sensor, and data are transferred in real-time to the study server. The recruitment goal is 42 participants, 14 in each arm. Electronic health records were used to pre-screen candidates, with 20 participants recruited to date. Conclusions: This study aims to investigate the effects of different types of intelligent technology solutions on promoting physical activity in cancer survivors. This innovative approach can easily be expanded and customized to other interventions. Early lessons from our initial participants are helping us develop additional advanced solutions to improve health outcomes. Clinical Trial: ClinicalTrials.gov Identifier: NCT03212079. Retrospectively registered on July 10, 2017.

  • Mobile applications dealing with Parkinson’s disease: A systematic review

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 3, 2017

    Open Peer Review Period: Oct 3, 2017 - Nov 28, 2017

    Background: Numerous PD-related applications have been developed in recent years, particularly for the major operating systems: Android and iOS. Besides, there is not a single application that covers...

    Background: Numerous PD-related applications have been developed in recent years, particularly for the major operating systems: Android and iOS. Besides, there is not a single application that covers all aspects of the Parkinson's Disease. In fact, different symptoms are treated with very different apps. Objective: Our goal is to carry out a systematic review of available apps related with PD for the operating systems iOS and Android. In addition, our goal is also to classify the apps according to their approach to the disease. Methods: We searched the term “Parkinson” in Google Play Store and the Apple App Store. After sieving non PD-related apps, we examined the PD apps to assess their features of usability and to classify in different categories depending on the symptoms that are treated or the therapy that is applied. Results: The number of free apps (72.2%) is significantly higher than paid apps (27.8%) and price of paid apps differ slightly between the operating systems. Apps rated by Android users (82.7%) are more than apps rated by iOS users (26.1%) and in general apps have a good rating. There is no correlation between price and valuation by users. With respect to the distribution of the classification, apps focused on motion and tremor and apps dedicated to health professionals and researchers are the most downloaded. Conclusions: This study evidences that the development of the applications dedicated to the PD is quite parallel in both systems. Additionally, we have performed a comparative market analysis considering operating systems, acquisition costs, popularity or user rating, and the distribution in the classification.

  • An exercise intervention to unravel the mechanisms underlying insulin resistance in a cohort of black South African women: Protocol for a randomized controlled trial

    From: Journal of Medical Internet Research

    Date Submitted: Oct 3, 2017

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

    Background: The pathogenesis of type 2 diabetes (T2D) in black African women is complex and differs to that of their white counterparts. However, earlier studies have been cross-sectional and provide...

    Background: The pathogenesis of type 2 diabetes (T2D) in black African women is complex and differs to that of their white counterparts. However, earlier studies have been cross-sectional and provide little insight into the causal pathways. Exercise training is consistently used as a model to examine the mechanisms underlying insulin resistance and risk for T2D. Objective: To examine the mechanisms underlying the changes in insulin sensitivity and secretion in response to a 12-week exercise intervention in obese black South African (SA) women. Methods: Forty-five obese (BMI 30-40 kg/m2) black SA women were randomized into a control (n=22) or experimental (exercise; n=23) group. The exercise group completed 12 weeks of supervised combined aerobic and resistance training (40-60 min, 4 days/week), while the control group maintained their typical physical activity patterns, and both groups were requested not to change their dietary patterns. Prior to and following the 12-week intervention period, insulin sensitivity and secretion (frequently sampled intravenous glucose tolerance test), and its primary and secondary determinants, were measured. Dietary intake, sleep quality and quantity, physical activity and sedentary behaviors were measured every four weeks. Results: The final sample included 20 exercise and 15 control participants. Baseline socio-demographics, cardiorespiratory fitness, anthropometry, cardio-metabolic risk factors, physical activity and diet did not differ between the groups (p>0.05). Conclusions: We describe a research protocol for an exercise intervention to understand the mechanisms underlying insulin sensitivity and secretion in obese black SA women. We aim to identify causal pathways underlying the high prevalence of insulin resistance and risk for T2D in black SA women, targeting specific areas for therapeutic intervention.  Clinical Trial: The trial has not been registered.

  • 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.

  • Influence of radiofrequency electromagnetic waves on fertility system: A protocol of systematic review and meta-analyses

    From: JMIR Research Protocols

    Date Submitted: Oct 3, 2017

    Open Peer Review Period: Oct 9, 2017 - Oct 23, 2017

    Background: Concerns about the potential impact of mobile health are growing, which has increased the user of the mobile phone, tablet, etc. over the past few years. Cell phones, wireless telephones,...

    Background: Concerns about the potential impact of mobile health are growing, which has increased the user of the mobile phone, tablet, etc. over the past few years. Cell phones, wireless telephones, mobile base stations and power lines are one of the main sources of our daily exposure to radiofrequency electromagnetic radiation (RF-EMR). There are more than 2 billion mobile phones in use worldwide (1-3). Exposure to RF energy depends on the frequency of the mobile phone used. The most common frequency of used phones is 1900-900 MHz in the United States, while in many parts of the world these phones work at frequencies from 1800 to 850 MHz. The higher frequency has the higher energy. Radial energy is absorbed by the three main mechanisms in the human body: (i) aueral effect: The body receives and absorbs the RF signal depending on the size of the body part and the signal wavelength; (ii) RF signal binding with tissue; and (iii) absorption intensification (4,5). The effects of electromagnetic radiation can be divided into two main categories - thermal properties and non-thermal properties. The thermal properties caused by the increase in temperature due to the energy absorption of oscillating electric fields. This can lead to heat in the exposed parts of the body. Thermal effects are calculated in terms of SAR (specific absorption rate) calculation. This SAR depends largely on the antenna, location, and frequency settings (6). Some studies showed that human exposure to radiofrequency waves can cause cognitive, behavioral impairments and decreased learning and memory. Also, induce significant thermal effects may be associated with adverse health effects such as sleep problems, impairment of the nervous system, health problems, and increased cancer risk, hearing and reproductive (7,8). Infertility is an inability to get pregnant after one year of intercourse without the use of contraceptive methods and affecting 15% of couples. 30-50% of the infertility causes related to male infertility, as well as 40 to 30% of the male infertility causes referred to sperm disorders (9). The influence of mobile exposure on man fertility have been studied in recent years. [10] In normal physiological conditions, spermatogenesis is a balanced process of maturation, cell division, and storage, which is particularly susceptible to environmental stimuli and chemical. However, its mechanism is unclear but they guess that particularly sensitive could be Cytoskeleton, consist of charged proteins: middle actions, and microtubules. The cytoskeleton is structural and functional part of the cell that plays a main role in motility of the sperm and is actively participates the morphological alterations that happen during mammalian sperm genesis (10-11). A study of EMFs effects on female rats using a transmission electron microscopy (TEM), representing an increase existence of numerous drops of lipid in patches and luteal cells also increase in the number of autophilia vaccines and macrophages in some granulosic cells (12). Other researchers showed that EMFs increase macrophages in the range of lutea corpora and growing follicles. They believe that EMFs increase apoptosis in mice ovaries. In addition, most researchers believe that EMF damage stromal cells in the uterine and uterine tubes through apoptosis to the glandular epithelium, ovarian cortex, luminal epithelium (13, 14). Now it is necessary to explore the safety criteria for these radiations in the direction toward future research. The physical phenomena of electronic devices that exposed RF are very close to the body. Therefore, it could be used RF shielding in electronic devices that can block RF-EMF waves, various time scales for a fixed minute with intermittent and increasing distance from them. Systematic review papers are a type of review that analyzes the findings of other studies and provide the best evidence for decision about health approach (15). yildirim et al(2015) in assessing the potential harmful effects of RF on sperm parameters, we found that there is no significant difference between sperm counts and sperm morphology excluding sperm motility, due to mobile phone usage period(16). Due to conflicting results and since no systematic review performed the effects of RF-EMF exposed from other electronic devices on fertility system in recent year, the evidence base study is necessary. Objective: The main objectives of this study are to clarify the best evidence associated with the influence of radiofrequency electromagnetic field on the male and female reproductive system and considered any common observations that could provide insights on a potential mechanism. The other objective of this study is determining the effect of a radiofrequency electromagnetic field on primary or secondary infertility. Methods: Inclusion criteria Types of participants -Couples who were infertile (inability to get pregnant after one year of intercourse without the use of contraceptive methods) -Infertile male and women 18–65-year-old who used the radio-frequency electromagnetic device for various exposure times -infertile couples did not have any underlying disease - Hormonal assessment, diagnostic imaging techniques, biopsy, spermatograms were used to assess the reproductive system. - No limitation in frequency‏ and duration use of device Type of intervention This systematic review will include only human studies that participants used any device that exposed radiofrequency electromagnetic waves for any frequency and duration. No restriction has in exposure condition, type of signal device, distance and exposure time. Comparator All studies with or without the control group will be included in this study. Outcomes This current systematic review will consider papers that include change rate in reproductive system parameters after the use of radio-frequency electromagnetic devices (Sperm and endocrine parameter, testis, and ovary function) as primary outcomes. The secondary outcomes will be primary or secondary infertility. The outcomes measurement will be assessed by hormonal assessment, diagnostic imaging techniques, biopsy, and spermatograms. Types of studies Any observational study designs will be included. Case reports and case series, review, and letter to the editor article will not be included. Articles with incomplete data were excluded from the study. We will try to contact the authors by email whose studies related but not accessible. Search strategy In this systematic review, the databases and gray literatures will be searched with no language and date limitation. The following databases were " Cochrane Library (Wiley), MEDLINE (Ovid), Pub Med, EMBASE, CINAHL (EBSCO), ProQuest, Scopus, Science Direct, Google Scholar "and Persian databases. Also, the reference lists of articles and reports will be checked. The gray literatures will be included the International Clinical Trials Registry Platform, Dissertations, Thesis Global, and Thesis. The combination of the mesh terms "radiofrequency electromagnetic", and "male reproductive system" or "female reproductive system" will be used for searching. To ensure the inclusion of all the related articles, search will be sensitive. The title and abstract of the articles would be evaluated ; any disagreement will be resolved through the discussion between authors. The full-text of articles will be assessed to the objectives of this systematic review. Quality assessment Papers selected for retrieval will be evaluated by two independent referees for methodological validation before entering the review using the standard evaluation tool "OTTAWA" for cohort studies and non-randomized controlled trials. (17). Any differences which rises between reviewers, will be resolved through conversation or with a third reviewer. Data extraction The data from the articles extracted in this study using the standard data extraction tool that is accessible in JBI-SUMARI by two independent reviewers. The data extracted will comprise specific details about the populations, interventions, study methods and results are important to the question of review and particular goals. Any differences that arise will be resolved through discussion or with a third reviewer. Authors of papers will be contacted to request missing or additional data where required. We will try to contact the corresponding authors of studies by email if it is necessary to obtain data missing from published articles. Data synthesis By using STATA V.12 software, analyses will be conducted. Heterogeneity will be evaluated by the I2 statistic, and χ2 test (recommended by the Cochrane Handbook for Systematic Reviews of Interventions). We will explain the I2 statistic using the guide. When substantial heterogeneity (I2>50%) is evident among the articles, the results of this study will be presented in the text qualitatively. The author's decision to use the random-effects model will be based on understanding of whether not all included trials share a common effect size, They are not only on results of tests but also on statistical heterogeneity. All results of this paper will be given to two inputs. For classified data the effect sizes are calculated as OR and for continuous data the weighted average difference and their 95% CI for analysis. By using the standard x2 Non-correlation will be evaluated. If statistical data of studies do not collect, the results of this article will be presented in the appropriate tables and figures. By using a funnel plot, Begg's, and Egger's tests publication bias will be explored. If it is possible, this systematic review will be performed subgroup meta-analysis based on the type of device and exposure time disagreement. Results: This is a protocol for a systematic review, and the result is not presented. The results of this study will be submitted to a peer-reviewed journal for publication and also presented at PROSPERO (International prospective register of systematic reviews), which the number of PROSPERO is CRD42017072462. Conclusions: The purpose of systematic review is to present the comprehensive summary of related article to a study question and it can be the best answer to the controversy between studies (18). This systematic review will provide the evidence base data about the effect of radiofrequency electromagnetic waves on fertility system changes. This article will also classify the harmful effect of RF waves on primary and secondary infertility. Due to the growth of infertility rate among people, negative outcomes of this problem for couple, and heath care system, the results of this study can be useful for decrease the infertility rate (19).

  • Parents’ experiences of caring for their child at the time of discharge after cardiac surgery and during the post-discharge period: qualitative study using an on-line forum

    From: Journal of Medical Internet Research

    Date Submitted: Oct 4, 2017

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

    Background: Congenital heart disease is the most common class of birth defects and includes a broad spectrum of severity from relatively minor to extremely complex.  Improvements in surgery and inten...

    Background: Congenital heart disease is the most common class of birth defects and includes a broad spectrum of severity from relatively minor to extremely complex.  Improvements in surgery and intensive care have resulted in increasing numbers of infants with the most complex lesions surviving to hospital discharge after surgery but there remain concerns about out of hospital mortality, variability in how services are provided at the time of discharge and beyond and difficulties experienced by some families in accessing care.  Objective: As part of a mixed-methods programme of research we wanted to elicit parental experiences of caring for a child with congenital heart disease after discharge following cardiac surgery and to collect information to inform interviews for a subsequent stage of the project. Methods: A closed online discussion group was set up via the main Facebook page of the Children’s Heart Federation, a national charity offering support to children with heart disease and their families. The discussion group was advertised through the charity’s webpage and interested participants were directed to the charity's Facebook page from where they could access the closed Facebook group and respond to questions posted. The Children’s Heart Federation moderated the forum and the research team provided questions to be posted on the forum.  Responses were collated into a single transcript and subjected to thematic analysis. Results: The forum was open for four months and 91 participants (mean age 35 years; range 23-58 years; 89 female; 89 parents, 2 grandparents) submitted demographic information and were given access to the closed forum group.  A common experience of isolation emerged from the data with descriptons of how that isolation was experienced (physical, social, knowledge) and its psychological impact, together with the factors that made that worse or better.  Woven through this theme was the notion that parents developed expertise over time.   Conclusions: Use of an on-line forum provided a means of eliciting a large number of parents’ experiences of caring for their child after discharge from hospital following cardiac surgery.  Parents engaged with the forum and were able to articulate what went well and what went less well, together with sharing their stories and supporting each other through doing so.  Some parents clearly found participating in the forum a positive experience in itself, demonstrating the potential of social media as a mechanism for providing support and reducing isolation. Information gained from the forum was used to shape questions for interviews with parents in a subsequent phase of the study. Furthermore, the themes identified in the on-line forum have contributed to identifying ways of improving the provision of care and support for parents of high risk babies following discharge after cardiac surgery.

  • Feasibility and acceptability of a web-based treatment with telephone support for postpartum women with anxiety: A randomized controlled trial

    From: JMIR Mental Health

    Date Submitted: Oct 6, 2017

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

    Background: Postpartum anxiety can have adverse effects on the mother and child if left untreated. Time constraints and stigma are common barriers to postpartum treatment. Web-based treatments offer p...

    Background: Postpartum anxiety can have adverse effects on the mother and child if left untreated. Time constraints and stigma are common barriers to postpartum treatment. Web-based treatments offer potential flexibility and anonymity. “What Am I Worried About” (WaWa) is self-guided treatment based on cognitive behavioral and mindfulness principles for women experiencing postpartum anxiety. WaWa was developed in Australia and consists of nine modules with optional weekly telephone support. WaWa was adapted to a web-based version for the use in England (iWaWa). Objective: This study aimed to investigate the feasibility (engagement and usability), acceptability (usefulness, satisfaction, and helpfulness), and potential efficacy of iWaWa among English postpartum women with anxiety. Methods: Postpartum (<12 months) women with mild to severe anxiety were recruited anonymously via social media during an 8-week period. Participants were randomized to the iWaWa treatment (8 weeks) or wait-list control conditions. Treatment and study feasibility and acceptability were assessed post-treatment and anxiety symptoms were assessed before treatment, immediately after treatment and 1-month later using online questionnaires. Semi-structured telephone interviews were carried out after the treatment period for a more in-depth exploration of treatment acceptability and feasibility. Results: Eighty-nine eligible women were recruited through social media and randomized into the treatment (n=46) or wait-list control condition (n=43). Women were predominantly White/Caucasian, well-educated, married, on maternity leave, first-time mothers and reported moderate levels of anxiety. Drop-out rates were high, especially in the treatment group (treatment: 82.60%, n=38; waitlist-control: 51.16%, n=22). Twenty-six women started iWaWa with only two women completing all nine modules. Anxiety levels decreased significantly for both groups from baseline to the 8-week follow-up, but there was no difference between the groups. Quantitative and qualitative data suggest iWaWa was experienced as generally useful and helpful. Participants enjoyed iWaWa’s accessibility, anonymity and weekly reminders, as well as the introduction to the principles of cognitive-behavioural therapy and mindfulness. However, iWaWa was also experienced as not user-friendly enough, too wordy and long and not smartphone-friendly. Parts of the content were experienced as not always relevant and appropriate. Participants felt that iWaWa could be improved by having it in a smartphone app format and by making the content more concise and inclusive of different parenting styles. Conclusions: Despite interest in iWaWa, the results suggest that both the study and iWaWa were not feasible in the current format. However, this first trial provides useful evidence about treatment format and content preferences which can inform research and development of web-based postpartum anxiety treatments to optimize adherence. Clinical Trial: ClinicalTrials.gov NCT02434406 https://clinicaltrials.gov/ct2/show/NCT02434406

  • Evaluating the CARE4Carer blended care intervention for partners of patients with acquired brain injury: protocol for a randomized controlled trial

    From: JMIR Research Protocols

    Date Submitted: Oct 8, 2017

    Open Peer Review Period: Oct 9, 2017 - Oct 23, 2017

    Background: Support programs for partners of patients with acquired brain injury are necessary, since these partners experience several unfavorable consequences of caregiving, such as a high burden, e...

    Background: Support programs for partners of patients with acquired brain injury are necessary, since these partners experience several unfavorable consequences of caregiving, such as a high burden, emotional distress, and poor quality of life. Evidence-based support strategies that can be included in these support programs are psycho-education, skill building, problem solving and improving feelings of mastery. A promising approach would seem to be to combine web-based support with face-to-face consultations, creating a blended care intervention. Objective: This paper outlines the protocol of a randomized controlled trial to evaluate the CARE4Carer blended care intervention for partners of patients with acquired brain injury. Methods: A multicenter two-arm randomized controlled trial will be conducted. A total of 120 partners of patients with acquired brain injury will be recruited from five rehabilitation centers in the Netherlands. The blended care intervention consists of a nine-session web-based support program and two face-to-face consultations with a social worker. Themes that will be addressed are: giving partners insight into their own situation, including possible pitfalls and strengths, learning how to cope with the situation, getting a grip on thoughts and feelings, finding a better balance in the care for the patient with acquired brain injury, thinking about other possible care options, taking care of oneself, and communication. The intervention lasts 20 weeks and the control group will receive usual care. The outcome measures will be assessed at baseline and at 24- and 40-week follow-up. The primary outcome is caregiver mastery. Secondary outcome measures are strain, burden, family functioning, emotional functioning, coping, quality of life, participation, and social network. Results: The effect of the intervention on the primary and secondary outcome measures will be determined. Additional economic and process evaluations will be conducted. Conclusions: The findings of this study will be used to improve the care for partners of patients with acquired brain injury. Barriers and facilitators that emerge from the process evaluation will be used in the nationwide implementation of the intervention. Clinical Trial: Dutch Trial Register NTR6197, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6197

  • Attitudes towards e-Mental health services in a community sample of adults: Predictors of preferences and intentions

    From: Journal of Medical Internet Research

    Date Submitted: Oct 12, 2017

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

    Background: Despite evidence that e-Mental health services are effective, consumer preferences still appear to be in favor of face-to-face services. However, the Theory of Planned Behavior suggests th...

    Background: Despite evidence that e-Mental health services are effective, consumer preferences still appear to be in favor of face-to-face services. However, the Theory of Planned Behavior suggests that cognitive intentions are more proximal to behavior and thus may have a more direct influence on service use. Investigating individual characteristics that influence both preferences and intentions to use e-Mental health services is important for better understanding factors that might impede or facilitate use of these services. Objective: This study explores predictors of preferences and intentions to access e-Mental health services relative to face-to-face services. Five domains were investigated (demographics, technology factors, personality, psychopathology, and beliefs), identified from previous studies and informed by the Internet Interventions model. We expected that more participants would report intentions to use e-Mental health services relative to reported preferences for this type of support, and that these five domains would be significantly associated with both intentions and preferences towards online services. Methods: A mixed sample of 308 community members and university students were recruited through social media and the host institution in Australia. Ages ranged between 17 and 68 years, and 82.5% were female. Respondents completed an online survey. Chi-square analysis and t-tests were used to explore group differences, and logistic regression models were employed to explore factors predicting preferences and intentions. Results: Most respondents (85.7%) preferred face-to-face services over e-Mental health services. Relative to preferences, a larger proportion of respondents (39.6%) endorsed intentions to use e-Mental health services if experiencing mental health difficulties in the future. In terms of the five predictor domains, 95% confidence intervals of odds ratios derived from bootstrapped standard errors suggested prior experience with online services significantly predicted intentions to use self-help (95% CI: 2.08 – 16.24) and therapist-assisted (95% CI: 1.71 – 11.90) online services in future. Being older predicted increased intentions to use therapist-assisted online services in future (95% CI: 1.01 – 1.06), as did more confidence using computers and the internet (95% CI: 1.06 – 2.69). Technology confidence was also found to predict greater preference for online services versus face-to-face options (95% CI: 1.24 – 4.82), while higher doctor-related locus of control (95% CI: 0.76 – 0.95) and extraversion (95% CI: 0.88 – 1.00) were predictive of lower likelihood of preferring online services relative to face-to-face. Conclusions: Despite generally low reported preferences towards e-Mental health services, intentions to access these services are higher, raising the question of how to best encourage translation of intentions into behavior (i.e. actual use of programs). Strategies designed to ease people into new internet-based mental health programs (to enhance confidence and familiarity) may be important for increasing the likelihood that they will return to such programs later.

  • Lessons learned from a Living Lab on broad adoption of eHealth in primary healthcare

    From: Journal of Medical Internet Research

    Date Submitted: Oct 4, 2017

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

    eHealth solutions are considered to relieve current and future pressure on the sustainability of primary healthcare systems. However, evidence of the effectiveness of eHealth in daily practice is abse...

    eHealth solutions are considered to relieve current and future pressure on the sustainability of primary healthcare systems. However, evidence of the effectiveness of eHealth in daily practice is absent. Furthermore, eHealth solutions are often not implemented structurally after a pilot phase, even if successful during this phase. Although many studies on barriers and facilitators were published in recent years, including theoretical models on implementation of innovations, eHealth implementation still progresses only slowly. To further unravel the slow implementation process in primary healthcare and accelerate the implementation of eHealth, a three-year Living Lab project was set up in the Netherlands, resulting in in-depth information on the development and adoption of eHealth. In the Living Lab, called eLabEL, patients, healthcare professionals, small- and medium-sized enterprises (SMEs) and research institutes collaborated to select and integrate fully mature eHealth technologies for implementation in primary healthcare. Seven primary healthcare centres, ten SMEs, and four research institutes participated. Reflective and process-based notes from all meetings of the project partners, interview data and data of focus groups were analysed systematically using four theoretical models to study the adoption of eHealth in primary care. The results showed that large-scaled implementation of eHealth depends on the effort of and interaction and collaboration among four groups of stakeholders: patients, healthcare professionals, enterprises, and those responsible for healthcare policy (healthcare insurers and policy makers). These stakeholders are all acting within their own contexts and with their own values and expectations. In the eLabEL project we experienced that patients reported expected benefits regarding the use of eHealth for self-management purposes, and healthcare professionals stressed the potential benefits of eHealth and were interested in using eHealth to distinguish themselves from other care organisations. In addition, eHealth entrepreneurs valued the intensive collaboration among SME’s as they were not big enough to enter the healthcare market on their own and valued the collaboration with research institutes. Furthermore, healthcare insurers and policymakers shared the ambition and need for the development and implementation of an integrated eHealth infrastructure. However, we learned that for optimal and sustainable use of eHealth, patients should be actively involved, primary healthcare professionals need to be reinforced in their management, entrepreneurs should work closely with healthcare professionals and patients, and the government needs to focus on new healthcare models stimulating innovations. Only when all these parties act together, starting in local communities with a small range of eHealth tools, the potential of eHealth will be enforced.

  • 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.

  • Usage Patterns Associated with a Mobile Application in Patients Prescribed a Smoking Cessation Medicine

    From: Journal of Medical Internet Research

    Date Submitted: Oct 6, 2017

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

    Background: Cigarette smoking is the leading preventable cause of death and is responsible for more than 480,000 deaths per year in the United States (US). Smoking cessation is challenging for many pa...

    Background: Cigarette smoking is the leading preventable cause of death and is responsible for more than 480,000 deaths per year in the United States (US). Smoking cessation is challenging for many patients. Regardless of available treatment options, most quit attempts are unaided and it takes multiple attempts before a patient is successful. With the ever-increasing use of smartphones, mobile applications (apps) hold promise in supporting cessation efforts. The current study evaluates the ease of use and user satisfaction with the Pfizer Meds app to support smoking cessation among patients prescribed varenicline (Chantix®). Objective: Study participants included varenicline users who downloaded and used the app on their personal smartphone. The main objective was to report mobile app download frequency and usage details and to describe the participant-reported satisfaction with and usefulness of the application over the 14-week follow-up study period. Methods: Adults 18 years or older who had been prescribed varenicline were identified from the ESI pharmacy claims database. After meeting privacy restrictions, subjects were sent an invitation letter and second reminder letter with instructions on how to download the Pfizer Meds mobile application. Participants received a push notification to complete a smart phone-enabled survey regarding the utility of the application 12 weeks after downloading the application. Descriptive statistics summarized socio-demographics, use of varenicline, and details of use and satisfaction with the mobile application. Results: Of the 38,129 varenicline users who were sent invitation letters, 1,281 participants (3.4%) downloaded the Pfizer Meds application. Of the 1,032 with demographic and other data, 585 (56.7%) were females and 446 (43.2%) were males; mean age was 46.4 years (Standard Deviation [SD] 10.8). The mean number of app sessions per participant was 4.0 (SD 6.8). The end-of-study survey was completed by 131 survey respondents (10.2%); a large proportion (117/131; 89.3%) reported being extremely, very, or moderately satisfied with the app. A total of 97 survey respondents (97/131; 74.0%) reported setting up a quit date in the application. Of those, 74 (74/97; 76.3%) reported quitting on their quit date. Conclusions: Positive patient engagement was observed in this study based on app download and usage. This study quantified how the Pfizer Meds app performed in an observational real world data setting. The findings demonstrate the willingness of participants to set a quit date and use the app for support in medication adherence, refill reminders, and information regarding how to take the medication. This study provides real world evidence of the contribution apps can make to the continued encouragement of smokers to improve their health by smoking cessation.

  • Enhancing Survivorship Care Planning for Patients with Localized Prostate Cancer Using A Couple-focused Tailored mHealth Symptom Self-management Program

    From: JMIR Research Protocols

    Date Submitted: Oct 4, 2017

    Open Peer Review Period: Oct 5, 2017 - Oct 19, 2017

    This project explores a new model of care that enhances survivorship care planning and promotes health for men with localized prostate cancer transitioning to post-treatment self-management. Survivors...

    This project explores a new model of care that enhances survivorship care planning and promotes health for men with localized prostate cancer transitioning to post-treatment self-management. Survivorship care planning is important for patients with prostate cancer because of its high incidence rate in the U.S., the frequent occurrence of treatment-related side effects, and reduced quality of life for both men and their partners. A key component of comprehensive survivorship care planning is survivorship care plans (SCPs), documents that summarize cancer diagnosis, treatment, and plans for follow-up care. However, research concerning the effectiveness of survivorship care plans (SCPs) on patient outcomes or health service use has thus far been inconclusive. SCPs that are tailored to individual patients’ needs for information and care may improve effectiveness. In this study, we will examine the feasibility of an Enhanced Survivorship Care Plan (ESCP) that integrates a symptom self-management mHealth program called Prostate Cancer Education and Resources for Couples (PERC) into the existing standardized SCP. We will use a two-group randomized controlled pretest-posttest design and collect data at baseline (T1) and 4 months later (T2) among 50 patients completing initial treatment for localized prostate cancer and their partners. The specific aims are: Aim 1: Examine the feasibility of delivering ESCPs (as assessed by recruitment, enrollment, and retention rates, program satisfaction with the ESCP, and perceived ease of use of the ESCP). We will use mixed methods to achieve this aim. Aim 2: Estimate the magnitude of benefit of ESCPs. We hypothesize that, compared with the standardized SCP users, the ESCP users will report: (1) greater improvement in their primary outcomes of quality of life (overall, physical, emotional, and social quality of life); (2) greater improvement in secondary outcomes (reduction in negative appraisals and improvement in self-efficacy, social support, and health behaviors to manage symptoms); and (3) fewer visits to post-treatment care services from T1 (baseline) to T2 (four-month followup). The results from this study will help design a definitive randomized trial to test the efficacy of the ESCPs.

  • 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.

  • Influencing the conversation about masculinity and suicide: Using Twitter data in the evaluation of the ‘Man Up’ multi-media campaign

    From: Journal of Medical Internet Research

    Date Submitted: Oct 9, 2017

    Open Peer Review Period: Oct 9, 2017 - Oct 18, 2017

    Background: It has been suggested that some dominant aspect of traditional masculinity are contributing to the high suicide rates among Australian men. We developed a three-episode documentary called...

    Background: It has been suggested that some dominant aspect of traditional masculinity are contributing to the high suicide rates among Australian men. We developed a three-episode documentary called Man Up which explores the complex relationship between masculinity and suicide and encourages men to question socially imposed rules about what it means to be a man, asks them to open up, express difficult emotions, and seek help if and when needed. We ran a three-phase social media campaign alongside the documentary using five channels (Twitter, Facebook, Instagram, YouTube and TUMBlr). Objective: We aimed to create a social media audience, promote a conversation about masculinity and suicide, and generate and maintain engagement with the documentary. This paper examines the extent to which the Man Up Twitter campaign influenced the social media conversation on masculinity and suicide. Methods: We used Twitter Insights data to assess the reach of and engagement with the campaign (using metrics on followers, likes, retweets and impressions) and to determine the highest and lowest performing tweets in the campaign (using an aggregated performance measure of ‘reactions’). We used raw Twitter data to determine whether the campaign increased the volume of relevant Twitter conversations (aggregating the number of tweets for selected campaign hashtags over time), and we used a subset of these data to gain insight into the main content themes with respect to audience engagement. Results: The campaign was successful in generating a following that was engaged with the content of the campaign; over its whole duration the campaign earned nearly 5,000 likes and 2,500 retweets and gained around 1,022,000 impressions. The highest performing tweets posted by the host included video footage and occurred during the most active time period of the campaign (around the screening of the documentary). The volume of conversations in relation to commonly used hashtags (#MANUP, #ABCMANUP, #LISTENUP and #SPEAKUP) grew in direct relation to the campaign activities, achieving strongest growth during the three weeks when the documentary was aired. Strongest engagement was found with content related to help-seeking, masculinity and expressing emotions. A number of followers tweeted personal stories that revealed overwhelmingly positive perceptions of the content of the documentary and strongly endorsed its messages. Conclusions: The Man Up Twitter campaign triggered conversations about masculinity and suicide that might otherwise not have happened. For some this may have been game-changing in terms of shifting attitudes towards expressing emotions and reaching out to others for help. The campaign was particularly effective in disseminating information and promoting conversations in real-time, an advantage that it had over more traditional health promotion campaigns. This sort of approach could well be adapted to other areas of mental (and physical) health promotion campaigns to increase their reach and effectiveness.

  • 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.

  • Patient Continuance Use towards Online Healthcare Communities: Web Mining of Patient-Doctor Communication

    From: Journal of Medical Internet Research

    Date Submitted: Oct 7, 2017

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

    Background: In practice, OHCs have passed the adoption stage to reach the diffusion phase of development. In this phase, patients equipped with knowledge regarding the issues involved in healthcare ar...

    Background: In practice, OHCs have passed the adoption stage to reach the diffusion phase of development. In this phase, patients equipped with knowledge regarding the issues involved in healthcare are capable of switching among different communities to maximize their OHC activities. OHCs employ doctors to answer patient questions, and high quality doctors are more likely to be consulted by patients. Therefore, one important question that must be addressed is which factors drive patients to sustain ongoing relationships with OHCs, in which communication occurs between doctors and patients. However, this important question has only received limited scholarly attention. Objective: The purpose of this study is to identify factors drive patients to sustain ongoing relationships with online healthcare communities (OHCs), in which communication occurs between doctors and patients, integrating the information system success model (ISSM) and OHC features. Methods: A web spider is employed to download and extract data from the most authoritative Chinese OHC in which communication occurs between doctors and patients. The time span analyzed in our study was the period from January 2017 to March 2017. Finally, a sample of 469 valid anonymous patients with 9667 posts were obtained, which is equal to 469 respondents in survey research. Then a combination of web mining and structural equation modeling (SEM) is conducted to test the research hypotheses. Results: The results show that research framework for integrating the ISSM and OHC features contributes to our understanding about the roles of constructs that drive patients to sustain ongoing relationships with OHCs. (1) Social support, information quality, and service quality exert significant direct effects on perceived usefulness and patient satisfaction. (2) Regarding the influences of perceived usefulness and patient satisfaction, both have significant effects on continuance useuse of OHC patients. In addition, the effects of social support, information quality and service quality on patient satisfaction are mediated by perceived usefulness. (3) Overall, these results suggest that by increasing social support, informational quality and service quality may improve the perceived usefulness and patient satisfaction of OHCs, which could in turn foster the continuance use of OHC patients. (4) Unexpectedly, individual literacy has no influence on perceived usefulness and satisfaction of OHC patients. Conclusions: First, this study enriches the literature on the continuance use of OHC, in which communication occurs between doctors and patients, using an empirical approach. The study complements previous analyses of OHCs with a new perspective that reflects the intricacies of human health behavior at individual, community, and social levels. Second, a web spider is a data collection method that enables us to acquire objective data relatively easily and frequently, thereby overcoming a major limitation of survey techniques. Additionally, the method develops an appropriate metric for constructs. Third, this study not only reveals how to use web mining to evaluate the success of OHCs but also provides a foundation for future research in the information systems field, which is increasingly turning its attention to web mining.

  • 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.

  • 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.

  • Including psychosocial factors in screening for surgery: A preliminary literature review from a social work perspective

    From: JMIR Human Factors

    Date Submitted: Oct 7, 2017

    Open Peer Review Period: Oct 9, 2017 - Oct 23, 2017

    Introduction. The area of psychosocial screening for surgery holds considerable potential for social work practice, but to date there is little clarity regarding tools or roles. Methods. A practice...

    Introduction. The area of psychosocial screening for surgery holds considerable potential for social work practice, but to date there is little clarity regarding tools or roles. Methods. A practice-based scoping review was conducted by social workers to provide an overview of relevant issues. Articles were screened for alignment with the research question, as well as for quality and relevance. Of the 26 articles included, quality and relevance varied considerably. Results. The review summarised key psychosocial factors, screening issues, intervention issues and organisational aspects in the literature. It elucidated the importance of psychosocial factors in the acute hospital setting and specifically in the case of surgery. While the review found that there were many tools associated with psycho-social screening, there was no consensus as to which tool was most appropriate. There appeared to be little connection between tools and potential interventions, or indeed little consensus on suitable interventions. Conclusion. Reviewed articles suggested that appropriate psychosocial screening and intervention would result in considerable individual and systems benefits. This is an area that requires greater clarity and research investment from the social work profession.

  • Increasing reasoning awareness: A video analysis of students' two-party virtual patient interactions

    From: Journal of Medical Internet Research

    Date Submitted: Oct 8, 2017

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

    Background: Patient cases are often used in learning activities for medical students to train clinical reasoning. The computerized virtual patient (VP) cases allow for a stepwise exploration of cases...

    Background: Patient cases are often used in learning activities for medical students to train clinical reasoning. The computerized virtual patient (VP) cases allow for a stepwise exploration of cases and, thereby, stimulate active learning. In terms of reasoning, peer settings during VP sessions are believed to have benefits, but have received scant attention in literature. Objective: The objective of this study is to scrutinize the two-party virtual patient setting in terms of clinical reasoning. Methods: An in-depth exploration of dyad students’ pairwise interactions in VP sessions was performed by using video-observation. Two VP sessions, one-hour each, were video-recorded and transcribed in full. The transcriptions were analyzed using thematic analysis and short video-clips were selected for subsequent collaborative analysis in relation to clinical reasoning and clinical aspects. Results: Four categories of interactions were identified: (i) Task-related dialogue, in which students negotiated a shared understanding of the task and strategies for information gathering. (ii) Case-related insights and perspectives were gained, and the students consolidated and applied pre-existing biomedical knowledge into a clinical setting. (iii) Clinical reasoning interactions were made explicit. In these, hypotheses were followed up and clinical examples were used. The researchers observed interactions not only between students and the VP, but also (iv) interactions with other resources, such as a textbook. The interactions are discussed in relation to theories of clinical reasoning and peer learning. Conclusions: The dyad virtual patient setting corresponds to activities promoting analytic clinical reasoning. The peer setting, access to different resources and time to pursue different lines of reasoning seem to be valuable components promoting students’ clinical reasoning in this setting.

  • Cluster Analysis of Objectively Measured Physical Activity Patterns in Women in the mPED Trial

    From: JMIR Public Health and Surveillance

    Date Submitted: Oct 9, 2017

    Open Peer Review Period: Oct 10, 2017 - Oct 18, 2017

    Background: Determining patterns of physical activity throughout the day could assist in developing more personalized interventions or physical activity guidelines in general, and in particular for wo...

    Background: Determining patterns of physical activity throughout the day could assist in developing more personalized interventions or physical activity guidelines in general, and in particular for women, who are less likely to be physically active than men. Objective: The aims of this report are to identify clusters of women based on accelerometer measured raw metabolic equivalent values (METs) and a normalized version of the METs ≥ 3 data and to compare sociodemographic and cardiometabolic risks among these identified clusters. Methods: 215 women wearing an accelerometer for at least 8 hours per day for the last 7 days prior to the randomization visit were analyzed. A K-means clustering method, the Lloyd’s algorithm, was used. To choose the number of clusters, we used the elbow method, looking at the percentage of variance explained as a function of the number of clusters. Results: The results of k means cluster analyses of raw METs revealed three different clusters and the Low Active Group (n=102) had the highest depressive symptoms score compared to the Afternoon Active (n=65) and Morning Active (n=48) groups (overall P < .001). Based on a normalized version of the METs ≥ 3 data, the moderate to vigorous physical activity (MVPA) Evening Peak group (n = 108) had higher BMI, and waist and hip circumference than the MVPA Noon Peak group (n=61) (overall P =.03, .02, and .03 respectively). Conclusions: Categorizing physical inactive individuals into more specific activity patterns could aid in creating timing, frequency, duration, and intensity of physical activity interventions for women. Further research is needed to confirm these cluster groups using a large national dataset. Clinical Trial: ClinicalTrials.gov NCT01280812

  • A tailored web-based parenting intervention to prevent adolescent depression and anxiety problems: Post-intervention findings from a randomized controlled trial

    From: Journal of Medical Internet Research

    Date Submitted: Oct 9, 2017

    Open Peer Review Period: Oct 11, 2017 - Oct 19, 2017

    Background: Depression and anxiety disorders in young people are a global health concern. Parents have an important role in reducing the risk of these disorders in their adolescents, but cost-effectiv...

    Background: Depression and anxiety disorders in young people are a global health concern. Parents have an important role in reducing the risk of these disorders in their adolescents, but cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. Objective: The aim of this study was to examine the post-intervention effects of the Partners in Parenting program (PiP) on parenting risk and protective factors for adolescent depression and anxiety, and on adolescent depression and anxiety symptoms. Methods: A 2-arm randomized controlled trial was conducted with 359 parent-adolescent dyads, recruited primarily through schools across Australia. Parents and adolescents completed online measures of parenting and adolescent symptoms at baseline and 3 months later (post-intervention). Parents in the intervention condition received PiP, a tailored web-based parenting intervention designed following Persuasive Systems Design principles to target parenting factors associated with adolescents’ risk for depression and anxiety problems. PiP comprises a tailored feedback report highlighting each parent’s strengths and areas for improvement, followed by a set of interactive online modules (up to nine) that is specifically recommended for the parent, based on individually identified areas for improvement. Parents in the active control condition received a standardized package of five online factsheets about adolescent development and wellbeing. Parents in both conditions received a 5-minute weekly call to encourage progress through their allocated program to completion. Both programs were delivered weekly via the trial website. The primary outcome measure at post-intervention was parent-reported changes in parenting risk and protective factors for adolescent depression and anxiety, measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report Spence Children’s Anxiety Scale (anxiety symptoms). Results: Parents in the intervention condition completed a mean of 73.7% of their intended personalized PiP program. 318 parents (88.6%) and 308 adolescents (92.8%) completed the post-intervention assessment. Attrition was handled using mixed-model repeated-measures ANOVA. As hypothesized, we found a significant condition-by-time interaction on the PRADAS, with a medium effect size, Cohen’s d = 0.57, [95% CI: 0.34, 0.79]. No significant differences between conditions were found at post-intervention on any of the secondary outcome measures, with adolescent depressive (parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing significantly from baseline to post-intervention in both conditions. Conclusions: The fully-automated Partners in Parenting intervention showed promising short-term effects on parenting behaviors that are associated with adolescents’ risk for depression and anxiety. Longer-term follow-up is required to ascertain whether these effects translate into reduced adolescent depression and anxiety problems. The intervention may be useful as a low-cost universal public health program to increase parenting practices believed to benefit adolescents’ mental health. Clinical Trial: ANZCTR.org.au ACTRN12615000328572 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368274 (Archived by WebCite® at http://www.webcitation.org/6qgsZ3Aqj)

  • Open notes in Swedish Psychiatric Care: Professionals’ Expectations

    From: JMIR Mental Health

    Date Submitted: Oct 9, 2017

    Open Peer Review Period: Oct 9, 2017 - Oct 18, 2017

    Background: When the Swedish version of open notes, an electronic health record (EHR) service that allows patients online access, was introduced in somatic care in 2012, psychiatric care was exempt. T...

    Background: When the Swedish version of open notes, an electronic health record (EHR) service that allows patients online access, was introduced in somatic care in 2012, psychiatric care was exempt. This was because the medical specialty was considered too sensitive for patient access. However, as the first region in Sweden, Region Skåne added adult psychiatry to its open notes service in 2015. This made it possible to carry out a unique baseline study to investigate how different health care professionals in adult psychiatric in the region expect open notes to impact their patients and their practice. Objective: The objective of this study was to describe, compare, and discuss how different health care professionals in adult psychiatric care in Region Skåne expect open notes to impact their patients and their own practice. Methods: A full population web questionnaire was distributed to psychiatric care professionals in Region Skåne in late 2015. The response rate was 29% (n=871). Analyses show that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between different professionals and attitudes to the open notes service. Results: The results show that the psychiatric health care professionals are generally of the opinion that the service would affect their own practice and their patients negatively. The most striking result was that 61% of both doctors and psychologists were concerned that they would be less candid in their documentation in the future. Conclusions: Open notes increase transparency in psychiatry because patients are able to access their EHRs online without delay and can read unsigned notes. This may be one explanation as to why health care professionals are concerned that the service will affect both their own work and their patients.

  • Healthcare Professional Satisfaction in India, Russia, China and the US with a New Blood Glucose Meter with a Color Range Indicator and Country Specific Clinical Perspectives on Glycemic Control

    From: JMIR Diabetes

    Date Submitted: Oct 10, 2017

    Open Peer Review Period: Oct 10, 2017 - Oct 18, 2017

    Background: We previously demonstrated in patients with diabetes that displaying blood glucose (BG) results in association with color improved their ability to interpret glucose results Objective: The...

    Background: We previously demonstrated in patients with diabetes that displaying blood glucose (BG) results in association with color improved their ability to interpret glucose results Objective: The objective of this study was to investigate in specific countries health care professional (HCP) perceptions of the value of color on a new glucose meter, and to determine if HCP perspectives among countries differ on the value of this approach in clinical practice Methods: 180 HCPs including 105 endocrinologists, 34 primary care physicians, 25 diabetes educators and 16 pharmacists were recruited from India (50), Russia (50), China (50) and the US (30). These HCPs experienced the OneTouch Select Plus Simple meter on-line from their own office computer using interactive demonstrations (webpages, meter simulator and video clips). After providing demographic and current clinical practice insights, HCPs responded to questions about the utility of the color enhanced glucose meter Results: Mean age (standard deviation, SD) and years in their current professional role (SD) for the 180 HCPs was 41.3 (8.1); 13.3(6.8) (endocrinologists); 41.3(8.3); 14.1(6.8) (primary care physicians); 37.5(8.7); 12.7(6.8) (diabetes educators); and 35.9(5.3); 9.5(5.2) (pharmacists). 88% (44 of 50) of Russian and 83% (25 of 30) of US HCPs said their patients find it easy to recognize low, in-range or high BG results compared to only 56% (28 of 50) of HCPs in China and 42% (21 of 50) in India. Regardless of country, HCPs had less confidence that their patients act on blood glucose results with 52% (26 of 50) in Russia, 63% (19 of 30) in US, 60% (30 of 50) in China, and 40% (20 of 50) in India responding positively. During the interactive online meter experience, HCPs from all countries responded positively to questions about a meter with color features. After reflecting on the value of this meter, most HCPs strongly agreed or agreed their patients would be more inclined to act on results using a meter with color features: Russia 92% (46 of 50), US 70% (21 of 30), China 98% (49 of 50), India 94% (47 of 50). They also said that color was particularly useful for patients with lower numeracy or education who may struggle with interpreting results: Russia 98% (49 of 50), US 77% (23 of 30), China 100% (50 of 50), India 82% (41 of 50) Conclusions: This multi-country online study provides evidence that HCPs had high overall satisfaction with the One Touch Select Plus meter which uses color coded information to assist patients with interpreting blood glucose information. This may be especially helpful in patient populations with low numeracy or literacy and limited access to healthcare and direct interaction with HCPs Clinical Trial: None

  • Perceived Threat and Internet Use Predict Intentions to Get Bowel Cancer Screening (Colonoscopy): A Longitudinal Questionnaire Study

    From: Journal of Medical Internet Research

    Date Submitted: Oct 9, 2017

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

    Background: Many people use the Internet for health-related information search, which is known to help regulate their emotional state. However, not much is known yet about how online information searc...

    Background: Many people use the Internet for health-related information search, which is known to help regulate their emotional state. However, not much is known yet about how online information search together with negative emotional states (i.e., threat of cancer diagnosis) relate to preventive medical treatment decisions (i.e., colonoscopy intentions). Objective: The present study investigated how frequency of health-related Internet use together with perceived threat of a possible (bowel) cancer diagnosis influence intentions to get a colonoscopy. Previous research has shown that people who experience threat preferentially process positive information in an attempt to downregulate the aversive emotional state. The Internet can facilitate this regulatory strategy through allowing self-directed, unrestricted and thus biased information search. In the context of threat regarding a possible bowel cancer diagnosis, feelings of threat can still be effectively reduced through cancer screening (i.e., colonoscopy). We, therefore, predict that in that particular context, feelings of threat should be related to stronger colonoscopy intentions, and that this relationship should be enhanced for people who use the Internet often. Methods: A longitudinal questionnaire study was conducted among healthy participants who were approaching or just entering the bowel cancer risk group (45 – 55 years old). Perceived threat of a possible (bowel) cancer diagnosis, frequency of health-related Internet use and intentions to have a colonoscopy were assessed at two time points (6-month time lag between the two measurement points T1 and T2). Multiple regression analyses were conducted to test whether threat and Internet use at T1 together predicted colonoscopy intentions at T2. Results: In line with our predictions, we found that threat of a possible (bowel) cancer diagnosis interacted with frequency of Internet use (both T1) to predict colonoscopy intentions (T2; B = .23, SE = .09, P = .01). For people who used the Internet relatively often (+ 1SD) the positive relationship between threat and colonoscopy intentions was significantly stronger (B = .56, SE = .15, P < .001) compared to participants who used the Internet less often (- 1 SD; B = .17, SE = .09, P = .07). This relationship was unique to online (vs. offline) information search and independent of objective risk factors (e.g., BMI, smoking). Conclusions: The results of the present study suggest that health-related Internet use can facilitate emotion-regulatory processes. People who feel threatened by a possible (bowel) cancer diagnosis reported stronger colonoscopy intentions, especially when they used the Internet often. We propose that this is because people who experience threat are more likely to search for and process information that allows them to downregulate their aversive emotional state. In the present case of (bowel) cancer prevention, the most effective way to reduce threat is to get screened.

  • Employees’ perspectives on the facilitators and barriers to engaging with digital mental health in the workplace: a qualitative study

    From: Journal of Medical Internet Research

    Date Submitted: Oct 9, 2017

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

    Background: Prevalence rates of work related stress, depression and anxiety are high, resulting in reduced productivity and increased absenteeism. There is evidence that these conditions can be succes...

    Background: Prevalence rates of work related stress, depression and anxiety are high, resulting in reduced productivity and increased absenteeism. There is evidence that these conditions can be successfully treated in the workplace but take-up of psychological treatments amongst workers is low. Digital mental health interventions delivered in the workplace may be one way to address this imbalance, but while there is evidence that digital mental health is effective at treating stress, depression and anxiety in the workplace, uptake of and engagement with these interventions remains a concern. Additionally, there is little research on the appropriateness of the workplace for delivering these interventions, or on what the facilitators and barriers to engagement with digital mental health interventions in an occupational setting might be. Objective: The aim of this research was to get a better understanding of the facilitators and barriers to engaging with digital mental health interventions in the workplace. Methods: Semi-structured interviews were held with 18 participants who had access to an occupational digital mental health intervention as part of a randomised controlled trial. The interviews were transcribed and thematic analysis was used to develop an understanding of the data. Results: Digital mental health interventions were described by interviewees as convenient, flexible and anonymous; these attributes were seen as being both facilitators and barriers to engagement in a workplace setting. Convenience and flexibility could increase the opportunities to engage with digital mental health, but in a workplace setting they could also result in difficulty prioritising time and ensuring a temporal and spatial separation between work and therapy. The anonymity of the Internet could encourage use, but that benefit may be lost for people who work in open plan offices. Other facilitators to engagement included interactive and interesting content and design features such as progress trackers and reminders to login. The main barrier to engagement was the lack of time. The perfect digital mental health intervention was described as a website that combined a short interactive course that was accessed alongside time-unlimited information and advice that was regularly updated and could be dipped in and out of. Participants also wanted access to e-coaching support. Conclusions: Occupational digital mental health interventions may have an important role in delivering healthcare support to employees. Although the advantages of digital mental health interventions are clear, they do not always fully translate to interventions delivered in an occupational setting and further work is required to identify ways of minimising potential barriers to access and engagement. Clinical Trial: This is a qualitative study

  • Type 1 Doing Well: Randomized Pilot Study Protocol for a Strengths-Based Behavioral Intervention for Parents of Adolescents with Type 1 Diabetes Using an mHealth App

    From: JMIR Research Protocols

    Date Submitted: Oct 13, 2017

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

    Background: Supportive parent involvement for adolescents’ type 1 diabetes self-management promotes optimal diabetes outcomes. However, family conflict is common and can interfere with collaborative...

    Background: Supportive parent involvement for adolescents’ type 1 diabetes self-management promotes optimal diabetes outcomes. However, family conflict is common and can interfere with collaborative family teamwork. Few interventions have used explicitly strengths-based approaches to help reinforce desired management behaviors and promote positive family interactions around diabetes care. Objective: This protocol describes the development of a new, strengths-based behavioral intervention for parents of adolescents with type 1 diabetes delivered via mobile-friendly web app called Type 1 Doing Well. Methods: Ten adolescent-parent dyads and five diabetes care providers participated in a series of qualitative interviews to inform the design of the app. The 3-month pilot intervention will involve n=82 parents receiving daily prompts to use the app, in which they will mark the diabetes-related strength behaviors (i.e., positive attitudes or behaviors related to living with or managing type 1 diabetes) their teen engaged in that day. Parents will also receive training on how to observe diabetes strengths and how to offer teen-friendly praise via the app. Each week, the app will generate a summary of the teen’s most frequent strengths from the previous week based on parent reports, and parents will be encouraged to praise their teen either in person or from a library of reinforcing text messages. Results: The major outcomes of this pilot study will include intervention feasibility and satisfaction data. Clinical and behavioral outcomes will include glycemic control, regimen adherence, family relationships and conflict, diabetes burden, and health-related quality of life. Conclusions: This strengths-based, mHealth intervention aims to help parents increase their awareness of and efforts to support their adolescents’ engagement in positive diabetes-related behaviors. If efficacious, this intervention has the potential to reduce the risk of family conflict, enhance collaborative family teamwork, and ultimately improve diabetes outcomes. Clinical Trial: NCT02877680

  • Automating Heart Failure Quality Measurement with Natural Language Processing

    From: JMIR Medical Informatics

    Date Submitted: Oct 9, 2017

    Open Peer Review Period: Oct 9, 2017 - Oct 18, 2017

    Background: We developed an accurate, stakeholder-informed, automated, natural language processing (NLP) system to measure the quality of heart failure (HF) inpatient care and explored the potential f...

    Background: We developed an accurate, stakeholder-informed, automated, natural language processing (NLP) system to measure the quality of heart failure (HF) inpatient care and explored the potential for adoption of this system within an integrated healthcare system. Objective: To accurately automate a VA quality measure for inpatients with heart failure. Methods: We automated the HF quality measure CHI19 that identifies whether a given patient has left ventricular ejection fraction <40%, and if so, whether an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker was prescribed at discharge if there were no contraindications. We used documents from 1083 unique inpatients from eight VA medical centers to develop a reference standard (RS) to train (n=314) and test (n=769) the Congestive Heart Failure Information Extraction Framework (CHIEF). We also conducted semi-structured interviews (n=15) for stakeholder feedback on implementation of the CHIEF. Results: The CHIEF classified each hospitalization in the test set with a sensitivity (SN) of 98.9% and positive predictive value of 98.7%, compared with an RS and SN of 98.5% for available External Peer Review Program assessments. Of the 1083 patients available for the NLP system, the CHIEF evaluated and classified 100% of cases. Stakeholders identified potential implementation facilitators and clinical uses of the CHIEF. Conclusions: The CHIEF provided complete data for all patients in the cohort and could potentially improve the efficiency, timeliness, and utility of HF quality measurements. Clinical Trial: not applicable

  • Analysis of hourly variations in search engine query volumes for depression-related health information

    From: JMIR Mental Health

    Date Submitted: Oct 10, 2017

    Open Peer Review Period: Oct 10, 2017 - Dec 5, 2017

    Background: Depression is one of the most burdensome noncommunicable diseases in the world. One of the characteristics of depression is diurnal mood variation (DMV), which refers to noticeable daily c...

    Background: Depression is one of the most burdensome noncommunicable diseases in the world. One of the characteristics of depression is diurnal mood variation (DMV), which refers to noticeable daily changes in the overall mood state in individuals suffering from depression. Studying search engine data for depression-related health information seeking behaviour has the potential to provide new meaningful insights into DMVs, as individuals suffering from mental health issues are more likely to seek information about their problems online. This kind of infodemiological research is promising, and has been shown to be reliable for predicting patterns of both communicable and noncommunicable diseases. Objective: The objective of this study is to analyse hourly search engine query data to find evidence for diurnal mood variation in Finland. Methods: Query volume data in the form of relative search volume (RSV) for six depression-related queries in Finland was downloaded from the Google Trends database. Data was downloaded every week to obtain data for every hour during the month of March 2017. This resulted in a relative search volume value for 744 hours for the six query terms (n=4464). Arithmetical means for the RSVs of the search queries for the different hours of the day were calculated. The hourly data was also trichotomized and analysed in three time blocks: 0.00 a.m. - 7.59 a.m, 8.00 a.m. - 3.59 p.m. and 4.00 p.m. - 11.59 p.m. to make comparisons between different time periods during the 24 hours of the day. Results: All query term volumes showed a unimodal regular pattern during the 24 hours of the day, with increasing search volumes from the evening towards midnight and decreasing interest from 3.00 a.m. towards morning. Analysis of mean search activity of the three time blocks showed peaks in the first time block (00.00 a.m. – 7.59 a.m.) for all six terms. The search volumes decreased significantly during the second time block (8.00 a.m. - 3.59 p.m), and rose again between the third (4.00 p.m. - 11.59 p.m) and the first time block. Conclusions: Search engine query data support the notion of the evening-worse pattern in depression. Symptoms of diurnal mood variation may be tracked by monitoring changes in Google search engine query volume during the different hours of the day. Information on the timely nature of depression on an hourly level could improve the chances for early intervention.

  • Feasibility study of a novel intelligent two-way communication system for remote heart failure medication uptitration: the CARDIOCOACH study

    From: Journal of Medical Internet Research

    Date Submitted: Oct 11, 2017

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

    Background: ESC guidelines for the treatment of heart failure (HF) prescribe uptitration of angiotensin converting enzyme inhibitors (ACE-I) and β-blockers to the maximum tolerated evidence-based dos...

    Background: ESC guidelines for the treatment of heart failure (HF) prescribe uptitration of angiotensin converting enzyme inhibitors (ACE-I) and β-blockers to the maximum tolerated evidence-based dose. Although HF prognosis can drastically improve when correctly implementing these guidelines, studies showed that they are insufficiently implemented in clinical practice. Objective: The aim was to verify whether the addition of the CardioCoach follow-up tool to the usual care is feasible and safe to use and adds in the efficient implementation of guideline recommendations for β-blocker and ACE-I. Methods: 25 HF patients were randomly assigned to either the usual care (n=10) or CardioCoach intervention group (n=15) and followed for six months. The CardioCoach follow-up tool is a two-way communication platform with decision support algorithms for semi-automatic remote medication uptitration. Remote monitoring sensors automatically transmit patients' blood pressure, heart rate and weight on a daily basis. Results: Patients’ satisfaction and compliance for medication intake (93%) and vital sign measurements (95%) were excellent. However, the amount of technical issues was large, with 831 phone contacts (median 41 (IQR 32-65) in total. The semi-automatic remote uptitration was safe, as there were no adverse events and no false positive uptitration proposals. Although, no significant differences were found between both groups, a higher number of patients was on guideline-recommended medication dose in both groups compared to literature. Conclusions: The CardioCoach follow-up tool for remote uptitration is feasible and safe to use and showed to be efficient in facilitating information exchange between care actors, with high patient satisfaction and compliance. Clinical Trial: Clinicaltrials.gov, NCT03294811, https://clinicaltrials.gov/ct2/show/NCT03294811?term=cardiocoach&rank=1

  • DIABEO-telemedicine versus usual follow-up in the treatment of diabetic patients poorly controlled with a basal-bolus insulin regimen: the TELESAGE randomized, open label trial

    From: JMIR Research Protocols

    Date Submitted: Oct 10, 2017

    Open Peer Review Period: Oct 13, 2017 - Oct 27, 2017

    Background: Self-management of diabetes minimizes the risk of macrovascular and microvascular complications, but understanding and/or adherence to self-management recommendations is often suboptimal....

    Background: Self-management of diabetes minimizes the risk of macrovascular and microvascular complications, but understanding and/or adherence to self-management recommendations is often suboptimal. DIABEO is a software application uploaded onto smartphones (with an Internet connection) for calculation of bolus insulin doses. A previous study (TELEDIAB 1) showed that the use of DIABEO is associated with a significant improvement of glycemic control in poorly controlled diabetes type 1 (DT1) patients, particularly when combined with physicians’ teleconsultations. Here, we present the protocol of a new study (TELESAGE) conducted in a larger population of poorly controlled diabetic patients. Methods: TELESAGE is a multicentre, double-randomized, open-label, three parallel-arms study, conducted in approximately 100 centers in France. The study compares a control group (arm 1: usual follow-up) versus two DIABEO-telemedicine systems: one with physician-telemedicine (arm 2) and the other with nursing tele-monitoring and teleconsultations by diabetologist’s task delegation (arm 3). A first randomization step will allocate the study arms in 12 French regions. A second randomization will assign patients in the groups allocated to each studied region. The primary objective of TELESAGE is to demonstrate the superiority of a 12-month follow-up by the DIABEO-telemedicine system versus usual follow-up, with respect to improvement of HbA1c levels in approximately 696 DT1 or DT2 patients poorly controlled by a basal-bolus insulin regimen. Here, we present the baseline the protocol of the TELESAGE study. Discussion: The TELESAGE study is expected to confirm the previous results of TELEDIAB 1 study in a larger sample of diabetic patients. It is also expected to evaluate a nurse tele-monitoring system. If this is the case, the DIABEO-telemedicine service will clearly demonstrate its utility to become an integral part of the ambulatory care of an intensive insulin regimen treated patient. The study was registered by the French ANSM (Agence Nationale de Sécurité du Médicament; National Agency for Drug Safety) under Trial ID number: 2012-A00072-41.

  • 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.

  • 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.

  • An integrated approach to fight parasitic worm infections and diarrhoea: a cluster randomised trial study protocol

    From: JMIR Research Protocols

    Date Submitted: Oct 12, 2017

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

    Background: The global strategy to control helminthiases emphasises preventive chemotherapy. However, in the absence of access to clean water, improved sanitation and adequate hygiene, re-infection af...

    Background: The global strategy to control helminthiases emphasises preventive chemotherapy. However, in the absence of access to clean water, improved sanitation and adequate hygiene, re-infection after treatment can occur rapidly. Hence, integrated approaches are necessary to sustain preventive chemotherapy and make progress towards interruption of helminthiases transmission. Objective: The aim of the current study is to assess and quantify the effect of an integrated control package that consists of preventive chemotherapy, community-led total sanitation (CLTS) and health education, on soil-transmitted helminthiasis, schistosomiasis, intestinal protozoa infection and diarrhoea in rural Côte d’Ivoire. Methods: In a first step, a community health education programme will be developed that includes an animated cartoon for hygiene and health targeting school-aged children, coupled with a community health education theatre for the entire community. In a second step, a cluster randomised trial will be implemented in 56 communities of south-central Côte d’Ivoire with four intervention arms: (i) preventive chemotherapy; (ii) preventive chemotherapy plus CLTS; (iii) preventive chemotherapy plus health education; and (iv) all three interventions combined. In a third step, a baseline parasitological, anthropometric and hygiene-related knowledge, attitudes, practices and beliefs (KAPB) survey will be conducted. These surveys will be repeated 18 and 39 months after the baseline cross-sectional survey to determine the effect of different interventions on helminth and intestinal protozoa infection, nutritional indicators and KAPB. Monitoring of diarrhoea will be done over a 24-month period at 2-week intervals, starting right after the baseline survey. Results: This study will allow determining the effect of an integrated, community-based approach on infection patterns of intestinal parasites and diarrhoeal incidence, anthropometric measures and hygiene-related KAPB. Conclusions: The acceptability of an integrated control package in the community will be evaluated, including strengths and limitations. Clinical Trial: ISRCTN53102033 (assigned: 26 March 2014).

  • The development of consumer mHealth interventions for chronic condition self-management: A systematic review.

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 12, 2017

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

    Background: Innovative, patient-centred mHealth interventions have the potential to help with the burden of chronic conditions, yet development processes are seldom reported. Objective: To describe th...

    Background: Innovative, patient-centred mHealth interventions have the potential to help with the burden of chronic conditions, yet development processes are seldom reported. Objective: To describe the development of consumer mHealth interventions for chronic condition self-management. Methods: CINAHL, Pubmed, PsychINFO and Embase databases were searched on 2nd September 2016 and re-searched on 22nd February 2017. Eligible reports were those published since 2010 that provided information on consumer mHealth interventions to assist the self-management of the priority non-communicable diseases determined by the World Health Organisation; respiratory disease, cancer, diabetes and cardiovascular disease. Results: Nineteen reports were included, representing the development of 13 mHealth interventions covering each of the four disease categories. Most were collaboratively developed, using user-centred and participatory design processes with patients/users, healthcare professionals and experts with the aim to support patient enablement and accessibility. Pre-design work involved a thorough needs assessment, often specific to the healthcare context. The re-design processes were described as iterative, engaging with usability testing and incorporating findings into design improvements. A demonstration of the importance of a user-centred philosophy and incorporating participatory design in mHealth development were key research findings. Tensions of competing priorities between patients and healthcare professionals throughout development were uncovered, with the intention to develop a useful product for the patient whilst ensuring clinical relevance. Conclusions: This review provides clear evidence that consumer mHealth interventions are developed inconsistently even when engaging with participatory or user-centred design principles, sometimes without direct involvement of patients themselves. The relative paucity of articles and the incomplete description of the development processes within the articles, presents challenges to furthering the knowledge base within the speciality. Healthcare professionals need timely access to quality information on mHealth products in order to recommend safe, effective consumer mHealth interventions to complement existing healthcare services. Robustly developed mHealth innovations may advance healthcare beyond the traditional methods of delivery to be accessible, reliable and useful to the many community-dwelling individuals living with a chronic condition.

  • Adverse Drug Event Discovery using Biomedical Literature: a Big Data Neural Network Adventure

    From: JMIR Medical Informatics

    Date Submitted: Oct 13, 2017

    Open Peer Review Period: Oct 13, 2017 - Oct 21, 2017

    Background: The study of adverse drug events (ADEs) is a tenured topic in medical literature. In recent years, increasing numbers of scientific articles and health-related social media posts have been...

    Background: The study of adverse drug events (ADEs) is a tenured topic in medical literature. In recent years, increasing numbers of scientific articles and health-related social media posts have been generated and shared daily, albeit with very limited use for ADE study, and with little known about the content with respect to ADEs. Objective: The aim of this study was to develop a big data analytics strategy which mines the content of scientific articles and health-related Web-based social media to detect and identify ADEs. Methods: We analyzed two data sources: (1) Biomedical articles and (2) Health-related social media blog posts. We developed an intelligent and scalable text mining solution on big data infrastructures, composed of Apache Spark, natural language processing, and machine learning. This was combined with an Elasticsearch No-SQL distributed database to explore and visualize ADEs. Results: The accuracy, precision, recall and area under ROC (receiver operating characteristic) of the system were 92.7%, 93.6%, 93.0% and 0.905 respectively, and showed better results in comparison with traditional approaches in the literature. This work not only detected and classified ADE sentences from big data biomedical literature, but also scientifically visualized ADE interactions. Conclusions: To the best of our knowledge, this work is the first to investigate a big data machine learning strategy for ADE discovery on massive datasets downloaded from PubMed Central and social media. This contribution illustrates possible capacities in big data biomedical text analysis using advanced computational methods with real-time update from new data published in a daily basis.

  • 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

  • Forecasting the West-Nile virus in the USA: a Google Trends-based time series analysis

    From: JMIR Public Health and Surveillance

    Date Submitted: Oct 13, 2017

    Open Peer Review Period: Oct 13, 2017 - Oct 21, 2017

    Background: West-Nile virus (WNV) is an arbovirus responsible of an infection, which tends to peak during the late summer and early fall period. Recently, tools monitoring web searches are emerging as...

    Background: West-Nile virus (WNV) is an arbovirus responsible of an infection, which tends to peak during the late summer and early fall period. Recently, tools monitoring web searches are emerging as powerful sources of data concerning especially infectious diseases. Objective: This study aimed at exploring the potentially predictive power of WNV-related web searches. Methods: Google Trends (GT) was used to extract search trends. Data regarding WNV were obtained from Centers for Disease Control and prevention (CDC). Data were analyzed using times series analysis. Results: We found that there was a good correlation between web searches and real-world epidemiological figures (Spearman's coefficient 0.73, p<0.0001). The best seasonal autoregressive integrated moving average (SARIMA) model was (0,1,1)X(0,1,1)4. Using data from 2004 to 2015 we were able to predict data for 2016. Conclusions: Our study demonstrated correlation between epidemiological data and search pattern related to WNV. Based on this correlation, further studies are needed to examine the practicality of these findings, making our model more accurate and reliable.

  • Young-people’s, parents’ and professionals’ views on required components of mobile applications to support self-management of chronic rheumatic disease: A qualitative study.

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 14, 2017

    Open Peer Review Period: Oct 14, 2017 - Oct 23, 2017

    Background: Background: There is growing evidence that supporting self-management of chronic rheumatic disease (CRD) can benefit both patients and professionals. Young-people with CRD and their healt...

    Background: Background: There is growing evidence that supporting self-management of chronic rheumatic disease (CRD) can benefit both patients and professionals. Young-people with CRD and their healthy peers increasingly use mobile technologies to access information and support in day-to-day life. Therefore, a user-led, rigorously developed and evaluated mobile-app could be valuable for facilitating young-people’s self-management of CRD. Objective: Objective: To seek the views of young-people with CRD, their parents/carers and healthcare professionals as to what should be included in a mobile-app to facilitate young-people’s self-management of chronic rheumatic disease. Methods: Methods: A qualitative approach was adopted with a purposeful sample of 9 young-people aged 10-18 years with CRD, 8 parent/carers and 8 healthcare professionals (professionals), involved in their care. Data were gathered through semi-structured focus group and individual interviews with young people and their parent/carers and healthcare professionals Interview discussion was facilitated through demonstration of four existing health apps to explore participants’ views on strengths and limitations of these, barriers and facilitators to mobile app use, preferred designs, functionality, levels of interaction and data sharing arrangements. Data were analysed using the framework approach. Results: Results: Analysis revealed three interlinked, overarching themes: 1. Purpose, 2. Components and content, and 3. Social support. Despite some differences in emphasis on essential content, general agreement was found between young-people with CRD, their parent/carers and professionals that a mobile app to aid self-management would be useful. Underpinning the themes, was a prerequisite that young-people are enabled to feel a sense of ownership and control of the app, and that it be an interactive, engaging resource that offers developmentally appropriate information and reminders, as well as enabling them to monitor their symptoms and access social support. Conclusions: Conclusions: Findings justify and pave the way for a future feasibility study into the production and preliminary testing of such an app. This would consider issues such as compatibility with existing technologies, costs, age, and cross-gender appeal as well as resource implications.

  • 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.

  • The impact of Small Private Online Course as a new approach in teaching oncology

    From: Journal of Medical Internet Research

    Date Submitted: Oct 16, 2017

    Open Peer Review Period: Oct 16, 2017 - Oct 24, 2017

    Background: The complexity of medical care in oncology with the multidisciplinary management of patients is not optimal due to a lack of effective communication and misinformation. Objective: The educ...

    Background: The complexity of medical care in oncology with the multidisciplinary management of patients is not optimal due to a lack of effective communication and misinformation. Objective: The educational objective was to build a new teaching method to improve cancer treatment and management by emphasizing the link between hospital and city. Methods: We developed a SPOC (small private online courses) over 2 sessions with the participation of 22 professionals from public and private institutions. Each session lasted for 6 weeks including 6 topics: individual health care plans, cancer surgery, ionizing radiation, anti-cancer drug treatments, clinical research and oncological supportive care. We targeted audience working on cancer. This SPOC chose an active teaching method with a collaborative and multidisciplinary learning. A final exam test was suggested for each session. We evaluated the satisfaction rate by means of a questionnaire and the success of this SPOC by its completion, success and commitment rate. Results: Among 1574 participants, 446 filled the evaluation form. The majority of the participants was aged between 31 and 45 years. There were 56 nurses, 103 pharmacists, 26 from the medical corpus, 53 participants from patient’s associations, 28 health teachers and 13 health students. Among the participants, 24.7% had an independent medical activity, 38.5% worked in a public institution and 36.8% in a private institution. 86% thought they learnt new information, 90.8% felt their expectations were met, 90.4% considered this formation had a positive impact on their professional practice. The completion rate was 35.5%, the success rate was 71.5% and the commitment rate was 64.7%. Conclusions: This SPOC showed the positive interest on the management of patients suffering from cancer. This digital learning is a new and very attractive concept to integrate in our teaching. It offered an optimal propagation of information and it met the students’ expectations. Clinical Trial: NA

  • Translation and validation of the Nomophobia Questionnaire (NMP-Q) in the Italian language: insights from factor analysis

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 15, 2017

    Open Peer Review Period: Oct 15, 2017 - Oct 24, 2017

    Background: Nomophobia, which is a portmanteau word for no mobile phone phobia, a fear of feeling disconnected, is considered to be a modern situational phobia. Objective: No psychometric scales in It...

    Background: Nomophobia, which is a portmanteau word for no mobile phone phobia, a fear of feeling disconnected, is considered to be a modern situational phobia. Objective: No psychometric scales in Italian are available for investigating nomophobia. We therefore planned a translation and validation study of the Nomophobia Questionnaire (NMP-Q) developed by Yildirim and Correia. Methods: The NMP-Q was translated from English into Italian using a backwards and forwards procedure. In order to explore the underlying factor structure of the translated questionnaire, exploratory factor analysis (EFA) was carried out. A principal component analysis (PCA) approach with varimax rotation was performed. Multivariate regression analyses were computed to shed light on the psychological predictors of nomophobia. Results: 403 subjects volunteered to take part in the study. They were aged 27.91±8.63 years and comprised 160 males (39.7%) and 243 females (60.3%). 45 subjects normally spent less than 1 hour on their mobile (11.2%), 94 between 1 and 2 hours (23.3%), 69 between 2 and 3 hours (17.1%), 58 between 3 and 4 hours (14.4%), 48 between 4 and 5 hours (11.9%), 29 between 5 and 7 hours (7.2%), 36 between 7 and 9 hours (8.9%) and 24 more than 10 hours (6.0%). The eigenvalues and scree plot supported a 3-factorial nature of the translated questionnaire. The NMP-Q showed an overall Cronbach’s alpha coefficient of 0.95 (0.94, 0.89 and 0.88 for the three factors). The first factor explained 23.32% of the variance, while the second and third explained 23.91% and 18.67% respectively. The total NMP-Q score correlated with the number of hours spent on the mobile. Conclusions: The Italian version of the NMP-Q proved to be reliable.

  • Diet and fitness apps in daily life in France: diversity of uses and digital inequalities

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 16, 2017

    Open Peer Review Period: Oct 16, 2017 - Oct 24, 2017

    Background: Digital devices are driving economic and social transformations, but assessing the uses, perceptions, and impact of these new technologies on diet and physical activity remains a major soc...

    Background: Digital devices are driving economic and social transformations, but assessing the uses, perceptions, and impact of these new technologies on diet and physical activity remains a major societal challenge. Objective: We aimed to determine under which social, economic, and cultural conditions individuals in France were more likely to be actively invested in the use of self-tracking diet and fitness applications as new ways of self-governance. Methods: Existing users of three diet and fitness self-tracking applications (Weight Watchers®, MyFitnessPal, and “sport” apps) were recruited from three regions of France. In-depth semi-directive interviews were conducted with each participant using open-ended questions to gain qualitative information about their use of diet and fitness apps. Results: We interviewed 79 individuals (Weight Watchers®, n=37; MyFitnessPal, n=20; sport apps, n=22). Quantitative analysis revealed three clusters of interviewees who differed by (1) social background and curative goal linked to use under constraint versus preventive goal linked to chosen use; and (2) intensity of their self-quantification efforts and participation in social networks. Interviewees used the applications for a diversity of uses including measurement, tracking, quantification, and participation in digital communities. A “digital divide” was revealed, comprising a major social gap. Social conditions for appropriation of self-tracking devices included socio-demographic factors, life course stages, and crosscutting factors of heterogeneity. Conclusions: Individuals from affluent or intermediate social milieus were most likely to use the applications and to participate in the associated on-line social networks. These interviewees also demonstrated a preventative approach to a healthy lifestyle. Individuals from lower milieus are more reluctant to digital devices in the field of diet / physical activity, and to the self-quantification process. The results of the study have major implications for public health.

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