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Journal Description

JMIR Preprints contains pre-publication/pre-peer-review preprints intended for community review. For a list of all preprints under public review click here. 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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  • Pleural Effusion resembling a lung tumor: Phantom Tumor of the Lung.

    From: JMIR Preprints

    Date Submitted: Jul 3, 2016

    Open Peer Review Period: Oct 3, 2016 - Sep 18, 2017

    Background: Phantom tumor of the Lung (also called Pseudo tumor of the lung) is a mass like appearance of inter-lobar pleural fluid collection in Congestive Heart Failure. The words Phantom or Pseudo...

    Background: Phantom tumor of the Lung (also called Pseudo tumor of the lung) is a mass like appearance of inter-lobar pleural fluid collection in Congestive Heart Failure. The words Phantom or Pseudo are coined, for this unusual finding, because it resembles to a tumor on radiograph and vanishes after initiating diuretic therapy. Objective: Phantom tumor of the Lung (also called Pseudo tumor of the lung) is a mass like appearance of inter-lobar pleural fluid collection in Congestive Heart Failure. The words Phantom or Pseudo are coined, for this unusual finding, because it resembles to a tumor on radiograph and vanishes after initiating diuretic therapy. Methods: Case report Results: We suggest that, Phantom tumor be always kept in differentials of mass-like finding on chest radiograph in patients with congestive heart failure; if there has been an increase in symptoms and signs of congestive heart failure. And treatment with diuretics be provided, before going for any other expensive and unnecessary investigations or procedures. Conclusions: We suggest that, Phantom tumor be always kept in differentials of mass-like finding on chest radiograph in patients with congestive heart failure; if there has been an increase in symptoms and signs of congestive heart failure. And treatment with diuretics be provided, before going for any other expensive and unnecessary investigations or procedures.

  • Nurse-moderated Internet-based Support for New Mothers: A Non-inferiority, Randomised Controlled Trial

    From: Journal of Medical Internet Research

    Date Submitted: Oct 19, 2016

    Open Peer Review Period: Oct 19, 2016 - Dec 14, 2016

    Background: Internet-based interventions moderated by community nurses have the potential to improve support offered to new mothers, many of whom now make extensive use of the internet to obtain infor...

    Background: Internet-based interventions moderated by community nurses have the potential to improve support offered to new mothers, many of whom now make extensive use of the internet to obtain information about infant care. However, evidence from population-based randomised controlled trials is lacking. Objective: The aim of this study was to test the non-inferiority of outcomes for mothers and infants who received a clinic-based postnatal health check plus nurse-moderated, internet-based-group support when infants were aged 1-7 months as compared to outcomes for those who received standard care consisting of postnatal home-based support provided by a community nurse. Methods: The design of the study was a pragmatic, preference, non-inferiority randomised control trial. Participants were recruited from mothers contacted for their postnatal health check, which is offered to all mothers in South Australia. Mothers were assigned either: 1) on the basis of their preference to clinic+internet or home-based support groups (n=328), or 2) randomly assigned to clinic+internet or home-based groups if they declared no strong preference (n=491). The overall response rate was 45%. Primary outcomes were Parenting Stress Index (PSI) Confidence and Karitane Parenting Confidence Scale scores. Secondary outcomes were PSI Isolation, Interpersonal Support Evaluation List – Short Form, Maternal Support Scale, Ages and Stages Questionnaire – Social-Emotional and MacArthur Communicative Development Inventory (MCDI) scores. Assessments were completed offline via self-assessment questionnaires at enrolment, (mean child age = 4.1 weeks, SD = 1.3) and again when infants were aged 9, 15 and 21 months. Results: Generalised estimating equations adjusting for post-randomisation baseline imbalances showed that differences in outcomes between mothers in the clinic+internet and home-based support groups did not exceed the pre-specified margin of inferiority (0.25 SD) on any outcome measure at any follow-up assessment, with the exception of MCDI scores assessing children’s language development at 21 months for randomised mothers, and PSI Isolation scores at 9 months for preference mothers. Conclusions: Maternal and child outcomes from a clinic-based postnatal health check plus nurse-moderated internet-based support were not inferior to those achieved by a universal home-based postnatal support program. Postnatal maternal and infant support using the internet is a promising alternative to home-based universal support programs. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12613000204741

  • Motivational determinants of exergame participation for older people in Assisted Living facilities: a mixed methods study.

    From: Journal of Medical Internet Research

    Date Submitted: Oct 18, 2016

    Open Peer Review Period: Oct 18, 2016 - Dec 13, 2016

    Background: Exergames (exercise based videogames) as a mode of delivering strength and balance exercise for older people are growing in popularity with the emergence of new Kinect based technologies,...

    Background: Exergames (exercise based videogames) as a mode of delivering strength and balance exercise for older people are growing in popularity with the emergence of new Kinect based technologies, however little is known about the factors affecting their uptake and use with older people. Objective: The aim of this study is to determine the factors that may influence the motivation of older people to use exergames to improve their physical function and reduce fall risk. Methods: Mixed methods were employed in which fourteen semi-structured interviews were conducted with older people (n=12, aged 59-91 years) from two supportive housing facilities in the North West of the UK who participated in a 6 week trial of the exergames, one manager and one physiotherapist; 81 hours of observation and Technology Acceptance Model questionnaires were conducted. Results: The findings suggest that the participants were intrinsically motivated to participate in the exergames due to the enjoyment experienced when playing the exergames and perceived improvements of their physical and mental health and/or social confidence. The social interaction provided in this study was an important extrinsic motivator which increased the intrinsic motivation to adhere to the exergame programme. Conclusions: The findings of this study suggest that exergames may be a promising tool for delivering falls prevention exercises and increasing adherence to exercise in older people. Understanding the motivation of older people to use exergames may assist in the process of implementation.

  • Assessing the contextual factors influencing RFID implementation in hospitals of a developing country: A conceptual model

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 18, 2016

    Open Peer Review Period: Oct 21, 2016 - Dec 16, 2016

    Background: Wasting economic resources in a developing country like Iran will have numerous negative consequences. Thus, in order to avoid possible failures, necessary infrastructures must be provided...

    Background: Wasting economic resources in a developing country like Iran will have numerous negative consequences. Thus, in order to avoid possible failures, necessary infrastructures must be provided before implementing new technologies. Objective: The present study aimed at assessing the degree of readiness for implementing RFID in the hospitals of a developing country through a conceptual model. Methods: The research study adopted a descriptive design and structural equation modeling was used for data analysis. Data were collected from the hospitals affiliated to Semnan University of Medical Sciences. A questionnaire designed by the researchers was used to collect participants’ ideas about organizational readiness, cultural readiness, and human resource readiness in implementing RFID. Data were fed into Path SPSS (Version 16) and LISREL 8.8, followed by conducting path analysis. Results: The results showed that human resource readiness significantly predicted RFID implementation, with cultural readiness playing the role of a mediator variable. Cultural readiness itself was influenced by organizational readiness (p<0.01). Cultural factors play an important role in implementing RFID projects in developing countries like Iran. Conclusions: Paying more attention to these factors can reduce the risk of failure in implementing such technological projects. Hospitals should strengthen organizational factors and enhance top rank managers’ support for implementing RFID. By so doing, they will promote cultural readiness, prepare human resources, and win the cooperation of the personnel in implementing such a technological project. Clinical Trial: what is it?

  • Beyond use versus non-use: identifying subgroups based on older adults’ activities on the Internet

    From: Journal of Medical Internet Research

    Date Submitted: Oct 20, 2016

    Open Peer Review Period: Oct 20, 2016 - Dec 15, 2016

    Background: As for all individuals, the Internet is essential in everyday life of older adults. Research on older adults’ use of the Internet has merely focused on users versus non-users, and conseq...

    Background: As for all individuals, the Internet is essential in everyday life of older adults. Research on older adults’ use of the Internet has merely focused on users versus non-users, and consequences of Internet use and non-use. Older adults are a heterogeneous group, which may implicate that their use of the Internet is diverse as well. Older adults can use the Internet for different activities, and this usage can be of influence on benefits the Internet can have for older adults. Objective: The aim of this paper is to describe the diversity or heterogeneity in the activities for which older adults use the Internet, and to determine whether diversity is related to social or health related variables. Methods: We used data of a national representative Internet panel in the Netherlands. Panel members aged 65 years and older and who have access and make use of the Internet were selected (n=1418, 88.18% of the total sample were Internet users). We conducted a latent class analysis based upon the Internet activities that panel members reported to spend time on. Second, we described the identified clusters with descriptive statistics, and compared the clusters using ANOVA and chi-square tests. Results: Four clusters were distinguished. Cluster 1 was labelled as the ‘practical users’ (36.88%, n=523). These respondents mainly used the Internet for practical and financial purposes such as searching for information, comparing products, and banking. Respondents in cluster 2 ‘the minimizers’ (32.23%, n=457), reported the lowest frequency on most Internet activities, are older and spent the smallest time on the Internet. Cluster 3 was labelled as ‘the maximizers’ (17.77%, n=252): these respondents used the Internet for various activities, spent the most time on the Internet and were younger. Respondents in cluster 4 ‘the social users’ mainly used the Internet for social and leisure related activities, such as gaming and social network sites. The identified clusters were significantly different in age (P<.001, ω2=.07), time spent on the Internet (P<.001, ω2=.12), frequency of downloading apps (P<.001, ω2=.14) with medium to large effect sizes. Social and health related variables were significantly different between the clusters, except social and emotional loneliness. However, effect sizes were small. The minimizers scored significantly lower on psychological well-being, iADL and experienced health compared with the practical users and maximizers. Conclusions: Older adults are a diverse group concerning their activities on the Internet. This underlines the importance to look beyond use versus non-use when studying older adults Internet use. The clusters we have identified in this study can help tailor the development and deployment of eHealth intervention to specific segments of the older population.

  • What predicts online health information seeking behaviour among Egyptian adults? A cross-sectional study.

    From: Journal of Medical Internet Research

    Date Submitted: Oct 21, 2016

    Open Peer Review Period: Oct 21, 2016 - Dec 16, 2016

    Background: Over the last decade, the Internet has become an important source of health-related information for a wide range of people worldwide. However, little is known about who accesses this sourc...

    Background: Over the last decade, the Internet has become an important source of health-related information for a wide range of people worldwide. However, little is known about who accesses this source of information among Egyptian users. Objective: To identify personal characteristics of Egyptian online health information (OHI) seekers and their association with health information seeking behaviour. Methods: This cross-sectional study was conducted from June to October 2015. An online questionnaire was sent to Egyptian users of a popular health information website aged ≥ 18 years or older (N = 1400). The study questionnaire included: (1) demographic characteristics, (2) general health status, and (3) health information seeking behaviour which included: frequency of use, different topics sought, and self reported impact of obtained OHI on health behaviours. Data were analysed using descriptive statistics and multiple regression analysis. Results: A total of 490 respondents completed the electronic questionnaire with response rate equivalent to 35.0 % . Of the participants; 57.1% were females, 63.4% had a university level qualification, and 37.1 % had a chronic health problem. The results of the multiple regression analysis showed that 31.0% (F= 9.94, P < 0.05) of variance in frequency of using OHI can be predicted by personal characteristics. Participants who sought for OHI were more likely to be female, younger age, higher education levels, and good self-reported general health. Conclusions: Our results provide insights into Internet use and health information–seeking behaviours of the Egyptian internet users. This will contribute to better recognize their needs, highlight improvements of internet health information availability and provide tools to navigate to the highest-quality health information to Egyptian OHI users.

  • An Inter-hospital 12-Lead Electrocardiography Teleconsultation System and Mobile Application Based on Users’ Experiences

    From: Journal of Medical Internet Research

    Date Submitted: Oct 20, 2016

    Open Peer Review Period: Oct 21, 2016 - Dec 16, 2016

    Background: More and more hospitals have formed hospital alliance to share medical resources with one another in Taiwan. Consequently, the need for developing a safe and convenient inter-hospital 12-l...

    Background: More and more hospitals have formed hospital alliance to share medical resources with one another in Taiwan. Consequently, the need for developing a safe and convenient inter-hospital 12-lead electrocardiography (ECG) and tele-consultation system arises. Objective: The major goal of this study is to develop a safe and effective mobile application (App) and ECG system to deliver inter-hospital 12-lead ECG tele-consultation. Methods: The design of this APP and system was based on the experiences of cardiologists as users and human factor consideration so to minimize misuse, misdiagnosis, and violation of patients’ privacy. In addition, this technology facilitated the interoperability of 12-lead ECG across hospitals, which integrates heterogeneous 12-lead ECG from different hospitals and various mobile phones of consulting cardiologists. Notably, the use of role-based certificates enhanced the safety of ECG delivery on internet. This App was evaluated by two senior cardiologists as with credible usability. Results: This technology allowed the practice of 12-lead ECG tele-consultation easier and more convenient. It also helped clinicians give proper diagnosis and disposition more efficiently based on more comprehensive ECG reports and consultation. Conclusions: In summary, this App can be applied easily in clinical settings and greatly improves the efficiency and quality of medical services.

  • The feasibility and acceptability of a web-based alcohol management intervention in community sports clubs: a cross sectional study

    From: Journal of Medical Internet Research

    Date Submitted: Oct 20, 2016

    Open Peer Review Period: Oct 21, 2016 - Dec 16, 2016

    Background: The implementation of comprehensive alcohol management strategies can reduce excessive alcohol use and reduce the risk of alcohol related harm at sporting venues. Supporting sports venues...

    Background: The implementation of comprehensive alcohol management strategies can reduce excessive alcohol use and reduce the risk of alcohol related harm at sporting venues. Supporting sports venues to implement alcohol management strategies via the web may represent an effective and efficient means of reducing harm caused by alcohol in this setting. However, the feasibility and acceptability of such an approach is unknown. Objective: This study aimed to identify: (1) current access to and use of the web and electronic devices by sports clubs; (2) perceived usefulness, ease of use, and intention to use a web-based program to support implementation of alcohol management practices in sports clubs; (3) factors associated with intention to use such a web-based support program; and (4) the specific features of such a program that sports clubs would find useful. Methods: A cross-sectional survey was conducted with club administrators of community football clubs in the state of New South Wales, Australia. Perceived usefulness, ease of use and behavioural intention to use a hypothetical web-based alcohol management support program was assessed using the validated Technology Acceptance Model (TAM) instrument. Associations between intention to use a web-based program and club characteristics as well as perceived ease of use and usefulness was tested using Fisher’s exact test and represented using relative risk for high intention to use the program. Results: Of the 73 football clubs that were approached to participate in the study, 63 consented to participate, 46 were eligible and completed the survey. All participants reported having access to the web and 98% reported current use of electronic devices (e.g. computers, iPads/tablets, smartphones, laptops, televisions and smartboards). Mean scores (out of a possible 7) for the TAM constructs were high for: intention to use (Mean: 6.25, SD: 0.87), perceived ease of use (Mean: 6.00, SD: 0.99), and perceived usefulness (mean: 6.17, SD: 0.85). Intention to use the web-based alcohol management program was significantly associated with perceived ease of use (P=.02, RR: 1.4, CI: 1.0-2.9), perceived usefulness (P=.03, RR: 1.5, CI: 1.0-6.8) and club size (P=.02, RR: 0.8 CI: 0.5-0.9). The most useful features of such a program included the perceived ability to complete program requirements within users own time, complete program accreditation assessment and monitoring online, develop tailored action plans and receive email reminders and prompts to complete action. Conclusions: A web-based alcohol management approach to support sports clubs in the implementation of recommended alcohol management practices appears both feasible and acceptable. Future research should aim to determine if such intended use leads to actual use and club implementation of alcohol management practices. Clinical Trial: NA

  • Design, Implementation and Evaluation of Self-describing Diabetes Medical Records

    From: JMIR Medical Informatics

    Date Submitted: Oct 21, 2016

    Open Peer Review Period: Oct 23, 2016 - Dec 18, 2016

    Background: Each patient’s medical record consists of data specific to that patient and is therefore an appropriate source to adapt educational information content. Objective: This study aimed to de...

    Background: Each patient’s medical record consists of data specific to that patient and is therefore an appropriate source to adapt educational information content. Objective: This study aimed to design and implement an information provision system based on the medical records of diabetic patients and to investigate the attitudes of users towards using this product. Methods: The study was organized into three phases: need analysis, design and implementation, and final evaluation. The aim of the need analysis phase was to investigate the questioning behavior of the patient in the real-world context. The design and implementation phase consisted of four stages: determining the minimum dataset for diabetes medical records, collecting and validating content, designing and implementing a diabetes electronic medical record system, and data entry. Evaluating the final system was done based on the constructs of the Technology Acceptance Model (TAM) in the two dimensions of perceived usefulness and perceived ease of use. A semi-structured interview was used for this purpose. Results: Three main categories were extracted for the patient’s perceived usefulness of the system: raising the self-awareness and knowledge of patients, improving their self-care, and improving doctor-patient interaction. Both patients and physicians perceived the personalized sense of information as a unique feature of the application and believed that this feature could have a positive effect on the patient's motivation for learning and using information in practice. Specialists believed that providing personal feedback on the patient’s lab test results along with general explanations encourages the patients to read the content more precisely. Moreover, accessing medical records and helpful notes was a new and useful experience for the patients. Conclusions: One of the key perceived benefits of providing tailored information in the context of medical records was raising patient awareness and knowledge. The results obtained from field observations and interviews has shown that patients were ready to accept the system and had a positive attitude when it was put into practice. The findings related to user attitude can be used as a guideline to design the next phase of the research (i.e., investigation of system effectiveness on patient outcomes).

  • Analysis of Patient Narratives in Disease Blogs on the Internet: An Exploratory Study of Social Pharmacovigilance

    From: Journal of Medical Internet Research

    Date Submitted: Dec 8, 2016

    Open Peer Review Period: Dec 9, 2016 - Dec 17, 2016

    Background: While several reports have suggested that patient-generated data from Internet sources could be used to improve drug safety and pharmacovigilance, few studies have identified such data sou...

    Background: While several reports have suggested that patient-generated data from Internet sources could be used to improve drug safety and pharmacovigilance, few studies have identified such data sources in Japan. We introduce a unique Japanese data source: tōbyōki, which translates literally as “an account of a struggle with disease.” Objective: The purpose of this study was to evaluate the basic characteristics of the TOBYO database, a collection of tōbyōki blogs on the Internet, and discuss potential applications for pharmacovigilance. Methods: We analyzed the overall gender and age distribution of the patient-generated TOBYO database and compared this with other external databases generated by healthcare professionals. For detailed analysis, we prepared separate datasets for blogs written by patients with depression and blogs written by patients with rheumatoid arthritis, because these conditions were expected to entail subjective patient symptoms such as discomfort, insomnia, and pain. Frequently appearing medical terms were counted and their variations were compared with those in an external adverse drug reaction (ADR) reporting database. Frequently appearing words regarding patients with depression and patients with rheumatoid arthritis were visualized using word clouds and word co-occurrence networks. Results: As of 4 June 2016, the TOBYO database comprised 54,010 blogs representing 1405 disorders. Overall, more entries were written by female bloggers (68.8%) than by male bloggers (30.8%). The most frequently observed disorders were breast cancer (4983 blogs), depression (3556), infertility (2430), rheumatoid arthritis (1118), and panic disorder (1090). Comparison of medical terms observed in tōbyōki blogs with those in an external ADR reporting database showed that subjective and symptomatic events and general terms tended to be frequently observed in tōbyōki blogs (e.g. anxiety, headache, and pain) while events using more technical medical terms (e.g. syndrome and abnormal laboratory test result) tended to be observed frequently in the ADR database. We also confirmed the feasibility of using visualization techniques to obtain insights from unstructured text-based tōbyōki blog data. Word clouds described the characteristics of each disorder, such as “sleeping” and “anxiety” in depression and “pain” and “painful” in rheumatoid arthritis. Conclusions: Pharmacovigilance should maintain a strong focus on patients’ actual experiences, concerns, and outcomes, and this approach can be expected to uncover hidden adverse event signals earlier and to help us understand adverse events in a patient-centered way. Patient-generated tōbyōki blogs in the TOBYO database showed unique characteristics that were different from the data in existing sources generated by healthcare professionals. Analysis of tōbyōki blogs would add value to assessment of disorders with high prevalence in women, psychiatric disorders in which subjective symptoms have important clinical meaning, refractory disorders, and other chronic disorders. Clinical Trial: Not applicable

  • mHealth interventions for health system strengthening in China: a Systematic Review

    From: Journal of Medical Internet Research

    Date Submitted: Oct 26, 2016

    Open Peer Review Period: Oct 26, 2016 - Dec 21, 2016

    Background: With rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionise healthcare delivery. There is particular promise for mHealth to pos...

    Background: With rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionise healthcare delivery. There is particular promise for mHealth to positively influence health system reform, and confront the new challenges of chronic diseases. Objective: To systematically review existing mHealth initiatives in China, to characterise them and examine the extent to which mHealth contributes towards the health system strengthening in China. Also to identify gaps in mHealth development and evaluation. Methods: Systematically review of the literature from English and Chinese electronic database and trial registries, including PubMed, EMBASE, Cochrane, China National Knowledge of Infrastructure, and WHO International Clinical Trials Registry Platform. We used the English keywords of mHealth, eHealth, telemedicine, telehealth, mobile phone, cell phone, text messaging, and China, as well as their corresponding Chinese keywords. All articles using mobile technology for healthcare management were included in the study. Results: 1,704 articles were found using the search terms. and eventually 72 were included. Overall, few high quality interventions were identified. Most interventions were found to be insufficient in scope, and their evaluation was of inadequate rigour to generate scalable solutions and provide reliable evidence of effectiveness. Most interventions focused on text messaging for consumer education and behaviour change. There were a limited number of interventions that addressed health information management, health workforce issues, use of medicines and technologies, or leadership and governance from a health system perspective. Conclusions: We provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth interventions in effort to guide the development of future mHealth interventions, target disadvantaged populations with mHealth interventions, and generate appropriate evidence for scalable and sustainable models of care.

  • Linguistic Markers of Depression Severity Level: An Exploratory Study

    From: Journal of Medical Internet Research

    Date Submitted: Oct 26, 2016

    Open Peer Review Period: Oct 27, 2016 - Dec 22, 2016

    Background: Depression is a serious illness that affects millions of people globally. It is frequently undetected and commonly misdiagnosed. An objective marker of depression has the potential to dram...

    Background: Depression is a serious illness that affects millions of people globally. It is frequently undetected and commonly misdiagnosed. An objective marker of depression has the potential to dramatically improve current diagnostic approaches. Due to the ubiquity of smart phones and the popularity of social media, text is now a common form of communication, which could be very useful in monitoring linguistic patterns that might be indicative of symptoms of depression. Objective: The objective of this study was to explore the potential of using natural language processing and machine learning to automatically identify depression symptom severity. Methods: This study used the Distress Analysis Interview Corpus (DAIC), a multimodal collection of semi-structured clinical interviews. The interviews simulate the standard protocols for identifying people with major depression. The corpus contains audio and video recordings of participant interviews (N=688). In addition to manual transcriptions, automatic speech recognition (ASR) was performed to generate transcripts of the interviews. Semantic and syntactic linguistic features were extracted from the transcripts and then used to train linear regression models. Results: Using linguistic markers, we successfully train speaker-independent regression models that were able to predict depression severity (MAE=4.42, RMSE=5.06). We find a number of semantic and syntactic features to be significantly correlated with depression score (P<.001), including but not limited to: first person singular pronouns, words related to affective processes, word length, unique number of part-of-speech tags, attributes related to the syntactic dependency tree representation, and semantic coherence. Conclusions: Features extracted from unconstrained speech provided useful linguistics markers that were strongly related to depression. In addition, regression models trained with linguistic features were able to successfully predict depression level. These findings suggest that natural language processing and machine learning approaches offer numerous clinical opportunities, including an unobtrusive automatic assessment of depression severity, which could be used ubiquitously.

  • Development, usability and efficacy of a post-operative pain management computer game: an evaluation study

    From: JMIR Serious Games

    Date Submitted: Nov 7, 2016

    Open Peer Review Period: Nov 10, 2016 - Jan 5, 2017

    Background: Postoperative pain is a persistent problem after surgery and can delay recovery and develop into chronic pain. Better patient education has been proposed to improve pain management of pati...

    Background: Postoperative pain is a persistent problem after surgery and can delay recovery and develop into chronic pain. Better patient education has been proposed to improve pain management of patients. Serious games have not been previously developed to help patients to learn managing their postoperative pain. Objective: To describe the development of a computer-based game for surgical patients about post-operative pain management and to evaluate the usability, user experience and efficacy of the game. Methods: A computer game was developed by an interdisciplinary team following a structured approach. The usability, user experience and efficacy of the game were evaluated using self-reported questionnaires (AttrakDiff2, Post-operative Pain Management Game Survey (POP-MGS), Patient Knowledge About Post-operative Pain Management questionnaire (PAK-PPM)), semi-structured interviews and direct observation in one session with 20 participants recruited from the general public via Facebook (mean age 48 ±14, 11 women). Adjusted Barriers Questionnaire II and three questions on health literacy were used to collect background information. Results: Theories of self-care and adult learning, evidence for the educational needs of patients about pain management and principles of gamification were used to develop the computer game. Ease of use and usefulness received a median scores between 2.00 (IQR 1.00) and 5.00 (IQR 2.00) (possible scores 0-5), and ease of use was further confirmed by observation. Participants expressed satisfaction with this novel method of learning, despite some technological challenges. The attributes of the game, measured with AttrakDiff2 received a mean scores above 0 in all dimensions; highest for Attraction (1.350.78), followed by Pragmatic Quality (1.230.84), Hedonic Quality Interaction (0.920.69) and Hedonic Quality Stimulation (0.670.60). Knowledge of pain medication and pain management strategies improved after playing the game (P=0.001). Conclusions: A computer game can be an efficient method of learning about pain management; it has the potential to improve knowledge and is appreciated by users. To assess the game’s usability and efficacy in the context of preparation for surgery, an evaluation with a larger sample, including surgical patients and older people, is required.

  • Tips for PowerPoint based interactive lectures grounded on educational theories

    From: JMIR Medical Education

    Date Submitted: Oct 27, 2016

    Open Peer Review Period: Nov 1, 2016 - Dec 27, 2016

    PowerPoint, a strong tool for presentation, has been very commonly criticized for its shortcomings. Sentences like ‘death by PowerPoint’ almost always do the rounds whenever PowerPoint is discusse...

    PowerPoint, a strong tool for presentation, has been very commonly criticized for its shortcomings. Sentences like ‘death by PowerPoint’ almost always do the rounds whenever PowerPoint is discussed as a teaching tool. Nonetheless, PowerPoint continues to be used as a major teaching tool in lecture classes. This paper aims to address and thus abolish majority of shortcomings in 10 tips grounded in learning theories. The paper attempts to revive the art and importance of creating line diagrams and simplifying graphs, which we have conveniently shoved away with coming of PowerPoint. It also highlights well known but under or mis-utilised features of bulleted text and grids and their importance in higher order learning. However, reader should keep in mind, like any teaching tool to be effectively utilized, substantial effort, at least initially, is required on teachers’ part to implement the tips.

  • ‘Click for Closer Care’: A Content Analysis of Community Pharmacy Websites in Four Countries

    From: Journal of Medical Internet Research

    Date Submitted: Oct 30, 2016

    Open Peer Review Period: Nov 3, 2016 - Dec 29, 2016

    Background: Community pharmacies are undeniably taking up an increasingly extended role in health care provision nowadays, and this is leading to –potentially controversial- combinations of clinical...

    Background: Community pharmacies are undeniably taking up an increasingly extended role in health care provision nowadays, and this is leading to –potentially controversial- combinations of clinical and commercial services hitherto unprecedented in professional health care. However it is unknown to which extent this development manifests on the Internet. Objective: To fill the void of knowledge about clinical and commercial services presented on the websites of licensed community pharmacies nowadays. Methods: A content analysis of clinical and commercial services present in a random sample of 200 licensed community pharmacy websites from Great Britain, the Netherlands, the Canadian provinces British Columbia and Manitoba, and the Australian states New South Wales and Western Australia. Results: The top-5 specific services mentioned on the community pharmacy websites were cosmetic products (62.7%), medication refill request options (62.0%), over-the-counter medicine (57.5%), complementary and alternative medicine (53.5%), and home medical aids (49.0%) respectively. On average 72.5% of the community pharmacy websites across the four countries included combinations of clinical and commercial services. Combinations of clinical and commercial services were more often present on chain pharmacy websites (82.8%) than single pharmacy websites (47.2%) (P < .001), and most often on the Canadian community pharmacy websites, followed by the Australian, British, and Dutch pharmacy websites respectively (P < .05). Further, more than half of the pharmacies’ homepages contained combinations of clinical and commercial images (54.0%), and almost half of the homepage menus contained combinations of clinical and commercial items (49.5%). The latter were again more common on chain pharmacy than single pharmacy websites (P < .001), with significant differences between countries (P < .001). Conclusions: A considerable share of the websites of licensed community pharmacies in Great Britain, the Netherlands, Canada, and Australia nowadays combine a clinical offer with commercial services. Previous research into combinations of commercial and professional services suggests that such combinations may lead to increased interest in commercial services that may be unnecessary or inappropriate to patients’ health.

  • Characterising Measurements in Health Self Quantification: A Tools Review Study

    From: Journal of Medical Internet Research

    Date Submitted: Oct 27, 2016

    Open Peer Review Period: Oct 27, 2016 - Dec 22, 2016

    Background: Background: The use of wearable devices for health self-quantification (SQ) introduces new ways of thinking about one’s body and how to achieve the desired health outcomes. Measures rela...

    Background: Background: The use of wearable devices for health self-quantification (SQ) introduces new ways of thinking about one’s body and how to achieve the desired health outcomes. Measures related to heart rate, respiratory volume, skin temperature, blood volume pulse, sleep, mood, blood pressure, food consumed, quality of surrounding air – anything from mental, emotional, and physical to social and environmental aspects of daily life can be acquired, quantified, and aggregated in a holistic way that has never been possible before. However, health SQ lacks a formal common language or taxonomy for describing these measurements. Establishing such taxonomy is important because it enables systematic investigations which are needed to improve the use of wearable devices in health self-care, and contributes to provide evidence of sufficient quality to determine whether and how health SQ is a worthwhile healthcare paradigm. Objective: Objectives: This study aims to investigate a sample of wearable devices in order to build and test a taxonomy of measurements in health SQ. This is called the Classification of Data and Activity in Self-Quantification Systems (CDA-SQS). Methods: Methods: A sample of seven health SQ devices/services was selected to be examined in detail: 1) Zeo Sleep Manager, 2) Fitbit Ultra, 3) Fitlinxx Actipressure, 4) iBGStar, 5) Sensaris Senspod, 6) 23andMe, 7) uBiome. Open coding technique was followed to find all the themes that are related to our research aim. Results: Results: This study helped to distinguish between three types of measurements in health SQ: body structures and functions, body actions and activities, and around body. The CDA-SQS classification should be applicable to studying health SQ among people whatever their health objectives, health status and conditions are. Conclusions: Conclusion: CDA-SQS is a critical contribution to a much more consistent way of studying health SQ. It can be coupled to external taxonomies of tools, and models that describe the users’ health self-care activities and behaviours to facilitate a more rigorous analysis. This in turn may help in stratifying people into groups based on their health related measurements, wearable devices, health activities, etc. and ultimately enable the development of better personalised health interventions.

  • Comparing Crowdsourcing and Friendsourcing: a Social Media Based Feasibility Study to Support Alzheimer’s Disease Caregivers

    From: Journal of Medical Internet Research

    Date Submitted: Oct 30, 2016

    Open Peer Review Period: Nov 3, 2016 - Dec 29, 2016

    Background: In the United States, over 15 million informal caregivers provide unpaid care to people with Alzheimer’s disease (AD). Compared to others in their age group, AD caregivers suffer from h...

    Background: In the United States, over 15 million informal caregivers provide unpaid care to people with Alzheimer’s disease (AD). Compared to others in their age group, AD caregivers suffer from higher rates of stress, medical and psychiatric illness. Psychosocial interventions improve the health of caregivers. However, constraints of time, distance and availability inhibit the utilization of these services. Newer online technologies such as social media, online groups, friendsourcing and crowdsourcing, present alternative methods of delivering support. However, limited work has been done in this area with caregivers. Objective: The primary aim of this study was to determine the feasibility of innovating peer support group work delivered through social media with friendsourcing. A Facebook app provided support to AD caregivers through collecting friendsourced answers to caregiving questions from participants’ social networks. The study’s secondary aim descriptively compared friendsourced answers to crowdsourced answers. Methods: This feasibility study recruited AD caregivers online to participate in a 6 week long asynchronous, online, closed group on Facebook, where caregivers received support through moderator prompts, group member interactions and friendsourced answers to caregiving questions. Participants were surveyed and interviewed before and after the online group to assess their needs, views on technology and experience with the intervention. Caregiving questions were pushed automatically to the participants’ Facebook Newsfeed, allowing participants’ Facebook friends to see and post answers to the caregiving questions (Friendsourced answers). Two of these caregiving questions were pushed to crowdsource workers through the Amazon Mechanical Turk platform. Characteristics of these crowdsourced answers were descriptively compared with the friendsourced answers. Results: Six AD caregivers completed the initial online survey and semi-structured phone interview. Four of these six participants agreed to participate in the online Facebook closed group activity portion of the study. Friendsourcing and crowdsourcing answers to caregiving questions had similar rates of acceptability as rated by content experts, 90% and 100% respectively. Rates of emotional support and informational support for both groups of answers appeared to trend with the type of support emphasized in the caregiving question (emotional vs. informational support question). Friendsourced answers included more shared experiences (67%) than crowdsourced answers (9%). Conclusions: An asynchronous, online, closed group on Facebook was found to be generally acceptable as a means to deliver support to caregivers of people with AD. Both friendsourced and crowdsourced answers may be an acceptable way to provide informational and emotional support to caregivers of people with AD. Friendsourced answers demonstrated higher rates of shared experiences.

  • Supporting caregivers to promote child development: Using an innovative mHealth solution to get information to where it counts

    From: JMIR mHealth and uHealth

    Date Submitted: Oct 29, 2016

    Open Peer Review Period: Nov 3, 2016 - Dec 29, 2016

    Background: Suboptimal development during early childhood results in risks for ill health and diminished human capital in adulthood. Community-based service providers play a key role in promoting earl...

    Background: Suboptimal development during early childhood results in risks for ill health and diminished human capital in adulthood. Community-based service providers play a key role in promoting early child development in areas where government services are weak. While community-based service providers are tasked with collecting monitoring and evaluation (M&E) data for governments and donors, such data is rarely used beyond accountability. Objective: The purpose of this study is to test the Information for Action (IFA) mobile phone app we developed to convert routinely collected data into useful, real-time decision support to caregivers, community-based service providers and programme managers. Methods: The IFA was tested with a convenience sample of 10 Community Health Volunteers (CHVs) in West Katweng’ a sub-location of Rarieda Subcounty in western Kenya. CHVs were requested to use the app as part of regular home visits to households containing children 0–5 years of age over a period of five months, following which a qualitative assessment of the app was conducted. Results: CHVs reported initial concern and anxiety given that it was their first time using a smart phone. Though they appreciated not having to carry around heavy counselling materials and the app assisted them to recall key messages with ease. With time, an increased level of confidence was experienced by participants. CHVs reported that the app facilitated interactive dialogue which improved the quality of their home visits. Conclusions: A number of technical difficulties were experienced including short battery life, the cost of electricity to charge the phones and challenges uploading data to the cloud in real time. Nonetheless, CHVs expressed great appreciation for the support and mentorship they received during implementation. CHV supervisors from the Ministry of Health appreciated how the app was adapted for the context of western Kenya and commended the participatory implementation process which involved existing training, implementation and supervision structures.

  • Communicating Research Findings: EvidenceNetwork.ca as a Case Study

    From: Journal of Medical Internet Research

    Date Submitted: Oct 28, 2016

    Open Peer Review Period: Nov 1, 2016 - Dec 27, 2016

    Background: The disconnect between academic research and what is reported in the mainstream media suggests the need to connect journalists, policy makers, and the public with the best available eviden...

    Background: The disconnect between academic research and what is reported in the mainstream media suggests the need to connect journalists, policy makers, and the public with the best available evidence on high profile health policy topics. While well positioned to provide this evidence, approximately half of researchers do not engage with the media; fewer than half promote their research through social media. EvidenceNetwork.ca was created in Canada in 2011 to overcome obstacles faced by researchers and the media in accurately communicating health policy-related evidence. Objective: To describe and highlight the factors underlying a uniquely successful Canadian effort, EvidenceNetwork.ca, to widely disseminate important research results. The importance of a balanced effort building on both new and traditional media is emphasized. Methods: This case-study of EvidenceNetwork.ca describes a mechanism to engage both academics and the media to improve health policy reporting. We review the methods used by EvidenceNetwork.ca to gain credibility with the media and to adapt academic writing to better communicate evidence, while responding to the ever-changing needs of media outlets. Internet analytics highlight the growing reach of EvidenceNetwork.ca. Key examples demonstrate the potential impact of communicating research through the media. Results: EvidenceNetwork.ca engages academics and the media to improve health policy reporting primarily through supporting the development of evidence-based op-eds (a commentary placed opposite the editorial page). Once accepted by traditional print and new media outlets, EvidenceNetwork.ca uses social media (e.g., Facebook, Twitter, Reddit and LinkedIn) to further promote the spread and uptake of the evidence-based messages. To date, a pan-Canadian network of over 80 academics and strong relationships with key media outlets have been developed. Between 2011 and 2016, EvidenceNetwork.ca has helped to get op-eds written by academic experts published over 1,650 times in major Canadian media outlets and over 1,150 more times in smaller community papers (a total of > 2,800 publications). Other EvidenceNetwork.ca communications initiatives include media backgrounders, posters and infographics, podcasts, eBooks, webinars and conferences. Examples of evidence uptake by governments and policy makers at both provincial and federal levels demonstrate impact. Conclusions: EvidenceNetwork.ca has developed a successful method for overcoming tensions between academics and the media in order to improve health policy reporting. The network’s niche product pushes evidence-based knowledge using traditional, new media and social media. Academics are given a powerful opportunity to have their research understood and used by patients, the public and policy makers.

  • Directional and non-directional peer support in online mental health forums for young people

    From: Journal of Medical Internet Research

    Date Submitted: Oct 30, 2016

    Open Peer Review Period: Nov 3, 2016 - Dec 29, 2016

    Background: The internet has the potential to help young people by reducing the stigma associated with mental health and enabling young people to access services and professionals who they may not oth...

    Background: The internet has the potential to help young people by reducing the stigma associated with mental health and enabling young people to access services and professionals who they may not otherwise access. Online support can empower young people, help them develop new online friendships, share personal experiences, communicate with others who understand, provide information and emotional support and most importantly help them feel less alone and normalise their experiences in the world. Objective: The aim of the research was to gain an understanding of how young people use an online forum for emotional and mental health issues. Specifically, the project examined what the young people discuss and how they seek support on the forum (objective 1). Further it looked at how the young service users responded to posts in order to gain an understanding of how young people provided each other with peer to peer support (objective 2). Methods: Kooth is an online counselling service for young people aged 11-25 experiencing emotional and mental health problems. It is based in the UK and provides support that is anonymous, confidential and free at the point of delivery. Kooth provided the researchers with all the online forum posts between a two year period which resulted in a data set of 622 initial posts and 3,657 initial posts with responses. Thematic analysis was employed to elicit key themes from the data set. Results: The findings support the literature that online forums provide young people with both informational and emotional support around a wide array of topics. The findings from this large data set also reveal that this informational and/or emotional support can be viewed as directive or non-directive. The non-directive approach refers to when young people provide others with support by sharing their own experiences. These posts do not include explicit advice to act in a particular way but the sharing process is hoped to be of use to the poster. The directive approach, in contrast, involves individuals making an explicit suggestion of what they believe the poster should do. Conclusions: This study adds to the research exploring what young people discuss within online forums and provides insights into how these communications take place. Further, it highlights the challenge that organisations may encounter in mediating support that is multidimensional in nature (informational-emotional, directive-non-directive).

  • There are few high quality apps for people with rheumatoid arthritis to monitor their disease activity: a review of apps for best practice and quality

    From: Journal of Medical Internet Research

    Date Submitted: Nov 6, 2016

    Open Peer Review Period: Nov 9, 2016 - Jan 4, 2017

    Background: Rheumatoid arthritis (RA) is a chronic inflammatory arthritis requiring long-term treatment with regular monitoring by a rheumatologist to achieve good health outcomes. Since people with...

    Background: Rheumatoid arthritis (RA) is a chronic inflammatory arthritis requiring long-term treatment with regular monitoring by a rheumatologist to achieve good health outcomes. Since people with RA may wish to monitor their own disease activity with a smartphone application (app), it is important to understand the functions and quality of apps for this purpose. Objective: To assess the features and quality of apps to assist people to monitor their RA disease activity by: 1. Summarizing the available apps, particularly the instruments used for measurement of RA disease activity; 2. Comparing the app features with American College of Rheumatology/European League against Rheumatism (ACR/EULAR) guidelines for monitoring of RA disease activity; and 3. Rating app quality with the Mobile Application Rating Scale. Methods: Systematic searches of the New Zealand iTunes and Google Play app stores were used to identify all apps for monitoring of RA disease activity that could be used by people with RA. The apps were described both by key meta-data and the app functionality. App adherence with recommendations for monitoring of RA disease activity in clinical practice was evaluated by identifying if apps included calculation of a validated composite disease activity measure and recorded results for future retrieval. App quality was assessed by two independent reviewers using the Mobile App Rating Scale (MARS). Results: The search identified 721 apps in the Google Play store and 216 in the iTunes store, of which 19 unique apps met criteria for inclusion (eight from both app stores, eight iTunes and three Google play) Fourteen apps included at least one validated instrument measuring RA disease activity. Eight of eleven apps that allowed users to enter a joint count used the standard 28 swollen and tender joint count. Eight apps included at least one ACR/EULAR recommended RA composite disease activity (CDA) measure. Ten apps included data storage and retrieval. Only one app, Arthritis Power, included both a RA CDA measure and tracked data but this app did not include the standard 28 tender and swollen joint count. The median MARS score for apps was 3.41/5. Of the five apps which scored ≥4/5 on the MARS rating, only one included a CDA score endorsed by ACR/EULAR but this app did not have a data tracking function. Conclusions: This review found a lack of high quality apps for longitudinal assessment of RA disease activity. Current apps fall into two categories: simple calculators for rheumatologists, or data tracking tools for people with RA. The latter do not uniformly collect data using validated instruments or composite disease activity measures. There is a need for appropriate, high quality apps for use by rheumatologists and patients together in co-management of RA. Clinical Trial: Not applicable

  • How the “Understanding Research Evidence” web-based video series from the National Collaborating Centre for Methods and Tools contributes to public health capacity to practice evidence-informed decision making: A mixed-methods evaluation

    From: Journal of Medical Internet Research

    Date Submitted: Nov 8, 2016

    Open Peer Review Period: Nov 9, 2016 - Jan 4, 2017

    Background: The National Collaborating Centre for Methods and Tools (NCCMT) offers workshops and webinars to public health professionals to build capacity for evidence-informed public health. Despite...

    Background: The National Collaborating Centre for Methods and Tools (NCCMT) offers workshops and webinars to public health professionals to build capacity for evidence-informed public health. Despite positive feedback for NCCMT workshops and resources, NCCMT users found key terms used in research papers difficult to understand. The Understanding Research Evidence (URE) videos use plain language, cartoon visuals, and public health examples to explain complex research concepts. The videos are posted on the NCCMT website and on the NCCMT’s YouTube channel. Objective: An evaluation was conducted to examine public health professionals’ experience with the first four videos in the URE web-based video series to explain how the videos affected their professional practice. A mixed-methods approach was used to examine the delivery mode and the content of the videos. Specifically, the evaluation explored: 1) whether the videos were effective at increasing knowledge on the four video topics, 2) public health professionals’ satisfaction with the videos, and 3) how public health professionals applied the knowledge gained from the videos in their work. Methods: A three-part evaluation was conducted to determine the effectiveness of the first four URE videos. The evaluation included an online survey, telephone interviews, and pretest/posttests to evaluate public health professionals experience with the videos, and how the videos affected their public health work. Participants were invited to participate in this evaluation through various public health open-access e-mail lists, through informational flyers and posters at the Canadian Public Health Association conference, and through targeted recruitment to NCCMT’s network. Results: In the online surveys (n=46), participants achieved higher scores on the knowledge assessment questions from watching the odds ratio (P=.036), confidence interval (P=.036), and clinical significance (P=.049) videos but not the forest plot (P=.118) video, compared to participants who had not watched the videos. The pretest/posttest (n=124) demonstrated that participants had a better understanding of forest plots (P=.00) and confidence intervals (P=.00) after watching the videos. Due to small sample size numbers, there was insufficient pretest/posttest data to conduct meaningful analyses on the clinical significance and odds ratio videos. Telephone interview participants (n=18) thought the videos’ use of animation, narration, and plain-language was appropriate for people with different levels of understanding and learning styles. Participants felt that, by increasing their understanding of research evidence, they could develop better interventions and design evaluations to measure the impact of public health initiatives. Conclusions: Overall, the results of the evaluation showed that watching the videos resulted in an increase in knowledge, and participants had an overall positive experience with the URE videos. With increased competence in using the best available evidence, professionals are empowered to contribute to decisions that can improve health outcomes of communities.

  • ComMove: Designing Guided In-Car Mindful Movement Interventions for Commuters

    From: Journal of Medical Internet Research

    Date Submitted: Nov 12, 2016

    Open Peer Review Period: Nov 12, 2016 - Jan 7, 2017

    Background: The daily commute could be an opportune moment to teach drivers to use movement or breath towards improving their mental health. While driving safety is paramount, mindful exercise might h...

    Background: The daily commute could be an opportune moment to teach drivers to use movement or breath towards improving their mental health. While driving safety is paramount, mindful exercise might help commuters to decrease the effects of daily stress while staying alert. Increasing vehicle automation may present new opportunities but also new challenges. Objective: This paper aims to describe the design space for mindful movement interventions for commuters. We use qualitative analysis of simulated driving experiences in combination with simple movement-based commands to generate guidelines for design and research in this topic. Methods: We performed a semi-structured viability assessment in which drivers (N= 12) were given simple instructions to complete a series of basic movements, breathing exercises, and visualization techniques while engaged in either a simple or complex simulated urban driving task, using autonomous and manual driving modes. We also designed and evaluated a set of vibrotactile patterns from the car seat that cue users to perform these movements. We report a spectrum of obvious and less obvious individual emotional and cognitive reactions to the movements and the vibrotactile cues. Results: We report a summary of individual emotional and cognitive reactions to the movements and the vibrotactile cues. Based on our assessment, we suggest the best situations within a drive to perform movement-based interventions; we describe movements and exercises that may interfere with driving and those that are complementary with driving; identify the movements that are conducive towards “soothing,” and we evaluate vibrotactile stimuli that could trigger or guide such movements and exercises. We discuss key design elements such as the driving modality, system customization, social perception influence in users, and the role of prior awareness of mindful techniques in the adoption of new movement-based techniques. Conclusions: These findings provide insight into which movements to recommend when to encourage mindful movements while commuting, and how best to communicate the moves using non-invasive haptic cues.

  • Evaluating the factors associated with patients’ discussion with their physician about the risks of prescription opioid use in Maryland

    From: JMIR Public Health and Surveillance

    Date Submitted: Nov 13, 2016

    Open Peer Review Period: Nov 25, 2016 - Dec 9, 2016

    Background: Opioid abuse and misuse is a major public health concern. Although opioid use is appropriate at the beginning, the quantity and duration of prescription leads to misuse among diverse patie...

    Background: Opioid abuse and misuse is a major public health concern. Although opioid use is appropriate at the beginning, the quantity and duration of prescription leads to misuse among diverse patients sub-groups. Primary care remains at the forefront of chronic pain management and is the largest group of prescribers. Therefore, in the face of rising prescriptions in the last few years, the communication between the healthcare provider and patient about risk of opioids is critical for reducing misuse. Objective: This study describes if the patients in Maryland know about the risks associated with prescription opioid (PO) misuse from their physicians and discusses potential rescue plan. Methods: Data was collected from the Maryland Public Opinion Survey (MPOS), a web-based survey administered to patients over 24 jurisdictions in Maryland. We utilized Facebook to recruit our study population. Our question of interest was, “Have you ever had a talk with your doctor about the risks of taking prescription opioids?” We studied the association between the demographic characteristics of the respondents to the above question and their response using chi-square and multivariable logistic regression model. Results: Of 6623 responders to the MPOS, n=3259 responded to the question about discussing PO risks with their providers. The responder’s gender, race and their neighborhood in Maryland, were not associated with their propensity to discuss PO risks with providers. Patients who were significantly more likely to discuss PO risks with provider were, those who have ever used PO without doctor’s permission (OR=1.49, CI (1.24, 1.79)) and heroin (OR=2.21; CI (1.68, 2.91)), and not finished a college education (OR=1.2; CI (1.01, 2.78)). Conclusions: There exists a major gap among patient-provider communication as patients with a prior history of drug misuse or abuse only were more likely to discuss PO risks with their provider. Therefore, effective provider communication and educational approaches with concurrent evaluation would be essential to the intervention framework designed to reduce PO misuse and abuse.

  • Objective Attention Deficit Hyperactivity Disorder Assessment using a Kinectized Continuous Performance Test

    From: Journal of Medical Internet Research

    Date Submitted: Nov 13, 2016

    Open Peer Review Period: Nov 14, 2016 - Jan 9, 2017

    Background: One of the major challenges in mental medical care is to find out new instruments for an accurate and objective attention deficit hyperactivity disorder (ADHD) diagnosis. Early ADHD identi...

    Background: One of the major challenges in mental medical care is to find out new instruments for an accurate and objective attention deficit hyperactivity disorder (ADHD) diagnosis. Early ADHD identification and prompt treatment are essential to avoid the negative effects associated to this mental condition. Objective: To develop a novel ADHD assessment instrument based on Microsoft Kinect which identifies ADHD cardinal symptoms in order to provide a more accurate evaluation. Methods: A group of 10 children, aged 8 to 12 years (10.8±1.48; Male 50%) from the Child and Adolescent Psychiatry Unit of the Department of Psychiatry at Fundación Jiménez Díaz Hospital (Madrid, Spain), were included in this study. Children were required to meet DSM-5 criteria of ADHD diagnosis. One of the parents or guardians of the children filled the Spanish version of the Strengths and Weaknesses of ADHD Symptoms and Normal Behaviors Rating Scale (SWAN) used in clinical practice. Each child conducted a kinectized continuous performance test in which the reaction time (RT), the commission errors, and the time required to complete the reaction (CT) were calculated. The correlations of the three predictors, obtained using Kinect methodology, with respect to the scores of the SWAN scale were calculated. Results: The RT achieved a correlation of 0.08, -0.30 and -0.04 with respect to the inattention, hyperactivity and impulsivity factors of the SWAN scale. The correlations of the commission error with respect to these three factors were -0.16, 0.35 and 0.33, respectively. Regarding the CT, the correlations with the three factors of the SWAN scale were 0.27,-0.05, -0.01. Conclusions: Our findings show a relation between the kinectized version of the CPT and ADHD symptomatology assessed through parental report. Results points out the importance of future research on the development of objective measures for the diagnosis of ADHD among children and adolescents.

  • Development of a theory- based online intervention for post-treatment cancer survivors

    From: Journal of Medical Internet Research

    Date Submitted: Nov 14, 2016

    Open Peer Review Period: Nov 14, 2016 - Jan 9, 2017

    Background: Cancer-related fatigue (CrF) is the most common and disruptive symptom experienced by cancer survivors. This paper describes the development of a theory-based, interactive web-based interv...

    Background: Cancer-related fatigue (CrF) is the most common and disruptive symptom experienced by cancer survivors. This paper describes the development of a theory-based, interactive web-based intervention designed to facilitate self-management and enhance coping with CrF following cancer treatment. Objective: This paper outlines the process and method of development of the intervention. The content and principles used in the development process are described, while also clarifying hypothesised causal mechanisms Methods: In this paper, we outline the process of establishing a therapeutic approach based on theory and an extensive review of the literature. We describe the design of the content of the intervention, and of the website features. the initial usability testing of the website. The aim is to outline the rationale, decision-making processes, methods, and findings which led to the development of an online intervention to be tested in a feasibility trial Results: The co-creation of the intervention with the experts and service users allowed the design team to ensure that an acceptable intervention was developed. This evidence-based online programme is the first intervention of its kind based on self-regulation model theory, with the primary aim of targeting the representations of fatigue and enhancing self-management of CrF specifically. Conclusions: This research sought to integrate psychological theory, existing evidence of effective interventions, empirically derived principles of web design, and the views of potential users into the systematic planning and design of the intervention of an easy to use website for cancer survivors Clinical Trial: ISRCTN55763085

  • Understanding health information seeking online; who, when, and why: a qualitative study in Hong Kong.

    From: Journal of Medical Internet Research

    Date Submitted: Nov 16, 2016

    Open Peer Review Period: Nov 18, 2016 - Jan 13, 2017

    Background: The Internet has become an established source for health information. The number of individuals using the Internet to search for health information, ranging from healthy lifestyle advices...

    Background: The Internet has become an established source for health information. The number of individuals using the Internet to search for health information, ranging from healthy lifestyle advices to treatment and diseases, continues to grow. Scholars have emphasized the need to give greater voice and influence to health consumers. Hong Kong being one of the most technologically advanced and connected cities in the world, has one of the highest Internet penetration in the world. Given the dearth of research in an Asian context, Hong Kong is an excellent platform to study individuals’ perceptions (e.g., benefits and limitations on seeking health information online, and how the information is used) on health information seeking. Objective: To study individuals’ perceptions on health information seeking and to document their online information seeking behaviours. Methods: Five focus groups (n=49) were conducted during November 2015 to January 2016 with individuals across different age groups (18 or above). Focus group contents were audiotaped, transcribed, and analyzed using thematic analysis techniques. Results: Older (55+ years old) and less educated respondents were less likely to use the Internet to search for health information. Among individuals who obtained health information online, regardless of the severity of the health issue, the Internet was always the first source for information. Limited doctor consultation time and barriers to accessing professional health services were the main reasons for using the Internet. Convenience and coverage, were regarded as the main advantages, while credibility and trustworthiness of health information were noted as limitations. The use of online health information varied among individuals, hence the implications on the doctor-patient relationship were mixed. Conclusions: The prevalent and increasing use of Internet for health information seeking suggests the need for health care professionals to understand how it can be optimally utilized to improve health outcomes. Strategies for communicating and disseminating credible health information in a form that users can understand and use are essential. Because of the rapid technological and related behavioural changes, online health information seeking and its effects need to be closely monitored.

  • The impact of social processes in online health communities on patient empowerment in relationship with the physician: Emergence of functional and dysfunctional empowerment

    From: Journal of Medical Internet Research

    Date Submitted: Nov 17, 2016

    Open Peer Review Period: Nov 21, 2016 - Jan 16, 2017

    Background: Substantial research has demonstrated the importance of online health communities (OHCs) for patient empowerment, but little is known about the impact of social processes in OHCs on the pa...

    Background: Substantial research has demonstrated the importance of online health communities (OHCs) for patient empowerment, but little is known about the impact of social processes in OHCs on the patient-physician relationship. Patient empowerment also occurs in relationship with the physician, but studies of OHC disregard this or measure phenomena with single item, rendering it impossible to establish psychometric properties. The question also remains about the nature and consequences of this empowerment as it might be based on limited validity of some information in OHCs. Objective: The main purpose of this study was to examine the impact of social processes in OHCs (information exchange with users and medical experts, social support, finding meaning and self-expressing) on functional and dysfunctional patient empowerment in relationship with the physician (PERP). This impact is investigated by taking into account interactions with e-health literacy and physician's paternalism. Methods: The study undertakes a quasi-experimental design on a simple random sample of 25.000 registered users of the most popular general online health community in Slovenia. The final sample size consisted of 591 regular users of the studied OHC, who visited a physician at least once in the last 2 years. Variables with multi-item measurement were tested with exploratory and confirmatory factor analytical procedures. Functional and dysfunctional PERP was predicted with a series of OLS regression analyses with interactions included. Results: Factor analyses of PERP revealed 5-factor structure with acceptable fit (RMSEA=.06, SRMR=.06, CFI=.9). The main results show that functional self-efficacy is positively predicted by information exchange with experts (β=.12, P=.02), information exchange with users (β=.12, P=.05), giving social support (β=.12, P=.02), but negatively with receiving of social support (β=-.21, P<.001). Functional control is also predicted by information exchange with experts (β=.16, P=.005). Dysfunctional aspects of empowerment are also dependent on social processes in OHC. Dysfunctional control and competence are inhibited by information exchange with experts (β=-.12, P=.03), but stimulated by receiving social support (β=.11, P=.05), while dysfunctional self-efficacy is inhibited by self-expressing (β=-.12, P=.05). Perceived paternalism of physician and e-health literacy are important control and moderating variables. Most notably, process of finding meaning will likely lead to development of dysfunctional competences and control if physician is perceived as paternalistic (β=-14, P=.03). On the other hand under condition of high e-health literacy, process of finding meaning will inhibit development of dysfunctional competences and control (β=-.17, P=.01). Conclusions: Social processes in OHCs do not have a uniform impact on PERP and this impact is moderated by E-health literacy and physician’s paternalism. Exchanging information with health professionals in OHCs is most important factor for stimulating functional and diminishing dysfunctional PERP. Social support in OHCs plays an ambiguous role, often making patients behave in a strategic, uncooperative way toward physicians.

  • Randomised controlled trial to assess feasibility and acceptability of web-based enhanced relapse prevention for bipolar disorder (ERPonline)

    From: Journal of Medical Internet Research

    Date Submitted: Nov 17, 2016

    Open Peer Review Period: Nov 21, 2016 - Jan 16, 2017

    Background: Interventions that teach people with Bipolar Disorder (BD) to recognise and respond to early warning signs of relapse are NICE recommended but implementation in clinical practice is poor....

    Background: Interventions that teach people with Bipolar Disorder (BD) to recognise and respond to early warning signs of relapse are NICE recommended but implementation in clinical practice is poor. Objective: This study tests the feasibility and acceptability of an online trial to evaluate an online enhanced relapse prevention intervention (ERPonline), and reports preliminary evidence of effectiveness. Methods: Single blind, parallel primarily online randomised controlled trial (n=96) over 48 weeks comparing ERPonline plus usual treatment to waitlist (WL) control for people with BD recruited through national health services, voluntary organisations, and media. Randomisation was independent, minimised on number of previous episodes (<8,8-20,21+). Primary outcomes were feasibility and acceptability assessed by rates of study recruitment and retention, levels of intervention use, adverse events and participant feedback. Process and clinical outcomes were assessed by telephone and online and compared using linear models with intention-to-treat analysis. Results: Two hundred and eighty people registered interest online, from which ninety-six met inclusion criteria, consented and were randomised (49 to WL, 47 to ERPonline) over seventeen months, with 80% retention in telephone and online follow up, except week 48 online (76%). Acceptability was high for both ERPonline and trial methods. Qualitative data highlighted the importance of the relationship users have with online interventions and how this is created as an extension of the relationship with the humans perceived as offering and supporting its use. Access to ERPonline was associated with: a more positive model of bipolar disorder at 24 (10.70 (0.90-20.5 95%CIs)) and 48 weeks (13.1 (2.44-23.93 95%CIs)); increased monitoring of early warning signs of depression at 48 weeks (-1.39 (-2.61, -.163 95%CIs)) and of (hypo)mania at 24 (-1.72 (-2.98, -0.47 95%CIs)) and 48 weeks (-1.61 (-2.92, -0.30 95%CIs)), compared to WL. There was no evidence of impact of ERPonline on clinical outcomes or medication adherence, but relapse rates across both arms were very low (15%) and the sample remained high functioning throughout. One person died by suicide prior to randomisation. Five people in ERPonline and six in WL control reported ideas of suicide or self-harm during the study. None were deemed study related by an independent Trial Steering Committee. Conclusions: ERPonline offers a cheap accessible option for people seeking ongoing support following successful treatment. However, given high functioning and low relapse rates in this study, testing clinical effectiveness for this population would require very large sample sizes. Building in human support to use ERPonline should be considered. Clinical Trial: ISRCTN56908625

  • Using Feedback to Promote Physical Activity: The Role of the Feedback Sign

    From: Journal of Medical Internet Research

    Date Submitted: Nov 21, 2016

    Open Peer Review Period: Nov 24, 2016 - Jan 19, 2017

    Background: Providing feedback is a technique to facilitate behavior change that is widely used in health interventions. One important characteristic of feedback is the feedback sign, i.e. whether the...

    Background: Providing feedback is a technique to facilitate behavior change that is widely used in health interventions. One important characteristic of feedback is the feedback sign, i.e. whether the feedback signals success or failure. Despite its widespread use, the effect of the feedback sign has so far not been examined with regard to health behavior change and the underlying theoretical mechanisms are unclear. Objective: To examine the effect of the feedback sign in a health behavior change intervention. Methods: Data from N = 1623 participants of a six-month physical activity intervention was used. Participants received five feedback emails over the course of the intervention. Feedback was either positive or negative depending on the participants’ physical activity. In two separate analyses, monthly comparisons of step counts were used to evaluate the feedback effect. Results: Results indicate a small but substantial main effect of the feedback sign on behavior change (r = .25; r = .21). Negative feedback was followed by an increase and positive feedback was followed by a decrease of step counts. Conclusions: Our study illustrates that feedback can have detrimental effects on behavior and should therefore be implemented with high diligence. Theoretical and practical implications as well as limitations of the study are discussed.

  • A Systematic Review of Consent Processes for Mobile Application Mediated Research

    From: JMIR mHealth and uHealth

    Date Submitted: Nov 17, 2016

    Open Peer Review Period: Nov 21, 2016 - Jan 16, 2017

    Background: Since the launch of ResearchKit on the iOS platform in March 2015 and ResearchStack on the Android platform in June 2016, a variety of both academic and commercial institutions from around...

    Background: Since the launch of ResearchKit on the iOS platform in March 2015 and ResearchStack on the Android platform in June 2016, a variety of both academic and commercial institutions from around the world have adapted these frameworks to develop mobile application (“app”) based research studies. These studies cover a wide variety of subject areas including melanoma, cardiomyopathy, and autism. Additionally, these app-based studies target a variety of participant populations, including children and pregnant women. Objective: We undertook this review to document the variety of self-administered remote informed consent processes used in app-based research studies available between May and September, 2016. Methods: We examine both the process of information giving and specific content shared, with special attention to data privacy, aggregation, and sharing. Results: We find consistency across some elements of the app-based consent processes, for example informing participants about how data will be curated from the phone. We identified variation in other elements, for example where specific information is shared and the level of detail disclosed. Additionally, we highlight several novel elements present in eConsent not typically seen in traditional consent for research. Conclusions: We advocate the importance of participant informedness in a novel, and largely unregulated research setting.

  • What motivates young adults to talk about physical activity on social network sites?

    From: Journal of Medical Internet Research

    Date Submitted: Nov 20, 2016

    Open Peer Review Period: Nov 24, 2016 - Jan 19, 2017

    Background: Electronic word-of-mouth on social network sites has been used successfully in marketing. In social marketing, electronic word-of-mouth about products of health behaviors on SNSs has the p...

    Background: Electronic word-of-mouth on social network sites has been used successfully in marketing. In social marketing, electronic word-of-mouth about products of health behaviors on SNSs has the potential to be more effective and reach more young adults than health education through traditional mass media. However little is known about what motivates people to actively initiate electronic word-of-mouth about health behaviors on their personal pages/profiles on social network sites where electronic word-of-mouth can reach all their contacts on social network sites. Objective: This study filled the gap by applying a marketing theoretical model to explore the factors associated with electronic word-of-mouth on social network sites about leisure-time physical activity. Methods: A web survey link was sent to undergraduate students at a Midwestern university and 439 completed the survey. Results: Results suggested emotional engagement with leisure-time physical activity (i.e., affective involvement in leisure-time physical activity) predicted providing leisure-time physical activity opinions or information on social network sites. Social network sites users who felt closer to their contacts on social network sites were more likely to provide and seek leisure-time physical activity opinions and information. People who provided leisure-time physical activity opinions and information were more likely to seek opinions and information. People who forwarded leisure-time physical activity information about leisure-time physical activity were more likely to chat about leisure-time physical activity information. Conclusions: This study shed light on the application of the electronic word-of-mouth theoretical framework in promoting health behaviors. The findings can also guide the development of future social marketing interventions using social network sites to promote leisure-time physical activity.

  • Rationale and Design of Cardiovascular Diseases (CVD) risk assessment and communication by nurses for primary and secondary prevention of CVDs in India

    From: JMIR Research Protocols

    Date Submitted: Nov 25, 2016

    Open Peer Review Period: Nov 26, 2016 - Dec 10, 2016

    Background: Background: Rising burden of CVDs is the biggest challenge of 21st century in India and has contributed enormously to the increased burden on health care services including human resourc...

    Background: Background: Rising burden of CVDs is the biggest challenge of 21st century in India and has contributed enormously to the increased burden on health care services including human resources. Innovative approaches are required to implement prevention programmes with limited human resource. One such approach is task shifting of CVD risk assessment and communication to nurses, as nurses are one of the key health care providers in all levels of health care. Objective: The present study has been designed to test the innovative approach of risk assessment and communication by nurses for primary and secondary prevention of CVDs in tertiary health care setting. Methods: Methods and analysis: -The study is quasi experimental in nature with one year follow up to determine the effect of CVD risk assessment and communication by nurses using risk communication package on primary and secondary prevention of CVDs. Nurses (n=16) working in the selected OPDs of the tertiary health care setting will be trained in CVD risk assessment and communication. A total of 900 patients (400 for primary prevention and 500 for secondary prevention) attending the medicine and allied along with cardiology out patient departments will be enrolled by trained nurses for the study. Primary outcome measures for primary and secondary prevention groups will be the cardiovascular risk modification and medication adherence respectively. Results: none Conclusions: The study will evaluate the innovative approach of CVD risk assessment and management by nurses for primary and secondary prevention CVDs in India. Clinical Trial: Trial registration acknowledgement no :- REF/2015/09/009742

  • Methods for Coding Tobacco-Related Twitter Data: A Systematic Review

    From: Journal of Medical Internet Research

    Date Submitted: Nov 30, 2016

    Open Peer Review Period: Nov 30, 2016 - Jan 25, 2017

    Background: As Twitter has grown in popularity to 313 million monthly active users, researchers have increasingly been using it as a data source for tobacco-related research. Objective: The objective...

    Background: As Twitter has grown in popularity to 313 million monthly active users, researchers have increasingly been using it as a data source for tobacco-related research. Objective: The objective of this systematic review was to assess the methodological approaches of categorically coded tobacco Twitter data and make recommendations for future studies. Methods: Data sources included PsychInfo, Web of Science, PubMed, ABI/INFORM, Communication Source, and Tobacco Regulatory Science. Searches were limited to peer reviewed journals in English from January 2006 to July 2016. The initial search identified 274 articles using a Twitter keyword and a tobacco keyword. One coder reviewed all abstracts and identified 27 articles that met the following inclusion criteria: 1) original research; 2) focused on tobacco or a tobacco product; 3) analyzed Twitter data; and 4) coded Twitter data categorically. One coder extracted data collection and coding methods. Results: The most common type of Twitter data analyzed was e-cigarettes, followed by specific tobacco campaigns. The most prevalent data sources were Gnip and Twitter’s Streaming Application Programming Interface (API). The primary methods of coding were hand-coding and machine-learning. The articles predominantly coded for relevance, sentiment, theme, user/account, and location of user. Conclusions: Standards for data collection and coding should be developed to be able to more easily compare and replicate tobacco-related Twitter results. Additional recommendations include: sample Twitter’s databases multiple times, make a distinction between message attitude and emotional tone for sentiment, code images and URLs, and analyze user profiles. Being relatively novel and widely used among adolescents and Black and Hispanic individuals, Twitter could provide a rich source of tobacco surveillance data among vulnerable populations.

  • Ethics and Privacy Implications of Using the Internet and Social Media to Recruit Participants for Health Research: A Privacy-by-Design Framework for Online Recruitment

    From: Journal of Medical Internet Research

    Date Submitted: Nov 22, 2016

    Open Peer Review Period: Nov 25, 2016 - Jan 20, 2017

    Introduction: The Internet, and in particular social media, offer promising ways to improve the reach, efficiency and effectiveness of recruitment efforts at a reasonable cost, but raise unique ethica...

    Introduction: The Internet, and in particular social media, offer promising ways to improve the reach, efficiency and effectiveness of recruitment efforts at a reasonable cost, but raise unique ethical dilemmas. We describe how we used social media to recruit cancer patients for a research study, ethical issues we encountered, and the strategies we developed to address them. Drawing on the principles of Privacy by Design (PbD), a globally recognized standard for privacy protection, we offer a PbD framework for online research recruitment. Case: A focus group study on the dietary behaviors of cancer patients and their families, and the role of web-based dietary self-management tools. Using an established blog on our hospital website, we proposed publishing a recruitment post and sharing the link on our Twitter and Facebook pages. The Research Ethics Board (REB) raised concern about the privacy risks associated with our recruitment strategy: by clicking on a recruitment post, an individual could inadvertently disclose personal health information to third party companies engaged in tracking online behavior. Discussion: Ethical guidelines recommend a proportionate approach to ethics assessment, which advocates for risk mitigation strategies that are proportional to the magnitude and probability of risks. We include a critical reflection of the perceptions of potential risks associated with our social media recruitment strategy and the appropriateness of our risk mitigation. Conclusion: Researchers, REBs, ethicists, students, and potential study participants are often unaware of the privacy risks of social media research recruitment and there is no official guidance. Our PbD framework for online recruitment is a resource for these wide audiences.

  • COPD self-management with web-based platforms: high level of integration in integrated disease management leads to higher usage in the e-Vita COPD study

    From: Journal of Medical Internet Research

    Date Submitted: Nov 24, 2016

    Open Peer Review Period: Nov 28, 2016 - Jan 23, 2017

    Background: Worldwide nearly 3 million people die from chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves disease-specific quality of life and exerci...

    Background: Worldwide nearly 3 million people die from chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves disease-specific quality of life and exercise capacity for people with COPD, but can also reduce hospital admissions and hospital days. Self-management of COPD through eHealth interventions has shown to be an effective method to improve the quality and efficiency of IDM. Objective: Our study, e-Vita COPD, compares different levels of integration of web-based self-management platforms in IDM in 3 primary care settings. The main aim of this study is to analyze the factors that successfully promote the use of a self-management platform for COPD patients. Methods: We investigated different implementation methods of two platforms using a parallel cohort design. The design included three different levels of integration in IDM (group 1, 2 and 3) and randomization of two levels of personal assistance for patients (group A high assistance and B no assistance). Every visit to the platforms e-Vita and Zorgdraad was tracked objectively by collecting log data (sessions and services). The amount of use and user's patterns were analyzed. Baseline characteristics were extracted from the log files, i.e. age, gender, education level, scores on the Clinical COPD Questionnaire (CCQ) and on 3 questionnaires. Multiple regression analyses were used to evaluate the care group, integration in IDM (high, medium, non) and personal assistance for the participants (high vs. low assistance) as determinants for the usage. We analyzed the educational level and self-efficacy level (GSES) as independent variables to predict the usage of the platform. A correction was made for age and gender. Results: Of the 702 invited COPD patients, 215 (31%) registered to a platform. 82 patients participated in group 1 (high integration IDM); 36 patients in group 1A (personal assistance), 46 in group 1B (low assistance). 96 patients participated in group 2 (medium integration IDM); 44 in group 2A (telephone assistance) and 52 in group 2B (low assistance). 37 patients participated in group 3 (no integration IDM). 107 users visited the platform at least once in the 15-month period. The mean (SD) number of sessions differed between the three groups 1, 2 and 3 (10.5 (SD 1.3); 8.8 (SD 1.4) and 3.7 (SD 1.8) respectively, p=0.011). The mean (SD) number of sessions differed between high assistance group 1A & 2A and low assistance group 1B & 2B; (11.8 (SD 1.3); 6.7 (SD 1.4) respectively, p=0.012). No association was found between the educational level and the usage and between the GSES and the usage. Conclusions: Use of a self-management platform is higher when the platform is an integrated part of IDM, with adequate personal assistance about how to use the platform. An implementation setup with blended care, will likely lead to increased use of the online program. Future research should provide additional insights into the preferences of different patient groups. Clinical Trial: NTR4098 (31072013)

  • Exercise Intensities: The Accuracy of Self-monitoring Heart Rate and Physical Activity Wearable Devices

    From: Journal of Medical Internet Research

    Date Submitted: Nov 24, 2016

    Open Peer Review Period: Nov 26, 2016 - Jan 21, 2017

    Background: Physical activity tracking wearables have emerged as an increasingly popular method for consumers to assess their daily activity and calories expended. However, it is unknown if these wear...

    Background: Physical activity tracking wearables have emerged as an increasingly popular method for consumers to assess their daily activity and calories expended. However, it is unknown if these wearables are valid at different levels of exercise intensity. Objective: To examine heart rate (HR) and energy expenditure (EE) validity of three popular wrist-worn activity monitors at different exercise intensities. Methods: 62 participants (36 females, 46.8% non-white) wore the Apple Watch (AW), Fitbit Charge HR (FCHR) and Garmin Forerunner 225 (GF). Validity was assessed by 2 criterion devices: HR chest strap and a metabolic cart. Participants completed a 10-min seated baseline; separate 4-min stages of light, moderate and vigorous-intensity treadmill exercises; and a 10-min seated recovery. Data from devices were compared to each criterion via two-way RM-ANOVA and Bland-Altman analysis. Differences were expressed in mean absolute percentage error values (MAPE). Results: AW – HR MAPE between 1.14-6.70%. HR not significantly different at the start (p = .13), baseline (p = .76) or vigorous intensity (p = .84). Lower HR readings during light (p < .05), moderate (p < .01) and recovery (p < .01). EE MAPE between 14.07-210.84%. Measured higher EE at all stages (p < .01). FCHR – HR MAPE between 2.38-16.99%. HR not significantly different at start (p = .43) or moderate intensity (p = .34). Lower HR readings during baseline, vigorous and recovery (p < .001) and higher HR in light (p < .001). EE MAPE between 16.85-84.98%. Measured higher EE at baseline (p < .05), light (p < .001) and moderate (p < .001). GF – HR MAPE between 7.87-24.38%. HR not significantly different at vigorous intensity (p = .35). Measured higher HR readings start, baseline, light, moderate (p < .001) and recovery (p < .05). EE MAPE between 30.77-155.05%. Measured higher EE at all stages (p < .001). Conclusions: This study provides one of the first validation assessments for the Fitbit Charge HR, Apple Watch and Garmin Forerunner 225. An advantage and novel approach of the study is the examination of HR and EE at specific PA intensities. Establishing validity of wearables is of particular interest as these devices are being used in weight loss interventions and could impact findings. Future research should investigate why differences between exercise intensities and the devices exist.

  • A Framework for the Study of Complex mHealth Interventions in Diverse Cultural Settings: The DREAM-GLOBAL pragmatic RCT Process Evaluation Protocol

    From: JMIR mHealth and uHealth

    Date Submitted: Nov 24, 2016

    Open Peer Review Period: Nov 26, 2016 - Jan 21, 2017

    Background: In order to facilitate decision making capacity between options of care under real-life service conditions, clinical trials must be pragmatic to evaluate mHealth intervention under the var...

    Background: In order to facilitate decision making capacity between options of care under real-life service conditions, clinical trials must be pragmatic to evaluate mHealth intervention under the variable conditions of health care settings with a wide range of participants. mHealth interventions often contain multiple active components that may require changes in the behavior of patients as well as providers, creating considerable complexity and even ambiguity related to causal chains. Process evaluations of the implementation process of mHealth interventions are necessary to shed light on the range of unanticipated effects an intervention may have, what the active ingredients in everyday practice are, how they exert their effect and how these may vary, among recipients or between sites. Objective: Building on the CONSORT-EHEALTH statement and participatory evaluation theory, we present a framework for process evaluations for mHealth interventions in multiple cultural settings. We also describe the application of this evaluation framework to the implementation of DREAM-GLOBAL, a pragmatic RCT and mHealth intervention designed to improve hypertension management in low resource environments. In addition, we describe data collection tools and processes that we developed to collect the process evaluation data necessary to inform implementation of the pragmatic RCT as well to inform future scale up of DREAM-GLOBAL in various geographic and cultural settings. Methods: Our review of the RCT reporting and process evaluation literature revealed that there is a significant knowledge gap related to the development of a process evaluation framework for mHealth interventions. We used community-based participatory research methods and formative research data to develop a process evaluation framework nested within a pragmatic RCT. Results: Four human organizational levels of participants impacted by the mHealth intervention were identified in our analysis and included patients, providers, community/organizations actors and health systems/settings. These four levels correspond with the organizational evaluation domains. In addition, primary implementation themes were identified as 1) the technology of the intervention, 2) cultural congruence, 3) task shifting and 4) unanticipated outcomes. Using the four organizational domains and their interaction with primary implementation themes, we developed detailed evaluation research questions and identified data or information sources that we concluded would best answer our questions. Conclusions: We have built reporting protocols for RCTs to identify items that are well suited to be studied during implantation of an mHealth intervention using process evaluation methodologies. Using DREAM-GLOBAL to illustrate our approach we succeeded in developing an uncomplicated process evaluation framework for mHealth interventions that provide key information to stakeholders, which can optimize implementation of the pragmatic trial and can be used to inform scale up. Clinical Trial: ClinicalTrials.gov registration: NCT02111226. 2014

  • Body Weight Misperception and Dissatisfaction Among Overweight and Obese Adult Nigerians

    From: JMIR Public Health and Surveillance

    Date Submitted: Nov 25, 2016

    Open Peer Review Period: Nov 28, 2016 - Dec 12, 2016

    Background: ABSTRACT: The increase in the prevalence of overweight and obesity in low/medium income countries has negative impact on the overall health of the populace as well as acting as socioeconom...

    Background: ABSTRACT: The increase in the prevalence of overweight and obesity in low/medium income countries has negative impact on the overall health of the populace as well as acting as socioeconomic and health burden. Correct perception of one’s body weight is a step in seeking healthy help towards weight reduction in overweight/obese individuals. This study was carried out to assess the body weight misperception and dissatisfaction among overweight and obese adults in an urban African setting. Designs: This study was a part of larger cross-sectional study that was designed to plan an intervention for overweight and obese adults in a urban African setting. For this study, only overweight and obese adults who consented to participate. Objective: This study was carried out to assess the body weight misperception and dissatisfaction among overweight and obese adults in an urban African setting. Methods: This study was a part of larger cross-sectional study that was designed to plan an intervention for overweight and obese adults in a urban African setting. For this study, only overweight and obese adults who consented to participate in the study were randomly selected from 15 enumeration areas in Alimosho Local Government area of Lagos State, Nigeria. The WHO guidelines for conducting community survey protocols were employed in recruiting the overweight/obese participants. Body weight perception and dissatisfaction were assessed through two questions: how do you describe your weight? I feel bad about my weight. Results: More than half (53.62%) of the participants misperceived their weight as either underweight or normal weight of which 61.2% were females. The strength of agreement between the actual BMI and weight perception was very poor (Kappa= 0.032, SE=0.015, p=0.037). The strongest predictor of weight perception was gender (male) with odds ratio of 1.63 (CI=1.13-2.35). About 15.7% of the participants were dissatisfied with their weight of which 83.1% were males. Age (young adult) was a predictor of weight dissatisfaction with odds ratio of 2.37 (CI=1.62-3.46). Conclusions: More than half of the participants misperceived their body weight as either underweight or normal weight and majority of them were females. More males were not happy with their body weight and participant within the young adult age group were more dissatisfied with their body weight. Clinical Trial: LREC/10/06/261

  • Comparison of different recruitment methods for sexual and reproductive health research: social media-based versus conventional methods.

    From: Journal of Medical Internet Research

    Date Submitted: Dec 5, 2016

    Open Peer Review Period: Dec 8, 2016 - Feb 2, 2017

    Background: Prior research about the sexual and reproductive health of young women has relied on self-reported survey studies. Recruitment using web-based methods can improve sexual and reproductive h...

    Background: Prior research about the sexual and reproductive health of young women has relied on self-reported survey studies. Recruitment using web-based methods can improve sexual and reproductive health research about cervical cancer prevention. In the prior study we reported that Facebook (Menlo Park, CA, USA) is a promising way to reach young women for sexual and reproductive health research. However, it is unknown whether web-based or the other classical recruitment methods (i.e., face-to-face or flyer distribution) yield comparable survey responses from similar participants. Objective: We conducted a survey to determine whether there was a difference in the sexual and reproductive health survey responses of young Japanese women based on recruitment methods, social media-based or conventional methods. Methods: From July 2012 to March 2013 (9 months), we invited 16- to 35-year-old women in Kanagawa, Japan, to complete a web-based questionnaire and recruited through either a social media-based (SNS group) or by conventional methods (Conventional group). All participants enrolled were required to fill out and submit their responses through web-based questionnaire about their sexual and reproductive health for cervical cancer prevention. Results: Of the 243, 52% (127/243) were recruited by SNS, whilst 48% (116/243) were by Conventional methods. We found no differences between recruitment methods in responses to behaviors and attitudes to sexual and reproductive health survey, although more participants from the Conventional group (14.7%, 14/95) selected not to answer the age of first intercourse ) as compared to the SNS group (5.2%, 6/116) (P = .03). Conclusions: No differences were found between recruitment methods in young Japanese women to a social media-based sexual and reproductive health survey.

  • Whiplash syndrome reloaded: digital echoes of whiplash syndrome inside the Europeans internet´s search-engine context

    From: Journal of Medical Internet Research

    Date Submitted: Nov 27, 2016

    Open Peer Review Period: Dec 2, 2016 - Jan 27, 2017

    Background: In many Western countries, after a motor vehicle collision, those involved seek health care for the assessment of injuries and for insurance documentation purposes. In contrast, in many le...

    Background: In many Western countries, after a motor vehicle collision, those involved seek health care for the assessment of injuries and for insurance documentation purposes. In contrast, in many less wealthy countries, there may be limited access to care, and no insurance or compensation system. Objective: The purpose of this study was to investigate the global pattern of evolving internet usage in countries with and without insurance and the corresponding compensation systems for whiplash injury. Methods: We used internet search engine analytics via Google Trends to study the health information-seeking behavior concerning whiplash injury at national population levels in Europe. Results: We found that the search for “whiplash” is strikingly and consistently often associated with the search for “compensation” in countries or cultures with a tort system. Frequent or traumatic painful injuries, diseases or disorders such as arthritis, headache, radius and hip fracture, depressive disorders, and fibromyalgia were not associated similarly with searches on "compensation". Conclusions: In this study, we present evidence from the evolving viewpoint of naturalistic internet search engine analytics that the expectations for receiving compensation may influence internet search behavior in relation to whiplash injury.

  • Mobile applications for eye care in Canada: a review of the iTunes store

    From: JMIR mHealth and uHealth

    Date Submitted: Nov 28, 2016

    Open Peer Review Period: Nov 29, 2016 - Jan 24, 2017

    Background: Smartphone screens can facilitate stimuli to varied, discrete visual systems and many mobile applications are accepted as a means of providing clinical assessments for the oculo-visual sys...

    Background: Smartphone screens can facilitate stimuli to varied, discrete visual systems and many mobile applications are accepted as a means of providing clinical assessments for the oculo-visual system. Although many of these apps are intended for use in clinical settings, there is a growing number of consumer-facing applications in eye care developed for self-tests, eye exercises. These and other features however have not yet been well described. Objective: To identify, describe, and categorize mobile phone apps related to eye care that are available to users in the Canadian iTunes market. Methods: We conducted an extensive search of the Apple iTunes store for apps that related to eye care. We used the terms “eye”, “eye care, “vision”, and “eye test” and included apps that are targeted to both lay consumers and medical professionals. We excluded apps whose primary function is not related to eye care. Eligible apps were categorized by primary purpose based on how they have been described by their developers in the iTunes store. Results: Our search yielded 10,657 apps, of which 427 met our inclusion criteria. After removing duplicates, 355 unique apps were subject to further review. We assigned eligible apps into three distinct categories: 11% intended for use by medical professionals, (n=39), 66% intended for use by consumers, (n=236) and 23% intended for purposes of marketing eye care and eye care products (n=80). We identified 9 subcategories of apps based on the description of their primary functions. Apps for medical professionals contained three subcategories: clinical calculators (n=6), clinical diagnostic tools (n=18), and education and networking apps for professionals (n=15). Consumer-facing apps fell into four subcategories: self-testing (n=153), eye exercises (n=30), patient tools and low vision aids (n=35), and apps for patient education (n=18). Mixed-use apps (n=80) were classified into two subcategories: marketing of individual practitioner or eye-care products (n=72) and marketing of multiple eye-care products or professional services. Conclusions: The most extensive subcategory pertaining to eye care were apps for use by consumers, especially for conducting self-tests (66%). This study revealed a previously uncharacterized category of apps intended for use by doctors and patients, of which the primary goal is marketing of eye care services and products (23%).

  • A protocol of a multicenter study looking for the association between workarounds and medication administration errors in bar code assisted medication administration

    From: JMIR Research Protocols

    Date Submitted: Nov 28, 2016

    Open Peer Review Period: Nov 29, 2016 - Dec 13, 2016

    Abstract Introduction: Information technology (IT) based methods such as bar code assisted medication administration systems (BCMA) have the potential to reduce Medication Administration Errors (MAE...

    Abstract Introduction: Information technology (IT) based methods such as bar code assisted medication administration systems (BCMA) have the potential to reduce Medication Administration Errors (MAE’s) in hospitalized patients. In practice however systems are often not used as intended and instructed, leading to workarounds. Workarounds may result in MAE’s which may cause patient harm. Aim: The primary aim is to study the association of workarounds with MAE’s in the BCMA process. Secondly we will determine the frequency and type of workarounds and MAE’s and explore the potential risk factors (determinants) for workarounds. Methods and analysis: A multicentre prospective study on internal medicine and surgical wards of four Dutch hospitals using BCMA to administer medication. A total of 6000 individual drug administrations will be included using direct observation as data collection method. Ethics: The regional medical ethics committee (‘Regionale Medisch Ethische Commissie Zorgpartners Friesland’) approved the study protocol. Study data are coded in order to guarantee privacy of the participants. Trial registration: Netherlands Trial Register NTR4355 (Dutch BCMA trial).

  • Using Facebook Advertisements to Collect Data from Cannabis Users

    From: JMIR Public Health and Surveillance

    Date Submitted: Nov 28, 2016

    Open Peer Review Period: Dec 1, 2016 - Dec 15, 2016

    Background: The legal landscape surrounding cannabis use is changing quickly. In turn, alternative administration methods like vaporizers and edibles are becoming increasingly popular. This state of f...

    Background: The legal landscape surrounding cannabis use is changing quickly. In turn, alternative administration methods like vaporizers and edibles are becoming increasingly popular. This state of flux requires quick and flexible research methods to perform repeated rapid surveillance that can inform regulatory and public health policies. Social media services like Facebook with associated targeted advertisement platforms can serve as the next generation of behavioral health and epidemiological research tools by providing researchers with access to convenient and inexpensive survey data from a diverse and representative global population. Objective: This study provides an illustration of how Facebook advertisements can be used to expeditiously collect survey data from cannabis users in a cost effective manner. Further, we describe the basic characteristics of cannabis users recruited with Facebook advertisements, discussing sampling strategy issues. Methods: Facebook advertisements were distributed to Americans 18 years of age and older who endorsed pro-cannabis or related interests on Facebook. The advertisements promoted a web link to an online survey on cannabis use. Two types of advertisement campaigns were conducted: one with no demographic filters other than a minimum age requirement and another that partially restricted delivery to racial minority participants to encourage sufficient representation. Results: Advertisements were shown to 168,894 people within a larger population of approximately 21,000,000, resulting in 3,892 clicks to the survey. The final sample size, N = 2,932, included only those that passed a data quality check, resulting in a cost of $0.27 per participant who completed the survey. Users reported initiating cannabis use at M = 15.7 years old, with a large proportion of participants (40%) currently using cannabis daily. Response rates were distributed across states at rates consistent with population levels from the 2014 US census. Restricting advertisements to minorities was an effective strategy for oversampling, increasing representation by 18.9%. Conclusions: Diverse and representative samples of cannabis users can be efficiently recruited with Facebook advertisements. Social media platforms ameliorate time and geographical constraints allowing researchers to survey collect data from thousands of respondents in a short time frame on a modest budget, allowing for rapid and repeated surveillance. Future work is needed to investigate the nuances of this sampling strategy to delineate best methods that ensure representativeness.

  • Sexual Health and the Internet: A Cross-Sectional Study on Online Preferences amongst Adolescents

    From: Journal of Medical Internet Research

    Date Submitted: Nov 29, 2016

    Open Peer Review Period: Nov 30, 2016 - Jan 25, 2017

    Background: The internet is widely used by adolescents for sexual health information and bears the potential to increase knowledge and positively affect behavior. Objective: The objective of this stud...

    Background: The internet is widely used by adolescents for sexual health information and bears the potential to increase knowledge and positively affect behavior. Objective: The objective of this study is to assess students’ preferences when looking for sexual health information online. Methods: We conducted a cross-sectional survey amongst 9th-grade students in a convenience sample of 13 secondary schools in Berlin, Germany. During a regular school period, participants were requested to rate the importance they attribute to nine aspects of sexual health websites in a paper-based questionnaire. Bivariate and multivariable analyses were used to assess awareness and preferences by gender, age, migrant background and school type. Results: Out of 1,190 eligible students, 1,177 (98.9%) students with a mean age of 14.6 years participated (SD = .67), 52.5% were male and 52.9% had at least one parent born abroad. Participant numbers were spread equally across the three types of secondary schools in Berlin. Website aspects most frequently cited as important were easily comprehensible wording (88.3%), clear information layout (80.6%) and reliability of the website’s publisher (79.2%), whilst the visual style of a website was deemed important by the lowest number of students (35.1%). Demographic differences were particularly visible in how important respondents found publisher reliability: the odds ratio from multivariable regression for male students to select this item was .50 (reference=female, Confidence Interval (CI) .37; .69). The odds ratio for students with migrant background was .64 (reference=no migrant background, CI .50;.81) and .49 for students of the most academic set of schools (reference=least academic, CI .25;.97). Conclusions: Students prefer easily understandable online resources. Setting up sexual health websites according to the explicit preferences of the target audience might encourage usage, especially by those subpopulations less likely to critically assess information validity: Male adolescents, children of immigrants and the academically disadvantaged.

  • A Digital Tool to Promote Alcohol and Drug Use SBIRT Skill Translation from Classroom to Clinic: Protocol for Mobile App Development and Validation

    From: JMIR Research Protocols

    Date Submitted: Nov 29, 2016

    Open Peer Review Period: Nov 30, 2016 - Dec 14, 2016

    Background: Background: Translation of knowledge and skills from classroom settings to clinical practice is a major challenge in health care training, especially for behavioral interventions. For exam...

    Background: Background: Translation of knowledge and skills from classroom settings to clinical practice is a major challenge in health care training, especially for behavioral interventions. For example, screening, brief intervention, and referral to treatment (SBIRT) is a highly-promoted, evidence-based approach to identifying and treating individuals at risk for alcohol or drug problems, yet effective, routine use of SBIRT has lagged. Objective: Objective: To promote SBIRT skill translation and application, the study team developed and piloted a mobile app based on the theory of planned behavior (TPB). Methods: Methods: Intended for use after classroom training occurs, the mobile app has 3 primary functions designed to increase behavioral intent to deliver SBIRT: 1) review skills (i.e., addresses knowledge and beliefs about SBIRT), 2) apply skills with patients (i.e., builds confidence and perceived behavioral control), and 3) report performance data (i.e., increases accountability and social norms/influence). A randomized controlled trial is in progress among health and social service learners (N=200) recruited from three universities and six different training programs in nursing, social work, internal medicine, psychiatry, and psychology. Participants are randomized to SBIRT classroom instruction alone vs. classroom instruction plus app access prior to beginning their field placement rotations. TPB-based data are collected pre-post and SBIRT utilization data are collected weekly for 10 weeks. Key outcomes include the frequency of screening, brief interventions, referrals to treatment, and self-reported confidence in delivery of SBIRT. Results: Results: Beta testing with advanced practice nursing students (N=22) indicated that the app and its associated assessment tools were acceptable and useful. Enrollment of trial participants began in September 2016. Results are expected by December 2017. Conclusions: Conclusions: This report describes the process of TPB-based app development and testing, and the protocol for a randomized controlled trial to determine the effectiveness of the app in enhancing skill translation. If effective, this approach could improve SBIRT implementation, fidelity and clinical outcomes. Clinical Trial: The study is not registered with clinicaltrials.gov because the design does not include collection of clinical data or patient-level outcomes.

  • Description of the Emergence of a Health Care Online Community of Practice: Using a Netnographic Framework for Twitter Hashtag Analytics

    From: Journal of Medical Internet Research

    Date Submitted: Nov 29, 2016

    Open Peer Review Period: Nov 30, 2016 - Jan 25, 2017

    Background: The advent of social media as an educational tool is based on the assumption that online communities of practice (CoP) emerge from these interactions. These communities offer an open digit...

    Background: The advent of social media as an educational tool is based on the assumption that online communities of practice (CoP) emerge from these interactions. These communities offer an open digital space and flat role hierarchy for information sharing and provide a strong group identity, rapid flow of information, content curation, and knowledge translation. To date, no evidence verifies the existence of online CoP. Objective: We aimed to demonstrate the emergence of a online CoP through the study of social media interactions of the Free Open Access Medical education movement. Methods: We examined the social media activity in Twitter by analyzing the network centrality metrics of tweets with the #FOAMed hashtag and compared them with previously validated criteria to determine whether it was a true community of practice. Results: The centrality analytics of the FOAMed community showed marked concordance with all aspects of a general community of practice (in terms of community, domain, and practice), as well as with the specific traits of a health care community, including interdependence, community-based interactions, social control common purpose, flat hierarchy, and network-based and concrete achievement. Conclusions: This study showed the emergence of online CoP focused on education and based on social media interactions. These communities result in significant knowledge translation and practice change for their participants. Clinical Trial: N/A

  • A Pilot Study of Technology-Enabled Co-Production in Pediatric Chronic Illness Care

    From: JMIR Research Protocols

    Date Submitted: Dec 2, 2016

    Open Peer Review Period: Dec 6, 2016 - Dec 20, 2016

    Background: Pediatric chronic illness care models are traditionally organized around acute episodes of care and may not meet the needs of patients and their families. Interventions that extend the pat...

    Background: Pediatric chronic illness care models are traditionally organized around acute episodes of care and may not meet the needs of patients and their families. Interventions that extend the patient-clinician interaction beyond the healthcare visit, allow for synchronous, bi-directional feedback loops that span visits and daily life, and facilitate seamless sharing of information are needed to support a care delivery system that is more collaborative, continuous, and data-driven. Orchestra is a mobile health technology platform and intervention designed to transform the management of chronic disease by optimizing patient-clinician co-production of care. Objective: The aim of this study is to assess the feasibility, acceptability, and preliminary impact of the Orchestra technology and intervention in the context of pediatric chronic illness care. Methods: This study will be conducted in the cystic fibrosis and inflammatory bowel disease clinics at Cincinnati Children’s Hospital Medical Center. We will enroll interested patients and their caregivers to work with clinicians to use the Orchestra technology platform and care model over a 6-month period. In parallel, we will use quality improvement methods, including small, iterative cycles of tests of changes, to improve processes for integrating Orchestra into clinic workflows and patient/family lifestyles. We will use surveys, interviews, technology use data, and measures of clinical outcomes to assess the feasibility, acceptability and preliminary impact of Orchestra. Outcome measures will include assessments of: (1) enrollment and dropout rates, (2) duration of engagement/sustained use, (3) symptom and patient-reported outcome (PRO) tracker completion rates, (4) perceived impact on treatment plan, communication with the clinical team, visit preparation, and overall care, (5) changes in disease self-efficacy and engagement in care, and (6) clinical outcomes and healthcare utilization. Results: Participant recruitment began in mid-2015, with results expected in 2017. Conclusions: Chronic disease management is in need of a dramatic transformation to support more collaborative, effective, and patient-centered care. This study is unique in that it is testing not only the impact of technology, but also the necessary processes that facilitate patient and clinician collaboration. This pilot study is designed to examine how technology enabled co-production can be implemented in real life clinical contexts. Once the Orchestra technology and intervention are optimized to ensure feasibility and acceptability, future studies can test the effectiveness of this approach to improve patient outcomes and healthcare value.

  • Development of a Web-Based Intervention for Addressing Distress in Caregivers of Patients Receiving Stem Cell Transplants.

    From: JMIR Research Protocols

    Date Submitted: Nov 30, 2016

    Open Peer Review Period: Dec 5, 2016 - Dec 19, 2016

    Background: Caregivers of cancer patients experience significant burden and distress including depression and anxiety. We previously demonstrated the efficacy of an eight session, in-person, one-on-on...

    Background: Caregivers of cancer patients experience significant burden and distress including depression and anxiety. We previously demonstrated the efficacy of an eight session, in-person, one-on-one stress management intervention to reduce distress in caregivers of patients receiving allogeneic hematopoietic stem cell transplants (allo-HSCT). Objective: The objective of this study was to adapt and enhance the in-person caregiver stress management intervention to a mobilized website (e.g., tablet, smartphone, or computer-based) for self-delivery in order to enhance dissemination to caregiver populations most in need. Methods: We used an established approach for development of a mhealth intervention, completing the first two research and evaluation steps: Step One: Formative Research (e.g., expert and stakeholder review from patients, caregivers, and palliative care experts) and Step Two: Pretesting (e.g., Focus Groups and Individual Interviews with caregivers of patients with autologous HSCT (auto-HSCT). Step one included feedback elicited for a mock-up version of Pep-Pal session one from caregiver, patients and clinician stakeholders from a multidisciplinary palliative care team (N = 9 caregivers and patient stakeholders and N = 20 palliative care experts). Step two included two focus groups (N = 6 caregivers) and individual interviews (N= 9 caregivers) regarding Pep-Pal’s look and feel, content, acceptability, and potential usability/feasibility. Focus groups and individual interviews were audio-recorded. In addition, individual interviews were transcribed, and applied thematic analysis was conducted in order to gain an in-depth understanding to inform the development and refinement of the mobilized caregiver stress management intervention, Pep-Pal (PsychoEducation and skills for Patient caregivers). Results: Overall, results were favorable. Pep-Pal was deemed acceptable for caregivers of patients receiving an auto-HSCT. The refined Pep-Pal program consisted of 9 sessions (Introduction to Stress, Stress and the Mind Body Connection, How Thoughts Can Lead to Stress, Coping with Stress, Strategies for Maintaining Energy and Stamina, Coping with Uncertainty, Managing Changing Relationships and Communicating Needs, Getting the Support You Need, and Improving Intimacy) delivered via video instruction through a mobilized website. Conclusions: Feedback from stakeholder groups, focus groups, and individual interviews provided valuable feedback in key areas that was integrated into the development of Pep-Pal with the goal of enhancing dissemination, engagement, acceptability, and usability. Clinical Trial: Funded in part by funding from NIA T32AG044296 (NAP), NCI CA126071 (MLL) and PCORI CE1304-6208 (MLL).

  • ‘Am I normal?’ Patients with lymphoma wish to compare their own quality of life and symptom scores with those of others of same age and sex

    From: Journal of Medical Internet Research

    Date Submitted: Dec 1, 2016

    Open Peer Review Period: Dec 2, 2016 - Jan 27, 2017

    Background: Providing feedback to patients on their health-related quality of life (HRQoL) and symptoms can help patients in monitoring their functioning and symptoms and may help empower them. Object...

    Background: Providing feedback to patients on their health-related quality of life (HRQoL) and symptoms can help patients in monitoring their functioning and symptoms and may help empower them. Objective: This study investigates whether patients with lymphoma wish to receive feedback, including the option to compare their scores to the scores of others, and how this feedback is evaluated. Methods: Sixty-four patients participating in a lymphoma cohort who were eligible for a follow-up questionnaire were invited and given an option to receive patient-reported outcomes (PRO) feedback. Patients completed questions about HRQoL and symptoms. PRO feedback was provided via bar-charts. Results: Forty-five of 64 invited patients participated (response=70%) and 36 patients (80%) wished to receive PRO feedback. The vast majority (34/36=94%) compared their scores to a lymphoma reference cohort, and 64% (23/36) to a normative population without cancer. All patients wished to receive feedback on their HRQoL and 81-92% on their functioning, fatigue, neuropathy, anxiety and depressive feelings. Ninety-seven percent reviewed the PRO feedback as useful, with reassurance and knowledge about own functioning in relation to what is ‘normal’ as most frequently mentioned arguments. Conclusions: Patients reported the comparison of their scores to a lymphoma reference cohort as most valuable. Research should demonstrate if PRO feedback could increase empowerment and possibly improve HRQoL.

  • Design of a Mobile App for Nutrition Education (TreC-LifeStyle) and Formative Evaluation with Parents of Overweight Children

    From: JMIR mHealth and uHealth

    Date Submitted: Dec 1, 2016

    Open Peer Review Period: Dec 5, 2016 - Jan 30, 2017

    Background: Nutrition and diet apps represent today a popular area of mHealth, offering the possibility of delivering behavior change interventions for healthy eating and weight management in a scalab...

    Background: Nutrition and diet apps represent today a popular area of mHealth, offering the possibility of delivering behavior change interventions for healthy eating and weight management in a scalable and cost-effective way. However, if commercial apps for pediatric weight management fail to retain users because of a lack of theoretical background and evidence-based content, mHealth apps that are more evidence-based are found less engaging and popular amongst consumers. Approaching the apps development process from a multidisciplinary and user-centered design perspective is likely to help overcome these limitations, raising the chances for an easier adoption and integration of nutrition education apps within primary care interventions. Objective: The aim of this study is to describe the design and development of the TreC-LifeStyle nutrition education app and the results of a formative evaluation with parents. Methods: The design of the nutrition education intervention was based on a multidisciplinary user-centered design (UCD) approach, involving a team of behavior change experts, working with 2 nutritionists and 3 pediatricians from a primary care center. The app content was derived from evidence-based knowledge founded on the Food Pyramid and Mediterranean Diet guidelines used by pediatricians in primary care. A formative evaluation of the TreC-LifeStyle app involved 6 parents of overweight children (aged 7-12) self-reporting daily food intake of children for 6 weeks and providing feedback on the user experience with the mHealth intervention. Analysis of the app’s usage patterns during the intervention and of participants’ feedback informed the refinement of the app design and a tuning of the nutrition education strategies to improve user engagement and compliance with the intervention. Results: Design sessions with the contribution of pediatricians and nutritionists helped to define the nutrition education app and intervention, providing an effective human and virtual coaching approach to raise parents’ awareness about children’s eating behavior and lifestyle. The six parents participating to the pilot study found the app usable and showed high compliance with the intervention over the 6 weeks, but they also asked for getting a better support from the app in specifying food intake quantities, in visualizing data on calories intake/burnt, in preparing guidelines-compliant meals over the week. Conclusions: The UCD and formative evaluation of TreC-LifeStyle show that nutrition education apps are feasible and acceptable solutions to support brief health promotion interventions in primary care.

  • Effect of viewing smoking scenes in motion pictures on audiences' subsequent smoking desire in South Korea

    From: JMIR Public Health and Surveillance

    Date Submitted: Dec 2, 2016

    Open Peer Review Period: Dec 2, 2016 - Dec 16, 2016

    Background: Even though movies constitute a medium transmitted and distributed worldwide, smoking scenes in movies are relatively free from public health monitoring. The effect of smoking scenes in mo...

    Background: Even though movies constitute a medium transmitted and distributed worldwide, smoking scenes in movies are relatively free from public health monitoring. The effect of smoking scenes in movies in promoting viewers’ smoking desire remains unknown. Objective: We explored whether exposure of adolescent smokers to images of smoking in fılms could stimulate smoking behavior. Methods: Data used for this study were derived from a survey of respondents using a nationally representative online sample of Korean high school students (N=748). Participants who were aged 16-18 years were randomly assigned to watch three short video clips with or without smoking scenes. After adjusting covariates using propensity score matching, we conducted paired sample t-test and logistic regression to compare the difference in smoking desire before and after exposure of participants to smoking scenes. Results: In the case of male adolescents, cigarette craving was significantly higher in the experimental group with exposure to smoking scenes than that in the control group without exposure to smoking scenes (t = 2.066, p < 0.05). After adjusting covariates, more impulsive adolescents had significantly higher cigarette cravings (aOR = 3.40, 95% CI: 1.40 - 8.23). However, the group who actively sought health information had considerably lower cigarette cravings than the group who did not engage in such information-seeking (aOR = 0.08, 95% CI: 0.01 - 0.88). Conclusions: Smoking scenes in motion pictures can initiate adolescent smoking behavior. Therefore, establishing a standard that restricts the frequency of smoking scenes in films and assigning smoking-related screening grade to films are warranted. Clinical Trial: N/A

  • A proposal for an anonymisation matrix for the secondary use of Big Data for research

    From: Journal of Medical Internet Research

    Date Submitted: Dec 6, 2016

    Open Peer Review Period: Dec 7, 2016 - Feb 1, 2017

    Background: The current law on anonymisation sets the same standard across all situations, which poses a problem for biomedical research. Objective: We propose a matrix for setting different standards...

    Background: The current law on anonymisation sets the same standard across all situations, which poses a problem for biomedical research. Objective: We propose a matrix for setting different standards which is responsive to the context and public expectations. Methods: The law and ethics applicable to anonymisation were reviewed. The social science on public attitudes and research on technical methods of anonymisation were applied to formulate a matrix. Results: The matrix adjusts anonymisation standards according to the sensitivity of the data and the safety of the place, people and projects involved. Conclusions: Conclusion: The matrix offers a tool for context-specific standards for anonymisation for data research.

  • Patient Portals as a Tool for Healthcare Engagement: A mixed-method Study of Older Adults with Varying Levels of Health Literacy and Prior Patient Portal Use

    From: Journal of Medical Internet Research

    Date Submitted: Dec 7, 2016

    Open Peer Review Period: Dec 9, 2016 - Feb 3, 2017

    Background: Growing evidence that patient engagement improves health outcomes and reduces healthcare costs has fueled healthcare organizations’ focus on patient portals as the primary access point f...

    Background: Growing evidence that patient engagement improves health outcomes and reduces healthcare costs has fueled healthcare organizations’ focus on patient portals as the primary access point for personal health information and patient-provider communication. While much attention has been given to identifying characteristics of older adults who do and do not adopt patient portals and necessary adaptions to portal design, little is known about older adults’ attitudes and perceptions regarding patient portal use as a tool for engagement in their healthcare within the context of health literacy, experience navigating online health information, and previous patient portal use. Objective: The specific aims of this study are to explore attitudes towards portal adoption and its perceived usefulness as a tool for healthcare engagement among adults (65 and older) who have varying levels of health literacy and degrees of prior patient portal use. Methods: A phone survey of 100 community dwelling adults gathered socio-demographic, health and technology related information. Older adults were purposefully selected for four follow-up focus groups based on survey responses to health literacy (high/low) and previous patient portal use (yes/no). A mixed-method approach was used to integrate phone survey data with thematic analysis of four focus groups. Due to variability in attitudes between focus group participants, an individual case analysis was performed and thematic patterns were used as the basis for subgroup formation. Results: Differences in health literacy, comfort navigating health information online, and previous portal experience explained some but not all differences related to the seven themes that emerged in the focus groups analysis. Individual cases who shared attitudes were arranged into 5 subgroups from least to most able and willing to engage in healthcare via a patient portal. The subgroups overall portal adoption attitudes were 1) Don’t want to feel pushed into anything, 2) Will only adopt if required, 3) Somebody needs to help me, 4) See general convenience of the portal for simple tasks and medical history, but prefer human contact for questions, 5) Appreciates current features and excited about new possibilities. Conclusions: Most older adults are interested in using a patient portal regardless of health literacy level, previous patient portal adoption or experience navigating health information online; only a minority of older adults believe security risks or trouble learning something new outweighs the potential benefits. Research targeting informal caregivers of older adults who are unable or unwilling to engage with information technology in healthcare on their own is warranted. Healthcare organizations should consider tailored strategies to meet the needs of older adults (and their informal caregivers) and explore alternative workflows that integrate patient portal information into phone conversations and face-to-face contact with healthcare providers.

  • Optimizing Protein Intake and Nitrogen Balance (OPINiB) in adult critically ill patients: a study protocol for a randomized controlled trial.

    From: JMIR Research Protocols

    Date Submitted: Dec 4, 2016

    Open Peer Review Period: Dec 7, 2016 - Dec 21, 2016

    Background: Adequate nutrition of critically ill patients plays a key role in the modulation of metabolic response to stress. Objective: The present paper presents the development of a protocol for a...

    Background: Adequate nutrition of critically ill patients plays a key role in the modulation of metabolic response to stress. Objective: The present paper presents the development of a protocol for a randomized controlled trial aimed at comparing clinical outcomes of patients in Intensive Care Unit (ICU) administered with standard parenteral/enteral diet and protein-fortified parenteral/enteral diet. Together with the study protocol, the results of the observational analysis conducted to assess the feasibility of the trial are presented. Methods: A randomized controlled trial on adult patients admitted to ICU and undergoing mechanical ventilation in the absence of renal or hepatic failure will be conducted. Patients enrolled will be randomized with an allocation rate 1:1 at standard diet vs protein-fortified diet to meet their daily caloric requirement. Results: The enrollment is expected to start by January, 2017. In the feasibility study, 14 patients were enrolled. Daily caloric and protein intakes were recorded, and nitrogen balance was calculated daily. Protein administration increased significantly (p<0.001) over time, but was significantly lower compared to that recommended (p<0.001). Blood urea nitrogen significantly increased (p<0.03) over the period of observation. Such increased catabolism resulted in negative cumulative nitrogen balance in all patients, and some patients presented with a more negative nitrogen balance compared to the others. Conclusions: Results of the feasibility study clearly confirmed that protein provision in ICU patients is below that recommended, and that this results in impaired nitrogen balance. The emerging of an inter-individual variability in nitrogen balance will be further analyzed in the trial. Clinical Trial: NCT02618837

  • Using Beta-Version Mobile Health Technology for Team-Based Care Management to Support Stroke Prevention: A Qualitative Analysis

    From: Journal of Medical Internet Research

    Date Submitted: Dec 5, 2016

    Open Peer Review Period: Dec 7, 2016 - Feb 1, 2017

    Background: Beta versions of health information technology tools are needed in service delivery models with health care and community partnerships to confirm the key components and assess the performa...

    Background: Beta versions of health information technology tools are needed in service delivery models with health care and community partnerships to confirm the key components and assess the performance of the tools and impact on users. Using an open-source mobile platform, we developed a care management technology (CMT) for an intervention called Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) that is being tested in a randomized controlled trial. In the SUCCEED intervention, community health workers (CHWs) work collaboratively with care managers (CMs) in the health care system to empower recent stroke survivors to eat healthy foods, engage in physical activity, and use medications that can lower the risk of another stroke. The CMT was expected to facilitate achieving the target health outcome of reduced stroke risk by enhancing both the efficiency and effectiveness of the healthcare team. Objective: The primary objective was to describe the SUCCEED CMT and investigate CM and CHW perceptions of the CMT’s usefulness for team-based care management. Methods: We performed in-depth analysis of interviews conducted with all users of the beta-version SUCCEED CMT, namely two CMs and three CHWs. They were asked to demonstrate and describe their perceptions of the CMT’s ease of use and usefulness for completing predefined key care management activities. They were also probed about their general perceptions of the CMT’s information quality, ease of use, usefulness, and impact on CM and CHW roles. Interview transcripts were coded using a priori codes. Coded excerpts were grouped into broader themes and then related in a conceptual model of how the CMT facilitated care management. We also conducted a survey with 14 patients to obtain their perspective on CHW tablet use during CHW-patient interactions. Results: Overall, CMs and CHWs expressed that the CMT was useful. It helped them keep track of patient interactions and plan their work to ensure patients received the minimum set of interactions. The CMT guided CMs in developing care plans and allowed them to share the care plans with CHWs. For CHWs, the tool enabled electronic collection of clinical assessment data and provided decision support. It also tracked patients’ risk factor values and allowed CHWs to access these values in the field. Long loading times and downtimes due to outages were the most significant challenges encountered. Additional issues included the inability to link to educational materials outside of the platform or generate graphics of risk factor values over time, the extensive use of free-text responses, lengthy forms, and manual data transfer from the electronic medical record. Despite these challenges, patients overall did not perceive the tablet interfering with CHW-patient interactions. Conclusions: Our findings suggest useful functionalities of CMTs supporting health care and community partners in collaborative chronic care management. However, usability issues need to be addressed during the development process. The SUCCEED CMT is an initial step toward the development of effective health information technology tools to support collaborative, team-based models of care and will need to be modified as the evidence base grows. Future research should assess the CMT’s effects on team performance.

  • The effect of the General Data Protection Regulation on medical research

    From: Journal of Medical Internet Research

    Date Submitted: Dec 7, 2016

    Open Peer Review Period: Dec 9, 2016 - Feb 3, 2017

    Background: The enactment of the General Data Protection Regulation (GDPR) will have an effect on European data science. There were concerns that suggested consent requirements would severely restrict...

    Background: The enactment of the General Data Protection Regulation (GDPR) will have an effect on European data science. There were concerns that suggested consent requirements would severely restrict medical data research. Objective: To explain the changes in data protection law that apply to medical research and their potential impact. Methods: Analysis of ethico-legal requirements imposed by the GDPR. Results: The GDPR makes the situation regarding pseudonymised data clearer, although it has not been entirely resolved. Biomedical research on personal data where consent has not been obtained must be of substantial public interest. Conclusions: Conclusions: The GDPR makes protections for data subjects more consistent across the EU. The proposed changes will make little impact on biomedical data research.

  • Development, Feasibility, and Small-Scale Implementation of a Web-based Prognostic Tool - SEER*CSC

    From: JMIR Cancer

    Date Submitted: Dec 7, 2016

    Open Peer Review Period: Dec 8, 2016 - Feb 2, 2017

    Background: Population data sets and the Internet are playing an ever-growing role in the way cancer information is made available to providers, patients, and their caregivers. The Surveillance, Epide...

    Background: Population data sets and the Internet are playing an ever-growing role in the way cancer information is made available to providers, patients, and their caregivers. The Surveillance, Epidemiology, and End Results Cancer Survival Calculator (SEER*CSC) is a cancer prognostic tool that uses SEER data, a large population data set, to provide physicians with highly valid, evidence-based prognostic estimates for increasing shared decision making and improving patient-provider communication of complex health information. Objective: The aim of this study was to develop, test, and implement a web-based cancer prognostic tool. Methods: An iterative approach was used to develop the SEER*CSC. Based on input from cancer patient advocacy groups and physicians, an initial version of the tool was developed. Next, providers from four healthcare delivery systems were recruited to do formal usability testing of the SEER*CSC tool. A revised version of the tool was then implemented in two healthcare delivery sites using a real world clinical implementation approach, and usage data was collected. Post-implementation follow-up interviews were also conducted with site champions. Finally, patients from two cancer advocacy groups participated in usability testing. Results: Overall feedback of the tool from both providers and patients was positive, with providers noting the site was professional and reliable, and patients finding the site to be informational and helpful to use when discussing their diagnosis with their provider. However, the use during the small-scale implementation was low. Reasons for low usage included time to enter data, not having treatment options in the tool, and the tool not being incorporated into the electronic health record (EHR). Patients found the language in its current version to be too complex. Conclusions: The implementation and usability results showed that participants were enthusiastic about the use and features of SEER*CSC, but sustained implementation in a real world clinical setting faced significant challenges. As a result of this testing, the tool is being redesigned with more accessible language for a public facing release. Meta-tools, which put different tools in context of each other, are needed to assist in understanding the strengths and limitations of various tools and their place in the clinical decision making pathway. The continued development and eventual release of the tools should include feedback from multidisciplinary healthcare teams, various stakeholder groups, patients, and caregivers. Clinical Trial: National Cancer Institute at the National Institutes of Health, grant number P20 CA137219

  • Randomized Controlled Trials of Technology-Based HIV/STI and Drug Abuse Preventive Interventions for African American and Hispanic Youth: A Systematic Review

    From: Journal of Medical Internet Research

    Date Submitted: Dec 8, 2016

    Open Peer Review Period: Dec 9, 2016 - Dec 17, 2016

    Background: HIV/STI and drug abuse remain significant public health concerns in the United States, and African American and Hispanic youth are disproportionately affected. Although technology-based in...

    Background: HIV/STI and drug abuse remain significant public health concerns in the United States, and African American and Hispanic youth are disproportionately affected. Although technology-based interventions are efficacious in preventing and reducing HIV/STI and drug use behaviors, relatively little is known with respect to the state of the science among African American and Hispanic youth. Objective: The aim of this review is to identify and examine randomized controlled trials (RCTs) of technology-based HIV/STI and drug abuse preventive interventions for African American and Hispanic youth. Methods: We searched electronic databases (i.e., PubMed, Proquest, PsycINFO, Ebscohost, Google Scholar) to identify studies between January 2006 and October 2016. RCTs of technology-based interventions targeting African American and Hispanic youth HIV/STI risk behaviors, including sexual risk and licit and illicit drug use, and HIV and STI testing, were included. Results: Our search revealed a total of three studies that used a RCT design and included samples comprised of > 50% African American and/or Hispanic youth. The follow-up assessments ranged from two weeks to six months and the number of participants in each trial ranged from 72 to 141. The three interventions were theory driven, interactive, and tailored. The long-term effects of the interventions were mixed, and outcomes included reductions in sex partners, licit drug use, and condomless anal sex acts. Conclusions: Although technology-based interventions seem promising in the prevention of HIV/STI among African American and Hispanic youth, more research is needed.

  • Assessing the usability of a self-regulation theory-based asthma management mobile app for adolescents

    From: JMIR Human Factors

    Date Submitted: Dec 8, 2016

    Open Peer Review Period: Dec 9, 2016 - Dec 23, 2016

    Background: Self-regulation theory suggests people learn to influence their own behavior through self-monitoring, goal-setting, feedback, self-reward, and self-instruction, all of which smartphones ar...

    Background: Self-regulation theory suggests people learn to influence their own behavior through self-monitoring, goal-setting, feedback, self-reward, and self-instruction, all of which smartphones are now capable of facilitating. Several mobile apps exist to manage asthma; however, little evidence exists about whether these apps employ user-centered design processes that adhere to government usability standards for mobile apps. Objective: Building upon a previous study that documented adolescent preferences for an asthma self-management app, we employed a user-centered approach to assess the usability of an asthma self-management app prototype intended for use by adolescents with persistent asthma. Methods: Individual interviews were conducted with adolescents (ages 11-18) with persistent asthma who owned a smartphone (n=8). Adolescents were asked to evaluate a PDF app prototype consisting of 76 screen shots displaying app features, including login and home screen, profile setup, settings and info, self-management features, and graphical displays for charting asthma control and medication. Preferences, comments, and suggestions for each set of screen shots were assessed using the audio-recorded interviews. Two coders reached consensus on adolescent evaluations of the following aspects of app features: 1) usability, 2) behavioral intentions to use, 3) confusing aspects, and 4) suggestions for improvement. Results: The app prototype was generally well-received, and several suggestions for improvement were given. Suggestions included increased customization of charts and notifications, reminders, and alerts. Participants preferred longitudinal data about asthma control and medication use to be displayed using line graphs. All participants reported that they would find an asthma management app like the one depicted in the prototype as useful for managing their asthma. Conclusions: Early stage usability tests that were guided by government usability standards (usability.gov) revealed areas for improvement for an asthma self-management app for adolescents. Addressing these areas will be critical to developing an engaging and effective asthma self-management app that is capable of improving adolescent asthma outcomes.

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