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Journal Description

JMIR Preprints contains pre-publication/pre-peer-review preprints intended for community review. 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:

  • Assessment of stress in healthy individuals using smartphones: a systematic review

    From: Journal of Medical Internet Research

    Date Submitted: Jul 26, 2016

    Open Peer Review Period: Jul 26, 2016 - Sep 20, 2016

    Background: Stress is a common experience in today’s society. Smartphone ownership is widespread and smartphones can be used to monitor health and wellbeing. Smartphone-based subjective self-assessm...

    Background: Stress is a common experience in today’s society. Smartphone ownership is widespread and smartphones can be used to monitor health and wellbeing. Smartphone-based subjective self-assessment of stress can be done in naturalistic settings. Smartphone data may potentially reflect a person’s real-time stress level. Objective: The objectives of this systematic review were 1) to evaluate how smartphones have been used to measure self-assessed stress in healthy adult individuals, 2) to evaluate the validity of self-assessed stress on smartphones compared with validated stress scales and 3) to evaluate the association between self-assessed stress and smartphone generated objective data. Methods: A systematic review of the scientific literature was reported and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The scientific databases PubMed, PsycINFO, Embase, IEEE and ACM were searched and supplemented by a hand search of reference lists. The databases were searched for original studies involving healthy individuals over the age of 18 years, measuring self-assessed stress on a smartphone. Results: A total of 31 published articles comprising a total of 1259 individuals were included for review. According to the objectives 1) The study designs were heterogeneous and self-assessed stress was measured using various methods, including a) a dichotomised question on stress (yes/no), b) a Likert-scale on stress and c) a questionnaire on stress; 2) The validity of self-assessed stress compared with validated stress scales was investigated in three studies, and of these only one study found a moderate statistically significant positive correlation (r=0.4; P < 0.05); 3) Some of the reported smartphone generated objective data, including voice, activity and usage data, were found to correlate with self-assessed stress in exploratory analyses. Conclusions: Smartphones are being used to measure self-assessed stress in different contexts. The evidence of the validity of self-assessed stress is limited and should be investigated further. Smartphone generated objective data can potentially be used to monitor, predict and reduce stress-levels.

  • YouTubeTM as a source of patient education on the role of the hospitalist

    From: Interactive Journal of Medical Research

    Date Submitted: Jul 23, 2016

    Open Peer Review Period: Jul 26, 2016 - Sep 20, 2016

    Background: “Hospitalist” is a new field, dedicated to the delivery of comprehensive medical care to hospitalized patients. YouTubeTM is one of the most frequently used websites, offering access t...

    Background: “Hospitalist” is a new field, dedicated to the delivery of comprehensive medical care to hospitalized patients. YouTubeTM is one of the most frequently used websites, offering access to a gamut of videos, from self-produced to professionally-made. Objective: We sought to determine the adequacy of YouTubeTM as an effective means to define and depict the role of hospitalists. Methods: YouTubeTM was searched on 11/17/2014 using the following search words: “hospitalist,” “hospitalist definition,” “what is the role of a hospitalist,” “define hospitalist” and “who is a hospitalist.” Only videos found in the first 10 pages of each search were included. Non-English, non-educational and non-relevant videos were excluded. A novel 7 point scoring tool was created by the authors based on the Society of Hospital Medicine definition of a hospitalist. Three independent reviewers evaluated, scored and classified the videos into high, intermediate and low quality based on the average score. Results: A total of 102 videos out of 855 were identified as relevant and included in the analysis. Videos uploaded by academic institutions had the highest mean score. Only 6 videos were classified as high quality, 53 as intermediate quality and 42 as low quality, with 82% of the videos scoring an average of 4 or less. Conclusions: Most videos found in the search of a hospitalist definition are inadequate. Leading medical organizations and academic institutions should consider producing and uploading quality videos to YouTubeTM to help patients and their families better understand the roles and definition of the hospitalist.

  • How best to obtain valid, verifiable data online from male couples? Lessons learned from an eHealth HIV prevention intervention for HIV-negative male couples

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 22, 2016

    Open Peer Review Period: Jul 25, 2016 - Sep 19, 2016

    Background: As interest increases in the development of eHealth HIV preventive interventions for gay male couples, web-based methods must also be developed to help increase the likelihood that couples...

    Background: As interest increases in the development of eHealth HIV preventive interventions for gay male couples, web-based methods must also be developed to help increase the likelihood that couples enrolled and data collected from them represent true, unique dyads. However, methods to recruit and collect reliable and valid data from both members of a couple (i.e., dyadic data) are lacking yet are crucial for uptake of novel sexual health and HIV prevention eHealth interventions. Methods to describe best practices to recruit male couples using targeted advertisements placed on Facebook are also lacking in the literature yet could also help in the uptake of referring male couples to new and novel eHealth, HIV preventive interventions. Objective: Experiences pertaining to recruitment and eligibility, enrollment data from two phases (formative, development phase and online randomized control trial) of an eHealth HIV prevention intervention for concordant HIV-negative male couples are used to describe challenges and lessons learned associated with: 1) recruiting male couples using targeted advertisements on Facebook; 2) validating that data came from two partners of the couple; and 3) verifying that the two partners of the couple are in a relationship with one another. Methods: The developmental phase refined the intervention via in-person focus groups whereas the pilot-testing phase included an online randomized control trial. For both phases, couples were recruited via Facebook advertisements targeting adult (e.g., >18) males interested in men, in a relationship, and had an interest in the LGBT community and/or gay news. Advertisements directed men to a study webpage and screener; once eligible, participants provided consent electronically. A partner referral system was embedded in the consenting process to recruit the relationship partner of the participant. Both men of the couple had to meet all eligibility criteria – individually and as a couple – before they could enroll into the study. Verification of couples’ relationships was assessed via the concurrence of pre-determined screener items from both partners, done manually in the developmental phase and electronically in the pilot-testing phase. A system of decision rules was developed to assess the validity that data came from two unique partners of a couple. Results: Several important lessons were learned from these experiences, resulting in recommendations for future eHealth studies involving male couples. Use of certain ‘interests’ and types of images (e.g., shirtless) in targeted Facebook advertisements should be avoided or used sparingly as these interests and types of images may generate adverse reactions from a broader audience. Development of a systematic approach with pre-determined criteria and parameters to verify male couples’ relationships is strongly recommended. Further, researchers are encouraged to develop a system of decision rules to detect and handle suspicious data (e.g., suspicious email addresses/names, multiple entries, same IP address used in multiple entries) to help validate the legitimacy of male couples’ relationships online. Conclusions: These lessons learned combined with recommendations for future studies aim to help enhance recruitment efforts and the validity and reliability of collecting dyadic data from male couples for novel, eHealth preventive interventions.

  • Can Facebook be used for Research? Experiences using Facebook to Recruit Pregnant Women for a Randomized Control Trial in Edmonton, Alberta

    From: Journal of Medical Internet Research

    Date Submitted: Jul 25, 2016

    Open Peer Review Period: Jul 25, 2016 - Sep 19, 2016

    Background: Recruitment is often a difficult and costly part of any human research study. Social media and other emerging means of mass communication hold promise as means to complement traditional st...

    Background: Recruitment is often a difficult and costly part of any human research study. Social media and other emerging means of mass communication hold promise as means to complement traditional strategies used for recruiting participants because they can reach a large number of people, in short amount of time. With the ability to target a specified audience, paid Facebook advertisements have potential to reach future research participants of a specific demographic. A randomized control trial in trial in Edmonton, Alberta trialed various traditional recruitment approaches in addition to paid Facebook advertisements to find healthy pregnant women between 8-20 weeks gestation, to participate in a prenatal study. Objective: To evaluate the effectiveness of paid advertisements on Facebook as a platform for recruiting pregnant women to a randomized control trial, in comparison to Traditional recruitment approaches. Methods: Recruitment using Traditional approaches occurred for 7 months, while Facebook advertisements were trialed for a total of 26 days. Interested women were prompted to contact the study staff for a screening call to determine study eligibility. Costs associated with each recruitment approach were recorded and used to calculate the cost to recruit eligible participants. Performance of Facebook advertisements was monitored using Facebook Ads Manager. Results: Of the 115 women included, 39% (n=45) of the women who contacted study staff heard about the study through Facebook, while 61% (n=70) of them had heard about it through Traditional recruitment approaches. During the 215 days (~ 7 months) that the Traditional approaches were used, the average rate of interest was 0.3±0.2 women/day, while the 26 days of Facebook advertisements resulted in an average interest rate of 2.8±2.1 women/day. Facebook advertisements cost $506.91, with a cost per eligible participant of $20.28. In comparison, the Traditional approaches cost $1087, with an approximate of $24.15 per eligible participant. Demographic characteristics of women were similar between the two recruitment methods, except that women recruited using Facebook were significantly earlier in their pregnancy than those recruited using Traditional approaches (p<.03). Conclusions: Paid Facebook advertisements hold promise as a platform for reaching pregnant women. The relative ease of placing an ad, the comparable cost per participant recruited, and the dramatically improved recruitment rates in comparison to Traditional approaches highlights the importance of combining novel and traditional recruitment approaches to recruit women for pregnancy related studies. Clinical Trial: ClinicalTrials.gov ID: NCT02711644

  • ENHANCE—(ElectroNic Hydroxyurea AdhereNCE): An Adherence Strategy Protocol to Improve Hydroxyurea Adherence in Patients with Sickle Cell Disease

    From: JMIR Research Protocols

    Date Submitted: Jul 25, 2016

    Open Peer Review Period: Jul 25, 2016 - Aug 8, 2016

    Background: Hydroxyurea (HU) is the only disease-modifying medication for patients with sickle cell disease (SCD). HU can reduce SCD-related complications but only 35-50% of pediatric patients adhere...

    Background: Hydroxyurea (HU) is the only disease-modifying medication for patients with sickle cell disease (SCD). HU can reduce SCD-related complications but only 35-50% of pediatric patients adhere to HU at the rates achieved in clinical trials and this limits its clinical effectiveness. Objective: Mobile Directly Observed Therapy (Mobile DOT) is a pilot-tested, electronic, multi-dimensional HU adherence intervention that targets many components of the Health Behavior Model. The aim of this study is to evaluate the impact of Mobile DOT on HU adherence in children with SCD and the objective of this manuscript is to inform the development of future adherence interventions and pediatric SCD protocols. Methods: This is a single arm cross-over study of pediatric patients with SCD. Participants self-record videos of their daily HU administrations and receive (SMS) alerts to take HU, feedback on their HU adherence, and incentives when they achieve adherence goals during the six month Mobile DOT phase. Participants’ HU adherence during the Mobile DOT phase is compared to their baseline HU adherence (six months prior to study entry) and to their HU adherence six months after completing the Mobile DOT phase. The primary outcome of this study is HU adherence measured by medication possession ratio. Results: The trial is ongoing. Preliminary review of participant satisfaction results suggest that most participants can complete Mobile DOT in less than five minutes per day and are satisfied with the intervention. Conclusions: If effective, the Mobile DOT strategy will increase HU adherence and this could improve patients’ clinical outcomes and reduce costs of care. Clinical Trial: ClinicalTrials.gov NCT02578017

  • Do patients with ACL reconstruction who use eHealth to support their self-management plans have equal or improved function and self-efficacy with decreased health resource use, compared to a usual care group? A feasibility study

    From: JMIR Research Protocols

    Date Submitted: Jul 25, 2016

    Open Peer Review Period: Jul 25, 2016 - Aug 8, 2016

    Background: Rupture of the anterior cruciate ligament (ACL) is common, especially in the active population. Most patients are managed surgically and rehabilitation is essential but the optimal way for...

    Background: Rupture of the anterior cruciate ligament (ACL) is common, especially in the active population. Most patients are managed surgically and rehabilitation is essential but the optimal way for delivering rehabilitation is not clear. This study’s purpose is to assess the feasibility of a randomised controlled trial of eHealth to support service delivery in the ACL rehabilitation population. Current methods of service delivery in the NHS struggle to cater for large volumes of patients and the lengthy time span over which rehabilitation is delivered. This study can provide insights into how to address the challenges of service provision while still improving the patient experience. ‘eHealth’ refers to the use of the internet in healthcare. The use of eHealth has been successful at delivering behaviour change to a number of diverse patient groups. An eHealth intervention called TRAK – (Taxonomy for the RehAbilitaion of Knee conditions) specifically for knee conditions to support self-management has been developed and acceptability studies have yielded positive results. TRAK is not an exercise rehabilitation package, it is an adjunct to improve self-management and behaviour change that contains an individualised exercise package. This novel platform is directly in line with current NHS England, National Institute for Health and Care Excellence and NHS Improvement agendas call for initiatives around rehabilitation using both technology and support for patients to self-manage. Given the promising results of TRAK the next stage is to address the feasibility of eHealth to support delivery of ACL rehabilitation in the NHS, based on a standard model of care. Patients’ exercise programmes and duration of treatment are still based on individual needs but use of a website or app may offer improved self-management and function and reduced health resource use. Objective: The primary objective is to assess the feasibility of undertaking an eHealth intervention RCT in the ACL population. Secondary objectives include the feasibility of collecting costings data and patient rated outcomes and to develop an RCT protocol Methods: This is a feasibility randomised controlled non-inferiority trial comparing two groups: standard care and standard care plus eHealth. It will use convergent parallel mixed methods where both qualitative and quantitative data are sought for a more thorough understanding of the objectives (52, 53). Primary outcomes relate to feasibility, including recruitment, retention and usage. Secondary outcomes relate to health resource use and patient rated outcome measures. Results: This research expects to establish the feasibility of a full scale non-inferiority randomised control trial to explore whether patients who use an eHealth intervention to support ACL rehabilitation have better or equal outcomes plus improved self efficacy and reduced health resource use than a usual care group. Conclusions: The study will provide essential information to support the development and powering of a future clinical trial of eHealth and physiotherapy for patients with ACL reconstruction in the NHS. Clinical Trial: N/A

  • A Five-Step Framework on Biomedical Signal Analysis for Tackling Noncommunicable Diseases: Current and Future Perspectives

    From: Journal of Medical Internet Research

    Date Submitted: Jul 25, 2016

    Open Peer Review Period: Jul 25, 2016 - Sep 19, 2016

    Low- and middle-income countries (LMICs) continue to face major challenges in providing high-quality and universally accessible healthcare. Researchers, policy-makers, donors, and program implementers...

    Low- and middle-income countries (LMICs) continue to face major challenges in providing high-quality and universally accessible healthcare. Researchers, policy-makers, donors, and program implementers consistently strive to develop and provide innovative approaches to eliminate geographical and financial barriers to healthcare access. Recently, interest has increased in using mobile health (mHealth) as a potential solution to overcome barriers to improving healthcare in LMICs. Moreover, with use increasing and cost decreasing for cellphones and internet, mHealth solutions are becoming considerably more promising and efficient. As part of mHealth solutions, biomedical signals collection and processing could play a major role in improving global healthcare. Information extracted from biomedical signals might increase diagnostic precision while augmenting the robustness of healthcare workers’ clinical decision making. This paper presents a high-level framework using biomedical signal processing (BSP) to tackle noncommunicable diseases (NCDs), especially in LMICs. Researchers can consider each of these elements during the research and design of BSP-based devices, enabling them to elevate their work to a level that extends beyond the scope of local application and use. This paper includes technical examples to emphasize the applicability of the proposed framework, which is relevant to a wide variety of stakeholders, including researchers, policy makers, clinicians, computer scientists, and engineers.

  • Mobile Applications in Oncology: A Survey on the Attitude of Healthcare Professionals about Telemedicine, mHealth and an Oncological App

    From: Journal of Medical Internet Research

    Date Submitted: Jul 25, 2016

    Open Peer Review Period: Jul 25, 2016 - Sep 19, 2016

    Background: Mobile applications (apps) are an evolving trend in the medical field. To date, few apps in an oncological context exist. Objective: We analyzed health care professionals’ (HCP) attitude...

    Background: Mobile applications (apps) are an evolving trend in the medical field. To date, few apps in an oncological context exist. Objective: We analyzed health care professionals’ (HCP) attitude about telemedicine, mHealth, and mobile apps. Methods: We developed and conducted an online survey with 24 questions evaluating HCPs’ attitude towards telemedicine and patients using medical mobile apps in general, as well as specified questions on functionality and possible disadvantages of an app. Results: A total of 108 HCPs completed the survey. Of all, 88.9% consider telemedicine as useful, 84.3% versus 15.7% support the idea of an oncological app complementing classical treatment. Automatic reminders, timetables, and assessing side effects as well as quality of life during therapy were rated as the most important functions. In contrast, uncertainty regarding medical responsibility and data security were reasons mostly named by critics. Favorable of an alert function due to data input by patients with the need for further clarification are 64.8% (versus 35.2%), 94.3% are willing to contact the patient after notification. Of all, 93.5% support the idea to use collected data for scientific research and 75.0% believe it could beneficial for the providing hospital. Conclusions: A majority of HCPs are in favor of telemedicine and the use of an oncological app by patients. Not least because the fields of application are limitless. Assessing side effects can lead to quicker response and thus lower inconvenience of patients. Clinical data as life quality and treatment satisfaction could be used to evaluate and improve the therapy workflow. Eventually, a mobile app would enhance the patient relation to his treating department as he is continually linked to it by the mobile app. Clinical Trial: no registration needed

  • Barriers to Remote Health Interventions for Type 2 Diabetes: A Systematic Review and Proposed Classification Scheme

    From: Journal of Medical Internet Research

    Date Submitted: Jul 22, 2016

    Open Peer Review Period: Jul 22, 2016 - Sep 16, 2016

    Background: Diabetes self-management involves adherence to good daily habits typically involving blood glucose monitoring, medication, exercise, and diet. To support self-management, some providers ha...

    Background: Diabetes self-management involves adherence to good daily habits typically involving blood glucose monitoring, medication, exercise, and diet. To support self-management, some providers have begun testing remote interventions for monitoring and assisting patients between clinic visits. Although some studies have shown success, there are barriers to widespread adoption. Objective: This systematic review seeks to identify and classify barriers to adoption of remote systems for management of type 2 diabetes. Methods: Six electronic databases, MEDLINE (Ovid), Embase (Ovid), CINAHL, Cochrane Central, Northern Light Life Sciences Conference Abstracts, and Scopus (Elsevier), were searched for articles published from 2010 to 2015. The search identified studies involving remote technologies for type 2 diabetes self-management. Reviewers worked in teams of two to review and extract data from identified papers. Information collected included study characteristics, outcomes, drop-out rates, technologies used, and barriers identified. Results: Fifty-three publications on 42 studies met the specified criteria. Lack of data accuracy due to input bias (n=13/42, 31%), limitations on scalability (n=10/42, 24%), and technology illiteracy (n=10/42, 24%) were the most commonly cited barriers. Technology illiteracy was most prominent in low-income populations while limitations on scalability was more prominent in mid-income populations. Barriers identified were applied to a conceptual model of successful remote health, which includes patient engagement, patient technology accessibility, quality of care, system technology cost, and provider productivity. Forty-one percent of identified barrier instances impeded patient engagement, which is manifest in the large drop-out rates cited (up to 57%). Conclusions: The barriers identified represent major challenges in the design of remote health systems for diabetes. Breakthrough technologies and systems are needed to alleviate the barriers identified so far, particularly those associated with patient engagement. Monitoring devices that provide objective and reliable data streams on medication, exercise, diet, and glucose monitoring will be essential for widespread effectiveness. Additional work is needed to understand root causes of high drop-out rates, and new interventions are needed to identify and assist those at greatest risk of dropout. Finally, future studies must quantify costs and benefits to determine financially sustainability.

  • Technologies to support community-dwelling persons with dementia: an INTERDEM position paper on issues regarding development, usability, (cost)effectiveness, implementation and ethics

    From: Journal of Medical Internet Research

    Date Submitted: Jul 20, 2016

    Open Peer Review Period: Jul 21, 2016 - Sep 15, 2016

    Background: With the expected growing number of people with dementia, providing timely, adequate and affordable care and support is challenging. Assistive and health technologies may be a valuable con...

    Background: With the expected growing number of people with dementia, providing timely, adequate and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. Objective: To review the state of the art of technologies for people with dementia in three fields of technologies: 1) managing everyday life, 2) pleasurable and meaningful activities, and 3) health care technologies to support dementia care provision. And to identify challenges and calls for action. Methods: Reviews of literature in the three fields of technologies regarding issues on development, usability, (cost)effectiveness, implementation and ethics. Results: Results showed that: persons with dementia want to be included in development of technologies, little research is performed on usability of assistive technologies, various benefits are reported but mainly based on low quality studies, various barriers are found to implementation of technologies in dementia care and ethical issues were addressed by researchers but often not studied. Many challenges remain. These are: including the target group more often in development, performing more high quality studies on usability and (cost)effectiveness, having access to high quality data on existing technologies to enable adequate implementation of technologies in dementia care and to ensure that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on the results of the state of the art, various actions are recommended for development, usability, evaluation, implementation and ethics of assistive and health technologies across Europe. Examples are to ensure that unnecessary replication of technology development that is provenly unhelpful or ineffective does not occur and to better focus on how technological services succeed in addressing individual needs of persons with dementia, as the population is heterogeneous and many face co-morbid conditions. Furthermore, it is suggested to have these recommendations implemented in national and international calls for funding and assistive technology research programmes in the coming decade. In practice, policy makers, care insurers and care providers together with technology enterprises and researchers should prepare strategies for the implementation of assistive technologies in different care settings, to ensure that next generations of people with dementia are enabled to actually utilize the developed technologies in an affordable way and that they can all benefit from it Clinical Trial: NO clinical trial

  • Self-monitoring utilization patterns among individuals in an incentivized program for healthy behaviors

    From: Journal of Medical Internet Research

    Date Submitted: Jul 20, 2016

    Open Peer Review Period: Jul 21, 2016 - Jul 28, 2016

    Background: The advent of digital technology has enabled individuals to track meaningful biometric data about oneself. This novel capability has spurred non-traditional health care organizations to de...

    Background: The advent of digital technology has enabled individuals to track meaningful biometric data about oneself. This novel capability has spurred non-traditional health care organizations to develop systems that aid users in managing their health. One of the most prolific systems is Walgreens’ Balance Rewards for healthy choices™ (BRhc™) program, an incentivized, online self-monitoring program. Objective: This study was performed to evaluate health data self-tracking characteristics of individuals enrolled in the Walgreens BRhc™ program, including the impact of manual versus automatic data entries through a supported device or application. Methods: We obtained activity tracking data from total of 455,341 BRhc™ users during the 2014 calendar year. Upon identifying users with sufficient follow-up data, we explored temporal trends in user participation. Results: Thirty-four percent of users quit participating after a single entry of an activity. Among users who tracked at least two activities on different dates, the median length of participating was 8 weeks, with an average of 5.8 activities entered per week. Furthermore, users who participated for at least 20 weeks (28.3% of users) consistently entered 8 to 9 activities per week. Majority of users (77%) recorded activities through manual data entry alone. However, individuals who entered activities automatically through supported devices or apps participated roughly four times longer than their manual activity-entering counterparts (average 20 and 5 weeks, respectively; P<.001). Conclusions: This study provides insights into the utilization patterns of individuals participating in an incentivized, online self-monitoring program. Our results suggest automated health tracking could significantly improve long-term health self-management and engagement.

  • The Inclusion of Ethnic Minority Patients and the Role of Language in Telehealth Trials for Type 2 Diabetes: A Systematic Review

    From: Journal of Medical Internet Research

    Date Submitted: Jul 20, 2016

    Open Peer Review Period: Jul 20, 2016 - Sep 14, 2016

    Background: Type 2 diabetes is a serious, pervasive metabolic condition that disproportionately affects ethnic minority patients. Telehealth interventions can facilitate type 2 diabetes monitoring and...

    Background: Type 2 diabetes is a serious, pervasive metabolic condition that disproportionately affects ethnic minority patients. Telehealth interventions can facilitate type 2 diabetes monitoring and prevent secondary complications. However, trials designed to test the effectiveness of telehealth interventions may under-recruit or exclude ethnic minority patients, with language a potential barrier to recruitment. The underrepresentation of minorities in trials limits the external validity of the findings for this key patient demographic. Objective: This systematic review examines (1) the research reporting practices and prevalence of ethnic minority patients included in telehealth randomized controlled trials (RCTs) targeting type 2 diabetes, as well as the trial characteristics associated with recruiting a high proportion of minority patients, and (2) the proportion of included RCTs that report using English language proficiency as a patient screening criterion and how and why they do so. Methods: Telehealth RCTs published in refereed journals targeting type 2 diabetes as a primary condition for adults in Western majority English speaking countries were included. Ethnically-targeted RCTs were excluded from the main review but included in a post-hoc subgroup analysis. Abstract and full-text screening, risk of bias assessment, and data extraction were independently conducted by two reviewers. Results: Of 3358 records identified in the search, 79 articles comprising 58 RCTs were included. Nearly two-thirds of the RCTs (38/58) reported on the ethnic composition of participants, with a median proportion of 23.5% patients (range: 0%-97.7%). Fourteen studies (24%) that included at least 30% minority patients were all US-based, predominantly recruited from urban areas, and described the target population as underserved, financially deprived, or uninsured. Seven of these 14 studies (50%) offered intervention materials in a language other than English or employed bilingual staff. Half of all identified RCTs (29/58) included language proficiency as a participant screening criterion. Language proficiency was operationalized using non-standardized measures (e.g., having sufficient “verbal fluency”), with only three studies providing reasons for excluding patients on language grounds. Conclusions: There was considerable variability across studies in the inclusion of ethnic minority patients in RCTs, with higher participation rates in countries with legislation to mandate their inclusion (e.g., US) than in those without such legislation (e.g., UK). Less than 25% of the RCTs recruited a sizeable proportion of ethnic minorities, which raises concerns about external validity. The lack of objective measures or common procedures for assessing language proficiency across trials implies that language-related eligibility decisions are often based on trial recruiters’ impressionistic judgments, which could be subject to bias. The variability and inconsistent reporting on ethnicity and other socioeconomic factors in descriptions of research participants could be more specifically emphasized in trial reporting guidelines to promote best practice. Clinical Trial: PROSPERO International Prospective Register of Systematic Reviews: CRD42015024899 http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015024899

  • Evaluation of Diet Related Infographics on Pinterest for use of Behavior Change Theories; a content analysis

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 17, 2016

    Open Peer Review Period: Jul 20, 2016 - Sep 14, 2016

    Background: There is increasing interest in Pinterest as a method of disseminating health information, however it is unclear whether the health information promoted on Pinterest is evidence-based or p...

    Background: There is increasing interest in Pinterest as a method of disseminating health information, however it is unclear whether the health information promoted on Pinterest is evidence-based or promotes behavior change. Objective: To determine the presence of Health Behavior Theory (HBT) constructs in pins found on Pinterest and to assess the relationship between various pin characteristics and the inclusion of HBT. Methods: A content analysis was conducted on pins collected from Pinterest identified with the search terms “nutrition infographic” and “healthy eating infographic.” The coding rubric included HBT constructs, pin characteristics, and visual communication tools. Each HBT construct was coded as present or not present (yes = 1/no = 0). A total theory score was calculated by summing the values for each of the 9 constructs (range 0 - 9). Adjusted regression analysis was used to identify factors associated with the inclusion of health behavior change theory in pins (P < .05). Results: The mean total theory score was 2.03 (SD = 1.2). Perceived benefits were present most often (72.03%), followed by behavioral capacity (51.68%) and perceived severity (33.47%). The construct that appeared the least was self-regulation/self-control (0.84%). Pin characteristics associated with the inclusion of HBT included a large amount of text (P=.01), photographs of real people (P = .001), cartoon pictures of food (P = .01) and the presence of references (P = .001). The number of repins (P = .04), likes (P = .01) and comments (P = .01) were positively associated with the inclusion of HBT. Conclusions: These findings suggest that current Pinterest infographics targeting healthy eating contain little HBT elements. Health professionals and organizations need to create and disseminate infographics that contain more elements of HBT to better influence healthy eating behavior. This may be accomplished by creating pins that utilize both text and images of people and food in order to portray elements of HBT and convey nutritional information.

  • High Touch and High Tech (HT2): Transforming Patient Engagement Throughout the Continuum of Care by Engaging Patients with Portal Technology at the Bedside

    From: JMIR Research Protocols

    Date Submitted: Jul 18, 2016

    Open Peer Review Period: Jul 19, 2016 - Aug 2, 2016

    For patients with complex care needs, engagement in disease management activities is critical. Chronic illnesses touch almost every person in the U.S. The costs are real, personal and pervasive. In re...

    For patients with complex care needs, engagement in disease management activities is critical. Chronic illnesses touch almost every person in the U.S. The costs are real, personal and pervasive. In response, patients often seek tools to help them manage their health. Patient portals -- a Personal Health Record tethered to an Electronic Health Record -- show promise as tools that patients value and that can improve health. Although patient portals currently focus on the outpatient experience, the Ohio State University Wexner Medical Center has deployed a portal designed specifically for the inpatient experience that is connected to the ambulatory patient portal available after discharge. While this inpatient technology is in active use at only one other hospital in the U.S., healthcare facilities are currently investing in infrastructure necessary to support large-scale deployment. Times of acute crisis such as hospitalization may increase a patient’s focus on his/her health. During this time, patients may be more engaged with their care and especially interested in using tools to manage their health after discharge. Evidence shows that enhanced patient self-management can lead to better control of chronic illness. Patient portals may serve as a mechanism to facilitate increased engagement. Our proposed four-year study uses a mixed-methods approach to evaluate a randomized controlled trial studying the effectiveness of a High Tech Intervention (MyChart Bedside, the inpatient portal), and an accompanying High Touch Intervention (training patients to use the portal to manage their care and conditions) in a sample of hospitalized patients with two or more chronic conditions. This study measures how access to a patient portal tailored to the inpatient stay can improve patient experience and increase patient engagement by 1) improving patients’ perceptions of the process of care while in the hospital, 2) increasing patients’ self-efficacy for managing chronic conditions, and 3) facilitating continued use of a patient portal for care management after discharge. In addition, we aim to enhance patients’ use of the portal available to outpatients, MyChart Ambulatory, once they are discharged. Our specific aims are: 1. To study the independent effects of providing both High Tech and High Touch interventions on patient-reported outcomes at discharge, including patients’ self-efficacy for managing chronic conditions and satisfaction with care. 2. To conduct a mixed-methods analysis to determine how providing patients with access to MCB (High Tech) and training/education on patient portals and MCA (High Touch) will influence engagement with the patient portal and relate to longer-term outcomes. Providing patients real-time access to health information can be a positive force for change in the way care is provided. Meaningful Use policies require minimum demonstrated use of patient portal technology, most often in the ambulatory setting. However, as the technology matures to bridge the care transition, there is a greater need to understand how patient portals transform care delivery. By working in concert with patients to address and extend current technologies, our study aims to advance efforts to increase patients’ engagement in their care and develop a template for how other hospitals might integrate similar technologies.

  • The effects of e-mental health program and job coaching on the risk of major depression and productivity in Canadian male workers: Protocol for a randomized controlled trial

    From: JMIR Research Protocols

    Date Submitted: Jul 18, 2016

    Open Peer Review Period: Jul 19, 2016 - Aug 2, 2016

    Background: Background: Major depression (MDE) is prevalent in men and affects men’s health and productivity. Because of the stigma against depression and social/gender norms, men are less likely to...

    Background: Background: Major depression (MDE) is prevalent in men and affects men’s health and productivity. Because of the stigma against depression and social/gender norms, men are less likely to seek help for emotion and stress-related issues. Therefore, innovative solutions tailored for men are needed. With rapid development of the Internet and information technologies, one promising solution that has drawn considerable attentions is e-mental health programs and services. Objective: Objectives: To evaluate the effectiveness of an e-mental health program (BroHealth) on reducing the risk of having major depression, improving productivity and return to investment. Methods: Methods: The target population are Canadian working men who are at high risk of having major depression (N = 1200). Participants will be recruited using the method of random digit dialing across the country and workplace advertisement. Eligible participants will be randomly allocated into three groups: 1) a control group, 2) a group receiving BroHealth only, and 3) a group receiving BroHealth and telephone-based job coaching service. The groups will be assessed at 6- and 12-month after randomization. Results: Results: This study has been approved by the Conjoint Health Research Ethics Review Board of the University of Calgary. The trial is funded by a team grant from the Movember Foundation, a global charity for men’s health. BroHealth was developed at the Digital Health Office, University of British Columbia, and the usability testing has been completed. The proposed trial is registered at clinicaltrials.gov (registration number: NCT02777112). Conclusions: Conclusions: BroHealth was developed based on men’s needs. We hypothesis that BroHealth will be an effective, acceptable and sustainable product for early prevention of depression in workplaces. Clinical Trial: registration number: NCT02777112

  • Revelation and easy management of Rhomboids muscle Trigger point as a cause of distressing Non – Cardiac Chest pain- A case series

    From: Interactive Journal of Medical Research

    Date Submitted: Jul 13, 2016

    Open Peer Review Period: Jul 18, 2016 - Sep 12, 2016

    Background: Non-cardiogenic chest pain is a major health problem all over the world. Besides, non organic musculoskeletal pain affects up to 85% of the general population at any point of time. Patient...

    Background: Non-cardiogenic chest pain is a major health problem all over the world. Besides, non organic musculoskeletal pain affects up to 85% of the general population at any point of time. Patients with musculoskeletal chest pain remain under diagnosed, untreated and potentially continuously disabled in terms of anxiety, depression and ability to carry out activities of daily living [1]. Here we present a new dimension in this area by revealing Rhomboids muscle trigger point as the cause of referred chest pain, which in itself lacks enough description in the available literature. Objective: Non-cardiogenic chest pain is a major health problem all over the world. Besides, non organic musculoskeletal pain affects up to 85% of the general population at any point of time. Patients with musculoskeletal chest pain remain under diagnosed, untreated and potentially continuously disabled in terms of anxiety, depression and ability to carry out activities of daily living [1]. Here we present a new dimension in this area by revealing Rhomboids muscle trigger point as the cause of referred chest pain, which in itself lacks enough description in the available literature. Methods: A prospective study was conducted between January 2013 to September 2014 at Physiotherapy Unit in the Department of Orthopaedics and Trauma of North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS) Shillong, Meghalaya (India), a tertiary teaching health care institute which comprised of 30 patients with age group ranging from 12 yrs to 60 yrs. All patients were ruled out of cardiac and other known causes of chest pain by evaluating them based on a properly designed Performa. Ischemic pressure was applied on Rhomboids muscle after establishing Rhomboids muscle trigger point as the possible cause of chest pain. They were subjected to Ischemic pressure therapy and all of them had fulfilled the new ACR criteria for fibromyalgia. The duration of Ischemic pressure varied from 2 to 7 days, and subsequent follow up was done till 2 months. Visual Analogue scale (VAS) and Modified DALLAS Pain Questionnaire was used as measurement tool for assessing the treatment outcome. Results: The results were analysed by using two tailed paired ‘t’ test and was performed using SPSS version 20. The two-tailed P value of <0.005 considered extremely significant for our data. Conclusions: Our study has highlighted that while evaluating a clinician should remember that Rhomboid Muscle trigger point can be a distressing cause of chest pain and which can be effectively taken care of by Ischemic compression therapy. It may help such patients of “Non Specific cardiac chest pain” who otherwise run from pillar to post or one department to another, in vain. Clinical Trial: yes

  • Datathons and software to promote reproducible research

    From: Journal of Medical Internet Research

    Date Submitted: Jul 17, 2016

    Open Peer Review Period: Jul 18, 2016 - Sep 12, 2016

    Background: Datathons facilitate collaboration between clinicians, statisticians, and data scientists in order to answer important clinical questions. Previous datathons have resulted in numerous publ...

    Background: Datathons facilitate collaboration between clinicians, statisticians, and data scientists in order to answer important clinical questions. Previous datathons have resulted in numerous publications of interest to the critical care community and serve as a viable model for interdisciplinary collaboration. In the most recent datathon, participants were provided with open-source software called Chatto that was created by members of our group. Results: This suite of tools fulfills two purposes: (1) facilitation of interdisciplinary teamwork through archiving and version control of datasets, analytical code, and team discussions; and (2) advancement of research reproducibility by functioning post-publication as an online environment in which independent investigators can rerun or modify analyses with relative ease. Conclusions: With the introduction of Chatto, we hope to solve a variety of challenges presented by collaborative data mining projects while improving research reproducibility.

  • Qualitative improvement methods through analysis of inquiry contents for cancer registration

    From: JMIR Medical Informatics

    Date Submitted: Jul 17, 2016

    Open Peer Review Period: Jul 17, 2016 - Sep 11, 2016

    Background: In South Korea, the national cancer database was constructed after the initiation of the national cancer registration project in 1980, and the annual national cancer registration report ha...

    Background: In South Korea, the national cancer database was constructed after the initiation of the national cancer registration project in 1980, and the annual national cancer registration report has been published every year since 2005. Consequently, data management must begin even at the stage of data collection in order to ensure quality. Objective: To determine the suitability of cancer registries’ inquiry tools through the inquiry analysis of the Korea Central Cancer Registry (KCCR), and identify the needs to improve the quality of cancer registration. Methods: Results of 721 inquiries to the KCCR from 2000 to 2014 were analyzed by inquiry year, question type, and medical institution characteristics. Using Stata version 14.1, descriptive analysis was performed to identify general participant characteristics, and chi-square analysis was applied to investigate significant differences in distribution characteristics by factors affecting the quality of cancer registration data. Results: The number of inquiries increased in 2005–2009. During this period there were various changes, including the addition of cancer registration items such as brain tumors and guideline updates. Of the inquirers, 65.3% worked at hospitals in metropolitan cities and 60.89% of hospitals had 601–1000 beds. Tertiary hospitals had the highest number of inquiries (64.91%), and the highest number of questions by type were 353 (48.96%) for histological codes, 92 (12.76%) for primary sites, and 76 (10.54%) for reportable. Conclusions: A cancer registration inquiry system is an effective method when not confident about codes during cancer registration, or when confronting cancer cases in which previous clinical knowledge or information on the cancer registration guidelines are insufficient.

  • Designing a mobile health application for patients with dysphagia following head and neck cancer

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 13, 2016

    Open Peer Review Period: Jul 16, 2016 - Sep 10, 2016

    Background: Adherence to swallowing rehabilitation exercises is important to develop and maintain functional improvement, yet more than half of head and neck cancer (HNC) patients report having diffic...

    Background: Adherence to swallowing rehabilitation exercises is important to develop and maintain functional improvement, yet more than half of head and neck cancer (HNC) patients report having difficulty adhering to prescribed regimens. Health applications (apps) with game elements have been used in other health domains to motivate and engage patients. Understanding the factors that impact adherence may allow for more effective gamified solutions. Objective: (1) Identify self-reported factors that influence adherence to conventional home therapy without a mobile device in HNC patients, and (2) identify appealing biofeedback designs that could be used in a health app. Methods: Ten (4 females) HNC patients (M = 60.1 years) with experience completing home-based rehabilitation programs were recruited. Thematic analysis of semi-structured interviews was used to answer the first objective. Convergent interviews were used to obtain reactions to biofeedback designs. Results: Facilitators and barriers of adherence to home therapy were described through six themes: patient perceptions on outcomes and progress; clinical appointments; cancer treatment; rehabilitation program; personal factors; and connection. App visuals that provide feedback on performance during swallowing exercises should retain the chief goals of biofeedback (e.g., immediate representation of effort relative to a goal). Simple, intuitive graphics were preferred over complex, abstract ones. Conclusions: Continued engagement with the app could be facilitated by tracking progress and by using visuals that build or create structures with each subsequent use.

  • The Physical Activity Tracker Testing in Youth (P.A.T.T.Y) Study: Content analysis and Children’s Perceptions

    From: Journal of Medical Internet Research

    Date Submitted: Jul 15, 2016

    Open Peer Review Period: Jul 15, 2016 - Sep 9, 2016

    Background: Activity trackers are widely used by adults and several models are now marketed for childre Objective: The purposes of this study were to: 1) perform a content analysis of behavioral chang...

    Background: Activity trackers are widely used by adults and several models are now marketed for childre Objective: The purposes of this study were to: 1) perform a content analysis of behavioral change techniques (BCTs) used by three commercially available youth-oriented activity trackers; 2) obtain feedback describing children’s perception of these devices and the associated websites. Methods: A content analysis recorded the presence of 36 possible BCTs for the MovBand™, Sqord™ and Zamzee™ activity trackers (MB, SQ, and ZZ, respectively). In addition, 16 participants (age: 8.6±1.6 y, 50% female) received all three trackers and oriented to the devices and websites. Participants were instructed to wear the trackers on 4 consecutive days and spend ≥10 min/d on each website. A cognitive interview and survey were administered when the participant returned the devices. Qualitative data analysis was used to analyze the content of the cognitive interviews. Chi square analyses were used to determine differences in behavioral monitoring and social interaction features between websites. Results: The MB, SQ, and ZZ devices/websites included 8, 15 and 14 of the possible 36 BCTs, respectively. All of the websites had a behavioral monitoring feature (charts for tracking activity) but the percentage of participants indicating that they “liked” those features varied by website (MB: 50%, SQ: 38%, ZZ: 69%). Two websites (SQ and ZZ) included an “avatar” the user could create to represent themselves on the website. Participants reported that they “liked” creating and changing their avatar (SQ: 75%, ZZ: 94%), which was supported by the qualitative analyses of the cognitive interviews. Most participants (75%) indicated that they would want to wear the devices more if their friends were wearing a tracker. No significant differences were observed between SQ and ZZ devices in regards to liking or use of social support interaction features (P=0.21-0.37) Conclusions: The websites contained several BCTs consistent with previously identified strategies. Children “liked” the social aspects of the websites more than the activity tracking features. Developers of commercial activity trackers for youth may benefit from considering a theoretical perspective during the website design process.

  • Comprehensive laboratory- and field-based validation of youth-oriented activity trackers

    From: Journal of Medical Internet Research

    Date Submitted: Jul 15, 2016

    Open Peer Review Period: Jul 15, 2016 - Sep 9, 2016

    Background: Commercial activity trackers are growing in popularity among adults and some are beginning to be marketed to children. There is, however, a paucity of independent research examining the va...

    Background: Commercial activity trackers are growing in popularity among adults and some are beginning to be marketed to children. There is, however, a paucity of independent research examining the validity of these devices to detect physical activity of different intensity levels. Objective: The purpose of this study was to determine the validity of the output from three commercial youth-oriented activity trackers in three phases; 1) orbital shaker, 2) structured indoor activities, and 3) four days of free-living activity. Methods: Four units of each activity tracker (Movband™, Sqord™, and Zamzee™; MB, SQ, and ZZ, respectively) were tested in an orbital shaker for 5-minutes at three frequencies (1.3, 1.9, and 2.5 Hz). Participants for Phase 2 (N=14) and Phase 3 (N=16) were 6-12 year old children (50% male). For Phase 2, participants completed nine structured activities while wearing each tracker, the ActiGraph GT3X+ (AG) research accelerometer, and a portable indirect calorimetry system to assess energy expenditure (EE). For Phase 3, participants wore all four devices for four consecutive days. Correlation coefficients, linear models and non-parametric statistics evaluated the criterion and construct validity of the activity tracker output. Results: Output from all devices was significantly associated with oscillation frequency (r = .92 to .99). During Phase 2 the MB and ZZ only differentiated sedentary from light intensity (P < .01) while the SQ significantly differentiated among all intensity categories (all comparisons P < .01), similar to AG and EE. During Phase 3, AG counts were significantly associated with activity tracker output (r = .76, .86, and .59 for the MB, SQ, and ZZ, respectively). Conclusions: Across study phases, the SQ demonstrated stronger validity than the MB and ZZ. The validity of youth-oriented activity trackers may directly impact their effectiveness as behavior modification tools, demonstrating a need for more research on such devices.

  • Development of a mobile, avatar-based application for improving body perceptions among adolescents

    From: Journal of Medical Internet Research

    Date Submitted: Jul 14, 2016

    Open Peer Review Period: Jul 14, 2016 - Sep 8, 2016

    Background: One barrier to effectively treating weight issues among adolescents is that most adolescents do not perceive they are overweight or that being overweight is a problem. When adolescents cor...

    Background: One barrier to effectively treating weight issues among adolescents is that most adolescents do not perceive they are overweight or that being overweight is a problem. When adolescents correctly perceive themselves as overweight, they are more likely to adopt healthy lifestyle behaviors. Objective: The purpose of this pilot test was to develop and assess acceptability and feasibility of an avatar-based, theoretically derived, mobile application entitled, Having A Positive Perception of You Application (HAPPY App). Methods: The HAPPY App was engineered for high school students to identify what they thought they looked like, what they wanted to look like, and what they actually looked like based on body measurements using avatars. Results: The HAPPY App was pilot tested with male and female adolescents ages 15 to 18 to assess for acceptability and feasibility. A total of 42 students created and viewed their avatars. A majority of the students were female (67%), age 16 (38.1%), white (74%), non-Hispanic (86%), and in Grade 10 (47.5%). The students had positive reactions to the avatar application. Almost half thought it was good to be able to see their actual selves. Most of the students were comfortable creating and viewing the avatars (95.2%) and would use the application in the future to see how their bodies change (95.2%) over time. Conclusions: Avatar-based mobile applications, such as the HAPPY App, provide immediate feedback and allow users to engage with images that are personalized to represent their perceptions and actual body images. This pilot study adds to the increasing but limited research of using games to improve health outcomes among high school students. There is a need to further adapt the HAPPY App and implore feedback from a larger number of high school students including those from diverse backgrounds.

  • Twitter content analysis for investigating subjective experience and the influence of weather among fibromyalgia sufferers

    From: Journal of Medical Internet Research

    Date Submitted: Jul 13, 2016

    Open Peer Review Period: Jul 13, 2016 - Sep 7, 2016

    Background: Little is understood about the determinants of symptom expression in individuals with fibromyalgia syndrome (FMS). While FMS sufferers often report environmental influences, including weat...

    Background: Little is understood about the determinants of symptom expression in individuals with fibromyalgia syndrome (FMS). While FMS sufferers often report environmental influences, including weather events, on their symptom severity, a consistent effect of specific weather conditions on FMS symptoms has yet to be demonstrated. Content analysis of a large number of messages by FMS sufferers on Twitter can provide valuable insights into variation in the fibromyalgia experience from a first-person perspective. Objective: To use content analysis of tweets to investigate the association between weather conditions and fibromyalgia symptoms among individuals who tweet about fibromyalgia. Secondly, to gain insight into how Twitter is used as a form of communication and expression by fibromyalgia sufferers, and to explore and uncover thematic clusters and communities related to weather. Methods: Computerised sentiment analysis was performed to measure the association between negative sentiment scores (indicative of severe symptoms such as pain) and coincident environmental variables. Date, time and location data for each individual tweet were used to identify corresponding climate data (such as temperature). We used graph analysis to investigate the frequency and distribution of domain-related terms exchanged in Twitter and their association strengths. A community detection algorithm was applied to partition the graph and detect different communities. Results: We analysed 140,432 tweets related to fibromyalgia from 2008 to 2014. There was a very weak positive correlation between humidity and negative sentiment scores (r=.009, P=.001). There was no significant correlation between other environmental variables and negative sentiment scores. The graph analysis showed that ‘pain’ and ‘chronicpain’ were the most frequently used terms. The Louvain method identified 6 communities. Community 1 was related to feelings and symptoms at the time (subjective experience). It also included a list of weather related terms such as ‘weather’, ‘cold’ and ’rain’. Conclusions: According to our results, a uniform causal effect of weather variation on fibromyalgia symptoms at the group level remains unlikely. Any impact of weather on fibromyalgia symptoms may vary geographically or at an individual level. Future work will further explore geographical variation and interactions focusing on individual pain trajectories over time. Clinical Trial: N/A

  • Methods for Evaluating Respondent Attrition in Online Survey Data

    From: Journal of Medical Internet Research

    Date Submitted: Jul 12, 2016

    Open Peer Review Period: Jul 12, 2016 - Sep 6, 2016

    Background: Electronic surveys are a convenient, cost effective, and increasingly popular tool to collect information. While the online platform allows researchers to recruit and enroll more participa...

    Background: Electronic surveys are a convenient, cost effective, and increasingly popular tool to collect information. While the online platform allows researchers to recruit and enroll more participants, there is an increased risk of participant dropout in web-based research. Often, these dropout trends are simply reported, adjusted for, or ignored altogether. Objective: This manuscript proposes a conceptual framework for analyzing respondent attrition and demonstrates the utility of these methods through application to existing survey data. Methods: First, we suggest visualization of attrition trends using bar charts and survival curves. Next, we propose a generalized linear mixed model (GLMM) to detect or confirm significant points of attrition. Finally, we suggest applications of existing statistical methods to investigate the effect of internal survey characteristics and patient characteristics on dropout. In order to apply this framework, we present a case study, a seventeen-item Informed Decision-Making (IDM) module addressing how and why patients make decisions about cancer screening. Results: Using this framework, we were able to find significant points of attrition at Questions 4, 6, 7, and 9. We were also able to identify participant responses and characteristics associated with dropout at these points and overall. Conclusions: When applied to survey data, these methods reveal significant attrition trends, both visually and empirically, that can inspire researchers to investigate factors associated with survey dropout, address whether survey completion is associated with health outcomes, and compare attrition patterns between groups. The framework can be used to extract information beyond simple responses, can be useful during survey development, and can help determine the external validity of survey results.

  • The role of Web-based health information in help-seeking behaviour prior to a diagnosis of lung cancer: A mixed-methods study

    From: Journal of Medical Internet Research

    Date Submitted: Jul 11, 2016

    Open Peer Review Period: Jul 12, 2016 - Sep 6, 2016

    Background: Early diagnosis of lung cancer depends largely on timely presentation of symptoms to health services. The Web has become an important lay information source and is often used to appraise s...

    Background: Early diagnosis of lung cancer depends largely on timely presentation of symptoms to health services. The Web has become an important lay information source and is often used to appraise symptoms. Objective: A questionnaire and interview study was conducted to understand the role of the Web in symptom appraisal prior to lung cancer diagnosis. Methods: Patients diagnosed with lung cancer in the 6 months before study entry completed a survey about Web use to appraise their symptoms prior to diagnosis. Based on survey responses, sociodemographic variables and smoking status, we purposively sampled patients and their family/friends for semi-structured interviews (24 interviews with 33 participants). Survey data were analysed descriptively. Interview data were analysed qualitatively using Framework Analysis. Results: 113 patients completed the survey (mean age=67, SD=8.8). 20.5% (23/112) reported they or a family member/friend had researched symptoms online. Only seven patients (7/112, 6.3%) had researched their own symptoms, four of these with the help of family/friends. The remainder of searches were conducted by family members/friends. Interview results suggest that patients and family/friends perceived an impact of Web use on decisions to seek help and on communication with health professionals. Some reported Web-based information triggered help-seeking while others reported it delayed help-seeking. Some participants used information found online to support their requests for further investigations of symptoms. Online health information also reportedly impacted on understanding of medical jargon during the diagnostic process. Conclusions: Although its role is at present still limited, the Web appears to have an impact on the diagnostic process, and seems to play a role not only in the time before seeking medical help, but also following first consultation with a health professional. Improving online resources to meet specific needs may help to encourage early help-seeking and facilitate communication with health professionals. Clinical Trial: n/a

  • Women’s Perceptions of Participation in an Extended Contact Text Message Weight Loss Intervention

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 7, 2016

    Open Peer Review Period: Jul 11, 2016 - Sep 5, 2016

    Background: Extending contact with participants after the end of an initial weight loss intervention has been shown to lead to maintained weight loss and related behavior change. Mobile phone text mes...

    Background: Extending contact with participants after the end of an initial weight loss intervention has been shown to lead to maintained weight loss and related behavior change. Mobile phone text messaging offers a low cost and efficacious method to deliver extended contact. In this rapidly developing area, formative work is required to understand user perspectives of text message technology. An extended contact intervention delivered by text messages following an initial telephone-delivered weight loss intervention in breast cancer survivors provided this opportunity. Objective: To qualitatively explore women’s perceptions of participation in an extended contact intervention using text messaging to support long-term weight loss, physical activity and dietary behavior change Methods: Following the end of an initial 6-month randomized controlled trial of a telephone-delivered weight loss intervention (versus usual care), participants received a 6-month extended contact intervention via tailored text messages. Participant perceptions of the different types of text messages, the content, tailoring, timing and frequency of the texts and the length of the intervention were assessed through semi-structured interviews conducted after the extended contact intervention. The interviews were transcribed verbatim and analysed with key themes identified. Results: Participants (n=27) were Caucasian with a mean age of 56.0 years (SD 12.0), mean BMI of 30.0kg/m2 (SD 4.2) and were a mean of 16.1 months (SD 3.1) post-diagnosis at study baseline. Participants perceived the texts to be useful behavioral prompts and felt the messages kept them accountable to their behavior change goals. The individual tailoring of the text content and schedules was a key to the acceptability of the messages, however some women preferred the support and real-time discussion via telephone (during the initial intervention) compared to the text messages (during the extended contact intervention). Conclusions: Text message support was perceived as acceptable for the majority of women as a way of extending intervention contact for weight loss and behavioral maintenance. Texts supported the maintenance of healthy behaviors established in the intervention phase and kept the women accountable to their goals. A combination of phone and text support was suggested as a more acceptable option for some of the women for an extended contact intervention. Clinical Trial: Not registered

  • How Accurate Is Your Activity Tracker? A Comparative Study of Step Counts in Low-Intensity Physical Activities

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 6, 2016

    Open Peer Review Period: Jul 8, 2016 - Sep 2, 2016

    Background: Tracking physical activity is crucial for monitoring individuals diagnosed with a range of chronic conditions including heart failure, diabetes, and cancer. One simple, yet effective, appr...

    Background: Tracking physical activity is crucial for monitoring individuals diagnosed with a range of chronic conditions including heart failure, diabetes, and cancer. One simple, yet effective, approach to monitor the amount of daily physical activity that individuals perform is to count the number of steps taken throughout a day. Several commercially available activity trackers have been tested for reliability and validity in many research studies in various exercise activities such as walking and running at a wide range of speeds. However, there have been only a few studies within healthcare research. Currently, there exists a gap in our knowledge regarding the performance of these trackers facing low intensity activities. In this study, we evaluate the reliability of the Fitbit step counters during a number of moderate and light everyday physical activities, and we investigate whether or not using the trackers on different body locations affect their performance. Objective: This paper answers the four following questions: (1) which activities are certain motion sensor based trackers more accurate at monitoring? (2) to what extent does body location affect step counting accuracy? (3) for each activity, which particular body location results in the best step counting performance? (4) how does the intensity of certain physical activities and the physical characteristics of the users affect the performance of activity trackers in counting steps? Methods: We recruited 15 healthy young adults (aged 21-33) to perform six physical activities while wearing three Fitbits (i.e., Zip, One, and Flex) on different body locations (i.e., chest, pocket, and wrist). These activities include walking at 1.5, 3, and 4.5 mph, walking with a shopping cart, walking with aid of a walker, and eating while sitting. We compared the number of steps counted by each tracker with the ground truth (video recorded during the experiments). Results: Our results show that these trackers are most accurate in the treadmill experiment with an average margin of error of five steps per minute from the actual step counts. On the other hand, in the walker experiment, the average error over the three body locations is significantly higher than the other activities, which demonstrates the poor performance of the activity trackers in detecting movements in slow and abnormal walking patterns. However, there was no significant difference between the step counts of the trackers in the treadmill and shopping cart experiments and the ground truth. The wrist-band tracker, Flex, counted several steps when eating (p < .01), showing that the Flex is inaccurate when encountering vigorous stationary tasks. Looking at different locations, pants pocket is the most promising location to capture steps in high intensity PAs, while wrist is the best choice to wear the activity tracker on in lower intensity PAs. Conclusions: Accelerometer-based activity monitoring devices such as Fitbit trackers are most accurate in exercise activities, such as walking on treadmill, and least accurate in lower intensity activities, which has a significantly different pattern from the normal gait, such as walking with walking aids. Compared to the wrist-band and pocket trackers, the activity tracker on the chest is superior in tracking more intense physical activities (e.g., walking on treadmill), but oversensitive in light activities such as walking with a walker and eating. These results demonstrate that the body location significantly affects the accuracy of the trackers. This result demonstrates the need for activity recognition algorithms to consider the locations of trackers and intensity of activities.

  • Tweet for (Behaviour) Change: Using Social Media for the Dissemination of Public Health Messages

    From: Journal of Medical Internet Research

    Date Submitted: Jul 8, 2016

    Open Peer Review Period: Jul 8, 2016 - Sep 2, 2016

    Background: Social media (SM) public health campaigns have the advantage of tailored messaging at low cost and large reach but we know little about what in practice would determine their feasibility a...

    Background: Social media (SM) public health campaigns have the advantage of tailored messaging at low cost and large reach but we know little about what in practice would determine their feasibility as tools for inducing attitude and behaviour change and subsequent effectiveness. Objective: Our aim is to test the feasibility of designing, implementing and evaluating a bespoke SM-enabled intervention for skin cancer prevention and to learn broader lessons for using SM in public health practice. Methods: A quasi-experimental study, utilising SM (Twitter) to disseminate different message “frames” relating to Care in the Sun and cancer prevention was employed. Phase 1 utilised the Northern Ireland (NI) regional cancer charity’s Twitter platform between May 1st and July 14th 2015, and content was tracked using unique hashtags. Following a 2-week “washout” period, Phase 2 commenced (August 1st to September 30th 2015) using a bespoke campaign-specific Twitter platform and hashtag. Phase 2 also included a Thunderclap, whereby users allow their SM accounts to automatically post a bespoke common message created for the intervention on their behalf. Message frames were categorised; humour, shock/disgust, informative, personal stories and opportunistic. Seed users with a notable SM following, as identified at a co-design workshop, were contacted to be ‘influencers’ in retweeting campaign content to their followers, with the aim of ultimately creating viral health messages. A pre- and post-intervention online survey recorded knowledge and attitudes regarding skin cancer prevention in NI (population 1.8 million). Results: During the campaign period, there was a total of 417,678 tweet impressions, 11,213 engagements and 1,211 retweets related to our specific campaign hashtags. Of those, 92 retweets were part of the Thunderclap. Of the message frames employed, shocking messages generated the greatest number of impressions (shock n=2,369; informative n=2,258; humorous n=1,458; story n=1,680), whereas humorous messages generated greater engagement with Twitter social media users (humorous n=148; shock n=147; story n=117; informative n=100). Informative messages however, resulted in the greatest number of shares (informative n=17; humorous n=10; shock n=9; story n=7). Tweets which were paid-for, promoted posts did not notably increase impressions, engagements or retweets. Study findings included a trend towards improved knowledge of skin cancer severity in a pre- and post-intervention online survey, with greater awareness that skin cancer is the most common form of cancer (pre-intervention: 28.5% vs. post-intervention: 39.3% answered ‘True’) and that melanoma is most serious (49.4% vs. 55.5%). Results also suggest a trend towards improved attitudes towards UV exposure and skin cancer with a reduction in agreement that respondents “like to tan” (60.4% vs 55.6%). Conclusions: Social media disseminated public health messages reached over 23% of the NI population and an online survey suggested that the campaign may have contributed to a trend in improved knowledge and attitudes towards skin cancer among the target population. Findings also suggest that shocking and humour messages generated greatest impressions and engagement, but informative messages were likely to be shared most. The extent of any behaviour change as a result of the campaign remains to be explored, however the trend in change of attitudes and knowledge is promising. Social media is an inexpensive, effective method for delivering public health messages. However, existing and traditional process evaluation methods utilised may not be suitable for SM.

  • Are demographic and indication-specific variables associated with social network engagement?

    From: Journal of Medical Internet Research

    Date Submitted: Jul 7, 2016

    Open Peer Review Period: Jul 7, 2016 - Sep 1, 2016

    Background: Digital Health Social Networks (DHSNs) are widespread, and the general consensus is that they contribute to wellness through offering social support and knowledge sharing. The success of a...

    Background: Digital Health Social Networks (DHSNs) are widespread, and the general consensus is that they contribute to wellness through offering social support and knowledge sharing. The success of a DHSN is based on number of participants, and their consistent creation of externalities though the generation of new content. To promote network growth and individual agency, it would be helpful to identify actors who create value by generating positive network externalities. Objective: The objective of this study is to examine the association between posting behavior, demographic characteristics, and indication severity from actors and non-actors from four large DHSNs. Methods: Data were extracted from the custom SQL databases of four digital health behavior change interventions. To investigate associations between user characteristics and social network engagement, ten models were analyzed with standard multiple regression and F-tests. Results: The DHSNs varied in number of days active (36,580 vs. 5,210), number of registrants (5,049 vs. 78,903), number of actors (1,085 vs. 8,452), and number of posts (16,231 vs. 620,487). Eight of the ten models had low R2 results (.004-.064), with limited statistically significant demographic and indication specific independent variables. The exception was the panic disorder social network, where the R2 results were 0.363 for all registrants, and 0.343 for all actors. F-tests indicated that independent variables were preferable to reduced models in six of the ten models. In regards to categorical variables, level of education had limited association with engagement. Conclusions: Some of the demographic variables were statistically associated with social network engagement as evidenced by t-tests and F-tests for ungrouped variables, and F-tests for categorical variables. Although some of these individual variables are statistically significant, they do not appear to be significant from a practical perspective due to the low R2 results. Based on the large number of study participants, variation in DHSN theme, and extensive time-period, we did not find strong evidence that demographic characteristics or indication severity sufficiently explain the variability in number of posts per actor. Researchers should investigate alternative models that identify individuals who promote social network growth.

  • Analysis of Requirements for developing an mHealth based Health Management Platform

    From: Journal of Medical Internet Research

    Date Submitted: Jul 7, 2016

    Open Peer Review Period: Jul 7, 2016 - Sep 1, 2016

    Background: Studies have consistently shown that mobile and web-based applications have positive impacts on people’s daily lifestyles, health management and disease treatment. As the development of...

    Background: Studies have consistently shown that mobile and web-based applications have positive impacts on people’s daily lifestyles, health management and disease treatment. As the development of medical and health informationization in China has evolved, different kinds of mobile based applications for individuals and hospitals have been developed by software vendors. However, doubts and challenges posed by the media have prevented these applications from having a stable and substantial user base. We think the key problem is that the software does not satisfy the main needs of general users, which means an analysis of user requirements has not been performed prior to design of the application. The health information government authority in Liaoning Province, China, was planning to set up a mHealth based health management platform, aiming to alleviate the difficulties citizens have in seeking hospital services. Objective: The goal of this study was to determine the actual health and medical needs of citizens that may be addressed by medical information technologies. The results may contribute to the functional design and development of health management and appointed treatment-oriented mobile applications. Methods: In this study, an unstructured questionnaire on mHealth requirements was designed and tested, and 240 questionnaires were given to the outpatients of the First Hospital of the China Medical University in Shenyang, Liaoning Province, China; of these, 228 valid responses were collected, for a response rate of 95%. We discussed the current development of mHealth with 50 related experts and engineers from health authorities and a medical information company. SPSS 13.0 was used for statistical and analysis. Results: After detailed analysis of the questionnaire data and interview results, several findings were made: firstly, most citizens were unclear about their health conditions (64.5%) and would like to receive a mobile application (app) as a tool to manage their health and medical needs (71.1%); on the other hand, the main problems for outpatients were long waiting times (66.4%) and difficulties in making appointments (46.5%), and they also worried about payments and internet problems when using a mobile application for appointment reservations. Furthermore, as the main service target of mHealth is innovated health management of the general population, first we need to solve the associated interoperability and data security problems. Conclusions: This study provides insight into the health and medical requirements of Smartphone apps and draws attention to some of the challenges and opportunities of mHealth. We suggest several value-added features and characteristics that app developers should take into consideration when developing health and medical related apps. The findings also highlight some major challenges that require further consideration and research to ensure these apps meet the core needs of patients and aid the development of the health information system in Liaoning Province, China. Clinical Trial: This study had been confirmed by ethics committee of Shengjing Hospital of China Medical University before started that the study has no relationship with any clinical actions with patients or animals , the need for ethics approval is not necessary.

  • Efficacy of mobile applications to support the care of patients with diabetes mellitus: systematic review and meta-analysis

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 4, 2016

    Open Peer Review Period: Jul 7, 2016 - Sep 1, 2016

    Background: Diabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satis...

    Background: Diabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satisfactory metabolic control enabling improved management and reduced morbidity and mortality. The global growth in the use of mobile phones makes them a powerful platform to help provide tailored health, delivered conveniently to patients through health applications (apps). Objective: Evaluate the efficacy of mobile apps through a systematic review and meta-analysis to assist diabetes mellitus patients in treatment. Methods: We conducted searches in the electronic databases MEDLINE (Pubmed), CENTRAL/ Cochrane Register of Controlled Trials and LILACS, manual search in references of publications included, systematic reviews, specialized journals and gray literature. We considered eligible randomized controlled trials (RCTs) conducted after 2008 with participants of all ages, diabetes mellitus patients and users of apps to help manage the disease. The meta-analysis of glycated hemoglobin (HbA1c) was performed in Review Manager Software 5.3. Results: The literature search identified 1036 publications. From these, 10 studies were included that evaluated 980 patients. In four RCTs, there were a statistical significant reduction (P < 0.03) of HbA1c at the end of studies in the intervention group. The HbA1c data were evaluated by meta-analysis with the following results (MD = - .42; CI: - .60, - .25; P < .11; I² = 34%).The evaluation favored the treatment in patients who used apps without significant heterogeneity. Conclusions: The use of apps by diabetic patients could help improve the control of HbA1c. In addition, the apps seem to strengthen the perception of self-care contributing better information and health education to patients. Patients also become more self-confident to deal with their diabetes, mainly, by reducing fear of not knowing how to deal with potential hypoglycemic episodes that may occur.

  • Stepping into the Era of Personal Big Data: a Roadmap to the Design of a Personal Digital Life Coach

    From: Journal of Medical Internet Research

    Date Submitted: Jul 5, 2016

    Open Peer Review Period: Jul 5, 2016 - Aug 30, 2016

    The increased availability of devices that can record every aspect of a person’s life will allow the recording of a large amount of data that will be primarily useful for that particular user. These...

    The increased availability of devices that can record every aspect of a person’s life will allow the recording of a large amount of data that will be primarily useful for that particular user. These devices and their data will place each and every one of us at the doorstep of the era of personal big data. Using this data, in a not so distant future, we will be able to set a personal digital life coach, a digital platform that will act at an individual level, but also considering a global interaction, not only as a social networking tool, but as a platform that will profit from the individual experiences of its users. This position paper focuses on the identification of the milestones that will mark the creation of such a software and hardware platform, by exploring the opportunities and challenges that it poses to the computer science researchers, and how such a solution can be designed to be a user-adoptable lifestyles monitoring and training tool.

  • Improving medical student communication skills through a telehealth training platform

    From: Journal of Medical Internet Research

    Date Submitted: Jul 4, 2016

    Open Peer Review Period: Jul 4, 2016 - Aug 29, 2016

    Background: In the interests of patient health outcomes, it is important for medical students to develop clinical communication skills. We previously proposed a telehealth communication skill training...

    Background: In the interests of patient health outcomes, it is important for medical students to develop clinical communication skills. We previously proposed a telehealth communication skill training platform (EQClinic) with automated nonverbal behavior feedback for medical students, and it was able to improve medical students’ awareness of their nonverbal communication. Objective: This study aimed to evaluate the effectiveness of EQClinic to improve clinical communication skills of medical students. Methods: Two group randomised crossover trial was conducted between February and May 2016. Participants were 268 (Group A: n=133; Group B: n=135) second year medical students enrolled in a clinical communication skills course at an Australian university. Student-Patient Observed Communication Assessment (SOCA) was collected by blinded assessors (n=28) at two time points and a standardized patient (SP; n=83). Students were randomly allocated to complete EQClinic training and clinical consultation with an SP immediately in weeks 1-5 (Group A) or were allocated to complete EQClinic in weeks 8-11 (Group B). EQClinic delivered a combination of automated visual presentation of students’ nonverbal behaviour coupled with human feedback from the SP. Tutor-rated clinical communications skills in face-to-face consultations was the primary outcome and was assessed with the SOCA. T-tests were used to examine the students’ performance during face-to-face consultations pre- and post-exposure to EQClinic. Results: SOCA communication skills measures (score range 4-16) from the first face-to-face consultation were significantly improved for students who completed EQClinic training and reviewed the nonverbal behaviour feedback (Group A) compared to Group B who completed only the course curriculum components (p=0.04). Furthermore the group that completed a tele-consultation between the two face-to-face consultations (Group B) showed improved communication skills (p=0.005), yet the one who had tele-consultations before face-to-face did not show improvement. Conclusions: The EQClinic is a useful tool for medical students clinical communication skills training that can be applied to university settings to improve students clinical communication skills development.

  • Development of the Pediatric Cardiovascular Risk Reduction Clinical Decision Support Tool

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 29, 2016

    Open Peer Review Period: Jul 2, 2016 - Aug 27, 2016

    Background: Integrated Pediatric Cardiovascular Disease Risk Reduction Guidelines were developed by the National Heart, Lung, and Blood Institute. A mobile clinical decision support (CDS) application...

    Background: Integrated Pediatric Cardiovascular Disease Risk Reduction Guidelines were developed by the National Heart, Lung, and Blood Institute. A mobile clinical decision support (CDS) application was implemented as a strategy to increase guideline uptake in primary care pediatric practices and to facilitate adherence to recommendations. Objective: We describe the process and outcomes of a project to operationalize the Integrated Guideline into a mobile CDS system that was made available to pediatric primary care providers as a native Android and iOS application for use on smartphones and tablet devices. Methods: To overcome the difficulty of translating clinical practice guidelines into a computable form that can be used by a clinical decision support system, we used a multilayer framework to convert the evidence synthesis into executable knowledge. We used an iterative process of design, testing, and revision through each step in the translation of the guidelines for use in a CDS tool to support the development of four validated modules: an integrated risk assessment; a blood pressure calculator; a body mass index calculator; and a lipid management instrument. Results: The iterative revision process identified a number of opportunities to improve the CDS tool. Operationalizing the integrated guideline identified numerous areas in which the guideline was vague or incorrect and required more explicit operationalization. Iterative revisions led to workable solutions to problems, an understanding of the limitations of the tool. Subsequent revisions led to workable solutions and to a better understanding of the limitations of the CDS tool. Conclusions: The process and experiences described provide a model for other mobile clinical decision support systems that translate written clinical practice guidelines into actionable, real-time clinical recommendations.

  • You sort of go down a rabbit hole ……You’re just going to keep on searching’. A qualitative study of searching online for pregnancy related information during pregnancy

    From: Journal of Medical Internet Research

    Date Submitted: Jul 1, 2016

    Open Peer Review Period: Jul 1, 2016 - Aug 26, 2016

    Background: The internet is becoming increasing popular for gaining information on medical/health issues; with women in particular likely to search online for this type of information and support. Des...

    Background: The internet is becoming increasing popular for gaining information on medical/health issues; with women in particular likely to search online for this type of information and support. Despite the increased use of the internet for health-related information, we need to question if the internet and the ease of seeking health information that it provides, leads to more [patient] empowerment. Pregnancy is a particularly worrying time for women, especially first time mums-to-be, with unfamiliar experiences and symptoms and concerns for the baby as well as the self. Objective: Our aim was to explore how and why pregnant women with different levels of health anxiety (HA) use the internet to gain information and support during pregnancy and what they consider a reliable source. The aim was also to explore any notable differences between women with differing levels of HA. Methods: To meet the objectives of the study, a qualitative approach was required to gather information on the experiences of currently pregnant women who use the internet to gain information and support during their pregnancy. Sixteen pregnant women took part in a semi-structured interview, either face-to-face or via telephone. Qualitative analytical procedures were employed, supported by NVivo software. Results: Pregnant women found reassurance from the experiences of others. This reassurance resulted in them feeling less alone, as well as enabling them to normalize any symptoms or experiences they were undergoing. The women understood that caution was needed at times whilst reading the stories of others, acknowledging the potential for extreme cases or worst case scenarios. This is particularly pertinent to the internet, as this wide range of stories may not be as easily accessible if stories where confined to those in a woman’s offline social circle. The interviews combined with the HA levels of the participants provide insights into how and why pregnant women search online for information and perhaps more so, support whilst pregnant. The project had the novel aspect of HA level as well as the interview data, this made for a more interesting discussion in relation to anxiety level and disparities between those with low, moderate and high health anxiety in terms of what was said. Conclusions: Searching for health information and advice online during pregnancy is viewed as quick, easy and accessible. The affordances of the internet provided women the opportunity to go online as a first port of call, irrespective of health anxiety levels. Knowing they were not alone and reading the experiences and/or symptoms of other pregnant women enabled women to normalize their experience and was ultimately reassuring for pregnant women. Clinical Trial: n/a

  • Evaluation of a Web-Based E-Learning Platform for Brief Motivational Interviewing by Nurses in Cardiovascular Care: A Pilot Study

    From: Journal of Medical Internet Research

    Date Submitted: Jun 30, 2016

    Open Peer Review Period: Jul 1, 2016 - Aug 26, 2016

    Background: Brief motivational interviewing (MI) can contribute to reductions in morbidity and mortality related to coronary artery disease, through health behavior change. Brief MI, unlike more inten...

    Background: Brief motivational interviewing (MI) can contribute to reductions in morbidity and mortality related to coronary artery disease, through health behavior change. Brief MI, unlike more intensive interventions, was proposed to meet the needs of clinicians with little spare time. While the provision of face-to-face brief MI training on a large scale is complicated, web-based e-learning is promising because of the flexibility it offers. Objective: The primary objective of this pilot study was to examine the feasibility and acceptability of a web-based e-learning platform for brief MI (MOTIV@CŒUR), which was evaluated by nurses in cardiovascular care. The secondary objective was to assess the preliminary effect of the training on nurses’ perceived brief MI skills and self-reported clinical use of brief MI. Methods: A single-group, pre-post pilot study involving nurses working in a coronary care unit was conducted to evaluate MOTIV@CŒUR, which is a web-based e-learning platform for brief MI, consisting of two 30-minute sessions. MOTIV@COEUR covers 4 real life clinical situations based on role modeling videos showing nurse-patient interactions. A brief introduction to MI is followed by role-playing during which a nurse practitioner evaluates patients’ motivation to change, and intervene according to the principles of brief MI. The clinical situations target smoking, medication adherence, physical activity, and diet. Nurses were asked to complete both training sessions online asynchronously within 20 days, which allowed assessment of the feasibility of the intervention. Data regarding acceptability and preliminary effects (perceived skills in brief MI and self-reported clinical use of conviction and confidence interventions) were self-assessed through online questionnaires 30 days (± 5 days) after the first session. Results: We enrolled 27 women and 4 men (mean age 37 ± 9 years) in March 2016. Twenty-four of the 31 participants (77%, confidence interval: 95%, range: 63–91%) completed both sessions in ≤20 days. At 30 days, 28 out of the 31 participants (90%) had completed at least one session. The training was rated as highly acceptable, with the highest scores observed for information quality (6.26 ± 0.60), perceived ease of use (6.16 ± 0.78), and system quality (6.15 ± 0.58). Posttraining scores (34.72 ± 6.29, P = .032) for self-reported clinical use of confidence interventions were higher relative to pretraining scores (31.48 ± 6.75). Other results were nonsignificant. Conclusions: Brief MI training using a web-based e-learning platform including role-modeling videos is both feasible and acceptable according to cardiovascular care nurses. Further research is required to evaluate the e-learning platform in a randomized controlled trial. Clinical Trial: International Standard Randomized Controlled Trial Registry: ISRCTN16510888; http://www.isrctn.com/ISRCTN16510888

  • Mobile Application (App) Design, Development and Publication for Adverse Drug Reaction (ADR) Assessments of Causality, Severity and Preventability

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 27, 2016

    Open Peer Review Period: Jun 30, 2016 - Aug 25, 2016

    Background: Adverse drug reactions (ADRs) cause significant morbidity and mortality. Improved assessment of ADRs to identify the causal relationship, the severity and the preventability will help prev...

    Background: Adverse drug reactions (ADRs) cause significant morbidity and mortality. Improved assessment of ADRs to identify the causal relationship, the severity and the preventability will help prevent ADRs or reduce their burden on patients. Objective: The objective were to develop mobile application in assisting clinical decision in ADR assessments of causality, severity and preventability using validated tools. Methods: We designed mobile applications or apps using validated assessment tools for ADRs. They are the Liverpool ADRs Causality Assessment Tool, Hartwig’s Severity Assessment Scale and the Modified Schumock and Thronton Preventability Scale. The apps were designed using MIT App Inventor, then uploaded into a Google Developer Console and published onto Google Play Store. The apps were named “Adverse Drug ReactionCausality”, “Adverse Drug ReactionSeverity” and “Adverse Drug RxnPreventability”. Results: These apps can be downloaded through Google Play Store for free since January 2015. The apps were tested in the pediatric department of Hospital Ampang, Kuala Lumpur in assessment of suspected ADRs to improve consistency and user-friendliness. Conclusions: The usage of these apps will improve detection, assessment and avoidance of future ADRs. They will also contribute to further research on ADRs thus increasing drug safety.

  • Validated smartphone based applications for ear and hearing assessment: a review

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 23, 2016

    Open Peer Review Period: Jun 26, 2016 - Aug 21, 2016

    Background: An estimated 360 million people have disabling hearing loss (DHL) globally. However, these figures are uncertain as few data are available from population-based surveys. This gap is largel...

    Background: An estimated 360 million people have disabling hearing loss (DHL) globally. However, these figures are uncertain as few data are available from population-based surveys. This gap is largely due to the significant logistical challenges that exist in performing these surveys in low and middle-income countries (LMIC) such as the requirement for skilled hearing healthcare professionals and specialist equipment to measure hearing. Objective: To explore the use of low-cost smartphone applications (apps) for audiological assessments and consider if they could be incorporated into population-based survey methodologies to enable scale-up of data collection in LMICs. Methods: Commercial appstores, Google Play and Apple Appstore, were searched to identify apps for tests of auditory function. A literature review was undertaken to assess which of the apps identified in the appstores review app had been validated in peer-reviewed literature. A comparison was made between validated apps. Results: Search queries returned 30 applications that could be used for audiological assessments, of which 5 were validated in peer-reviewed literature. One additional app was identified in the literature search that is not yet available commercially. uHear, an app for self-administered audiometry, was validated in the most number of peer reviewed studies against gold standard pure tone audiometry. However, the accuracy of uHear varied across these studies. Conclusions: Very few of the available apps have been validated in peer-reviewed studies identified in the literature. Of the apps that have been validated, further independent research is required in order to fully understand their accuracy at detecting hearing loss. With further validation, the use of smartphone apps has the potential to enhance data collection for hearing loss prevalence and allow planning of services accordingly.

  • A Multimedia Child Developmental Screening Checklist-Design and Validation

    From: Journal of Medical Internet Research

    Date Submitted: Jun 26, 2016

    Open Peer Review Period: Jun 26, 2016 - Aug 21, 2016

    Background: Identifying disability early in life confers long-term benefits for children. To detect those who need help early, judicious use of practical and reliable standardized screening tools is o...

    Background: Identifying disability early in life confers long-term benefits for children. To detect those who need help early, judicious use of practical and reliable standardized screening tools is of great importance. Objective: This study intended to construct the multimedia version child development checklists, and investigate the measurement equivalence of this multimedia version to the original text-based paper-and-pencil version. Methods: In order to develop the multimedia version of the Taipei City Child Development Screening tool, Second Version (Taipei II), a team of experts created illustrations, translations, and dubbing of the original checklists. The developmental process lasted approximately 10 months. The developmental screening test was administered to a total of 390 primary caregivers of children aged between 4 months and 6 years. Results: Psychometric testing revealed excellent agreement between the paper and multimedia versions. Good to excellent reliabilities were demonstrated for all age groups for both the cross-mode similarity (ICCmode range = 0.85-0.96) and test–retest reliability (r = 0.93). Regarding usability, 98% of the participants preferred the multimedia version because of its dynamic illustrations and explanatory dubbing. Conclusions: The multimedia tool produced essentially equivalent results to the paper-and-pencil tool, in addition to numerous advantages. It can facilitate active participation and promote early screening of target populations. Clinical Trial: NCT02359591

  • “Back on Track” – ACL Rupture Study: A Mobile App Observational Study Using Apple’s ResearchKit Framework

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 23, 2016

    Open Peer Review Period: Jun 26, 2016 - Aug 21, 2016

    Background: In March 2015 Apple, Inc. announced ResearchKit, a novel open-source framework intended to help medical researchers to easily create apps for medical studies. With the announcement of this...

    Background: In March 2015 Apple, Inc. announced ResearchKit, a novel open-source framework intended to help medical researchers to easily create apps for medical studies. With the announcement of this framework Apple presented five apps built in a beta-phase based on this framework. Objective: In this work the development of a study app based on ResearchKit is described. The objective of this study is the decision making in patients with acute anterior cruciate ligament (ACL) ruptures. Methods: A multi-language observatory study is conducted. At first a suitable research topic, target groups, participating territories and programming method are carefully identified. The ResearchKit framework is used to program the app. A secure server connection is realized via SSL. A data storage and security concept separating personal information and study data is proposed. Furthermore an efficient method to allow multi-language support and distribute the app in many territories is presented. Ethical implications are considered and taken into account regarding privacy policies. Results: An app study based on ResearchKit is developed without comprehensive iOS development experience. The Apple App Store is a major distribution channel causing significant download rates (> 1.200/y) without active recruitment. Preliminary data analysis shows moderate dropout rates and a good quality of data. 180 participants are currently enrolled with 107 actively participating and producing 424 completed surveys in 9 months. Conclusions: ResearchKit is an easy-to-use framework and powerful tool to create medical studies. Advantages are the modular built, the extensive reach of iOS devices and the convenient programming environment. Clinical Trial: Deutsches Register Klinischer Studien (DRKS) - https://www.germanctr.de: DRKS00009270

  • LGBT health-care disparities in Multiple Sclerosis: a cross-sectional web-based study in Italy

    From: Journal of Medical Internet Research

    Date Submitted: Jun 25, 2016

    Open Peer Review Period: Jun 25, 2016 - Aug 20, 2016

    Background: Lesbian, gay, bisexual and transgender (LGBT) patients might experience unique difficulties and barriers to treatment of chronic diseases related to their sexual orientation. Objective: To...

    Background: Lesbian, gay, bisexual and transgender (LGBT) patients might experience unique difficulties and barriers to treatment of chronic diseases related to their sexual orientation. Objective: To investigate health-care disparities experienced by LGBT patients with multiple sclerosis (MS). Methods: We conducted a survey on an Italian social-network (www.smsocialnetwork.com) for MS patients, by using standardized multiple-choice questions. The survey investigated: socio-demographic factors, lifestyle habits, MS-related health status and LGBT specific issues (e.g. friendliness to their sexual orientation or homophobic behaviors from the staff of their MS Center). Results: LGBT patients were associated with a smaller number of psychological consultations, compared to heterosexuals (Coeff.=-0.449; p<0.001; 95%CI=-0.682--0.217). LGBT patients were more likely to change MS Center, compared to heterosexuals (OR=2.064; p=0.046; 95%CI=1.011-4.212). The number of MS Center changes was associated with MS Center friendliness (p=0.037; rho=-0.229) and with the occurrence of homophobic behaviors (p=0.036; rho=0.234). Conclusions: LGBT MS patients more frequently changed MS Center and had a reduced use of psychological services, compared to heterosexuals. The attitude towards LGBT MS patients might affect resource utilizations and, possibly, LGBTs’ health status.

  • Costs and Cost-Effectiveness of a Web-Based Physical Activity Intervention for Spanish Speaking Latinas

    From: Journal of Medical Internet Research

    Date Submitted: Jun 22, 2016

    Open Peer Review Period: Jun 22, 2016 - Aug 17, 2016

    Background: Latinas report particularly low levels of physical activity (PA), and suffer from greater rates of lifestyle-related conditions such as obesity and diabetes. Interventions are needed that...

    Background: Latinas report particularly low levels of physical activity (PA), and suffer from greater rates of lifestyle-related conditions such as obesity and diabetes. Interventions are needed that can increase physical activity in this growing population in a large-scale, cost-effective manner. Web-based interventions may have potential given the increase in Internet use among Latinos and the scalability of web-based programs. Objective: To examine the costs and cost-effectiveness of a web-based Spanish language PA intervention for Latinas compared to a contact control. Methods: Healthy adult Latinas (N=205) were recruited from the community and randomly assigned to receive a Spanish language web-based individually-tailored PA intervention (Intervention), or were given access to a website with content on wellness topics other than PA (Control). PA was measured by 7-Day Physical Activity Recall Interview and ActiGraph accelerometer at baseline, 6 months (post-intervention) and 12 months (maintenance phase). Costs were estimated from a payer perspective and included all features necessary to implement the intervention in a community setting, including staff time (wage, benefits and overhead), materials, hardware, website hosting, and routine website maintenance. Results: At 6 months, the cost of the Intervention and Control groups were $17/month and $8/month, respectively. These fell to $12 and $6 at 12 months. Linear interpolation showed Intervention participants increased their PA by 1362 total minutes at six months (523 by accelerometer) compared to 715 minutes in Controls (186 by accelerometer). At six months, each minute increase in PA for the Intervention cost $0.08 ($0.20 by accelerometer), compared to $0.07 in Controls ($0.26 by accelerometer). Incremental costs per minute increase associated with the intervention were $0.08 at six months and $0.04 at 12 months ($0.16 and $0.08 by accelerometer, respectively). Sensitivity analyses showed variations in staffing costs or intervention effectiveness yielded only modest changes in incremental costs. Conclusions: While the web-based PA intervention was more expensive than the wellness control, both were quite low cost compared to face-to-face or mail-delivered interventions. Cost-effectiveness ranged markedly based on physical activity measure, and was similar between the two conditions. Overall, the web-based intervention was effective and low cost, suggesting a promising channel for increasing PA on a large scale in this at-risk population. Clinical Trial: NCT01834287

  • Happy, a Smartphone-based Intervention to Promote Cancer Prevention Behaviors: Usability and Feasibility Study

    From: Journal of Medical Internet Research

    Date Submitted: Jun 22, 2016

    Open Peer Review Period: Jun 22, 2016 - Aug 17, 2016

    Background: Estimates predict that more than half of all cancers are due to inadequate lifestyle choices. Smartphones can be successfully used to support the behavior change needed to prevent cancer....

    Background: Estimates predict that more than half of all cancers are due to inadequate lifestyle choices. Smartphones can be successfully used to support the behavior change needed to prevent cancer. Objective: The purpose of this study was to field-test Happy, a smartphone app designed to promote cancer prevention behaviors, based on tailored-messages deliver. Methods: Thirty-two participants downloaded and used the app for 28 consecutive days (4 weeks). At the end of this period, they all answered to an online questionnaire and ten of them were interviewed. Usability, feasibility, message receptivity, and perceived impact of the app were assessed. Results: Compliance with cancer prevention guidelines was lower than expected. Happy was considered simple, intuitive and easy to use. Messages sent by the app were considered easy to understand, providing good advices and meaningful information that grabbed reader’s attention. Participants also considered that Happy might be an effective way to promote cancer prevention. Behavioral data collected during the trial showed an increase in several cancer prevention behaviors and a significant increase in the overall cancer prevention level, 7 points in average (P=.031). Conclusions: This study showed the viability of designing and implementing smartphone-based interventions to promote cancer prevention behaviors. The results suggest that Happy is usable and might help users change their behavior, making healthier choices, thus reducing their personal risk of developing cancer.

  • Internet and adolescents: use and access, behavior, cyberbullying and grooming. Results of an investigative whole city survey.

    From: Journal of Medical Internet Research

    Date Submitted: Jun 21, 2016

    Open Peer Review Period: Jun 21, 2016 - Aug 16, 2016

    Background: According to the Digital Agenda for Europe, the way children use Internet and mobile technologies changed dramatically in the past years. Objective: This study aims to break down the modal...

    Background: According to the Digital Agenda for Europe, the way children use Internet and mobile technologies changed dramatically in the past years. Objective: This study aims to break down the modalities of access and use of the Internet by teenagers to assess risks and risky behaviours and to provide scientific data to evaluate and counsel safe use of the Internet and new technologies by teenagers. Methods: The study was conducted under the program “Strategies for a better internet for children” started in May 2012 by the European Commission. It represents the main result of the project launched by Telecom Italia “Anche io ho qualcosa da dire” (I too have something to say) thanks to which many of contributions were collected and used to develop a survey. The questionnaire was structured in 45 questions, covering three macro areas of interest and it was approved by the Department Board at UMG’s School of Medicine. After authorization from the regional high school authority, it was administered to all 1534 students (aged 13 to 19) in the city of Catanzaro, Italy. Results: The data has been broken down into three main groups: describing education and access to the Internet, methods of use and social networking and finally perception and evaluation of risk and risky behaviours. Among noteworthy results in the first group we can mention that the average age of first contact with information technologies was around 9 years old. Moreover, 79% of the interviewed students reported the access to a smartphone or a tablet. Among the results of the second group we find that the most used social networks were Facebook (85%), Youtube (61%), and Google+ (52%). 72% of the interviewed teenagers use their name and surname on social networks. 40% of them knew all their Facebook contacts personally. Among the results of the third group we find that 7,7% of the interviewed teenagers have uploaded pictures or movies that they feel ashamed of. 27% have received invitations from people they met on the Internet to meet in real life, and 8,4% have accepted such invitations. Conclusions: The results offer a breakdown of the teenagers’ use of the Internet, focusing on how teenagers learn to use and access it considering factors such as parental coaching, schooling or self-education. It describes how they approach and interact with social networks, and how they perceive risks and/or risky behaviours in a virtual environment. Information technology must be seen as an instrument and not as a hindrance. For this to happen parental guidance, schooling, and medical counseling are needed for a sound evolution of the child in this critical stage of development.

  • WhatsApp Messenger as an Adjunctive Tool for Medical Internet: A Review

    From: Journal of Medical Internet Research

    Date Submitted: Jun 17, 2016

    Open Peer Review Period: Jun 17, 2016 - Aug 12, 2016

    Background: The advent of medical internet has allowed physicians to deliver medical treatment to patients from a distance. Mobile applications such as WhatsApp Messenger, an instant messaging service...

    Background: The advent of medical internet has allowed physicians to deliver medical treatment to patients from a distance. Mobile applications such as WhatsApp Messenger, an instant messaging service, came as a novel concept in all fields of medicine. The use of instant messaging services has been shown to improve communication within medical teams by providing means for quick teleconsultation, information sharing, and starting treatment as soon as possible. Objective: The aim of the current study was to perform a comprehensive systematic review of present literature on the use of the WhatsApp Messenger application as an adjunctive healthcare tool. Methods: Searches were performed in PubMed, Embase, and the Cochrane Library using the term whatsapp* in articles published before January 2016. A bibliography of all relevant original articles that used the WhatsApp Messenger application was created. The impact and the indications of WhatsApp Messenger are discussed in order to understand the extent to which this application currently functions an adjunctive tool for telemedicine. Results: The database search identified a total of 30 studies in which the term whatsapp* was used. Each article’s list of references was evaluated item by item. After review articles, letters to the editor, and low-quality studies were excluded, a total of 10 studies were found to be eligible for inclusion. Of these studies, nine had been published in the English language and one had been published in Spanish. Conclusions: The pooled data presents compelling evidence that the WhatsApp Messenger application is a promising system, whether used as a communication tool between healthcare professionals, as a means of communication between healthcare professionals and the general public, or as a learning tool for providing healthcare information to professionals or to the general population. However, high-quality and properly evaluated research is needed, as are improvements in descriptions of the methodology and the study processes. These improvements will allow WhatsApp Messenger to be categorically defined as an effective telemedicine tool in many different fields of healthcare.

  • Using Text Messaging in Long-Term Arthroplasty Follow-Up

    From: Journal of Medical Internet Research

    Date Submitted: Jun 16, 2016

    Open Peer Review Period: Jun 17, 2016 - Aug 12, 2016

    Background: Patient Reported Outcome Measures (PROMs) and mobile technology have to potential to change the way patients are monitored following joint replacement surgery. Objective: The aim of this s...

    Background: Patient Reported Outcome Measures (PROMs) and mobile technology have to potential to change the way patients are monitored following joint replacement surgery. Objective: The aim of this study was to determine the feasibility of text-messaging to record PROMs in long-term follow-up of hip/knee arthroplasty. In this pilot study our participants were 17 patients two-years-plus post hip/knee arthroplasty attending clinic with a mobile telephone number on record. Methods: A simple PROM (Oswestry Very Short Form) was texted to the patient. Responses were compared to clinical, radiographic and existing PROM findings. Patients were interviewed to discover their opinions on this use of texting. Results: Eleven patients engaged with the text-messaging. The mean age was 67. Reasons for six not engaging included wrong numbers, physical barriers and lack of understanding. Eight attending clinic allowed comparison of text-messaging with clinic findings. Four patients’ text-messaging responses matched clinical and radiographic findings; three also matched PROM scores collected in clinic. The three patients with mixed responses had abnormal clinical, radiographic or PROM findings. One patient’s text responses conflicted with clinical outcome. Analysis of patients’ views showed a generally positive opinion: patients were happy to communicate with surgeons by text. Practical problems, PROM limitations and trustworthiness of texting were highlighted. Conclusions: Engaging with changing technology created challenges for patients and healthcare professionals. Our results suggest text-messaging is a promising way to communicate with arthroplasty patients. Earlier integration of technology throughout the patient pathway may be important and needs further research.

  • Mobile telephone technology use by people experiencing Multiple Sclerosis fatigue.

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 13, 2016

    Open Peer Review Period: Jun 16, 2016 - Aug 11, 2016

    Background: Fatigue is one of the most commonly reported symptoms of Multiple Sclerosis (MS). It has a profound aspect on all spheres of life, both for the person with MS and their relatives. It is on...

    Background: Fatigue is one of the most commonly reported symptoms of Multiple Sclerosis (MS). It has a profound aspect on all spheres of life, both for the person with MS and their relatives. It is one of the key precipitants of early retirement. Individual, group and internet cognitive behavioural therapy based approaches to supporting people with MS to manage their fatigue have been shown to be effective. Objective: The aim of this project was to: 1) survey the types of mobile devices people with MS use or would consider using for a health intervention, together with the level of internet access they have, and 2) characterise the levels of fatigue severity and its impact experienced by the people in our sample, to provide an estimate of fatigue severity of people with MS in New Zealand. The ultimate goal of this work was to support the future development of a mobile intervention for the management of fatigue for people with MS. Methods: People with MS were surveyed using an online questionnaire. Results: This survey has demonstrated that NZ respondents with MS experienced high levels of both fatigue severity and fatigue impact. The majority of participants have a mobile device and access to the internet. Conclusions: These factors, alongside limited access to face-to-face cognitive behavioural therapy based interventions, create an opportunity to develop a mobile technology platform for delivering a cognitive behavioural therapy based intervention to improve the severity and impact of fatigue in people with MS.

  • Test-Enhanced Online Learning Strategies in Postgraduate Medical Education

    From: Journal of Medical Internet Research

    Date Submitted: Jun 14, 2016

    Open Peer Review Period: Jun 14, 2016 - Aug 9, 2016

    Background: The optimal design of pedagogical strategies for online learning in graduate and postgraduate medical education remains to be determined. Video-based e-learning use is increasing, with ini...

    Background: The optimal design of pedagogical strategies for online learning in graduate and postgraduate medical education remains to be determined. Video-based e-learning use is increasing, with initial research suggesting that taking short breaks while watching videos (independent of answering test questions) may improve learning by focusing attention. Interspersed test questions may also improve knowledge acquisition and retention. Objective: We undertook this study to examine the effect of interspersed test questions and periodic breaks on immediate knowledge acquisition and retention at six months by pediatric residents engaged in video-based online learning. Methods: First and second year pediatric residents were randomized to one of three groups: viewing the complete video uninterrupted (full video), viewing the video interrupted with unrelated logic puzzles (logic puzzles), or viewing the video interrupted with brief comprehension test questions (short answer questions). Residents answered pre- and post-tests before and after video viewing, followed by a retention test at six months. Primary outcome included comparison of the change in test scores between groups. Results: Forty-nine residents completed the initial testing session. All three learning groups had comparable mean increases in immediate knowledge gain, but with no significant differences between groups (F(2,46)=0.35, P=0.71). Thirty-five residents completed retention testing with comparable degrees of knowledge retention in the full video and short answer test questions groups (P<0.001) but no significant change in the logic puzzles group (F(1,32)=2.44, P=0.13). Conclusions: Neither answering interspersed questions nor completing an alternate mind-engaging activity during interrupted online video viewing improved the amount of knowledge gain as compared to traditional uninterrupted video viewing. Both uninterrupted video viewing and answering interspersed test questions during interrupted video viewing demonstrated significant knowledge retention at six months.

  • User-Centered Design of a Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits

    From: Journal of Medical Internet Research

    Date Submitted: Jun 13, 2016

    Open Peer Review Period: Jun 13, 2016 - Aug 8, 2016

    Background: Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by t...

    Background: Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits. Objective: To employ a user-centered design process to create a tablet tool for use by patients for visit discussion prioritization. Methods: We employed user-centered design methods to create a tablet-based waiting room tool that enables complex patients to identify and set discussion topic priorities for their primary care visit. In an iterative design process, we completed one-on-one interviews with 40 patients and their 17 primary care providers, followed by 3 design sessions with a 12-patient group. We audio-recorded and transcribed all discussions and categorized major themes. In addition, we met with 15 key health communication, education, and technology leaders within our health system to further review the design and plan for broader implementation of the tool. In this paper, we present the significant changes made to the tablet tool at each phase of this design work. Results: Patient feedback emphasized the need to make the tablet tool accessible for patients who lacked technical proficiency and reduce the quantity and complexity of text presentation. Both patients and their providers identified specific content choices based on their personal experiences (such as the ability to raise private or sensitive concerns), and recommended targeting new patients. Stakeholder groups provided essential input on the need to augment text with video and to create different versions of the videos to match gender and race/ethnicity of the actors with patients. Conclusions: User-centered design in collaboration with patients, providers, and key health stakeholders led to marked evolution in the initial content, layout, and target audience for a tablet waiting room tool intended to assist complex patients with setting visit discussion priorities.

  • Public Acceptability of E-Mental Health Treatment Services for Psychological Problems: A Scoping Review

    From: JMIR Preprints

    Date Submitted: Jun 9, 2016

    Open Peer Review Period: Jun 10, 2016 - Aug 5, 2016

    Background: Anxiety and mood disorders are the most prevalent mental health problems, though, the supply with effective psychological treatments, such as Cognitive Behavior Therapy (CBT), is deficient...

    Background: Anxiety and mood disorders are the most prevalent mental health problems, though, the supply with effective psychological treatments, such as Cognitive Behavior Therapy (CBT), is deficient in primary care. In view of the enduring diffusion of new media technologies into everyday live, internet-based computerized, respectively electronic mental health (i.e. e-mental health) programs, have been suggested as opportunity to expand the access to mental healthcare by overcoming regional, temporal or individual barriers. Previous research has confirmed the effectiveness of several online therapy approaches; however, the internationally targeted implementation of e-mental health into healthcare systems is remaining slow and the role of public acceptability of e-mental health for the envisioned large-scale uptake of e-mental health is barely understood. Objective: This scoping review aims at identifying recent evidence from surveys investigating acceptability of e-mental health in the general population. In accordance with technology acceptance models, we defined both perceived helpfulness and intentions to use web-delivered psychological services as indicators for public acceptability. Methods: We systematically searched electronic databases (MEDLINE/PubMed, PsycINFO, Psyndex, PsycARTICLES, and Cochrane Library) to identify studies investigating expectations, preferences and attitudes toward e-mental health in the respective general population. Studies published between January 2010 and December 2015 were considered. Exclusion criteria involved data collection in clinical trials. Results: Of 76 identified publications, four articles from Europe and Australia met the inclusion criteria. Sample sizes ranged from 217 to 2.411, participants aged between 14 and 95 years. Included studies used cross-sectional designs and self-developed surveys. Except for one randomized controlled trial (RCT), the others used correlational study designs. Findings of three studies included indicated that e-mental health treatment services were perceived as less helpful than face-to-face psychotherapy. The willingness to engage with e-mental health treatments was overall smaller in comparison to traditional services, especially for online therapy delivered via smartphone or without therapist-assistance. In the RCT, providing educational information about e-mental health yielded to mixed effects on attitudes. Nonetheless, some results indicated that e-preferences, e-awareness and familiarity with online self-help corresponded with improved assessments of e-mental health. Conclusions: Given the marginal amount and methodological limitations of the four studies identified in this review and vague theoretical foundation of self-developed surveys, further research is required to determine public acceptability of e-mental health. Future studies should combine evidence-based, theory-lead and collaborative approaches to determine the role of e-health literacy and e-awareness in the relationship between public acceptability of e-mental health and help-seeking behaviour.

  • Formative work to develop a tailored HIV testing smartphone application for diverse, at-risk HIV-negative men who have sex with men

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 7, 2016

    Open Peer Review Period: Jun 10, 2016 - Aug 5, 2016

    Background: Although gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV, few test for HIV at regular intervals. Smartphone applications (or “apps”) may...

    Background: Although gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV, few test for HIV at regular intervals. Smartphone applications (or “apps”) may be an ideal tool to increase regular testing among MSM. However, the success of apps to encourage regular testing among MSM will depend on how frequently they are downloaded, whether they are continued to be used over months or years, and the degree to which such apps are tailored to the needs of this population. Objective: The primary objectives of this study are to answer the following questions: 1) What features and functions of smartphone apps do MSM believe are associated with downloading apps to their mobile phones?; 2) What features and functions of smartphone apps are most likely to influence MSM’s sustained use of apps over time?; and 3) What features and functions do MSM prefer in a HIV testing smartphone app? Methods: Focus groups (n=7 with 34 participants) were conducted with a racially and ethnically diverse group of sexually active HIV-negative MSM (Mean age of 32; 42% tested for HIV ≥10 months ago in Miami, Florida and Minneapolis, Minnesota. Focus groups were digitally recorded, transcribed verbatim, and de-identified for analysis. A constant comparison method (i.e., grounded theory coding) was employed to examine and re-examine the themes that emerged from the focus groups. Results: Men reported cost, security, and efficiency as their primary reasons influencing whether they download an app. Usefulness and perceived necessity, as well as peer and posted reviews, affected whether they downloaded and used the app over time. Factors that influenced whether they keep and continue to use an app over time included reliability, ease of use, and frequency of updates. Poor performance and functionality and lack of use were the primary reasons why men would delete an app from their phone. Participants’ also shared their preferences for an app to encourage regular HIV testing by providing feedback on test reminders, tailored testing interval recommendations, HIV test locator, and monitoring of personal sexual behaviors. Conclusions: Mobile apps for HIV prevention have proliferated, despite relatively little formative research to understand best practices for their development and implementation. The findings of this study suggest key design characteristics that should be used to guide development of a HIV testing app to promote regular HIV testing for MSM. The features and functions identified in this and prior research, as well as existing theories of behavior change, should be used to guide mobile app development in this critical area.

  • mHealth or eHealth? A randomized controlled trial testing the efficacy, use, and appreciation of a web-based computer-tailored physical activity intervention for Dutch adults.

    From: Journal of Medical Internet Research

    Date Submitted: Jun 8, 2016

    Open Peer Review Period: Jun 8, 2016 - Aug 3, 2016

    Background: Until a few years ago, web-based computer-tailored interventions were almost exclusively delivered via the computer (eHealth). However, nowadays, interventions delivered via smartphones (m...

    Background: Until a few years ago, web-based computer-tailored interventions were almost exclusively delivered via the computer (eHealth). However, nowadays, interventions delivered via smartphones (mHealth) are an interesting alternative for health promotion as they may more easily reach people 24/7. Objective: The first aim of this study was to compare the efficacy of a mHealth and eHealth version of a web-based computer-tailored physical activity intervention with a control group. The second aim was to assess potential differences in use and appreciation between the 2 versions. Methods: Data was collected among 373 Dutch adults at 5 points in time (baseline, after 1 week, after 2 weeks, after 3 weeks and after 6 months). Participants were recruited via a Dutch online research panel and randomly assigned to the eHealth (N= 138), the mHealth (N= 108), or the control condition (N= 127). All participants were asked to complete questionnaires at the 5 points in time. Participants in the eHealth and mHealth group received fully automated tailored feedback messages about their current level of physical activity. Furthermore, they received personal feedback aimed at increasing their amount of physical activity when needed. ANOVA and linear regression analyses were used to examine differences between the study groups with regards to efficacy, use, and appreciation. Results: Participants receiving feedback messages (eHealth and mHealth together) were significantly more physically active after 6 months than participants in the control group (B = 8.48, P = .025, df= 2; Cohen’s d = 0.27). A small effect size was found favoring the eHealth condition over the control group (B = 6.13, df = 2; P =.091, Cohen’s d = 0.21). The eHealth condition had lower dropout rates (84.4%) than the mHealth condition (75.0%) and the control group (71.7 %). Furthermore, the eHealth condition was appreciated better in comparison to the mHealth condition with regard to receiving (t= 3.07; df= 182; P= .002) and reading the feedback messages (t = 2.34; df= 181; P = .02) as well as the clarity of the messages (t = 1.99; df = 181; P = .049). Conclusions: The overall effect was mainly caused by the more effective eHealth intervention. The mHealth application was less appreciated than the eHealth version. More research is needed to assess how both methods can complement each other. Clinical Trial: Dutch Trial Register: NTR4503

  • The issues associated with the use of Semantic Web Technology in Clinical Decision Support Systems: A Systematic Review of the Literature

    From: Journal of Medical Internet Research

    Date Submitted: Jun 6, 2016

    Open Peer Review Period: Jun 7, 2016 - Aug 2, 2016

    Background: Clinical Decision Support System (CDSS) is a particular form of intelligent system that helps practitioners to make a decision regarding diagnosis or treatment. Knowledge acquisition is on...

    Background: Clinical Decision Support System (CDSS) is a particular form of intelligent system that helps practitioners to make a decision regarding diagnosis or treatment. Knowledge acquisition is one of the well-known bottlenecks in CDSS, partly because of the enormous growth in health related knowledge and the difficulty in assessing the quality of this knowledge. The semantic web (SW) represents a set of technologies that may be able to assist in automatically discovering relevant and high-quality knowledge for CDSS along with discovering data that may be relevant for the decision-making process` Objective: The paper aims to define the role of Semantic Web technology in acquiring knowledge for CDSS and identifying issues with these approaches Methods: We conducted a systematic review of the recent related work using search key terms in different scientific databases Results: The retrieved papers were categorized based on four main issues addressed; format heterogeneity, lack of semantic definition, lack of automatic analysis system and data heterogeneity and lack of data integration. Most existing approaches will be discussed under these categories. 21 papers have been reviewed in this study. Conclusions: The potential for using Semantic Web technology in CDSS has only been considered to a minor extent so far despite its promise. The review shows the capability of using Semantic Web technology to supply knowledge for a CDSS. Clinical Trial: N/A

  • A criteria-based evaluation of Internet sites of orthodontists in private practice

    From: Interactive Journal of Medical Research

    Date Submitted: Jun 3, 2016

    Open Peer Review Period: Jun 6, 2016 - Aug 1, 2016

    Background: Health-related use of the Internet has increased markedly in recent years. The Internet offers patients not only information on diseases and therapy options, but also the possibility to se...

    Background: Health-related use of the Internet has increased markedly in recent years. The Internet offers patients not only information on diseases and therapy options, but also the possibility to search for dentists using physician directories or websites. For privately practicing dentists, having a website serves as an important tool for marketing and recruiting new patients. Objective: This study aimed to investigate existence, frequency, and quality of websites of privately practicing orthodontists. Methods: Internet sites of orthodontists listed with the association of statutory health insurance physicians in five German states were investigated. Websites were evaluated according to 68 operationalized criteria and data analyzed based to hypotheses. Results: The majority of orthodontists (368 of 619; 59.5%) had a website. The frequency of websites differed in terms of region (city states 66.8% vs. territorial states 55.2%; P=.005), and practice type (single physician practice 40.6% vs. multiple physician practice 59.2%), but not in terms of gender (P=.43). The mean overall score was 43.0% (29.2/68 points). More information was found on therapy options (74.7%) and extra services (61.7%) than on clinical pictures treated (30.8%) or corresponding diagnostics (25.7%). Legal requirements (publisher’s information 43.5%; data protection declaration 43.2%) were oftentimes not fully met. Conclusions: Orthodontists’ websites focused on marketing aspects, whereas a higher value should be placed on patient-oriented content. Since legal requirements were oftentimes only met with deficiencies, there is a clear need for optimization in this regard. Orthodontists did not make use of all available web functions, in particular those with advanced potential (e.g. social media integration). Recommendations are desirable from the competent professional associations regarding the content and form of websites for dental practices.

  • Point-of-sale tobacco advertising and display bans: results from a policy evaluation study using mobile data gathering methods in five Russian cities

    From: Journal of Medical Internet Research

    Date Submitted: Jun 6, 2016

    Open Peer Review Period: Jun 6, 2016 - Aug 1, 2016

    Background: Background: The tobacco industry uses point-of-sale (POS) advertising, promotion and product display to increase consumption of their products among current users, to attract new consumers...

    Background: Background: The tobacco industry uses point-of-sale (POS) advertising, promotion and product display to increase consumption of their products among current users, to attract new consumers, and to encourage former customers to resume tobacco use. As part of a comprehensive tobacco control effort, Russia – having one of the highest tobacco use prevalence rates in the world – enacted legislation that banned tobacco POS advertising in effect November 15, 2013, and banned the display of tobacco and the sale of cigarettes in kiosks, effective June 1, 2014. Objective: Objective: Evaluate the implementation of the national law by assessing the state of POS advertising and promotion and product display, and sales in kiosks across Russia. Methods: Methods: Two waves of observations were conducted to measure compliance with the POS restrictions: wave 1 took place April-May 2014 after the advertising ban was in effect, and again in August-September 2014 after the display ban and elimination of tobacco sales in kiosks came into effect. Observations were conducted by local trained staff who traveled to 5 populous cities in different regions of Russia (Moscow, St. Petersburg, Kazan, Ekaterinburg, and Novosibirsk). Staff followed a published POS evaluation protocol, and used smartphones to collect data. Observations were conducted in a roughly equal number of chain supermarkets, convenience stores, and kiosks. Observed items included advertising at POS, product displays, and cigarette sales in kiosks. Results: Results: Observations were made in 780 venues in wave 1, and 779 revisited venues in wave 2. In wave 1, approximately a third of supermarkets and convenience stores (34%) were advertising cigarettes using lightboxes, and over half of observed venues (54%) had signage such as banners or shelf liners that used colors or images related to cigarette brands. Product displays were common in wave 1. In Wave 2, compliance with advertising restrictions was very good: there were virtually no lightboxes (1%, n=5); banners or shelf liners were observed in 30% of supermarkets/convenience stores; approximately 7% of venues were still displaying products in a Powerwall. In wave 2, 41% (n=100) of kiosks continued to sell tobacco. Conclusions: Conclusion: Russia’s compliance with POS bans was excellent. Remaining compliance issues are largely with the use of cigarette brand colors or images used in banners or shelf liners; this type of infraction is more difficult to enforce as inspectors need to be deeply familiar with tobacco industry products and marketing. A sizeable proportion of kiosks continue to sell tobacco post restrictions. Clinical Trial: Not Applicable

  • Crafting health messages with knowledge translation to provoke interest, raise awareness, inspire change, impart knowledge and transform practice: Short Paper

    From: JMIR mHealth and uHealth

    Date Submitted: May 31, 2016

    Open Peer Review Period: Jun 3, 2016 - Jul 29, 2016

    Background: There is growing use of technology supported knowledge translation (KT) strategies like social media in health promotion and in Indigenous health. However, little is known about how indivi...

    Background: There is growing use of technology supported knowledge translation (KT) strategies like social media in health promotion and in Indigenous health. However, little is known about how individuals use technologies and the evidence base for the impact of these health interventions on health behaviour change is weak. Objective: We examine how Facebook is used to promote health messages to Indigenous people and discuss how KT can support planning and implementing health messages to ensure chosen strategies are fit for purpose and achieve impact. Methods: Conducted a desktop audit of health promotion campaigns on smoking prevention and cessation for Australian Indigenous people. Results: Our audit of health promotion campaigns on smoking prevention and cessation for Australian Indigenous people identified thirteen out of 21 eligible campaigns used Facebook. Facebook pages with the highest number of likes (greater than 5000) linked to a website and to other social media applications and demonstrated stickiness characteristics by posting frequently (triggers and unexpected), recruiting sporting or public personalities to promote campaigns (social currency and public), recruiting Indigenous people from the local region (stories and emotion), and sharing stories and experiences based on real life events (credible). Conclusions: KT planning may support campaigns to identify and select KT strategies that are best suited and well aligned to the campaigns’ goals, messages and target audiences. KT planning can also help to mitigate unforeseen and expected risks, reduce unwarranted costs and expenses, achieve goals, and limit the peer pressure of using strategies that may not be fit for purpose. One of the main challenges in using KT systems and processes involves coming to an adequate conceptualisation of the KT process itself.

  • Which characteristics and use of online health discussion forums? A systematic review from 2005 to 2015

    From: Journal of Medical Internet Research

    Date Submitted: May 31, 2016

    Open Peer Review Period: May 31, 2016 - Jul 26, 2016

    Background: With the development of the social web, the use of health-Internet is a frequent and omnipresent practice. It become a usual mean for retrieving health-related information but also a mode...

    Background: With the development of the social web, the use of health-Internet is a frequent and omnipresent practice. It become a usual mean for retrieving health-related information but also a mode of expression for communicating and exchanging This is facilitated by the development of online community and social media tools such as wikis, blogs, chats, social networks and online health discussion forums. However, while those media are increasingly used by a diverse population and contain a lot of information on interaction and content, they are still insufficiently explored: there is no real description and the whole set of interaction processes poorly documented. Objective: Through a systematic review, this study has two objectives. First it aims at defining and characterizing the health discussion forum and its users in comparison with general discussion forums. The second objective is to characterize the usage of health discussion forums by Internet users. Methods: Scientific papers have been collected on nine bibliographic databases: SCOPUS, DIAL, Cochrane library, Embase, Pubmed, BDSP, CAIRN, ERIC, Science Direct have been consulted. We also gather gray literature manually with general Internet queries, and from our personal bibliographic database. The 22 selected references have been analyzed independently by two researchers according to three types of criteria which consider (a) definitions and characteristics of online health forums; (b) online health forum users, and (c) usages of online health forums. Results: We identify six definitions of health discussion forums through the analysis of the literature review and we propose an exhaustive description .We also characterize the health forum users according to a multidimensional classification: 1. Official forum regulatory function; 2. Communication role; 3. Forum assiduity; 4. Impact of the contribution. Finally, we describe the user behavior on health forums: they take advantage of this media to share information on medical topics and non-medical, but also to support each other and to acquire knowledge useful for managing their disease. Conclusions: This systematic review lead us to elaborate a definition of the online health forums by identifying or by refining its characteristics and those of these users. We also highlight the essential role of the learning process when healthy people, patients and their families use health forums. Indeed, their experience accumulated through daily practice is a knowledge base which can be shared with peers on health forums. Thus, these can be assimilated to an apomediation medium fostering informal learning, autonomy and self-efficacy, especially in chronic patients, to acquire skills to manage their disease. In that context, we argue it is important to characterize the circumstances and conditions of health forum use, but also the users’ learning strategies throughout their involvement in such forums.

  • Putting young people at the forefront of their mental health care through technology for holistic assessment and routine outcome tracking

    From: Iproceedings

    Date Submitted: May 31, 2016

    Open Peer Review Period: May 31, 2016 - Jul 26, 2016

    Background: Young people have the highest need for mental health support yet are least likely to seek it from professional services. Enabling access and engagement in mental health care is essential t...

    Background: Young people have the highest need for mental health support yet are least likely to seek it from professional services. Enabling access and engagement in mental health care is essential to intervening early to provide appropriate and effective care to prevent escalation of young people’s mental health problems. In response, Australia initiated headspace: the national youth mental health foundation, which provides f2f and online services to young people aged 12-25 with emerging mental health problems. Innovations in technology are being developed to better engage and put young people at the forefront of their mental health care. Objective: The aim was to investigate how technology could be used to facilitate holistic psychosocial assessments for young people entering mental health services, and routinely track meaningful outcomes across an episode of care. Objectives were to determine whether this use of technology would be engaging and acceptable to young people, and how it would affect appropriateness and effectiveness of the care received. Methods: An electronic holistic psychosocial assessment tool (EhHAT) and a brief routine mental health outcome measure (MyLifeTracker) were developed in collaboration with young people and their service providers. The EhHAT was piloted using a quasi-experimental two phase Treatment-as-Usual/Intervention design with 339 youth and 13 clinicians. Engagement and rates of disclosure and risk across the psychosocial domains were compared in a mixed methods approach. MyLifeTracker was implemented with all clients and quantitative data were available from 15,222 young people and used to compare MyLifeTracker with standardised mental health outcome measures. Qualitative data were collected from a small sub-sample to examine their experience of this routine monitoring approach. Results: The EhHAT was shown to be highly engaging and acceptable to young people and resulted in disclosure of psychosocial risks that were 2.8 through 10.4 times higher compared with the non-intervention group. MyLifeTracker was shown to have concurrent validity against well-validated measures of psychological distress, functioning, and life satisfaction. It was highly sensitive to change with excellent stability. Young people valued the opportunity to report and track their progress. For both applications, the use of technology improved the experience for young people, making them feel more in control, and providing better information for clinicians. Conclusions: The results show that technology is effective at engaging young people in their own mental health care. They are comfortable providing personal information via tablet applications and are more likely to disclose in this format. This yields better information for clinicians to provide more appropriate and tailored care. Young people appreciate the opportunity to routinely track their outcomes via technology and find this a helpful way to have conversations with their clinicians around the changes that are meaningful to them, leading to more appropriate and effective care. These holistic assessment and outcome tracking tools are essential ways forward harnessing technology to put young people at the forefront of their own mental health care.

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