JMIR Publications

JMIR Preprints

Advertisement

Journal Description

JMIR Preprints contains pre-publication/pre-peer-review preprints intended for community review. For a list of all preprints under public review click here. With the exception of selected submissions to the JMIR family of journals (where the submitting author opted in for open peer-review, and which are displayed here as well for open peer-review), there is no editor assigning peer-reviewers.

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

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

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

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

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

 

Recent Articles:

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

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

    Authors List:

    Abstract:

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

Citing this Article

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

Latest Submissions Open for Peer-Review:

View All Open Peer Review Articles
  • Pleural Effusion resembling a lung tumor: Phantom Tumor of the Lung.

    From: JMIR Preprints

    Date Submitted: Jul 3, 2016

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

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

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

  • Systematic attrition of heavy drinkers in a web-based alcohol intervention study

    From: Journal of Medical Internet Research

    Date Submitted: Dec 13, 2016

    Open Peer Review Period: Dec 16, 2016 - Feb 10, 2017

    Background: Web-based alcohol interventions are a promising way to reduce alcohol consumption due to their anonymity and the possibility to reach high numbers of individuals including heavy drinkers....

    Background: Web-based alcohol interventions are a promising way to reduce alcohol consumption due to their anonymity and the possibility to reach high numbers of individuals including heavy drinkers. However, web-based interventions are often characterized by high rates of attrition. To date, very few studies have investigated whether individuals with higher alcohol consumption show higher attrition rates in web-based alcohol interventions compared to individuals with lower alcohol consumption. Objective: The aim of this study was to examine the attrition rate and predictors of attrition in a web-based intervention study on alcohol consumption. Methods: Analysis of predictors for attrition rate collected in a web-based randomized control trial. Data collection took place in [blinded for Review], Germany. 898 people (46.8% males; 53.2% women) with a mean age of 23.57 years (SD = 5.19) initially volunteered to participate in a web-based intervention study to reduce alcohol consumption. Participants were classified as non-completers (n = 439, 48.9%) if they did not complete the web-based intervention at time point 1. Potential predictors of attrition were self-reported alcohol consumption in the last seven days, per week, from Monday to Thursday, at weekends, excessive drinking behavior measured with the Alcohol Use Disorder Identification Test (AUDIT), and drinking motives measured by the drinking Motive Questionnaire (DMQ-R SF). Results: Significant differences between completers and non-completers emerged regarding alcohol consumption at weekends (B = -.05, 95% CI [0.92;0.98]), in the last seven days (B = -.02, 95% CI [0.97;1.00]), the AUDIT (B = -.06, 95% CI [0.90;0.98], and the status as a student (B = .68., 95% CI [1.92;2.99]). Most importantly, non-completers had a significantly higher alcohol consumption compared to completers. Conclusions: Hazardous alcohol consumption appears to be a key factor of the dropout rate in a web-based alcohol intervention study.

  • Smartphone-based monitoring of objective and subjective data in mood disorders: Where are we and where are we going? – A systematic review

    From: Journal of Medical Internet Research

    Date Submitted: Dec 15, 2016

    Open Peer Review Period: Dec 16, 2016 - Feb 10, 2017

    Background: E-mental health interventions for mood disorders have increased rapidly over the past decade, most recently in the form of various systems and applications (apps) that are delivered via sm...

    Background: E-mental health interventions for mood disorders have increased rapidly over the past decade, most recently in the form of various systems and applications (apps) that are delivered via smartphones. Objective: To provide an overview about studies on smartphone-based systems combining subjective ratings with objectively measured data for longitudinal monitoring of patients with affective disorders. Specifically, to examine current knowledge on 1) feasibility, acceptability and adherence of such systems; 2) the association of recorded data with affective symptoms and changes in symptomatology; and 3) effects on clinical outcomes. Methods: We searched PubMed, Web of Science, PsycINFO and the Cochrane Central Register of Controlled Trials for relevant articles published in the last ten years applying Boolean search operators with an iterative combination of search terms. Additional articles were identified via pearling, author correspondence, selected reference lists and trial protocols. Results: A total of 1276 records were identified, of which 23 met our inclusion criteria and were included in the review. In total, seven different self-monitoring systems for affective disorders that use subjective mood ratings as well as objective measurements of physiological and behavioral parameters were included. These parameters include phone usage, physical activity, location, physiological features, light exposure, as well as voice/speech features. Out of the 23 articles, 17 contained results of patients with affective disorders regarding acceptability and feasibility; and also partially showed a reasonable accuracy of predicting mood status and mood fluctuations according to time-series analysis of the objective measures. Only one article reported results from an RCT concerning effects on clinical outcome in patients with bipolar disorder. Conclusions: The first experimental studies substantiate the value of smartphone-based approaches for gathering long-term objective data other than self-ratings to monitor clinical symptoms, to predict changes in clinical states and to investigate causal inferences about state changes in patients with affective disorders. Though promising, a much larger evidence-base is necessary to fully assess the potential and the risks of these approaches as methodological limitations of the available studies such as small sample sizes, variations in the number of observations or monitoring duration, lack of RCTs and heterogeneity of methods restrict the interpretability of the results. However, a number of study protocols stated ambitions to expand and intensify research in this emerging and promising field. Clinical Trial: not applicable

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

    From: Journal of Medical Internet Research

    Date Submitted: Nov 21, 2016

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

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

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

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

    From: Journal of Medical Internet Research

    Date Submitted: Nov 20, 2016

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

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

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

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

    From: Journal of Medical Internet Research

    Date Submitted: Nov 30, 2016

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

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

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

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

    From: Journal of Medical Internet Research

    Date Submitted: Nov 24, 2016

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

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

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

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

    From: JMIR mHealth and uHealth

    Date Submitted: Nov 24, 2016

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

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

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

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

    From: Journal of Medical Internet Research

    Date Submitted: Dec 5, 2016

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

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

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

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

    From: Journal of Medical Internet Research

    Date Submitted: Nov 29, 2016

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

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

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

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

    From: Journal of Medical Internet Research

    Date Submitted: Dec 1, 2016

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

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

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

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

    From: JMIR mHealth and uHealth

    Date Submitted: Dec 1, 2016

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

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

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

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

    From: Journal of Medical Internet Research

    Date Submitted: Dec 6, 2016

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

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

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

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

    From: Journal of Medical Internet Research

    Date Submitted: Dec 7, 2016

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

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

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

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

    From: Journal of Medical Internet Research

    Date Submitted: Dec 5, 2016

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

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

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

  • Effectiveness of personalized web-based advice in combination with youth health care well-child visits to prevent overweight in young children: a cluster randomized controlled trial.

    From: Journal of Medical Internet Research

    Date Submitted: Dec 20, 2016

    Open Peer Review Period: Dec 23, 2016 - Feb 17, 2017

    Background: Overweight is a major health issue, and parent-targeted interventions to promote healthy development in children are needed. Objective: The objective of this study was to evaluate E-health...

    Background: Overweight is a major health issue, and parent-targeted interventions to promote healthy development in children are needed. Objective: The objective of this study was to evaluate E-health4Uth Healthy Toddler, an intervention that educates parents of children 18-24 months of age regarding overweight-related behaviors. The effect of this intervention on the following primary outcomes was evaluated when the children were 36 months of age: health-related behaviors (outside play, eating breakfast, sweetened beverage consumption, television viewing, and computer time) and body mass index (BMI). Methods: The BeeBOFT study is a cluster randomized controlled trial involving 51 Youth Health Care (YHC) teams. In total, 1094 parents participated in the control group and 1008 parents participated in the E-health4Uth Healthy Toddler intervention group. The intervention consisted of web-based personalized advice given to parents who completed an e-health module. The advice was then discussed during a regular well-child visit with a YHC professional when the child was 18 and 24 months of age. Parents completed questionnaires regarding family characteristics and health-related behaviors when the child was 1 month (inclusion), 6 months, 14 months, and 36 months (follow-up) of age. The child’s height and weight were measured by trained healthcare professionals from birth through 36 months of age. Multilevel linear and logistic regression models were used to evaluate the primary outcomes at 36 months of age. Results: Compared to the control group, the children in the intervention group ate breakfast at the table more often (OR: 1.39; 95% CI: 1.06 to 1.84) and ate breakfast less often while sitting on the couch in front of the television (OR: 1.39; 95% CI: 1.10 to 1.77). In contrast, the two groups did not differ significantly with respect to BMI or the prevalence of overweight or obesity at follow-up (P>.05). An analysis of the intervention effect revealed that boys and non-Dutch children benefited from eating breakfast daily, drinking ≤2 glasses of sweetened beverages per weekday, and playing outside daily (p<0.05) compared to the control group. Conclusions: The E-health4Uth Healthy Toddler intervention resulted in significant improvements in the family’s breakfast-eating behaviors, but had no significant effects with respect to the child’s BMI. Therefore, the E-health4Uth Healthy Toddler intervention may be useful for pediatric healthcare professionals in terms of providing parents with personalized information regarding their child’s health-related behaviors. Clinical Trial: Netherlands Trial Register: NTR1831, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1831 (Archived by WebCite at http://www.webcitation.org/6mm5YFOB0)

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

    From: JMIR Cancer

    Date Submitted: Dec 7, 2016

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

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

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

  • sickleCAPTCHA - Design and Testing a Touch-based CAPTHCA for Monitoring and Analysis of Sickle Cell Anemia: A Comparative Study

    From: Interactive Journal of Medical Research

    Date Submitted: Dec 13, 2016

    Open Peer Review Period: Dec 14, 2016 - Feb 8, 2017

    Background: Patients with Sickle Cell Anemia are monitored by scoring red blood cells according to their morphology in blood samples. Several image-processing algorithm for automated erythrocyte count...

    Background: Patients with Sickle Cell Anemia are monitored by scoring red blood cells according to their morphology in blood samples. Several image-processing algorithm for automated erythrocyte counts and morphological analysis in blood samples has been developed. However, overlapping, occluded, or grouped erythrocytes can generate erroneous results. We designed and tested an approach that users identify red blood cells with specific morphologies in the images through a touch-based CAPTCHA (sickleCAPTCHA). Objective: To answer three research questions: (1) Does sickleCAPTCHA allow the accurate analysis of red blood cells from sickle cell anemia patients (reliability)?, (2) is sickleCAPTCHA a valid system of access control (security)?, and (3) is sickleCAPTCHA appropriate for touch devices (adequacy)? Methods: We designed touch-based CAPTCHA to locate, count, and identify red blood cells in a microscopy blood sample image. We tested sickeCAPTCHA with 101 university students. We then compared the responses of participants to the sickleCAPTCHA tasks with expert classifications of images from erythrocytesIDB database (reliability). We also compared the results of applying an image-processing algorithm with the expert classifications, to determine to what extent verified tasks could be resolved automatically (security). We then conducted a usability test, comparing with reCAPTCHA, to determine the adequacy on touch devices. Results: With respect to reliability, participants correctly analyze the morphology of 100% clusters of red blood cells contained in erythrocytesIDB. About security, image-processing algorithm only classified correctly 0.7% of the clusters. Regarding adequacy, results show that resolving a sickleCAPTCHA, on average, is faster than reCAPTCHA (6.95 ± 3.92, P<.001, on touch devices). We also performed an ad-hoc power test to calculate the minimum sample size required (90 participants). Conclusions: The results confirmed that sickeCAPTCHA is suitable for use on touch devices, the resulting morphological analysis is reliable, and access control is safe. As future work, we plan to study whether this system is suitable for the analysis of other types of morphologies and to apply sickleCAPTCHA in a real environment with a large number of daily users.

  • Effect of a Web-based Intervention on Physical Activity and Fruit and Vegetable Intake Among Chinese University Students: a Randomized Controlled Trial

    From: Journal of Medical Internet Research

    Date Submitted: Dec 22, 2016

    Open Peer Review Period: Dec 28, 2016 - Feb 22, 2017

    Background: Ample evidence demonstrates that university students are at high risk for sedentary behaviours and inadequate fruit and vegetable intake. Internet-based interventions for multiple health b...

    Background: Ample evidence demonstrates that university students are at high risk for sedentary behaviours and inadequate fruit and vegetable intake. Internet-based interventions for multiple health behaviour appear to be promising in changing such unhealthy habits. Limited randomized controlled trials have tested this assumption among Chinese university students. Objective: This study aimed to test the efficacy of an 8-week web-based intervention compared to a control group condition to improve physical activity (PA) and fruit and vegetable intake (FVI) in Chinese university students. The intervention content was based on the Health Action Process Approach, and developed on the basis of previous evidence from the western hemisphere. Self-reported data including PA and FVI, stages of change for PA and FVI, motivational (risk perception, outcome expectancies, self-efficacy), volitional (action planning, coping planning, social support), and psychological (intention, habit) indicators for PA and FVI, as well as perceived health outcomes (quality of life, depression) were evaluated. Methods: In a randomized controlled trial, university students from one university in the central region of China were recruited during their PE class. 493 students were then randomly assigned into one of two groups: (1) intervention group: first 4-weeks on PA and subsequent 4-weeks on FVI; (2) the control group. Three web-based assessments were conducted including one at the beginning of the intervention (T1, N=493), at the end of the 8-week intervention (T2, N=337), and at a 1 month follow-up after the intervention (T3, N=142). The entire study was conducted throughout the fall semester of 2015. Results: Significant treatment by group interactions revealed superior intervention effects on FVI, motivational, volitional and psychological indicators of FVI behaviour change, and motivational indicators of PA behaviour change, with an effect size of Eta² ranging from .11 to .13. In addition, the overall intervention effects were significant for stage progression to the action group from T1 to T2 in PA (Chi² =11.75, df=1, P=.001) and FVI (Chi²=15.64, df=1, P<.001). Furthermore, the intervention effect was seen in the improvement of quality of life (F=1.23, Eta²=.03, P=.02). Conclusions: The present study is the first of its kind to provide evidence for the efficacy of a web-based multiple health behaviour intervention among Chinese university students. The majority of the study assumptions were supported. Future research should address the high dropout rate and optimize the most effective components of this intervention. Clinical Trial: Clinical trial ID number: NCT01909349

  • Implementing an Internet-delivered skin cancer genetic testing intervention to improve sun protection behavior in a diverse population

    From: Journal of Medical Internet Research

    Date Submitted: Dec 27, 2016

    Open Peer Review Period: Dec 28, 2016 - Feb 22, 2017

    Background: Currently little translational genomic research exists to guide the availability, comprehension, and appropriate use of personalized genomics in diverse, general population subgroups that...

    Background: Currently little translational genomic research exists to guide the availability, comprehension, and appropriate use of personalized genomics in diverse, general population subgroups that stand to benefit from it in the coming years. Melanoma skin cancers are preventable, curable, common in the general population, and disproportionately increasing in Hispanics. Variants in the melanocortin receptor gene (MC1R) are present in about 70% of the population, interact with sun exposure, and confer a 2-3 fold increase in melanoma risk in the general population, even in darker skin populations, thus feedback regarding MC1R risk status may raise risk awareness and protective behavior in the general population. Objective: We are conducting a randomized controlled trial examining Internet presentation of the risks and benefits of personalized genomic (MC1R) testing for melanoma (PGT-M). Methods: We will enroll 885 participants, who will be randomized 6:1 to PGT-M versus waiting list control. Control participants will be offered testing after outcome assessments. Participants will be balanced across self-reported Hispanic versus Non-Hispanic ethnicity, n=750 in PGT-M arm; n=135 in control arm), and will be recruited from a general population cohort in Albuquerque New Mexico, where there is year-round sun exposure. Results: Aim I of the trial will examine the personal utility of PGT-M in terms of short-term (three month) sun protection, skin screening behavior, family and physician communication, melanoma threat and control beliefs (i.e., putative mediators of behavior change). We hypothesize that behaviors and putative mediators will be higher in those who test compared to those who decline testing. We will also examine potential unintended consequences of testing among those who receive average risk PGT-M findings, examining predictors of sun protection at three months as the outcome. These findings will be used to develop messages for groups that receive average risk feedback. Aim II will compare rates of test consideration of PGT-M in Hispanic versus Non-Hispanics in terms of consideration of the pros and cons of testing and registration of PGT-M decision, either for or against testing. We hypothesize that Hispanics will show reduced reach, but that the reduction will reflect levels of health literacy, health system distrust, and sociocultural factors (cancer fatalism, family health orientation, skin cancer misconceptions), not ethnicity. Aim III will examine PGT-M feedback comprehension, recall, satisfaction, and cancer-related distress in those who undergo testing, and whether these outcomes differ by ethnicity (Hispanic versus Non-Hispanic) or sociocultural or demographic factors. Conclusions: The study has important implications for personalized genomics in the melanoma context, and may be broadly applicable as a model for delivery of personalized genomic feedback for other health conditions.

  • Feasibility of an e-learning module to improve non-genetic health professionals’ assessment of colorectal cancer genetic risk

    From: Journal of Medical Internet Research

    Date Submitted: Dec 15, 2016

    Open Peer Review Period: Dec 18, 2016 - Feb 12, 2017

    Background: Non-genetic health providers lack relevant knowledge, experience as well as communicative skills to adequately detect familial colorectal cancer (CRC), despite a possibly positive attitude...

    Background: Non-genetic health providers lack relevant knowledge, experience as well as communicative skills to adequately detect familial colorectal cancer (CRC), despite a possibly positive attitude towards a cancer family history assessment. Dedicated training may enable them to more optimally refer patients to genetic counseling. Objective: The aim of this study was to: 1) develop an e-learning module for gastroenterologists and surgeons (in training) aimed at improving attitudes, knowledge and comprehension of communication skills, and 2) assess the feasibility of the e-learning module for continued medical education of these specialists. Methods: A focus group was used to inform the development of a training framework. Next, the e-learning module itself was developed. Feasibility-testing of the e-learning module was performed first among a group of Dutch surgeons in training (3rd and 4th year residents) (SRs) and then among Dutch gastroenterologists (GEs) using pre- (T0) and post- (T1) questionnaires. Results: 124 SRs and 14 GEs participated. The e-learning was positively received (7.5 on a scale from 1-10). Attitude increased significantly on six of ten items from T0 to T1. Mean test score showed that knowledge and comprehension of communication skills improved significantly from 49-72% correct on the pretest to 67-87% correct on the posttest. Conclusions: We demonstrated feasibility of a problem-based e-learning on recognizing a hereditary predisposition in CRC patients for SRs and GEs. The e-learning led to intended improvements in attitude towards assessment of cancer family history, knowledge on criteria for referral to genetic counseling for colorectal cancer and comprehension of communication skills.

  • The Impact of Crowdfunding on Knowledge of Science and Rare Genet-ic Diseases Research

    From: Journal of Medical Internet Research

    Date Submitted: Dec 24, 2016

    Open Peer Review Period: Jan 2, 2017 - Feb 27, 2017

    Background: Although the cost to sequence a genome has been substantially reduced, it is still unaffordable for many patients because it is rarely covered by health insurance. Financial strain is all...

    Background: Although the cost to sequence a genome has been substantially reduced, it is still unaffordable for many patients because it is rarely covered by health insurance. Financial strain is all too familiar to many Americans today. Nearly half of respondents to a 2011 poll from the National Bureau of Economic Research stated that if they were given a 30-day timeframe, they would be unable to produce an extra $2,000. Beyond overtaxed household budgets, families dealing with undiagnosed or rare diseases incur countless unexpected healthcare costs that create tremendous financial burdens. These families shoulder these staggering health care expenses accumulated over years of seeking treatment. Crowdfunding may help support patients in need of DNA sequencing by providing access to a test that might uncover the cause of their disease and potentially lead to viable clinical treatment. Objective: The goal of Amplify Hope was to test the effectiveness of strategies for raising the necessary funding for trio exome sequencing through crowdfunding campaigns. More generally, we sought to understand the strategies that are the most successful for crowdfunding campaigns for medical expenses. Methods: Our research sought to 1) provide demographic information on the donor population; 2) identify common factors among successful medical crowdfunding campaigns; 3) identify factors that influenced people to donate, as reported by donors; and 4) describe the im-pact crowdfunding campaigns had on donors’ knowledge of genomics. We conducted the study in several phases, including a needs assessment, participant recruitment, a 30-day crowdfunding training period, a 30-day online crowdfunding period, and follow-up surveys given to participants and donors. Results: We found that social media played an important role in all campaigns. Specifically, a strong social media network, an active outreach process, and a high degree of comfort with networking all correlated with a higher success rate. Amplify Hope donors were more likely to support projects that were near their fundraising goals, and found video far more effective for learning about genomics than any other medium. Conclusions: The campaigns that achieved complete funding during the 30-day online crowdfunding campaign study period shared several characteristics. Individual campaign organizers who reached their campaign goals engaged more during the training program prior to the start of the crowdfunding campaign, as compared to those that did not achieve their campaign goals. These organizers read our shared Amplify Hope study materials, followed recommended guidelines, and perhaps most importantly initiated communication via phone calls and emails to their networks prior to the campaign launch. In other words, the successful campaigners frontloaded their campaigns. They also actively engaged their network and donors by providing updates throughout the campaigns rather than trailing off.

  • Persuasive antismoking interventions: Promoting smoking reduction and cessation through Facebook, email-listserv, and MTurk

    From: Journal of Medical Internet Research

    Date Submitted: Dec 16, 2016

    Open Peer Review Period: Dec 22, 2016 - Feb 16, 2017

    Background: We employed persuasion strategies to develop and evaluate social media- and crowdsourcing-based interventions for smoking reduction and cessation. Objective: We delivered various levels of...

    Background: We employed persuasion strategies to develop and evaluate social media- and crowdsourcing-based interventions for smoking reduction and cessation. Objective: We delivered various levels of informational and social support to current smokers and pilot-tested the acceptability, feasibility and persuasion effects of three antismoking interventions, Facebook Group (information and social support), Email-Listserv (information), and MTurk (assessment only) interventions. Methods: We used Amazon Mechanical Turk (MTurk) to solicit potential participants (N=223). Among 173 applicants who confirmed their interest, 46 U.S.-based eligible smokers were randomly assigned to one of three conditions. During the 4-week intervention, participants in the Email-Listserv (n=15) and Facebook (n=16) conditions received 56 randomly-ordered antismoking information materials. The Facebook Group participants also had the opportunity to exchange social support with other group members. MTurk participants (n=15) did not receive these antismoking messages or social support. All participants completed a baseline survey, weekly surveys and a 2-week follow-up survey via MTurk. Results: We achieved 100% study retention: all participants engaged in their assigned intervention and completed final assessments. Intervention feasibility and acceptability scores were above average. Participants significantly reduced the number of weekly-smoked cigarettes measured at baseline and at follow-up, t(45)=9.51, p<.01, Md =80.91, SDd = 57.70, 95% CI=63.78-98.05, , and 12-18% quit smoking, with the Facebook group reporting the higher rate of quitting. Smoking reduction did not significantly differ across conditions, F(2,43)=1.56, p=.22. Perceived social support was significantly higher among Facebook Group participants (M=4.63, SD=.71), compared to Email-Listserv participants (M=3.64, SD=1.15) and MTurk participants (M=3.38, SD=1.32), F(2,43)= 5.79, p = .006, η²=.21. Sustained motivation to quit was a significant predictor of reduction in smoking when baseline smoking was adjusted, B=10.79, SE=5.27, F(1, 45)=4.18, p=.05, 95% CI=.12-21.47. Conclusions: We leveraged strategic persuasion principles as well as features of Facebook, Email, and MTurk to disseminate antismoking content, achieve rapid outreach to smokers in the US and facilitate social support among current smokers. These social media and crowdsourcing platforms were acceptable and feasible in delivering antismoking interventions, maintaining motivation to quit, and promoting smoking reduction and cessation. Our findings suggest that all three intervention platforms may be beneficial, but the social support within Facebook user groups may be particularly promising and deserves further research. Clinical Trial: NA

  • mHealth for Clinical Decision-making Support in sub-Saharan Africa: A Scoping Review

    From: JMIR mHealth and uHealth

    Date Submitted: Dec 17, 2016

    Open Peer Review Period: Dec 21, 2016 - Feb 15, 2017

    Background: In a bid to deliver quality health services in resource-poor settings, mobile technology is increasingly adopted (mHealth). The role of mHealth in facilitating evidence-based clinical deci...

    Background: In a bid to deliver quality health services in resource-poor settings, mobile technology is increasingly adopted (mHealth). The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms and evidence-based guidelines for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa, and lessons learned about their use in such settings, is yet to be established. Objective: The aim of this study was to synthesize evidence on the use of mHealth for point-of-care decision support and improved quality of care by health care workers in Africa. Methods: A scoping review of four peer-reviewed and one grey literature databases was conducted. No date limits were applied, but only articles in English language were selected. Using pre-established criteria, two reviewers screened articles and extracted data. Articles were analysed using Excel and MAXQDA. Results: Twenty-two articles representing eleven different studies in seven sub-Saharan African countries were retained. Interventions were mainly in the domain of maternal health and ranged from simple text messaging to complex multi-component interventions. Although health workers are generally supportive of mCDSS and perceive them as useful, concerns about increased workload and altered workflow hinder sustainability. Facilitators and barriers to use of mCDSS include technical and infrastructural support, ownership, health system challenges and training. Conclusions: The use of mobile clinical decision support systems in sub-Saharan Africa is an indication of progress in mHealth, although their effect on quality of service delivery is yet to be fully explored. Lessons learned are useful for informing future research, policy and practice for technologically supported health care delivery, especially in resource-poor settings.

  • Ivermectin treatment in patients with onchocerciasis-associated epilepsy: a randomized clinical trial

    From: JMIR Research Protocols

    Date Submitted: Dec 19, 2016

    Open Peer Review Period: Dec 19, 2016 - Feb 13, 2017

    Background: Many studies have reported an association between epilepsy, including Nodding Syndrome (NS), and onchocerciasis (river blindness). A high prevalence of epilepsy has been noted particularly...

    Background: Many studies have reported an association between epilepsy, including Nodding Syndrome (NS), and onchocerciasis (river blindness). A high prevalence of epilepsy has been noted particularly in onchocerciasis hyperendemic areas where onchocerciasis is not or insufficiently controlled with mass Ivermectin distribution. There is evidence that increasing the coverage of Ivermectin reduces the incidence of epilepsy and anecdotal evidence suggests a reduction in seizure frequency in onchocerciasis associated epilepsy (OAE) patients who receive Ivermectin. Finding an alternative treatment for epilepsy in these patients will have major consequences. Objective: To assess whether Ivermectin treatment leads to seizure freedom in OAE patients, including patients with NS. Methods: We will conduct a randomized clinical trial in the Democratic Republic of Congo (DRC) to compare seizure freedom in onchocerciasis infested epilepsy patients who receive immediate Ivermectin treatment with delayed (after four months) Ivermectin treatment. All participants will simultaneously receive anti-epileptic drugs (AEDs) according to local guidelines for epilepsy treatment. The primary endpoint is seizure freedom defined as no seizures during the fourth month of follow-up. Secondary endpoint is significant (>50%) seizure reduction compared to baseline seizure frequency. Results: Start of enrolment is planned from March 2017 and we expect to have enrolled all 110 participants by August 2017. Results are expected by the end of 2017. Conclusions: If Ivermectin treatment, in addition to AEDs, is able to lead to seizure freedom or significantly reduces seizure frequency in OAE patients this will have major consequences for epilepsy treatment in Onchocerciasis endemic regions. Ivermectin is donated for free, and in non Loa-Loa endemic regions has negligible side effects. Reducing the burden of epilepsy will have a major impact on quality of life and socio-economic status of families with affected members in Africa. Clinical Trial: WHO International Registry Network

  • How do apps work?: An analysis of app users’ perceptions of behavior change mechanisms

    From: JMIR mHealth and uHealth

    Date Submitted: Dec 21, 2016

    Open Peer Review Period: Dec 28, 2016 - Feb 22, 2017

    Background: Physical activity apps are commonly used to increase levels of activity and health status. The focus of research to date has been to determine the potential of apps to influence behavior,...

    Background: Physical activity apps are commonly used to increase levels of activity and health status. The focus of research to date has been to determine the potential of apps to influence behavior, to determine the efficacy of a limited number of apps to change behavior, and to identify characteristics of apps that users prefer. Objective: The purpose of this study was to identify the mechanisms by which apps may influence users’ behavior. Methods: This study used a cross-sectional survey of users of health apps during the past 6 months. An electronic survey was created in Qualtrics and deployed on Amazon Mechanical Turk. Individuals that had used a physical activity app in the past 6 months were eligible to respond. The final sample consisted of 207 adults living in the US. Behavior change theory informed the creation of 20 items relating to mechanisms of behavior change. Respondents also reported about engagement with the app(s) and their actual physical activity behavior. Results: Respondents reported that using a physical activity app in the past 6 months resulted in a change in their attitudes, beliefs, perceptions and motivation. Engagement with the app (P < .001), frequency of app use (P = .03), and app price (P = .01) were related to reported impact of the behavior change theory or mechanisms of change. The mechanisms of change were associated with significant changes in physical activity behaviors (P < .001). Conclusions: The findings from this study provide an overview of the mechanisms by which apps may impact changes in behavior. App developers may wish to incorporate these mechanisms in an effort to increase impact. Practitioners should consider the extent to which behavior change theory is integrated into a particular app when they consider recommendations to others wishing to increase levels of physical activity.

  • Identification and Prediction of COPD Exacerbations during Home Monitoring in a Clinical Trial

    From: Journal of Medical Internet Research

    Date Submitted: Dec 21, 2016

    Open Peer Review Period: Dec 28, 2016 - Feb 22, 2017

    Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive, chronic respiratory disease with a significant socioeconomic burden. Exacerbations, the sudden and sustained worsening of sym...

    Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive, chronic respiratory disease with a significant socioeconomic burden. Exacerbations, the sudden and sustained worsening of symptoms, can lead to hospitalisation and reduce quality of life. Major limitations of previous telemonitoring interventions for COPD include low compliance, lack of consensus on what constitutes an exacerbation, limited numbers of patients and short monitoring periods. We developed a telemonitoring system based on a digital health platform that was used to collect data from the one-year EDGE COPD clinical trial aiming at daily monitoring in a heterogeneous group of patients with moderate to severe COPD. Objective: Firstly, to develop a systematic and reproducible approach to exacerbation identification, and to track the progression of patient condition during remote monitoring; and secondly to develop a robust algorithm able to predict COPD exacerbation, based on vital signs acquired from a pulse oximeter. Methods: We used data from 110 patients, with a combined monitoring period of over 35,000 days. We propose a finite-state machine based approach for modelling COPD exacerbation to gain a deeper insight into COPD patient condition during home monitoring to take account of the time-course of symptoms. A robust algorithm based on short-period trend analysis and logistic regression using vital signs derived from a pulse oximeter is also developed to predict exacerbations. Results: Based on 27,260 sessions recorded during the clinical trial (average usage of 5.3 times per week for 12 months), there were 361 exacerbation events. There was considerable variation in the length of exacerbation events, with a mean length of 8.2 days. The mean value of oxygen saturation was lower, and both the pulse rate and respiratory rate were higher prior to an impending exacerbation episode, compared to stable periods. Based on the classifier developed in this work, prediction of COPD exacerbation episodes with 60-80% sensitivity will result in 68-36% specificity. Conclusions: All three vital signs acquired from a pulse oximeter (pulse rate, oxygen saturation and respiratory rate) are predictive of COPD exacerbation events, with oxygen saturation being the most predictive, followed by respiratory rate and pulse rate. Combination of these vital signs with a robust algorithm based on machine learning leads to further improvement in positive predictive accuracy. Clinical Trial: ISRCTN40367841

  • Continuous monitoring of vital parameters using wearable devices on the general ward: a pilot study

    From: Journal of Medical Internet Research

    Date Submitted: Dec 21, 2016

    Open Peer Review Period: Dec 28, 2016 - Feb 22, 2017

    Background: Background: Measurement of vital parameters in hospitalized patients is necessary to assess the clinical situation of the patient. Early Warning Scores (EWS), such as the Modified Early Wa...

    Background: Background: Measurement of vital parameters in hospitalized patients is necessary to assess the clinical situation of the patient. Early Warning Scores (EWS), such as the Modified Early Warning Score (MEWS), are generally calculated three times a day, but may not capture early deterioration. A delay in diagnosing deterioration is associated with increased mortality. Continuous monitoring with wearable devices might detect clinical deterioration at an earlier stage, which allows clinicians to take corrective actions. Objective: In this pilot study, the feasibility of continuous monitoring using the ViSi Mobile (VM) and HealthPatch (HP) was tested and experiences of patients and nurses were collected. Methods: In this feasibility study, twenty patients at the internal medicine and surgical ward were monitored with VM and HP simultaneously for 2-3 days. Technical problems were analyzed. Vital parameter measurements by nurses were taken as reference and compared with vital parameters measured by both devices. Patient and nurse experiences were obtained by semi-structured interviews. Results: In total, 86 out of 120 MEWS measurements were used for analysis. Predominant VM artefact (70%) was a connection failure. Over 50% of all HP artefacts had an unknown cause, were self-limiting and never took longer than one hour. Vital parameter measurements by VM and HP were generally consistent with nurse measurements. In 30% of the cases, clinical relevant differences in MEWS were found based on inconsistent respiratory rate registrations. The majority of patients, relatives, and nurses were positive about the VM and HP. Conclusions: Both VM and HP are promising for continuously monitoring vital parameters in hospitalized patients, if the frequency and duration of artefacts are reduced. The devices were well received and comfortable for most patients.

  • Too Far to Care? The Role of Psychological Distance in Online Public Attention and Fear for Ebola

    From: Journal of Medical Internet Research

    Date Submitted: Dec 22, 2016

    Open Peer Review Period: Dec 28, 2016 - Feb 22, 2017

    Background: In 2014 the world was startled by a sudden outbreak of Ebola. Despite only a handful of cases occurring in countries outside Guinea, Sierra Leone and Liberia, the epidemic caused a great s...

    Background: In 2014 the world was startled by a sudden outbreak of Ebola. Despite only a handful of cases occurring in countries outside Guinea, Sierra Leone and Liberia, the epidemic caused a great stir of seemingly irrational human responses among the public in Western countries. While previous research has shown the potential of social media to assess real-time public opinion and sentiment, generalizable insights that further theory development have remained lacking. The current study builds on Construal Level Theory to examine the relationship between physical distance to an epidemic, and public attention and sentiment expressed on Twitter. Objective: To increase theoretical understanding of the relationship between psychological distance to a health crisis, public attention and sentiment expressed on Twitter. Methods: Epidemiological (number of Ebola infections and fatalities) and media data (tweet volume and key events reported in the media) for the 2014 Ebola outbreak were during the outbreak, and Twitter content was coded across 3.5 months with regard to (1) expressions of fear for self or fear for others and for (2) psychological distance of the outbreak to the tweet source. Results: Findings revealed that online public attention and expressions of fear responded mainly to the psychological distance of the epidemic. A Chi square test showed a significant positive relation between proximity and fear: χ2=103.20 (p<.001). Public attention and fear for self in the Netherlands showed peaks when Ebola became physically closer by crossing the Mediterranean Sea and Atlantic Ocean. Fear for others was mostly affected by the social distance to the affected parties. Increases in public attention co-occurred with severe events related to the epidemic, but not all severe events evoked fear. Conclusions: We discuss the role of psychological distance as an important boundary determinant of public responses that needs to be taken into account when communicating about human tragedies.

  • Healthier Together: Using an Internet-Based Communication Campaign and Improvement Science to Build Engagement in a Learning Network

    From: Journal of Medical Internet Research

    Date Submitted: Dec 22, 2016

    Open Peer Review Period: Dec 28, 2016 - Feb 22, 2017

    Background: Network-based Learning Health Systems that facilitate patient, clinician and researcher collaboration are emerging as a means to improve health and the healthcare system. The first step to...

    Background: Network-based Learning Health Systems that facilitate patient, clinician and researcher collaboration are emerging as a means to improve health and the healthcare system. The first step to engaging in a network is becoming aware that one exists. Objective: Our objective was to determine whether an Internet-based communication campaign within a network focused on improving outcomes for children and adolescents with inflammatory bowel disease could be used as a strategy for engaging a broad base of stakeholders – patients, families, clinicians and researchers – in a peer-produced learning network. Methods: We developed an Internet-based communication campaign targeting all stakeholder groups (patients, families, clinicians, researchers) in the ImproveCareNow (ICN) Network. Using existing network communication channels and 56 ICN clinical care centers as distribution nodes, we aimed to collect 1,000 expressions of support for collaborative healthcare and ICN over 9 weeks. Participants were stakeholder groups (patients, families, clinicians, researchers) in the ICN Network. Outreach took place via social media, email, blogs, e-newsletters, list-serves, webinars, and ICN clinics. Individuals were asked to post an expression of support on the HealthierTogether.org microsite. We used quality improvement methods to evaluate outreach channels and strategies and guide subsequent outreach interventions. The main outcome and measures were the number of microsite visits, number of posted expressions of support, and microsite visit-to-posted expression conversion rate were tracked daily via run and controls charts to determine impact. Results: Over the course of 9 weeks, the microsite received 5,496 visits from 2,183 unique visitors and collected over 1,000 expressions of support for collaborative healthcare, including written statements, photos, and videos. Expressions came from all stakeholder groups, including patients/families/friends (48%), clinicians (30%), researchers (5%), and interested others (17%). Submissions included stories of the importance of collaboration in improving health and healthcare. Frequent, repeated prompting, direct requests from known individuals, and increasing urgency were related to increased postings. Conclusions: An Internet-based communication campaign using network communication channels and care centers can be an effective means of motivating awareness and simple participation in contributing to improvement in care and outcomes.

  • A cross-sectional survey investigating the use of mobile health to deliver self-management support in young people with type 1 diabetes

    From: JMIR Diabetes

    Date Submitted: Dec 22, 2016

    Open Peer Review Period: Dec 28, 2016 - Feb 22, 2017

    Background: Young people living with Type 1 Diabetes (T1D) not only face the challenges typical of adolescence, but also the challenges of daily management of their health and evolving understanding o...

    Background: Young people living with Type 1 Diabetes (T1D) not only face the challenges typical of adolescence, but also the challenges of daily management of their health and evolving understanding of the impact of their diagnosis on their future. Adolescence is a critical time for diabetes self-management with a typical decline in glycemic control increasing risk for microvascular diabetes complications. To improve glycemic control there is a need for evidence-based self-management support interventions that address the issues pertinent to this population utilizing platforms that engage them. Increasingly, mobile health (mHealth) interventions are being developed and evaluated for this purpose with some evidence supporting improved glycemic control. A necessary step to enhance effectiveness of such approaches is to understand young people’s preferences for this mode of delivery. Objective: A cross-sectional survey was conducted to investigate the current and perceived roles of mHealth in supporting young people to manage their diabetes. Methods: Young adults (16-24 years) with T1D in Auckland, New Zealand were invited to take part in an online survey via letter from their diabetes specialist. Results: A total of 115 young adults completed the survey (mean age=19.5, male=45%, European=77%) with all reporting owning a mobile phone and 96% of those were smartphones. However smartphone applications (apps) for diabetes management had been used by only 33% of respondents. The most commonly reported reason for not using apps was a lack of awareness that they existed. Although the majority felt they managed their diabetes well, 62% reported wanting to learn more about diabetes and how to manage it. Sixty four percent reported that they would be interested in receiving diabetes self-management support via SMS (text message). Conclusions: Current engagement with mHealth in this population appears low, although the findings from this study provide support for the use of mHealth in this group due to the ubiquity and convenience of mobile devices. mHealth has potential to provide information and support to this population utilizing mediums common place for this group and with greater reach than traditional methods.

  • Gathering opinions on depression information needs and preferences: Samples and opinions in clinic vs. Internet surveys

    From: Journal of Medical Internet Research

    Date Submitted: Dec 25, 2016

    Open Peer Review Period: Dec 28, 2016 - Feb 22, 2017

    Background: There has been limited research on the information needs and preferences of members of the public concerning treatment for depression. There has also been limited research comparing sampl...

    Background: There has been limited research on the information needs and preferences of members of the public concerning treatment for depression. There has also been limited research comparing samples and opinions when recruitment for surveys is done over the Internet (responding to a mass mailing or clicking on a link in a posted invitation) as opposed to being done with a personal invitation to complete a paper survey. Objective: This study aimed first to explore information needs and preferences among members of the public and second to compare Clinic and Internet samples on sample characteristics and survey findings. Methods: Internet survey participants were recruited with a notice on three self-help association websites (N=280). Clinic survey participants were recruited by a research assistant in the waiting rooms of a family medicine clinic and a walk-in medical clinic (N=238) and completed a paper version of the survey. Results: The Clinic and Internet samples were similar in age, education, and proportion in full time employment. The Clinic sample was more diverse in demographic characteristics and closer to the demographic characteristics of the region with a higher proportion of males (43% vs 16%) and non-Caucasians (29% vs. 14%). The Internet sample reported a higher level of emotional distress and had more previous psychological (80% vs. 35%) and pharmacological (72% vs, 24%) treatment. In terms of opinions, most respondents in both settings saw information on a wide range of topics around depression treatment as very important including information about treatment choices, effectiveness of treatment, now long treatment takes to work, how long treatment continues, what happens when treatment stops, advantages and disadvantages of treatments, and potential side effects. Females, respondents with a Caucasian background, and those who had received or felt they would have benefitted from therapy in the past saw more information topics as very important. Those who had received or thought they would have benefitted in the past from medication treatment saw fewer topics as important. Participants in both groups expressed an interest in receiving information through discussion with a counsellor or a physician, through written brochures, or through a recommended website. Conclusions: The recruitment strategies were helpful in obtaining opinions from members of the public with different concerns and perspectives, and the results from the two methods were complementary. Persons coping with emotional distress and individuals not specifically seeking help for depression would be interested in information to answer a wide range of important questions about depression treatment. The Clinic sample yielded more cultural diversity that is a closer match to the population. The Internet sample was less costly to recruit and included persons who were most interested in receiving information. Clinical Trial: NA

  • Pacing to increase physical activity for adults with ME/CFS: Are active video games a feasible and acceptable strategy? A protocol for a pilot randomised controlled trial.

    From: JMIR Research Protocols

    Date Submitted: Dec 30, 2016

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

    Background Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a serious illness of biological origin characterised by profound physical and cognitive exhaustion and post-exertion malaise....

    Background Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a serious illness of biological origin characterised by profound physical and cognitive exhaustion and post-exertion malaise. Pacing is a common strategy used to manage available energy and complete activities of daily living; yet little research has investigated this as a strategy to increase physical activity levels. Typically, people living with ME/CFS are faced by unique barriers to physical activity participation and are less physically active than healthy peers. As such they are at increased risk of physical inactivity-related health consequences. Active video games may be a feasible and acceptable avenue to deliver physical activity intervention by overcoming many of the reported barriers to participation. Objectives The primary objective of this pilot study is to determine the feasibility and acceptability of active video games to increase physical activity levels of people with ME/CFS. The secondary aims are to a) explore the effectiveness of pacing, versus pacing plus conventional physical activity versus pacing plus active video gaming to increase physical activity levels of people living with ME/CFS, and b) explore the relationship between physical activity and cumulative inflammatory load (allostatic load). Methods This study will utilise a mixed method design, with a 3-arm pilot randomised controlled trial, exit interviews and collection of feasibility and process data. Thirty adults with ME/CFS will be randomised to receive either a) pacing, b) pacing plus conventional physical activity or c) pacing plus active video gaming. The intervention duration will be 6 months and participants will be followed up 6 months post intervention completion. The intervention will be conducted in the participant’s home and activity intensity will be determined by continuously monitored heart rate and ratings of perceived exertion. Feasibility and acceptability and process data will be collected during and at the end of the intervention. Health-related outcomes (e.g. physical activity, blood samples, quality of life and functioning) will be collected at baseline, end of intervention and 6 months after intervention completion. Results Six months of extensive stakeholder and community consultation has been conducted to develop this protocol. The first participants are expected to be enrolled in January 2017. Conclusions This pilot study will provide essential feasibility and acceptability data which will guide the use of active video games for people with ME/CFS to increase their physical activity levels. Physical activity promotion in this clinical population has been poorly and under-researched, and any exploration of alternative physical activity options for this population is much needed. Registration: ANZCTR: 12616000285459, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370224

  • Mobile phone interventions for sleep disorders: A Systematic review and meta-analysis

    From: JMIR mHealth and uHealth

    Date Submitted: Dec 31, 2016

    Open Peer Review Period: Jan 3, 2017 - Feb 28, 2017

    Background: Although mobile health technologies have been developed for interventions to improve sleep disorders, evidence of their effectiveness remains limited. Objective: A systematic literature re...

    Background: Although mobile health technologies have been developed for interventions to improve sleep disorders, evidence of their effectiveness remains limited. Objective: A systematic literature review and subsequent meta-analysis were performed to: 1) examine current research trends in mobile technologies, and 2) determine the effectiveness of mobile technology interventions for improving sleep disorders. Methods: Four electronic databases (CINAHL, PubMed/ Medline, Scopus (EBSCO), and Web of Science) were searched for articles on mobile technology and sleep disorders published between January 2001 and December 2015. Studies were eligible for inclusion if they met the following criteria: adequate details on study design, focus on sleep intervention research, sleep index measurement outcome provided, and publication in peer-reviewed journals. A meta-analysis was conducted to examine the combined effect size and differences on the impact of mobile phone compared to traditional interventions on sleep disorders. Results: Nine eligible studies were evaluated to examine the impact of mobile phone interventions on sleep disorders. These included one case study, two pre/posttest studies, and six randomized control trials (RCTs). The studies were categorized as mobile ‘phone and traditional intervention’ or ‘smartphone application (apps) intervention’. All nine studies concluded that mobile phone interventions have the capability to attenuate sleep disorders. From the subgroup meta-analysis based on various sleep measurement tools, (i.e. PSQI (n=414); ISI, DBAS, SOL and WASO (n=445)), mobile phone interventions positively influence sleep quality, quantity, and sleep disorders. Conclusions: We found evidence to support the use of mobile phone interventions to address sleep disorders. Our findings suggest that mobile phone technologies can be effective for future sleep intervention research.

  • Critical Appraisal of E-Health Intervention for Anxiety Management in Youths

    From: Journal of Medical Internet Research

    Date Submitted: Jan 3, 2017

    Open Peer Review Period: Jan 11, 2017 - Mar 8, 2017

    Background: Advances in technology are progressively more relevant to the clinical practice of psychology and mental health services generally. Studies indicate that technology facilitates the deliver...

    Background: Advances in technology are progressively more relevant to the clinical practice of psychology and mental health services generally. Studies indicate that technology facilitates the delivery of interventions, such as Cognitive Behavioral Therapy (CBT), in the treatment of a number of psychological disorders in adults, including depression, anxiety, obsessive–compulsive disorder, panic symptoms, and eating disorders. Fewer data exist for computer-based (stand-alone; self-help) and computer-assisted (in combination with face-to-face therapy; therapist guided) programs in youths. Objective: This article summarizes and critically reviews the literature evaluating the acceptability and efficacy of using technology with treatment and prevention programs for anxiety in young children and adolescents. The aim is to improve the understanding of what would be critical for future development of effective technology-based interventions. Methods: A systematic literature search was conducted in three scientific electronic databases (including PsycINFO, Science Direct and PubMed). Keywords with various combinations were used: child/children, adolescent, pre-school children, anxiety, intervention or treatment or program, smartphone applications or apps, online or web-based tool, computer-based tool, serious games, cognitive behavioral therapy (CBT), biofeedback. Results: Available studies demonstrate promising results in reducing anxiety, especially relative to the application of CBT with technology. For those programs demonstrating efficacy, no difference was noted when compared with traditional intervention. Other approaches have been applied to technology-based interventions with inconclusive results. The majority of existing programs are developed to be used concurrently with traditional treatments and lack long term evaluation. Very little has been done in terms of prevention interventions. Conclusions: Future development of e-Health programs for the management of anxiety in children will have to address several unmet needs and overcome key challenges: although developmental stages may limit the applicability to preschool children, prevention should start in early ages; self-help format and personalization are highly relevant for large-scale dissemination; automated data collection should be built in for program evaluation and effectiveness assessment; a strategy to stimulate motivation to play and maintain high adherence should be carefully considered.

  • Framework for Clinical Validation of Heart Rate Apps

    From: Journal of Medical Internet Research

    Date Submitted: Jan 3, 2017

    Open Peer Review Period: Jan 3, 2017 - Feb 28, 2017

    Background: Photoplethysmography (PPG) is a proven way to measure heart rate (HR). This technology is already available in smartphones, which allows measuring HR only by using the smartphone. Given th...

    Background: Photoplethysmography (PPG) is a proven way to measure heart rate (HR). This technology is already available in smartphones, which allows measuring HR only by using the smartphone. Given the widespread availability of smartphones, this creates a scalable way to enable mobile HR monitoring. An essential precondition is that these technologies are as reliable and accurate as the current clinical (gold) standards. At this moment, there is no consensus on a gold standard method for the validation of HR applications. This results in different validation processes that not always reflect the veracious outcome of comparison. Objective: To investigate and describe the necessary elements in validating and comparing heart rate apps versus gold-standard technology. Methods: The FibriCheck application was used in two separate prospective, non-randomized studies. In the first study, the HR of the FibriCheck application was consecutively compared with two different FDA-cleared HR devices: the Nonin oximeter and the AliveCor Mobile ECG. In the second study, a next step in validation was performed by comparing the beat-to-beat intervals of the FibriCheck application to a synchronized ECG recording. Results: In the first study, the HR (beats/min) of 80 random subjects consecutively measured with the 3 devices showed a correlation coefficient of 0,856 between FibriCheck and Nonin, 0,937 between FibriCheck and AliveCor and 0,892 between Nonin and AliveCor. A single way ANOVA (p = 0.481) was executed to test the hypothesis that there was no significant difference between the heart rates as measured by the 3 devices. In the second study, 20298 RRI - PPI intervals (ms) from 229 subjects were analysed. A positive correlation of 0.993 was found between the PPI from FibriCheck and the RRI from the wearable ECG. There was no significant difference (p = 0.9215) between these intervals. Conclusions: The current findings suggest that the best suitable method for the validation of a HR app is a simultaneous measurement of the HR by the smartphone application and an ECG system, compared on the basis of beat-to-beat analysis. This approach could lead to very high accuracy in the clinical setting.

  • Detailed knowledge about HIV epidemiology and transmission dynamics and their associations with preventive and risk behaviors among gay, bisexual and other men who have sex with men in the United States

    From: JMIR Public Health and Surveillance

    Date Submitted: Jan 3, 2017

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

    Background: Gay, bisexual and other men who have sex with men (GBMSM) in the United States remain disproportionately impacted by HIV. Yet, their testing frequency is suboptimal and condomless anal sex...

    Background: Gay, bisexual and other men who have sex with men (GBMSM) in the United States remain disproportionately impacted by HIV. Yet, their testing frequency is suboptimal and condomless anal sex (CAS) is increasing. Behavioral theories posit that information about HIV/AIDS is a pivotal construct in individual risk reduction. However, measurements of knowledge have traditionally focused on whether one has ever heard about HIV, and being aware of the most common routes of spread. Objective: Using a national online sample of sexually active GBMSM, we sought to (1) quantify levels of detailed knowledge about HIV epidemiology and transmission dynamics, (2) describe variations in detailed knowledge levels across demographic strata, and (3) evaluate potential associations between increasing levels of detailed knowledge with HIV testing in the past year, and engaging in CAS with a male partner in the past 3 months. Methods: GBMSM were recruited through a social networking website (www.facebook.com) from August to September 2015, and asked 17 knowledge-based questions pertaining to the following two domains using an internet-based survey: HIV epidemiology (9 questions including statistics on incidence, prevalence, and distribution), and HIV transmission dynamics (8 questions including modes of spread, and per-act transmission probabilities). Ordinal domain-specific indices of detailed knowledge were created for each respondent by summing their number of correct responses. Separate cumulative logit models were used to identify factors independently associated with each of these indices, and multivariable logistic regression models were used to characterize associations with HIV testing history, and recently engaging in CAS. Results: Of the 1,064 participants in our study, only half (n=528, 50%) had tested for HIV in the past year, and almost half (n=509, 48%) had engaged in CAS with a male partner in the past 3 months. Majority scored 3 of 9 epidemiology questions correct (n=286, 27%), and 5 of 8 transmission dynamics questions correct (n=266, 25%). Participants younger than 35 years, of non-Hispanic non-White or Hispanic race/ethnicity, with lower educational levels, and who reported a sexual orientation other than homosexual/gay were significantly less knowledgeable about HIV transmission dynamics. Increasing levels of knowledge about this domain were independently associated with testing in the past year (adjusted odds ratio for each additional correct response: 1.10; 95% confidence interval: 1.01, 1.20), but not with recent CAS. Increasing knowledge about HIV epidemiology was not associated with either analytical outcome. Conclusions: Increasing detailed knowledge about HIV epidemiology might not be as important as educating those who are sexually active regarding transmission dynamics. Researchers and practitioners designing prevention messages targeting GBMSM should bear in mind that not all knowledge is equal, and that some aspects might have a greater positive impact than others. Future research to identify influential content and contemporary modes of delivery is needed.

  • E-Cigarette Perceptions in U.S. Geocoded Twitter Data

    From: JMIR Public Health and Surveillance

    Date Submitted: Jan 3, 2017

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

    Background: Background: E-cigarette use has grown rapidly in the U.S., and social media surveillance has been proposed as an innovative method for monitoring the public’s views of these products. Ob...

    Background: Background: E-cigarette use has grown rapidly in the U.S., and social media surveillance has been proposed as an innovative method for monitoring the public’s views of these products. Objective: This study uses U.S. geocoded twitter data to identify the diverse range of positive and negative perceptions associated with e-cigarettes and their use. More specifically, we identified a sample of tweets made within the U.S. related to e-cigarettes and applied a qualitative coding scheme to: a) identify the kinds of e-cigarette-related perceptions revealed by the naturally occurring discussions on Twitter; and b) determine which perceptions are most prevalent among a large sample of U.S. geocoded Tweets. Methods: A Python tool connecting to the Twitter streaming API was used to collect 4952 geocoded tweets originating within the U.S. referring to e-cigarettes. A qualitative coding scheme developed using inductive methods was used to explore perceptions expressed. Results: Positive perceptions included notions of trendiness, entertainment and relaxation, convenience, safety, and social desirability of e-cigarettes compared to traditional combustible cigarettes. Many tweets were suggestive of product substitution among traditional smokers. Social backlash against e-cigarette use was also evident, particularly among people using e-cigarettes for reasons other than as a substitute for traditional cigarettes. Other negative perceptions included complaints about e-cigarette use in places where traditional cigarette smoking is banned, dissatisfaction with the experience of e-cigarette use, and expressions of concern about the negative effects of e-cigarette use and marketing. Conclusions: Positive perceptions of e-cigarettes were mirrored by negative ones among tweets originating from the U.S., providing sentiments that can be confronted or tapped into by health communication campaigns and tobacco regulatory policies.

  • A health professional-led synchronous discussion in Facebook can provide personalized information and support but does not generate a peer-support network.

    From: Journal of Medical Internet Research

    Date Submitted: Jan 3, 2017

    Open Peer Review Period: Jan 6, 2017 - Mar 3, 2017

    Background: Arthritis is a major cause of pain and disability. Arthritis New Zealand is a non-government organization that provides advocacy, information, and advice and support services for people wi...

    Background: Arthritis is a major cause of pain and disability. Arthritis New Zealand is a non-government organization that provides advocacy, information, and advice and support services for people with arthritis in New Zealand. Since many people seek health information online Arthritis New Zealand has a webpage and a Facebook page. In addition to static content, Arthritis New Zealand provides synchronous discussions with an Arthritis Educator (AE) each week via Facebook. Objective: To determine how synchronous discussion with a health educator on a social media platform may provide information and support to people with arthritis and if such activity on social media can provide useful insights into consumers’ health care needs. Methods: Interpretive multi-methods were used. Facebook Analytics were used to describe the users of the Arthritis NZ Facebook page and provide descriptive summary statistics. Gephi and manual graphic analysis were used to summarise activity during a convenience sample of ten AE-led synchronous discussions. Principles of thematic analysis were employed to interpret transcripts of all comments from these ten weekly AE-led discussions. Results: Users of the Arthritis NZ Facebook page were predominately female (81%), aged 18-54 years. Three major activities occurred during AE-led synchronous discussions: (1) seeking or giving support; (2) information enquiry; and (3) information sharing across a broad range of topic areas, largely relating to symptoms and maintaining physical functioning. There was limited peer-to-peer interaction, with most threads consisting of two-comment exchanges between users and the AEs. Conclusions: The AE-led discussions provided a forum for informational and emotional support for users. The facilitated discussion forum for people with arthritis on Facebook could be enhanced by encouraging increased user participation and increasing peer-to-peer interactions, and further training of AEs in facilitation of online discussion. Future research should focus on addressing barriers to user participation and assessing the impact of AE facilitation training, with the latter leveraging the Action Research paradigm.

  • Mental & Emotional Self-Help Technology Apps: Their Efficacy and Theoretical Mechanisms of Behavior Change

    From: JMIR Mental Health

    Date Submitted: Jan 5, 2017

    Open Peer Review Period: Jan 6, 2017 - Mar 3, 2017

    Background: Mental and emotional self-help apps have emerged as potential mental illness prevention and treatment tools. The health behavior theory mechanisms by which these apps influence mental hea...

    Background: Mental and emotional self-help apps have emerged as potential mental illness prevention and treatment tools. The health behavior theory mechanisms by which these apps influence mental health-related behavior change has not been thoroughly examined. Objective: This study examines the theoretical mechanisms by which mental and emotional self-help apps change behavior. Methods: Cross-sectional survey of 150 users of mental or emotional health apps in the past six months. Survey questions included theory-based items, app engagement and likeability items, and behavior change items. Stata version 14 was used to calculate all statistics. Descriptive statistics were calculated for each of the demographic, theory, engagement and behavior variables. Multiple regression analysis was used to identify factors associated with reported changes in theory and separately for reported changes in actual behavior, after controlling for potentially confounding variables. Results: In multivariate regression analyses, engagement (P < .001) was positively associated with the reported changes in the theory items. In the multivariate regression model with behavior change as the dependent variable, theory was positively associated (p < .001) as were engagement (P = .004), frequency of app(s) use (P = .013), and income (P = .049). Conclusions: Participants’ reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. These increases in perceptions, beliefs, and attitudes surrounding their mental and emotional health were significantly associated with perceived change in behavior. There was a positive association between the level of engagement with the app(s) and the impact on theory items. Future efforts should consider the value of impacting key theoretical constructs when designing mental and emotional health apps. As apps are evaluated and additional theory-based apps are created, cost-effective self-help apps may become common preventative and treatment tools in the mental health field. Clinical Trial: N/A

  • Use of and beliefs about smartphone applications for diabetes self-management: surveys of people in a hospital diabetes clinic and diabetes health professionals in New Zealand

    From: JMIR mHealth and uHealth

    Date Submitted: Jan 4, 2017

    Open Peer Review Period: Jan 10, 2017 - Mar 7, 2017

    Background: People with diabetes mellitus (DM) are using smartphone applications (‘apps’) to support self-management. The numerous apps available to assist with diabetes management have a variety...

    Background: People with diabetes mellitus (DM) are using smartphone applications (‘apps’) to support self-management. The numerous apps available to assist with diabetes management have a variety of functions. Some functions, like insulin dose calculators, have significant potential for harm. Objective: 1. To establish if people with DM in Wellington, New Zealand, use apps for DM self-management and evaluate desirable features of apps. 2. To establish if health professionals (HPs) in New Zealand treating people with DM recommend apps to patients, the features HPs regard as important and confidence with recommending apps. Methods: A survey of patients seen at a hospital diabetes clinic over twelve months (n= 539) assessing current app use and desirable features. A second survey of HPs attending a diabetes conference (n=286) assessed confidence with app recommendations and perceived usefulness. Results: 19.6% (n=37) of the 189 responders (35.0% response rate) to the patient survey had used a diabetes app. App users were younger and more had Type 1 DM. App users most favoured feature was a glucose diary (86.5%, n=32/37), and an insulin calculator was the most desirable function for a future app (45.9%, n=17/37). In non-app users, the most desirable feature for a future app was a glucose diary (64.5%, n=98/152). Of the 115 responders (40.2% response rate) to the HPs survey 60.2% had recommended a diabetes app. Diaries for blood glucose levels and carbohydrate counting were considered the most useful app features and the features HPs felt most confident to recommend. HPs were least confident in recommending insulin calculation apps. Conclusions: The use of apps to record blood glucose was the most favoured function in apps used by people with diabetes, with interest in insulin dose calculating function. HPs do not feel confident in recommending insulin dose calculators. There is an urgent need for an app assessment process to give confidence in the quality and safety of diabetes management apps to people with diabetes (potential app users) and HPs (potential app prescribers).

  • Assess suicide risk and emotional distress in Chinese social media by natural language use

    From: Journal of Medical Internet Research

    Date Submitted: Jan 9, 2017

    Open Peer Review Period: Jan 13, 2017 - Mar 10, 2017

    Background: The mainstream assessment of individuals’ suicide risk or emotional distress relies on self-report scales or clinical assessments. Such assessment relies on individuals’ willingness an...

    Background: The mainstream assessment of individuals’ suicide risk or emotional distress relies on self-report scales or clinical assessments. Such assessment relies on individuals’ willingness and ability to seek help/treatment, which is often challenging for distressed or suicidal people. Objective: The present study explores how natural language can be utilized to proactively assess one’s suicide risk and emotional distress in Chinese social media. Methods: An online survey was conducted on Sina Weibo to assess the respondents’ suicide risk and emotional distress. With the respondents’ consent, we also downloaded all of their Weibo posts which were posted in the public domain during the 12 months prior to the survey by calling the Weibo API. Weibo posts were tokenized and language features were extracted by applying Simplified Chinese Linguistic Inquiry and Word Count (SC-LIWC). Logistic regression analysis were operated to examine the relationship between use of SC-LIWC categories and the respondents’ suicide risk with emotional distress. Support Vector Machines were trained to automatically classify whether a respondent was showing suicide risk or emotional distress. ROC curve analysis was operated for examining the diagnostic accuracy of the machine classifiers. Results: Weibo users with high suicide risk were marked by a higher usage of pronoun, prepend words, and multifunction words, a lower usage of verb, and a greater total word count. Severe depression was marked by more use of second-person plural and achievement-related words, but less use of work-related words. Anxiety was also marked by less use of work-related words. Stress was marked by more use of third-person and second-person plural, health-related words, and death-related word. and stress were marked by more use of second-person plural, and less use of work-related words. The machine classification on suicide risk and depression achieved satisfying results after adding a filter of Weibo suicide communication. However, the classification results for severe depression and stress were still not significant. Conclusions: The study demonstrates the utility of natural language as alternative assessment tool of suicide risk and emotional distress in Chinese social media. The current development can improve assessment coverage and efficiency but still requires experts’ inputs to increase accuracy. Clinical Trial: N/A

  • User and website characteristics related to attrition in a self-regulation-based eHealth intervention to promote a healthy lifestyle

    From: Journal of Medical Internet Research

    Date Submitted: Jan 6, 2017

    Open Peer Review Period: Jan 8, 2017 - Mar 5, 2017

    Background: EHealth interventions can reach large populations and are effective in increasing physical activity (PA) and fruit and vegetable intake. Nevertheless, the effects of eHealth interventions...

    Background: EHealth interventions can reach large populations and are effective in increasing physical activity (PA) and fruit and vegetable intake. Nevertheless, the effects of eHealth interventions are overshadowed by high attrition rates. Examining more closely when users decide to leave the intervention can help eHealth developers to make informed decisions about which intervention components should be reshaped or simply removed. Investigating which users are more likely to quit an intervention can inform developers about whether and how their intervention should be adapted to specific subgroups of users. Objective: This study investigates the pattern of attrition in a web-based intervention to increase PA, fruit and vegetable intake. The first aim is to describe attrition rates according to different self-regulation components. A second aim is to investigate if certain user characteristics are predictors for start session completion, returning to a follow-up session and intervention completion. Methods: The sample consisted of 549 adults who participated in an online intervention, based on self-regulation theory, to promote PA and fruit and vegetable intake, called ‘MyPlan 1.0’. Using descriptive analysis, attrition was explored per self-regulation component (e.g. action planning, coping planning, …). To identify which user characteristics predict completion, logistic regression analyses were conducted. Results: At the end of the intervention programme, there was an attrition rate of 78.2%. Attrition rates were very similar for the different self-regulation components. However, attrition levels were higher for the fulfilment of questionnaires (e.g. to generate tailored feedback) than for the more interactive components. The highest amount of attrition could be observed when people were asked to make their own action plan. There were no significant predictors for first session completion. Yet, two subgroups had a lower chance to complete the intervention, namely male users (OR: 2.24, 95% CI= 1.23-4.08) and younger adults (OR: 1.02, 95% CI= 1.00-1.04). Furthermore, younger adults were less likely to return to the website for the first follow-up after one week (OR= 1.03, 95% CI= 1.01-1.04). Conclusions: This study informs us that eHealth interventions should avoid the use of extensive questionnaires and that users should be provided with a rationale for several components (e.g. making an action plan, completing questions, …). Furthermore, future interventions should focus first on motivating users for the behaviour change, before guiding them through action planning. Though, this study provides no evidence for removal of one of the self-regulation techniques based on attrition rates. Lastly, strong efforts are needed to motivate male users and younger adults to complete eHealth interventions.

  • Towards understanding pain-monitoring electronic technologies for adults: a Systematic Literature Review

    From: Journal of Medical Internet Research

    Date Submitted: Jan 6, 2017

    Open Peer Review Period: Jan 9, 2017 - Mar 6, 2017

    Background: Remote monitoring of patients may decrease treatment costs and improve quality of care. Pain is the most common health problem that people seek help for in hospitals. Therefore, remote mon...

    Background: Remote monitoring of patients may decrease treatment costs and improve quality of care. Pain is the most common health problem that people seek help for in hospitals. Therefore, remote monitoring of patients with pain may have significant impact in improving treatment. Several studies have studied factors affecting pain, however, no previous study has characterized a patient’s situation through all the relevant contextual information that a monitoring system may capture. Objective: The objective of this study was to conduct a systematic review to (1) determine what types of technologies have been used to monitor adult patients with pain, and (2) construct a model of the context information relevant to pain monitoring that may be used to implement applications and devices aimed at monitoring patients with pain. Methods: A literature search (2005-2015) was conducted in electronic databases pertaining to medical and computer science literature (PubMed, Science Direct, ACM Digital Library, and IEEE Xplore), using a defined search string. Article selection was done through a process of removing duplicates, analyzing title and abstract, and then reviewing the full text of the article. Results: 87 articles were included in the final analysis and 53 of them (61%) used technologies to collect contextual information. 49 types of context information were found and a five-dimension model of context information to monitor patients was proposed, expanding a previous model. Most technological interfaces for pain monitoring are wearable, possibly because they can be used in more realistic contexts. Few studies focus on older adults, creating a relevant avenue of research on how to create devices for users that may have impaired cognitive skills or low digital literacy. Conclusions: The design of remote monitoring devices and interfaces for patients with pain must deal with the challenge of selecting relevant contextual information to understand the user’s situation, and not overburdening or inconveniencing users with information requests. A complete model of contextual information that a device can capture may be used by designers to review possible contextual information and choose which is relevant for a particular device.

  • Key Components in eHealth Interventions Combining Self-Tracking and Persuasive eCoaching to Promote a Healthier Lifestyle: a Scoping Review

    From: Journal of Medical Internet Research

    Date Submitted: Jan 9, 2017

    Open Peer Review Period: Jan 13, 2017 - Mar 10, 2017

    Background: The combination of self-tracking and persuasive eCoaching in automated interventions is a new and promising approach for healthy lifestyle management. Objective: This scoping review aims t...

    Background: The combination of self-tracking and persuasive eCoaching in automated interventions is a new and promising approach for healthy lifestyle management. Objective: This scoping review aims to identify key components of self-tracking and persuasive eCoaching in automated healthy lifestyle interventions that contribute to the effectiveness on health outcomes, usability, and adherence. A secondary aim was to identify the way in which the key components should be designed to contribute to improved health outcomes, usability, and adherence. Knowledge about these key components can be used during development of such healthy lifestyle interventions. Methods: The scoping review methodology proposed by Arskey and O’Malley was applied. Scopus, EMBASE, PsycINFO and PubMed were searched for publications between January 1st, 2013 – January 31st, 2016 that included (1) self-tracking, (2) persuasive eCoaching, and (3) healthy lifestyle intervention. Results: The search resulted in 32 publications of which 17 publications provided results on the effect on health outcomes, 27 studies provided results on usability and 13 studies provided results on adherence. Among the 32 publications, 27 described an intervention. The most commonly applied persuasive eCoaching components in the described interventions were personalization (n=24), suggestion (n=19), goal-setting (n=17), simulation (n=17), and reminders (n=15). Concerning self-tracking components, most interventions utilized an accelerometer to measure steps (n=11). In addition, the intervention was most often delivered via a smartphone (n=10). The following key components and their specific design both seem to influence health outcomes and usability in a positive way: reduction by setting short term goals to eventually reach long-term goals, personalization of goals, praise messages, reminders to input self-tracking data into the technology, use of validity tested devices, integration of self-tracking and persuasive eCoaching, and provision of face-to-face instructions during implementation. In addition, it did not seem to negatively affect health outcomes or usability when more effort was requested from participants to input data into the technology. Data extracted from the included publications limited the ability to provide key components on adherence. However, one key component identified for both usability and adherence was the provision of personalized content. Conclusions: This scoping review provides a first overview of the key components in automated healthy lifestyle interventions combining self-tracking and persuasive eCoaching that can be utilized during the development of such interventions. Future studies should focus on the identification of key components for effect on adherence as adherence is a prerequisite for an intervention to be effective.

  • Semantic location from mobile phones: Going beyond GPS

    From: JMIR mHealth and uHealth

    Date Submitted: Jan 10, 2017

    Open Peer Review Period: Jan 16, 2017 - Mar 13, 2017

    Background: Is someone at home, at their friend’s place, at a restaurant, or enjoying the great outdoors? Knowing the semantic location matters for delivering medical interventions, recommendations,...

    Background: Is someone at home, at their friend’s place, at a restaurant, or enjoying the great outdoors? Knowing the semantic location matters for delivering medical interventions, recommendations, and other context-aware services. This knowledge is particularly useful in mental healthcare for monitoring the behavioral indicators of mood states and improving treatment delivery. Local search-and-discovery services such as Foursquare can be used to detect semantic locations based on GPS coordinates, but GPS alone is often inaccurate. Smartphones can also sense other signals, such as movement, light, and sound, and using these signals promises to lead to a better estimation of the semantic location. Objective: To examine the ability of smartphone sensors in estimating semantic locations, and to evaluate the relationship between semantic location visit patterns and mental health. Methods: 208 participants across the United States were asked to log the type of locations they visited daily, including home and work, for a period of 6 weeks, while their phone sensor data was recorded. Based on the sensor data and Foursquare queries, we trained models to predict these logged locations, and evaluated their prediction accuracy on participants not seen by the model. We also evaluated the relationship between the amount of time spent in each semantic location and depression and anxiety, assessed at the baseline, in the middle, and at the end of the study. Results: While Foursquare queries detected the true semantic locations with an average area under the curve (AUC) of 0.60, using phone sensor data increased the AUC to 0.72. When we used Foursquare and sensor data together, the AUC further increased to 0.78. We found a few significant relationships between the time spent in certain locations and depression and anxiety, although these relationships were not consistent. Conclusions: The accuracy of location services such as Foursquare can significantly benefit from using phone sensor data besides their location databases. Our results suggest that the nature of the places we go to explains only a small part of the variance of anxiety and depression.

  • User testing of mobile apps and wearables to monitor rare disease in India

    From: Journal of Medical Internet Research

    Date Submitted: Jan 13, 2017

    Open Peer Review Period: Jan 14, 2017 - Mar 11, 2017

    Background: Remote monitoring may offer solutions for patients with limited access to clinicians, chronic disease sufferers who lives rurally or a great distance from specialist Doctors, and could off...

    Background: Remote monitoring may offer solutions for patients with limited access to clinicians, chronic disease sufferers who lives rurally or a great distance from specialist Doctors, and could offer a resolution to the data problem suffered in rare disease groups, where small populations and limited disease progression data exists. Objective: This was a user testing exercise coordinated with the Gauchers Association [UK] and the Lysosomal Storage Disorder Support Society [LSDSS] to explore the reception of remote monitoring using a wearable and mobile app with Type I Gauchers patients in India. Methods: Participants were provided with a wearable wristband that counts steps and a mobile app that collects additional health data. They had the opportunity to use these for a month before answering an online questionnaire about their experience of using the tech. Results: Six volunteers participated, with four becoming active users and responding to the questionnaires Conclusions: The mobile app and band collected information for all users. While the band was able to collect objective step data, some subjective measures in the app were identified as being more useful than others, and additional measurements were identified for future trials. The experience demonstrated that the tech could be successfully deployed in India and resulted in good engagement and adherence with patients. Clinical Trial: Not applicable

Advertisement