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Journal Description

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

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

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

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

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

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

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

 

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

    Authors List:

    Abstract:

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

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  • Enhancing Outcomes of Non-Communicable Diseases Care in Rural Settings and Refugee Camps: Could Low-cost mHealth Interventions Make a Difference?

    From: Journal of Medical Internet Research

    Date Submitted: Jul 24, 2017

    Open Peer Review Period: Jul 24, 2017 - Sep 18, 2017

    Background: Rural areas and refugee camps are characterized by poor access of patients to needed NCD-related health services, including diabetes and hypertension. Employing low-cost innovative eHealth...

    Background: Rural areas and refugee camps are characterized by poor access of patients to needed NCD-related health services, including diabetes and hypertension. Employing low-cost innovative eHealth interventions such as mobile health (mHealth) may help improve NCDs prevention and control among disadvantaged populations through delivering NCD-targeted care. Objective: Assess the effect of employing low-cost mHealth tools on the accessibility to health services and health outcomes of individuals with NCDs residing in rural areas and refugee camps in Lebanon. Methods: This is a randomized control trial study in which centers were allocated randomly into control and intervention sites. The effect of an employed mHealth intervention is assessed through selected quality indicators (QIs) examined in both control and intervention groups. Sixteen primary healthcare centers (8 controls, 8 interventions) located in rural areas and Palestinian refugee camps across Lebanon were included in this study. Data on diabetic and hypertensive patients- 1433 in the intervention groups and 926 in the control groups was extracted from patient files in the pre and post intervention periods. The intervention entailed weekly SMS messages including medical information, importance of compliance and reminders of appointments/ regular physician follow-up. QIs included results of Blood Pressure (BP), Glycosylated hemoglobin (HbA1c), smoking status, and dates of last visit for HbA1c testing, eye check-up, and foot exam. Descriptive analysis of baseline characteristics of participants, bivariate analysis, logistic regression, and linear regression were conducted using SPSS. Statistical significance was set at p-value of 0.05. Results: Bivariate analysis of QIs indicated that the intervention group had a significant increase in BP control (p= 0.03), as well as a significant decrease in the mean Systolic Blood Pressure (SBP) (p=0.02), mean HbA1c (p<0.01) and in the proportion of HbA1c poor control (p=0.02). Separate regression models controlling for age, gender, and setting, showed a 28% increase in the odds of BP control (p=0.05) and a 38% decrease in the odds of HbA1c poor control (p=0.04) among the intervention group in the post-test period. Females were at a lower odds of HbA1c poor control (p=0.01) and age was statistically associated with annual HbA1c testing (p<0.01). Regression models for mean SBP, mean Diastolic Blood Pressure, and mean HbA1c showed that a mean decrease in HbA1c of 0.87% (p<0.01) pre-test to post-test period was observed among the intervention group. Patients in rural areas belonging to the intervention group had a lower HbA1c score as compared to those in refugee camps (p<0.01). Conclusions: This study underlines the importance of employing integrative approaches of diseases prevention and control in which existing NCD programs in underserved communities (i.e. rural and refugee camps settings) can be coupled with innovative, low-cost approaches such as mHealth to provide an effective and amplified effect of traditional NCD-targeted care, that can be reflected by improved clinical outcomes among the population.

  • French validation of the Work Addiction Risk Test questionnaire

    From: JMIR Mental Health

    Date Submitted: Jun 30, 2017

    Open Peer Review Period: Jul 10, 2017 - Sep 4, 2017

    Background: Work addiction is a significant public health problem with a growing prevalence. The Work Addiction Risk Test (WART) is the gold standard questionnaire to detect “Workaholism”. Objecti...

    Background: Work addiction is a significant public health problem with a growing prevalence. The Work Addiction Risk Test (WART) is the gold standard questionnaire to detect “Workaholism”. Objective: The main objective was to validate the French version of the WART. Methods: Questionnaires were proposed to voluntary French workers using the Wittyfit software. There were no exclusions criteria. The questionnaire was administered anonymously for initial validity testing and readministered one week later for test-retest reliability. We also assessed the workers’ socio-demographic characteristics, as well as other measurements, for external validity such as stress, well-being, and co-addictions for tobacco, alcohol and cannabis. Several psychometric properties of the French-WART were explored: acceptability, reliability (internal consistency – Cronbach’s alpha coefficient, and reproducibility – Lin concordance coefficient), construct validity (correlation coefficients and principal component analysis) and external validity (correlation coefficients). Results: Among the 1580 workers using WittyFit, 187 (11.8%) agreed to complete the WART questionnaire. Of those, 128 completed the test-retest survey (68.5%). Acceptability found that all respondents had fully completed the questionnaire, with few floor or ceiling effects. Reliability was very good with a Cronbach’s alpha coefficient at 0.90 (internal consistency) and Lin concordance coefficient at 0.903 (95% CI 0.871–0.935) with a difference on the retest of 0.039±4.92 (95% CI -9.61–9.69) (reproducibility). We identified three main dimensions (construct validity). Relationships between the WART and stress and well-being confirmed its external validity. Conclusions: The French version of the WART is a valid and reliable instrument to assess work addiction, with satisfactory psychometric properties. Used in occupational medicine, this tool would allow the diagnosis of work addiction, and may be easily implemented in current practice. Clinical Trial: Clinicaltrials.gov: NCT02596737; https://www.clinicaltrials.gov/ct2/show/NCT02596737.

  • User-centered design of a mobile app for weight and health management in adolescents with complex health needs: A qualitative needs assessment

    From: Journal of Medical Internet Research

    Date Submitted: Jun 23, 2017

    Open Peer Review Period: Jun 25, 2017 - Aug 20, 2017

    Background: Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted towa...

    Background: Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted towards the development of these technologies for adolescents with complex health needs receiving specialized tertiary-level healthcare. Objective: The aim of the present study was to conduct a user-centered needs assessment of adolescents with complex health needs requiring specialized healthcare services and interested in weight management, their parents and healthcare providers, to inform the design and development of a mobile app for weight and health management. Methods: A qualitative study design was employed. Participants were recruited from 2 tertiary healthcare centres. Separate audio-taped focus group interviews were conducted with adolescents, parents and healthcare providers. Interviews were transcribed and field notes were collected by research staff. Iterative simple content analysis was performed independently by 4 research team members using computer software NVIVO 10.0. Results: 19 adolescents, 16 parents, and 21 healthcare providers were interviewed. Qualitative analysis revealed 7 major themes related to app functionality: healthy eating, social support, self-monitoring, communicating with healthcare professionals, supporting mental health, gamification and incentives, and user interface design. Adolescents provided several ideas related to each feature, while parents’ views focused on assistance with meal planning and greater access to healthcare professionals. Healthcare providers viewed the app as a novel and more acceptable platform to connect remotely with adolescents than conventional methods. They also strongly endorsed the value of social support capabilities and the ability to connect with a healthcare professional. Conclusions: This is the first study to conduct a qualitative needs assessment in adolescents receiving specialized healthcare services towards the design of a mobile app for weight and health management. Our results indicate that core components of the app should include tailored meal recommendations and assistance with meal planning, social networking for peer support, customized and convenient tracking, remote access to healthcare professionals, features to support mental health, and an attractive and engaging user interface. These findings will be used to develop and evaluate a mobile app targeting adolescents with complex health needs.

  • The Significance of “Witness Sensors”

    From: Journal of Medical Internet Research

    Date Submitted: Jul 4, 2017

    Open Peer Review Period: Jul 6, 2017 - Aug 31, 2017

    Due to the increasing number of natural and man-made disasters, mass casualty incident (MCI) events occur more often than ever before. As a result, the health providers need to adapt in order to cope...

    Due to the increasing number of natural and man-made disasters, mass casualty incident (MCI) events occur more often than ever before. As a result, the health providers need to adapt in order to cope with the overwhelming patient surge. On the quality and safety aspects of the health issues, the accurate information of pandemic disease control, death reduction, and health quality promotion should be further highlighted. Nevertheless, obtaining precise information in real-time is a hydra-headed challenge to all the researchers of the field. In this article, innovative strategies are presented, so to develop a sound information network by using the concept of “Witness Sensors” (WSs). In order to overcome the reliability and quality limitations of the information obtained by social media, researchers pay great attention to develop solutions that secure the authenticity of the messages, especially for matters related to health. In this research, we introduce a pioneering concept that is based on the two potential elements of “witness” and “sensor” to face the aforementioned matters. It is now more accepted than ever before, that the social media and any kind of information exchange through the internet is being transformed to a major communication tool for health providers and receivers. In this article, the WSs are designed to alleviate possible limitations and to distinguish fact from fiction in critical information matters. In order to enhance the health communication practices and deliver valid information to end users, the education and management of WSs should be further investigated, especially for the implementation of MCIs and epidemic outbreaks.

  • Behavioral and medical mechanisms that link diabetes to disability depend on the intersection of place and gender

    From: JMIR Diabetes

    Date Submitted: Jun 23, 2017

    Open Peer Review Period: Jun 25, 2017 - Aug 20, 2017

    Background: The mechanisms that link diabetes to disability may vary across populations. Objective: This study investigated gender by place differences in the behavioral and medical mechanisms behind...

    Background: The mechanisms that link diabetes to disability may vary across populations. Objective: This study investigated gender by place differences in the behavioral and medical mechanisms behind the link between diabetes (DM) and disability in eight countries. Methods: We borrowed data from Research on Early Life and Aging Trends and Effects (RELATE). This analysis included adults from eight countries including Barbados, Brazil, Costa Rica, Chile, Cuba, Puerto Rico, Mexico, and Uruguay. Diabetes was the independent variable, disability (activities of daily living) was the dependent variable, socioeconomics, obesity, health behaviors, and comorbidities were covariates, and gender was the moderator. We used country by gender specific- logistic regressions to test the effect of DM on disability after adjusting for socioeconomics (Model 1), socioeconomics, health behaviors, and obesity (Model 2), and socioeconomics, obesity, health behaviors, and medical comorbid conditions (Model 3). Results: Gender by country specific patterns of association between DM and disability were observed in Puerto Rico, Mexico, Brazil, Chile, and Cuba. In Puerto Rico, in men, DM – ADL could be explained by health behaviors and obesity, for women, however, the impact of DM on ADL was above all confounders for women. In Mexico, for men, DM was not associated with disability, however, for women, there was a link which could be explained by health behaviors and obesity. In Brazil, for men, DM – ADL limitation link could be fully explained by health behaviors and obesity, for women, however, DM was not associated with ADL at all. In Chile, for men, DM was not associated with ADL limitation, for women, however, there was an association between DM and ADL limitation which could not be explained by health behaviors, obesity, or comorbid medical conditions. In Cuba, for men, health behaviors and obesity fully mediated the effect of DM on ADL, for women, however, this link was mediated by comorbid medical conditions. Conclusions: Gender by place differences exist in the link between DM and disability, as well as behavioral and medical mechanisms behind such link. These findings advocate for the intersectionality approach in studying burden of illnesses such as DM.

  • Effects of mHealth and Wearable Activity Trackers to Promote Physical Activity among Healthy Children and Adolescents: A Systematic Review

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 27, 2017

    Open Peer Review Period: Jun 28, 2017 - Aug 23, 2017

    Background: A variety of children and adolescents are incapable to meet the current recommendations on physical activity (PA), with the result that health- related benefits of regular PA are not achie...

    Background: A variety of children and adolescents are incapable to meet the current recommendations on physical activity (PA), with the result that health- related benefits of regular PA are not achieved. Nowadays, technology-based programs represent an appealing and promising option for children and adolescents to promote PA. Objective: The present review systematically evaluated the effects of mobile health (mHealth) and wearable activity trackers on PA and related outcomes in this target group. Methods: Electronic databases CENTRAL, PubMed, Scopus, SPORTDiscus and Web of Science were searched to retrieve English language articles published in peer-reviewed journals from January 2012 to December 2016. Included were articles that contained descriptions of interventions designed to promote PA among children (6-12 years old) and/or adolescents (13-18 years old), and that measured at least one PA-related cognitive, psychosocial, or behavioral outcome. The interventions had to be based on mHealth tools (mobile phones, smartphones, tablets or mobile applications) or wearable activity trackers. Randomized controlled trials (RCTs) and non-randomized controlled trials, cohort studies, before-and-after studies, and cross-sectional studies were considered, but only controlled studies with PA comparison between groups were assessed for methodological quality. Results: In total, 831 articles were identified. Finally, 7 studies (5 with tools of mHealth, 2 with wearable activity trackers) met the inclusion criteria. All studies with tools of mHealth used a RCT design, and 3 were of high methodological quality. Intervention delivery ranged from 4 weeks to 12 months, whereby mainly smartphone applications were used as tool(80%). Intervention delivery in studies with wearable activity trackers covered a period from 22 sessions during school recess and 8 weeks. Trackers were used as intervention and evaluation tool. No evidence was found for the effect of mHealth tools respectively wearable activity trackers on PA-related outcomes. Conclusions: Given the small number of studies, poor compliance with accelerometers as measuring instrument for PA, risk of bias, missing RCTs in relation to wearable activity trackers, and the heterogeneity of intervention programs, caution is warranted regarding the comparability of the studies and their effects. There is a clear need for future studies to develop PA interventions grounded on intervention mapping with a high methodological study design for specific target groups to achieve meaningful evidence.

  • Texting condolences: adapting mHealth programs after unexpected pregnancy and infant outcomes

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 26, 2017

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

    SMS messaging programs for maternal and child health need to adapt and make available messaging for miscarriage, stillbirth and infant loss....

    SMS messaging programs for maternal and child health need to adapt and make available messaging for miscarriage, stillbirth and infant loss.

  • Smartphone applications for mindfulness interventions with suicidality in Asian youths: Evidence is lacking

    From: Journal of Medical Internet Research

    Date Submitted: Jun 27, 2017

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

    Background: Background: The advent of mobile technology has ushered in an era where smartphone applications can be used for intervention for suicidality. Objective: Objective: Review recent research r...

    Background: Background: The advent of mobile technology has ushered in an era where smartphone applications can be used for intervention for suicidality. Objective: Objective: Review recent research relevant to smartphone application that can be used for mindfulness intervention for suicidality in Asian youths. Methods: Methods: The inclusion criteria for this review is papers published in peer reviewed journals from 2007 to 2017 with usage of search terms namely ‘smartphone application’, and ‘mindfulness’, assessed against the inclusion criteria and screened by an experienced Asian clinician to be of clinical utility for mindfulness intervention for suicidality with Asian youths. Results: Results: Initial search on databases yielded 375 results. 14 Full text papers that fit the inclusion criteria were assessed for eligibility and 10 papers were included in the current review. Conclusions: Conclusions: This review highlighted the paucity of evidence-based and empirically validated research into effective smartphone applications that can be used for mindfulness interventions for suicidality with Asian youths. Clinical Trial: NA

  • Mobile Health (mHealth) Applications and Self HealthCare Management: Perspective of Iranian Female Patients

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 29, 2017

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

    Background: Mobile technologies are rapidly developing both in developed and developing country. Though, the main purpose of using smart phones, especially in developing countries, are for everyday co...

    Background: Mobile technologies are rapidly developing both in developed and developing country. Though, the main purpose of using smart phones, especially in developing countries, are for everyday communication, there are great potentials for using these devices for self-health care management notably in rural areas. Mhealth can be a major pathway for promoting telemedicine among rural woman who have restrictions such as time for their self-health care management. This paper analyzes the perspectives of women in rural areas of Iran to understand their perspectives regarding the best ways of employing a smart phone app for self-healthcare management. Objective: To assess the attitudes and preferences of rural Iranian female patients regarding various functionalities a mobile app should play on increasing their health literacy, adherence to medication and improving their self-care management. Methods: This is a descriptive, cross-sectional study collected data from 460 female patients visited " Health Houses" located in rural areas of Ardabil and Isfahan provinces. The respondents were selected randomly. The data collection tool is a questionnaire designed by the authors. Validity (content and form) and reliability (Spearman- Brown with r=0.83) includes two categories of questions: background and questions regarding the role of mobile information-communication apps. Data were analyzed by SPSS software. Results: This research shows the high willingness of Iranian female patients living in rural areas to use mobile apps for increasing their health literacy, to access and store their medical records, set appointments, and receive and pay their medical bills. The patients expressed little tendency to use mobile apps for accessing online reviews, and having virtual visits and consultation with their physicians. In general, they have medium trust to mobile apps, and they prefer to use mobile apps developed and run by a clinic or hospital and not a third party. In regard to methods a mobile app can increase their adherence to medication, the patients prefer receiving information on their diets and diseases over receiving alerts to take medication. Conclusions: This paper shows the tendency of female patients toward using mobile apps for establishing telemedicine systems in rural areas which access to medical and educational centers is hard. This paper will be a leading guideline for the development of mobile health apps in compatible with the needs of users and patients, specially vulnerable populations of developing countries.

  • Medication Adherence and Technology-based Interventions for Adolescents with Chronic Health Conditions: A Few Key Considerations

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 28, 2017

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

    Background: Not applicable Objective: Not applicable Methods: Not applicable Results: Not applicable Conclusions: Not applicable Clinical Trial: Not applicable...

    Background: Not applicable Objective: Not applicable Methods: Not applicable Results: Not applicable Conclusions: Not applicable Clinical Trial: Not applicable

  • A systematic literature review of models used in clinical decision support systems supporting healthcare professionals treating diabetic foot ulcers

    From: Journal of Medical Internet Research

    Date Submitted: Jun 30, 2017

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

    Background: Diabetic foot ulcer is one of the most devastating late diabetic complications. Many randomised controlled trials on the different wound care elements have been conducted and published in...

    Background: Diabetic foot ulcer is one of the most devastating late diabetic complications. Many randomised controlled trials on the different wound care elements have been conducted and published in the Cochrane Library, all of which have only a low evidential basis. Thus, healthcare professionals are forced to rely on their own experience when making decisions regarding the treatment of diabetic foot ulcers. To progress from experience-based practice to evidence-based wound care practice, clinical decision support systems that help healthcare providers with decision-making in a clinical workflow have been developed. These systems have proven useful in many areas within the healthcare sector, partly because they have increased the quality of care, and partly because they have generated a solid basis for evidence-based practice. However, no systematic reviews focus on clinical decision support systems within the field of diabetic foot ulcer care. Objective: The aims of this systematic literature review are to identify models used in clinical decision support systems that specifically support healthcare professionals treating diabetic foot ulcers, to classify each clinical decision support model according to selected variables and to create an overview. Methods: A systematic review was conducted using six databases. This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic reviews. The following aspects were extracted from each article: authors, year, country, sample size of data and variables describing the type of clinical decision support models. The decision support models were described and classified according to the variables. Results: The final number of studies included in the systematic literature review was 10: the ten clinical decision support models included four quantitative decision support models and six qualitative decision support models. The earliest eligible article was published in 2007, and the most recent article was from 2015. Conclusions: The clinical decision support models were targeted at a variety of different types of chronic wounds. The degree of accessibility of the inference engines varied. Quantitative models served as the engine and were invisible to the healthcare professionals, while qualitative models required interaction with the user. None of the decision support models focused specifically on supporting healthcare professionals treating diabetic foot ulcers. Clinical Trial: The protocol for this systematic literature review was registered on PROSPERO with the registration no.: CRD42017068495 and is available in full on ( http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017068495).

  • Development of eHOME, a mobile instrument for reporting, monitoring and consulting drug-related problems in homecare: a human-centered design study.

    From: JMIR mHealth and uHealth

    Date Submitted: Jun 29, 2017

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

    Background: Homecare patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, homecare could add to the multidisciplinary...

    Background: Homecare patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, homecare could add to the multidisciplinary expertise of general practitioners and pharmacists. The Homecare Observation of Medication-related problems by homecare Employees (HOME)-instrument is paper-based and assists homecare workers in reporting potential DRPs. To facilitate the multiprofessional consultation a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between homecare and general practices and/or pharmacies is desired. Objective: The objective of this study was to develop eHOME, a mobile version of the HOME-instrument including a monitoring and consulting system for primary care. Methods: The development phase of the Medical Research Council Framework was followed in which an iterative human-centered design (HCD) approach was applied. The approach involved a Delphi-round for context of use and user requirements analysis of the digital HOME-instrument and the monitoring and consulting system followed by two series of pilots for testing the usability and redesign. Results: By using an iterative design approach and by involving homecare workers, general practitioners and pharmacists throughout the process letting them hold the roles as informants, design partners and testers, important aspects that were crucial for system realization and user acceptance were revealed. Through the report web page interface which includes adjusted content of the HOME-instrument and added homecare practice based problems, homecare workers can digitally report observed DRPs. Furthermore it was found that the monitoring and consulting web page interfaces enables digital consultation between homecare and general practices and/or pharmacies. The web pages were experienced as convenient, clear, easy and usable. Conclusions: By employing a HCD approach, the eHOME-instrument was found to be an easy to use system. The systematic approach promises a valuable contribution for future development of digital mobile systems of paper-based tools.

  • Validation, in real conditions of use, of a sensor for Parkinson's Disease, which detects motor fluctuations and does not require previous calibration.

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 3, 2017

    Open Peer Review Period: Jul 4, 2017 - Aug 29, 2017

    Background: Using a single kinematic sensor worn on the waist, a new algorithm has been developed which combines information on gait bradykinesia and dyskinesia to detect motor fluctuations (On and Of...

    Background: Using a single kinematic sensor worn on the waist, a new algorithm has been developed which combines information on gait bradykinesia and dyskinesia to detect motor fluctuations (On and Off periods) without the need of being calibrated for each individual patient. Objective: The objective of the present study is to study the validity of this algorithm under real conditions of use. Methods: Validation study of the motor-fluctuations algorithm, on a sample of 23 patients with advanced Parkinson’s Disease. Patients were asked to wear the kinematic sensor for 1 to 3 days at home, while in parallel keeping a diary of their On and Off periods. Researchers were not present during the test period. Patients carried on their usual daily activities. The algorithm detections were compared with patient’s records, which were used as gold standard. Results: The algorithm produced 37% more results than patients’ records. The sensitivity of the algorithm to detect Off periods, compared with patients’ records, was 92% (IC95%: 87.33% - 97.3%) and the specificity was 94% (IC95%: 90.71% - 97.1%). Conclusions: The motor-fluctuation detecting algorithm is an accurate tool for outpatient monitoring of Parkinson patients with difficult-to-control motor fluctuations.

  • Usability and Usefulness Study of a Mobile Health App for Promoting Breastfeeding in Thailand

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 13, 2017

    Open Peer Review Period: Jul 13, 2017 - Sep 7, 2017

    Background: Breastfeeding is proven to have lasting health benefits for both mothers and infants, however, exclusive breastfeeding rate up to 6 months remains below 20% in Thailand. Although the numbe...

    Background: Breastfeeding is proven to have lasting health benefits for both mothers and infants, however, exclusive breastfeeding rate up to 6 months remains below 20% in Thailand. Although the number of research and commercial apps for breastfeeding women is significantly growing, they are country-specific and restricted to English-speaking users. There exists a major knowledge gap on how mobile health apps could support breastfeeding in Thailand. To address these gaps, MoomMae is developed with the intention to support Thai women in breastfeeding outside of their homes and in keeping their feeding records. Objective: To evaluate the usability and usefulness of MoomMae, a smartphone app designed to support breastfeeding women. Methods: A total of 21 breastfeeding women with at least one Android phone or tablet were recruited via convenience and snowball sampling. Each participant was requested to attend a pre-use interview and given the app to use for 4 weeks. Following this period, a post-use interview was conducted to examine the usability and usefulness of the app. Both sessions were held individually and audio-recorded for qualitative analysis. Results: The mean scores of usability and usefulness from the post-use survey were 4.33 (SD 0.87; range 1-5) and 4.60 (SD 0.74; range 2-5). Our qualitative analysis revealed a total of 137 feedbacks: 71 related to usability and 66 associated with usefulness. A further sentimental analysis showed that comments on usability were generally negative (59 negative, 11 positive, and 1 neutral) and comments on usefulness were relatively positive (56 positives, 9 negative, and 1 neutral). We discovered 26 unique design issues and proposed recommendations for future improvement. Conclusions: Our usability and usefulness assessment of MoomMae demonstrated that MoomMae is easy to use and offer great potential to be a useful self-management tool for breastfeeding mothers in Thailand. The qualitative analysis suggested that the app is supportive of breastfeeding on demand, but the flow and inputs of the app should be redesigned to be more intuitive. For future implementations, the most desirable feature is a pump-reminding notification system.

  • The Promise of Patient Portals for Adolescent Research

    From: Journal of Medical Internet Research

    Date Submitted: Jul 3, 2017

    Open Peer Review Period: Jul 4, 2017 - Aug 29, 2017

    Background: While adolescents can receive confidential health care without parental/guardian notification, they are rarely asked about their experiences and opinions regarding their care because parti...

    Background: While adolescents can receive confidential health care without parental/guardian notification, they are rarely asked about their experiences and opinions regarding their care because participation in research often requires parental consent. Anonymous research with adolescents via confidential patient portals may ameliorate this research gap. Objective: Because use of a confidential online adolescent patient portal is high at one academic institution, we hypothesized that adolescents would also respond to this portal for survey-based research. We sought to anonymously ask adolescents without parental consent about their knowledge, opinions and perceptions regarding their health and health care, including information on a long-acting reversible contraceptive (LARC). A secondary aim was to examine if and how adolescents use their patient portal to consider research participation. Methods: Upon receiving IRB approval, we sent two portal-based surveys about confidential services to two groups of females, ages 14-25 years, who had attended an adolescent clinic in the past three years. This clinic mostly serves Medicaid recipients (80%) and is racially and ethnically diverse with patients evenly divided between African-American and Caucasian, with roughly 10% Hispanic. The control group was a random sample of female patients who never received a LARC (n=150) and the intervention group included all female adolescents who had received a LARC from the same clinic (n=107). This second sample was manually cross-checked to confirm they had an office visit for this insertion. Consenting for themselves, the control group received an email through the patient portal with a link and a request to perform an assessment. The survey for the control group included items assessing health literacy and health communication preferences. The survey for the intervention group included health literacy items as well as items to assess their opinions and perceptions regarding their LARC. We tracked click-through rates and opened messages; each participant received four reminders. Results: While only three participants fully completed either survey, email ‘read rates’ (32.6% of LARC recipients and 37.5% of controls) were encouraging. Additionally, of those who opened the messages, almost twice as many of the LARC recipients (45.4%) read the entire survey as compared to those who received the survey asking about health literacy and health care preferences (22.2%). Conclusions: This study did not yield sufficient participation to understand these adolescents’ preferences. However, the methodology of using adolescent portals for online surveys was promising. Future studies need to test if a different survey topic would engage adolescents or if other methods like text-based reminders would improve participation.

  • Peer-based Social Media Features in Behaviour Change Interventions: A Systematic Review

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 3, 2017

    Open Peer Review Period: Jul 4, 2017 - Aug 29, 2017

    Background: Incorporating social media features into Digital Behaviour Change Interventions has the potential to contribute positively to their success. However, the lack of clear design principles to...

    Background: Incorporating social media features into Digital Behaviour Change Interventions has the potential to contribute positively to their success. However, the lack of clear design principles to describe and guide the use of these features in behavioural interventions limits cross-study comparisons of their use and effect. Objective: This work provides a systematic review of digital behaviour change interventions targeting modifiable behavioural risk factors which have incorporated social media features as part of their intervention infrastructure. A taxonomy of social media features is presented to inform the development, description and evaluation of behavioural interventions. Methods: Search terms were used in eight databases to identify digital behaviour change interventions that incorporated social media features and targeted tobacco smoking, diet & nutrition, physical activities or alcohol consumption. The screening and review process was performed by two independent researchers. Results: 5264 articles were screened and 143 articles describing a total of 134 studies were retained for full review. Most studies reported positive outcomes with regards to their respective objectives and hypothesis. Few studies reported on the association between the inclusions of social media features and intervention effect. A taxonomy of social media features used in behavioural interventions has been presented with thirty-six social media features organised under seven high level categories. The taxonomy has been used to guide the analysis of this review. Conclusions: Although social media features are commonly included in digital behaviour change interventions, there is an acute lack of information with respect to their effect on outcomes and a lack of clear guidance to inform the selection process based on features’ suitability for the different behaviours. The proposed taxonomy along with the set of recommendations included in this review will support future research aimed at isolating and reporting the effects of social media features in digital behaviour change interventions, cross-study comparisons and evaluations.

  • An Efficient Automated Classification Approach for Free-text Medical Narratives using Word Embedding and Convolutional Neural Networks

    From: Journal of Medical Internet Research

    Date Submitted: Jul 20, 2017

    Open Peer Review Period: Jul 21, 2017 - Sep 15, 2017

    Background: Automated disease code classification using free-text medical information is important for public health surveillance. However, traditional natural language processing (NLP) pipelines are...

    Background: Automated disease code classification using free-text medical information is important for public health surveillance. However, traditional natural language processing (NLP) pipelines are limited, so a method combining word embedding with a convolutional neural network (CNN) is proposed. Objective: We conducted a classification task identifying chapter-level ICD-10-CM diagnosis codes in discharge notes and compared the performance of traditional pipelines (NLP + supervised machine learning models) with that of word embedding combined with a CNN. Methods: Two classification methods are presented: (1) some features (terms, n-gram phrases, and SNOMED CT categories) are extracted from discharge notes and used to train a set of supervised machine learning models (support vector machine, random forests, and gradient boosting machine); (2) a feature matrix is built by a pre-trained word embedding model and used to train a CNN. These methods were used to identify the chapter-level ICD-10-CM diagnosis codes in a set of discharge notes. An evaluation was conducted using 103,390 discharge notes covering patients hospitalized from June 1, 2015 to January 31, 2017 in the Tri-Service General Hospital. The receiver operating characteristic curve was used as an evaluation measure, and the area under the curve (AUC) was taken as a global measure of effectiveness. Results: In five-fold cross-validation tests, our method had a higher testing accuracy (a mean AUC of 0.9696) than traditional NLP-based approaches (a mean AUC of 0.8183–0.9571). A real-world simulation that split the training sample and testing sample by date verified this result (a mean AUC of 0.9645 using the proposed method). Further analysis showed that the convolutional layers of the CNN effectively identified a large number of keywords and automatically extracted enough concepts to predict the diagnosis codes. Conclusions: Word embedding combined with a CNN shows outstanding performance compared with traditional methods, and it needs hardly any data pre-processing. This shows that future studies will not be limited by incomplete dictionaries. A large amount of unstructured information from free-text medical writing will be extracted by automated approaches in the future, and we believe that the healthcare field is about to enter the age of big data.

  • Development of e-Health Literacy Assessment (eHLA): a seven tool toolkit for assessesing the competencies needed to engage with digital health services

    From: Journal of Medical Internet Research

    Date Submitted: Jul 7, 2017

    Open Peer Review Period: Jul 7, 2017 - Sep 1, 2017

    Background: Digitalisation of health care systems has added a new dimension to health care services. To gain full potential of digitalization in healthcare, we need to better understand individuals’...

    Background: Digitalisation of health care systems has added a new dimension to health care services. To gain full potential of digitalization in healthcare, we need to better understand individuals’ e-health literacy. However, there is a lack of tools that provide a short and multi-facetted assessment of individuals engaging with digital health services. Objective: n response to this, the authors initiated the development and validation of the e-Health Literacy Assessment (eHLA) toolkit. eHLA consists of seven tools with four health-related (tool 1. “Functional Health Literacy”, tool 2. “Self-rated health literacy”, tool 3. “Familiarity with health and disease”, and tool 4. “Knowledge of health and disease”) and three digitally-related (tool 5. “Digital familiarity”, tool 6. “Digital confidence”, tool 7. “Digital motivation”) tools. The seven tools are a mix of existing, adapted, and original scales. Methods: eHLA was validated in a population sample of 475 respondents from the general community and an outpatient clinic north of Copenhagen, Denmark. Initial statistical analyses examined floor and ceiling effects, inter-item correlations, item-total correlations, calculation of Cronbach’s coefficient alpha (CCA), and further analyses examined fit of the data to the Rasch model (RM) and evaluated differential item functioning (DIF) with regards to age and sex. Each tool was reduced in items based on a combination of statistics results, face validity, and content validity. Results: Tool 1 was not reduced in items, and it consequently consists of 10 items. The overall fit to the RM was acceptable (Andersens CLR=10.8, df=9, p=0.2876), and CCA was 0.67. Tool 2 was reduced from 20 to nine items. The overall fit to a log linear RM was acceptable (Andersens CLR=78.4, df=45, p=0.0015) and CCA was 0.85. Tool 3 was reduced from 23 to five items. The final version of tool 3 consists of five items and showed excellent fit to a log linear RM (Andersens CLR=47.7, df=40, p = 0.1870). CCA was 0.90. Tool 4 was reduced from 12 to six items. The fit to a log linear RM was acceptable (Andersens CLR=42.1, df=18, p=0.0011) and CCA was 0.59. Tool 5 was reduced from 20 to six items. The fit to the RM was acceptable (Andersens CLR=30.3, df=17, p=0.0240) and CCA was 0.94. Tool 6 was reduced from five to four items. The fit to a log linear RM taking local dependency into account was acceptable (Andersens CLR=26.1, df=21, p=0.2031) and CCA was 0.91. Tool 7 was reduced from six to four items. The fit to a log linear RM taking LD and DIF into account was acceptable (Andersens CLR=23.0, df=29, p=0.7760) and CCA was 0.90. Conclusions: The eHealth Literacy Assessment toolkit is a validated set of tools to describe facets of individuals’ knowledge and skills in the engagement with digital health services.

  • ‘Wish you were here’: Examining assumptions about missing cases from psychotherapeutic trials

    From: JMIR Mental Health

    Date Submitted: Jul 6, 2017

    Open Peer Review Period: Jul 12, 2017 - Sep 6, 2017

    Background: Missing cases are common in clinical psychotherapeutic trials, and pose a challenge to the accuracy of measuring clinical outcomes [1]. However, little is known about the characteristics o...

    Background: Missing cases are common in clinical psychotherapeutic trials, and pose a challenge to the accuracy of measuring clinical outcomes [1]. However, little is known about the characteristics of psychotherapy participants with missing values, their likely clinical outcomes, or suitability of different statistical assumptions that can characterise missing cases. Objective: Using a large sample, undergoing psychotherapy for depressive symptoms (n=820), this study aimed to explore the characteristics of missing cases (n=138), their likely treatment outcomes, and compare between statistical methods for replacing missing values. Methods: Initially, common participant and treatment features were tested through binary logistic regression, identifying variables that predict missing cases. Secondly, the same variables were screened for their ability to increase, or impede the rate of symptom remission. Third, using recontacted cases at three-month follow-up, to proximally measure treatment outcomes, simulated replacement scores and observed clinical outcomes were compared. Results: Missing cases were dominantly predicted by lower treatment adherence and increased symptoms at pre-treatment, and report symptom that are 30% higher than average at follow-up. Longitudinal statistical methods (GEE or MIXED models) that adjusted their estimates for missing values by treatment adherence rates and baseline symptoms severity (under the MAR assumption), predicted follow-up missing cases outcomes minimal measurement bias (<8%). Conclusions: Missing cases demonstrated characteristics, which can jointly be associated with likelihood of becoming missing and lesser clinical improvement. Under such circumstances, treatment effects can become concealed. Statistical methods that ignore these characteristics can overlook an important clinical phenomenon and generate inaccurate treatment outcome replacement estimates (-32% to 70% off the mark).

  • Training Working Memory in Adolescents using Serious Game Elements

    From: JMIR Serious Games

    Date Submitted: Jul 6, 2017

    Open Peer Review Period: Jul 6, 2017 - Aug 31, 2017

    Background: Working memory capacity (WMC) has been found to be impaired in adolescents with various psychological problems, such as addictive behaviors. Training of WMC can lead to significant behavio...

    Background: Working memory capacity (WMC) has been found to be impaired in adolescents with various psychological problems, such as addictive behaviors. Training of WMC can lead to significant behavioral improvements, but is usually long and tedious, taxing motivation. Objective: We evaluated whether adding game elements to the training could help improve adolescents’ motivation to train while improving cognition. Methods: Eighty-four high school students were allocated to a WMC-training, a gamified WMC-training or a placebo condition. WMC, motivation to train, and drinking habits were assessed before and after training. Results: Self-reported evaluations did not show a self-reported preference for the game, but participants in the gamified WMC-training condition did train significantly longer. The game successfully increased motivation to train, but this effect faded over time. WMC increased equally in all conditions, but did not lead to significantly lower drinking. Conclusions: We recommend that future studies attempt to prolong this motivational effect, as it appeared to fade over time.

  • Identifying Asbestos-Containing Materials in Homes: Design and Development of the ACM Check Mobile Phone App

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 12, 2017

    Open Peer Review Period: Jul 13, 2017 - Sep 7, 2017

    Background: Asbestos-containing materials (ACM) can still be found in many homes in Australia and other countries. ACMs present a health risk when they are damaged or disturbed, such as during do-it-y...

    Background: Asbestos-containing materials (ACM) can still be found in many homes in Australia and other countries. ACMs present a health risk when they are damaged or disturbed, such as during do-it-yourself home renovations. However, there remains a lack of knowledge and awareness amongst community members about asbestos identification and its safe management in residential settings. Objective: To describe the process of developing a mobile phone application (“app”), ACM Check, that incorporates a questionnaire designed to identify and assess asbestos-containing materials located in residential settings. Methods: A multidisciplinary team was involved in the formative development and creation of the mobile phone app. The formative development process included 6 steps: defining the scope of the app; comprehensive desktop review; drafting and revising the content, questionnaire, conditional branching rules and scoring algorithms; expert input; manual pre-testing of the questionnaire; and formulation of a final content document to be provided to the software development company. ACM Check was then constructed on the iOS platform for use in a validation study prior to being updated, replicated on Android, and released to the public. Results: The ACM Check app identifies potential ACMs, prioritises the materials based on their condition and likelihood of disturbance, and generates a summary report for each house assessed. Conclusions: ACM Check is an initiative to raise community members’ awareness of asbestos in the residential environment and also serves as a data collection tool for epidemiological research. It can potentially be modified for implementation in other countries or used as the basis for the assessment of other occupational or environmental hazards.

  • Cell phones and HIV linkage to care: Lessons from a randomised clinical trial

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 7, 2017

    Open Peer Review Period: Jul 9, 2017 - Sep 3, 2017

    The high availability of cell phones and the growing access to internet-enabled ‘’smart’’ phones in developing countries, has led to interest in using the technology to improve patient engagem...

    The high availability of cell phones and the growing access to internet-enabled ‘’smart’’ phones in developing countries, has led to interest in using the technology to improve patient engagement with health care. In HIV treatment programmes, the ‘’cascade of care’’, where patients are lost between diagnosis, laboratory evaluation, treatment initiation and then subsequent retention on antiretroviral therapy, is a well described challenge. We evaluated a smart phone application (“app”) in a randomised controlled trial, to evaluate whether giving patients their confidential laboratory results through the app and with attendance reminders, improved engagement with care after initial HIV diagnosis. The results are being prepared for publication, but here we describe in detail the significant operational and technological issues we experienced within the study, that severely hampered recruitment, despite a large majority of patients approached expressing interest in the study. We found that many of the issues around software installation, as well as data availability, meant that only 10% of newly diagnosed HIV patients could install the app on their phones. These issues may assist future programmes planning similar interventions to avoid some of the pitfalls we encountered, including having to take into account the large variety of cell phones, software platforms, and available memory being used by the patient population we drew from, as well as issues such as data cost. Ensuring sufficient expertise and understanding of the programmatic needs by the software developer, as well as in the implementation team, with adequate and rapid piloting within the target groups, may have ensured better recruitment. That said, the majority of newly diagnosed patients were interested in the study, and the app was installed successfully and used, in patients with sufficiently powerful cell phones, suggesting that this may be a way to engage patients with their health care data in future.

  • Internet- and mobile-based general practice: Who are the suitable consultants?

    From: Journal of Medical Internet Research

    Date Submitted: Jul 7, 2017

    Open Peer Review Period: Jul 9, 2017 - Sep 3, 2017

    Background: As a promising technology for the promotion of quality healthcare, mHealth is increasing in the world. To make full use of the advantages, an increase of internet hospitals established in...

    Background: As a promising technology for the promotion of quality healthcare, mHealth is increasing in the world. To make full use of the advantages, an increase of internet hospitals established in China. However, there is no study of the service scope and patient satisfaction of the internet hospital yet. Objective: The aim of the study was to explore the features of outpatients in general practice clinic of the internet hospital in order to provide the references for general practitioners (GPs) who will work for online clinic. Methods: Data were collected from the internet hospital of the first affiliated hospital, Zhejiang University between February 2016 and February 2017. Patients logon the internet hospital with the computer or mobile phone. The information included patients’ characteristics and the information of diseases. Results: There were totally 715 visits. According to the system classification, the former five ones were musculoskeletal system (12.73%), the digestive system (11.33%), the reproductive system (9.23%), urinary tract (7.69%) and the endocrine system (6.58%). According to the management, 451 patients (63.08%) should visit the offline clinic, 181 patients (25.31%) had received medication or test appointment, 9 people (1.26%) should use emergency department, and 74 people (10.35%) need supportive counseling. All patients received the corresponding health education. According to the diagnosis, 563 patients (78.74%) are diagnosed, while 152 individuals (21.26%) are medically unexplained physical symptoms (MUPS). Conclusions: Internet- and mobile-based online practice is feasible and convenient for patients with high satisfaction. Patients with chronic disease, health consultation and health education are suitable for internet hospital.

  • Use of social network services for communication among health professionals: a systematic review

    From: Journal of Medical Internet Research

    Date Submitted: Jul 20, 2017

    Open Peer Review Period: Jul 20, 2017 - Sep 14, 2017

    Background: Social network services (SNSs) are subject to tremendous exploitation in health communication. Although much research has been done investigating the roles of SNSs in linking patients and...

    Background: Social network services (SNSs) are subject to tremendous exploitation in health communication. Although much research has been done investigating the roles of SNSs in linking patients and health professionals, there is a lack of evidence on their uses, benefits and limitations in connecting health professionals. Objective: This review aimed to examine the utilization of SNSs for communication among health professionals in (1) frontline clinical practice, (2) professional networks and (3) education and training, so as to identify areas for future health communication research. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search of the literature published in the last ten years (1 January 2007–1 March 2017) was performed in March 2017, using the following electronic databases: Medline via OvidSP, Embase, CINAHL Complete and InfoSci Journals. The searches were performed using the following defined search terms: ‘social media’ OR ‘social network’ OR ‘social network site’ OR ‘Facebook’ OR ‘Twitter’ OR ‘Linkedin’ OR ‘Instagram’ OR ‘Weibo’ OR ‘Whatsapp’ OR ‘Telegram’ OR ‘WeChat’ AND ‘health’ OR ‘health profession’. Results: A total of 32 studies were included in this review. They were exploratory in nature, and the majority utilized surveys, interviews and content analysis. The most reported SNSs were Twitter, Facebook, WhatsApp Messenger and LinkedIn. All retrieved studies stated that SNSs enhanced effective communication and information sharing. In clinical practice, SNSs were used for supporting operations, making referrals, and disseminating guidelines. They were beneficial in network building and professional collaboration. SNSs were novel tools to enhance educational interactions among peers, students, instructors and preceptors. Yet, the application of SNSs for professional communication came with restraints in technical knowledge and techniques. Concerns regarding data protection, privacy and liability should be addressed by proper institutional policy and training. Conclusions: SNSs create a new dimension in communication among health professionals. Expanding professional networks, disseminating multimedia information and producing positive learning experiences are the benefits observed. The evolving use of SNSs necessitates that health professionals match the pace of development. Further robust research such as randomized controlled trials is required to explore the full potential and relative effectiveness of SNSs in professional communication.

  • Feasibility of a Smart Phone Application Supporting Recovery from Addiction in China

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 10, 2017

    Open Peer Review Period: Jul 11, 2017 - Sep 5, 2017

    Background: Mobile health technologies have been shown to improve self-management of chronic diseases. However, there is limited research investigating its feasibility in supporting recovery from subs...

    Background: Mobile health technologies have been shown to improve self-management of chronic diseases. However, there is limited research investigating its feasibility in supporting recovery from substance use disorders (SUDs) in China. Objective: Mobile health technologies have been shown to improve self-management of chronic diseases. However, there is limited research investigating its feasibility in supporting recovery from substance use disorders (SUDs) in China. Methods: A total of 75 participants with SUDs in Shanghai were recruited to participate in the pilot study lasting 4 weeks, with 50 participants randomly assigned to the experimental group and 25 participants to the control group. The experimental group used m-health based ecological momentary assessment (EMA) technology to assess their daily drug use in natural environments, while the control group only received 2 short health messages each day from the app. Urine test and life experience timeline (LET) assessment were conducted at each week and a post-intervention survey was conducted for both groups. The correspondence between EMA and LET data were investigated. Results: The mean age of our participants was 41.6 years, and 70.7% were male. During 4 weeks of observation, 690 daily EMA survey data were recorded with the response rate being 49.3%. The percent agreement of drug use between EMA and LET was 66.7%, 79.2%, 72.4%, and 85.8% for each of the 4 weeks, and the correspondence between EMA and urine test was 51.2%, 65.1%, 61.9%, 71.5%. Post-intervention survey indicated that participants (45.7%) preferred to use face-to-face interview rather than m-health app. Conclusions: This study demonstrated a good concordance between EMA data and LET, but the acceptance of m-health among SUDs in China was not optimistic. Much more efforts are needed to improve its acceptance in China.

  • Investigating the Use of Smartphones for Learning Purposes by Iranian Dental Students

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 10, 2017

    Open Peer Review Period: Jul 10, 2017 - Sep 4, 2017

    Background: The use of smartphones for teaching and learning purposes is increasingly being developed in the field of dentistry. Objective: This study aims to investigating the use of smartphones for...

    Background: The use of smartphones for teaching and learning purposes is increasingly being developed in the field of dentistry. Objective: This study aims to investigating the use of smartphones for learning purposes by iranian dental students. Methods: This is a descriptive study. The population of study consists of the general students of The Faculty of Dentistry of Ahvaz Jundishapur University of Medical Sciences (AJUMS) located in south west of Iran. Sampling was practiced through census and by distributing questionnaires between all cases. Totally, 109 cases (64 females and 45 males) filled the questionnaire. Data was analyzed using SPSS 21. Results: Surfing course-related websites in the Internet and sharing notes with each other are the most frequent used items accounting for 96% and 94% of smartphone use, respectively. In addition, 91% of cases believe that smartphone improves their access to the content of courses. Moreover, 95% of cases have access to social media, especially Telegram, via their smartphone and acknowledge its usefulness in the education field. There was a positive correlation between the use of smartphones for general purposes and the use of them for learning purposes (0.483). In addition, the correlation between age and the use of smartphones for general purposes and between age and the use of smart phones for learning purposes is negative (-0.279). Conclusions: The use of smartphones for learning purposes or combining traditional educational approaches and e-teaching methods, including smartphones, can provide students with more diverse learning opportunities. Clinical Trial: The use of smartphones for learning purposes or combining traditional educational approaches and e-teaching methods, including smartphones, can provide students with more diverse learning opportunities.

  • Case Study: Implementing an Open Source Electronic Health Record (EHR) System in Secondary Care in Kenya

    From: Journal of Medical Internet Research

    Date Submitted: Aug 17, 2017

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

    Background: The Kenyan government, working with international partners and local organisations, has developed an e-Health strategy, specified standards and guidelines for EHR adoption in public hospit...

    Background: The Kenyan government, working with international partners and local organisations, has developed an e-Health strategy, specified standards and guidelines for EHR adoption in public hospitals, and implemented two major health IT projects: DHIS2, for collating national healthcare indicators, and HMIS (using KenyaEHR and IQCare), for managing 600 HIV clinics across the country. Following these projects, a modified version of the OpenMRS EHR system was specified and developed to fulfil the clinical and administrative requirements of primary and secondary healthcare facilities operated by devolved counties and to automate the process of collating healthcare indicators and entering them into the DHIS2 system. Objective: To present a case study of the implementation of an open source Electronic Health Record (EHR) system in secondary care facilities in Kenya. Methods: We conducted a landscape review of existing literature concerning e-Health policies and EHR development in Kenya. Following initial discussions with the Ministry of Health, WHO and implementing partners, we conducted a series of visits to implementing sites to conduct semi-structured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. Results: This case report describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital IT infrastructure, training users and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of socio-technical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. Conclusions: Implementing EHR systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. We hope this case study will provide some lessons and guidance for other challenging implementations of EHR systems as they continue across Africa.

  • Raising awareness about cervical cancer using Twitter: a content analysis of the 2015 #SmearForSmear campaign

    From: Journal of Medical Internet Research

    Date Submitted: Jul 12, 2017

    Open Peer Review Period: Jul 13, 2017 - Sep 7, 2017

    Background: Cervical cancer is the 2nd cause of cancer among women under age 45. To deal with the decrease of smear test (ST) coverage in United Kingdom, a Twitter campaign called #SmearForSmear has b...

    Background: Cervical cancer is the 2nd cause of cancer among women under age 45. To deal with the decrease of smear test (ST) coverage in United Kingdom, a Twitter campaign called #SmearForSmear has been launched in 2015 for the European Cervical Cancer Prevention Week. Its aim was to encourage women to take a selfie showing their lipstick going over the edge and post it on Twitter with a raising awareness message promoting cervical cancer screening. Estimated audience was 500 million of people. Other public health campaigns have been launched on social medias such as Movember to encourage participation and self-engagement. Their result was unsatisfactory as their aim had been diluted to become mainly a social buzz. Objective: Our objectives were to identify the tweets delivering a raising awareness message promoting cervical cancer screening (sensitizing tweets) and the characteristics of Twitter users posting about this campaign. Methods: 3-step content analysis of the English tweets tagged #SmearForSmear posted on Twitter for the 2015 European Cervical Cancer Prevention Week. Data were collected using Twitter API. Their extraction was based on an analysis grid generated by two independent researchers using a thematic analysis, validated by a strong Cohen’s kappa coefficient. 7 themes coded for sensitizing tweets and 13 for Twitter users’ status. Verbatims were thematically then statiscally analyzed. Results: 3018 tweets were collected, 1881 analysed. 70% of tweets had been posted by people living in United Kingdom. 57.4% of users were women, sex was unknown in 36% of cases. 54.4% of the users had posted at least one selfie with smeared lipstick. 32.2% of tweets were sensitizing. Independent factors associated with posting sensitizing tweets were: woman who experienced an abnormal ST (OR 13.456 [CI95% 3.101-58.378], p = 0.0005), female sex (OR 3.752 [CI95% 2.133-6.598], p < 0.0001) and live in the United-Kingdom (OR 2.097 [CI95% 1.447-3.038], p < 0.0001). Non-sensitizing tweets were statistically more posted by non-health or non-media company (OR 0.558 [CI95% 0.383-0.814], p = 0.0024). Conclusions: This study demonstrates that the success of a public health campaign using a social media depends on its ability to get its targets involved. It also suggests the need to use social marketing to help its dissemination. The clinical impact of this Twitter campaign to increase cervical cancer screening is yet to evaluate.

  • Digital health interventions in type 2 diabetes: a qualitative study of patient perspectives on digital diabetes self-management education and support

    From: Journal of Medical Internet Research

    Date Submitted: Jul 13, 2017

    Open Peer Review Period: Jul 14, 2017 - Sep 8, 2017

    Background: The prevalence of type 2 diabetes is increasing globally and health services in many countries are struggling with the morbidity, mortality and costs associated with the complications of t...

    Background: The prevalence of type 2 diabetes is increasing globally and health services in many countries are struggling with the morbidity, mortality and costs associated with the complications of this long-term condition. Diabetes self-management education and behavioural support can reduce the risks of developing diabetes-related complications and improve glycaemic control. However, their uptake is low. Digital health interventions can provide sustained support and may overcome challenges with attendance at diabetes self-management sessions. They have the potential for delivery at multiple locations at convenient times, anonymity, and presentation of content in attractive and tailored formats. This study investigates the needs and wants of patients with type 2 diabetes to inform the development of digital self-management education and support. Objective: To explore patient perspectives on unmet needs for self-management and support and the role of digital health interventions in adults living with type 2 diabetes. Methods: Qualitative study based on data generated from four focus groups with 20 patients. Results: The data generated by the focus groups illustrated the significant burden that the diagnosis of diabetes places on many patients and the negative impacts on their emotional wellbeing, work, social life and physical health. Although patients’ experiences of the health care services varied, there was agreement that even the best services were unable to meet all users’ needs to support the emotional regulation and psychological adjustment needed for successful self-management. Conclusions: By focusing on medical management and information provision, existing healthcare services and education programmes may not be adequately meeting all the needs of patients with type 2 diabetes. Digital health interventions have the potential to improve access to diabetes self-management education and behavioural support and extend the range of content offered by health services to fit with a wider range of patient needs. Features that could help digital health interventions meet some of the unmet needs described by participants in this study included placing an emphasis on emotional and role management, being available at all times, having up-to-date evidence based guidance for patients and providing access to peer-generated and professional advice.

  • Creating a Predictive Model for employee turnover utilizing behavioral risk factors extracted from an employer-based Happiness app

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 13, 2017

    Open Peer Review Period: Jul 14, 2017 - Sep 8, 2017

    Background: In the past, significant research has been directed towards predicting churn of customers, particularly in the telecoms industry. However, few works have addressed the equally important qu...

    Background: In the past, significant research has been directed towards predicting churn of customers, particularly in the telecoms industry. However, few works have addressed the equally important question of employee turnover in companies and none have been able to create a predictive model to manage retention Objective: To identify turnover risk factors of employees. Methods: Using a smartphone Happiness application that tracks Happiness, we applied search-engine like classification methods (such as Google page ranking algorithm) to rank employees by risk of turnover. We set a risk cut-off to cluster employees in two groups: the ones that turn over and the ones that stay in the company. Then we used the top discriminant traits of each group to identify risk factors. The data source is the employee interaction with a mobile app that is used to track happiness. Sample size: 4k employees. Time length: 2 years. Participating companies: 34. Results: We developed a turnover prediction model that identifies employees that turnover with Sensitivity 34% and Specificity 99.4%. Predictive value of the positive test is 80%. Predictive value of the negative test= 96%. Test set contained 116 churns, test set sample size 1944 employees. Risk factors related to app usage are identified. Conclusions: The top three risk factors related to employee churn are low number of likes received in the anonymous company forum (low employee comment likeability), infrequent company posts (disengaged company), lower happiness than the company average (low relative happiness). Other factors such as absolute individual happiness, or likes given to other's anonymous post (positivity and engagement of the employee) was not found to be correlated with turnover. Clinical Trial: Does not apply

  • Reproducibility and Validation of the Qardioarm Application in the Assessment of Blood Pressure and Heart Rate: Reliability and ValidityStudy

    From: Journal of Medical Internet Research

    Date Submitted: Jul 13, 2017

    Open Peer Review Period: Jul 17, 2017 - Sep 11, 2017

    Background: Self-measurement of blood pressure is a priority strategy for managing blood pressure. Objective: Following the European Society of Hypertension’s international validation protocol, we e...

    Background: Self-measurement of blood pressure is a priority strategy for managing blood pressure. Objective: Following the European Society of Hypertension’s international validation protocol, we evaluated the reliability and validity of blood pressure and heart rate as measured with the Qardioarm, a fully automatic, non-invasive wireless blood pressure monitor and mobile application. Methods: Test-retest validation study, with two measurement sessions separated by 2-5 days. A single study site with an evaluation room that was maintained at an appropriate temperature and kept free from noises and distractions. 100 healthy volunteers over age 25 from the general population of Ciudad Real, Spain. In each measurement session, 7 systolic blood pressure, diastolic blood pressure, and heart rate assessments were taken, alternating between two devices. The test device was the Qardioarm and the previously validated criterion device was the Omron M3. Results: The Qardioarm displayed very consistent readings both within and across sessions (intraclass correlation coefficients = .80-.95, standard errors of measurement = 2.5-5.4). The Qardioarm measurements corresponded closely to those from the criterion device (Pearson correlations > .96) and mean values for the two devices were nearly identical. The Qardioarm easily passed all validation standards set by the European Society of Hypertension international protocol. Conclusions: The Qardioarm can be recommended for clinical use in individuals with similar characteristics as those who participated in this study. Clinical Trial: IT IS NOT A CLINICAL TRIAL

  • Using a Web-based Transitions Intervention to Help Informal Caregivers of Older Adults with Dementia and Multiple Chronic Conditions: A Qualitative Study

    From: Journal of Medical Internet Research

    Date Submitted: Jul 14, 2017

    Open Peer Review Period: Jul 14, 2017 - Sep 8, 2017

    Background: Informal caregivers (ie, family members and friends) play a vital role in the ongoing care and well-being of older persons with Alzheimer disease and related dementia (ADRD) in combination...

    Background: Informal caregivers (ie, family members and friends) play a vital role in the ongoing care and well-being of older persons with Alzheimer disease and related dementia (ADRD) in combination with multiple chronic conditions (MCC) who are living at home. However, they often do so to the detriment of their own physical, mental and emotional health. Caregivers often experience multiple, concurrent transitions (eg, changes to their roles and responsibilities). Recent evidence suggests that Web-based interventions have the potential to support informal caregivers by decreasing caregiver stress and burden. However, we know little about how Web-based supports help caregivers deal with the complex transitions they experience. Objective: The objectives of this paper were to describe: (a) how the use of a self-administered, psychosocial, supportive, Web-based Transition Toolkit, My Tools 4 Care (MT4C), helped informal caregivers of older adults with ADRD and MCC deal with the transitions they experienced as caregivers; (b) which features of MT4C caregivers found most and least beneficial; and (c) what changes would they would recommend making to MT4C. Methods: This study was part of a larger multi-site mixed methods pragmatic randomized controlled trial (RCT). The qualitative portion of the study and the focus of this article used a qualitative descriptive design. Data collectors conducted semi-structured, open-ended, telephone interviews with study participants who were randomly allocated to use MT4C for 3 months. All interviews were audio-taped and ranged from 20-40 minutes. Interviews were conducted at 1 and 3 months following a baseline interview. Qualitative content analysis was used to analyze collected data. Results: Fifty-six informal caregivers from Alberta and Ontario, Canada, participated in either 1 or both of the follow-up interviews (89 interviews in total). Five main themes, describing how MT4C helped caregivers deal with transitions in the context of caring for an older adult with ADRD and MCC, were identified: (1) using MT4C encouraged reflection; (2) using MT4C encouraged sharing of caregiving experiences; (3) using MT4C provided a source of information and education; (4) using MT4C provided affirmation; and (5) for some participants, using MT4C did not help with significant changes. Conclusions: Study results indicate that a self-administered psychosocial supportive Web-based resource helps caregivers of community-dwelling older adults with ADRD and MCC deal with the complex transitions they experience in their roles and responsibilities, identifying supports for caring, caring for self, and planning for future caregiving roles and responsibilities. Caregivers shared important recommendations for future development of Web-based supports.

  • Exploring the role of in-person components for online health behaviour change interventions: Can a digital person-to-person component suffice?

    From: Journal of Medical Internet Research

    Date Submitted: Jul 14, 2017

    Open Peer Review Period: Jul 14, 2017 - Sep 8, 2017

    The growth of the digital environment provides tremendous opportunities to revolutionize health behaviour change efforts. This article explores the use of Web-based, mobile, and social media health be...

    The growth of the digital environment provides tremendous opportunities to revolutionize health behaviour change efforts. This article explores the use of Web-based, mobile, and social media health behaviour change interventions and determine if there is a need for a face-to-face or an in-person component. It is further argued that that although in-person components can be beneficial for online interventions, a digital person-to-person component can foster similar results while dealing with challenges faced by traditional intervention approaches. Using a digital person-to-person component is rooted in social and behavioural theories such as the Theory of Reasoned Action, and the Social Cognitive Theory, and further justified by the human support constructs of the Model of Supportive Accountability. Overall, face-to-face and online behaviour change interventions have their respective advantages and disadvantages and functions yet both serve important roles. It appears that it is in fact human support that is the most important component in the effectiveness and adherence of both face-to-face and online behaviour change interventions and thoughtfully introducing a digital person-to-person component, to replace face-to-face interactions, can provide the needed human support while diminishing the barriers of in-person meetings. The digital person-to-person component must create accountability, generate opportunities for tailored feedback, and create social support to successfully create health behaviour change. As the popularity of the online world grows, and the interest in using the digital environment for health behaviour change interventions continues to be embraced, further research into not only the use of online interventions, but the use of a digital person-to-person component, must be explored.

  • Proposed Taxonomy of Telemedicine

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 15, 2017

    Open Peer Review Period: Jul 16, 2017 - Sep 10, 2017

    Background: In the past 20 years, the use of telemedicine has increased, with telemedicine programs being conducted through the Internet and ISDN technologies. Objective: To validate a proposed taxono...

    Background: In the past 20 years, the use of telemedicine has increased, with telemedicine programs being conducted through the Internet and ISDN technologies. Objective: To validate a proposed taxonomy using keywords from a random sample Methods: I used three facets to search the Scopus database for telemedicine and drew a random sample from the results. I analyzed author and index keywords from the 327 random sample articles, along with taking into account the long literature review I conducted for my dissertation Toward a Discourse Community for Telemedicine: A Domain Analytic View of Published Scholarship to create my own taxonomy of telemedicine and to validate the three taxonomies of Tulu, Chatterjee and Maheshwari (2007), Bashshur, Shannon, Krupinski, Grigsby (2011), and Nepal, Li, Jang-Jaccard, and Alem (2014). Results: Results: The keywords collected from the random sample fit into the Proposed Taxonomy categories and so validated the Proposed Taxonomy. Conclusions: As is evident from the ontology rendered from the keywords found in the author and index keywords, telemedicine touches on several areas. Central to telemedicine are diagnosis and treatment of disease, including specific disease and specific telemedicine used.

  • The Effect of Using Mobile Phone on Medical Students’ Mental Focus in Respond to Knowledge Questions

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 18, 2017

    Open Peer Review Period: Jul 18, 2017 - Sep 12, 2017

    Background: BACKGROUND: Today, using the mobile phone has grown widely. This massive growth captures the attention of researchers on biological effects of mobile phone. Evidences have shown that exces...

    Background: BACKGROUND: Today, using the mobile phone has grown widely. This massive growth captures the attention of researchers on biological effects of mobile phone. Evidences have shown that excessive use of mobile phone has negative impact on physical and psychological health of mobile phone users. Objective: Aims: to evaluate the effect of using mobile phones on the students’ mental focus when they answer to general scientific questions, simultaneously in Ahvaz, Iran. Methods: METHOD: In this analytical study, a group of 60 students in the field of Health Information Technology (HIT) were participated. Participants were evaluated in order to verify the same level of information homogeneity and the ability of using a mobile phone. Therefore, the students were asked at the first step to respond to general information questions showed in computer monitor. Then, a message including 6-9 words by mobile phone was typed by the subjects while the typing time was registered. Next, they were asked to send a message while answering the questions showed on the monitor screen of the computers, simultaneously. Next, the difference between response accuracy to questions of graphical test in two phases was analyzed. Results: RESULTS: The results showed that the average scores of correct response to graphic test, as typing a text on the mobile phone, was (26.8000) and the average scores of correct respond to graphics test without typing a text on mobile phone was (30.2000). Moreover, the average scores when typing a text on mobile phone was (74.40) while the average scores for typing a text on mobile phone and responding to graphics test, simultaneously was (194.12). Conclusions: Conclusion: The results showed that using the mobile phone has a negative impact on the selected students’ performance to respond simultaneously to the general scientific questions.

  • Partners in Parenting: A multi-level web-based approach to support parents in prevention and early intervention for adolescent depression and anxiety

    From: JMIR Mental Health

    Date Submitted: Jul 17, 2017

    Open Peer Review Period: Jul 18, 2017 - Sep 12, 2017

    Depression and anxiety disorders in young people are a global health concern. Various risk and protective factors for these disorders are potentially modifiable by parents, underscoring the important...

    Depression and anxiety disorders in young people are a global health concern. Various risk and protective factors for these disorders are potentially modifiable by parents, underscoring the important role parents play in reducing the risk and impact of these disorders in their adolescent children. However, cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. In this paper, we propose a multi-level public health approach involving a web-based parenting intervention, Partners in Parenting. We describe the components of the web-based intervention and how each component was developed. Development of the intervention was guided by principles of the Persuasive Systems Design model, to maximize parental engagement and adherence in the program. A co-design approach was used through consultations with parents and adolescents about the content and presentation of the intervention. The Partners in Parenting intervention can be used at varying levels of intensity to tailor to the different needs of parents across the population. Challenges and opportunities for the use of the intervention are discussed. The Partners in Parenting web-based intervention was developed to address the dearth of evidence-based resources to support parents in their important role in their adolescents’ mental health. The proposed public health approach utilizes this intervention at varying levels of intensity based on parents’ needs. Evaluation of each separate level of the model is ongoing. Further evaluation of the whole approach is required to assess the utility of the intervention as a public health approach, as well as its broader effects on adolescent functioning and socioeconomic outcomes.

  • Automatic Health Assessment of Smart Home Residents via Unsupervised Learning from Ambient Sensor Data: An Observational Study

    From: Journal of Medical Internet Research

    Date Submitted: Jul 18, 2017

    Open Peer Review Period: Jul 19, 2017 - Sep 13, 2017

    Background: Existing approaches to health assessment for smart home residents mostly rely on the activities recognized by supervised learning methods, which require well-annotated sensor data. Obtaini...

    Background: Existing approaches to health assessment for smart home residents mostly rely on the activities recognized by supervised learning methods, which require well-annotated sensor data. Obtaining such labeled data is not a feasible task, especially for senior adults. Objective: Developing an unsupervised learning method to health assessment for smart home residents without the need of labeled data. Methods: Ambient sensors are deployed in participants’ home to collect activity data. Home resident’s health is assessed via a two-step approach. In the first step, the clusters of sensor data are discovered using K-means or Gaussian Mixture Models (GMM). In the second step, the time spent on each data cluster is used to compute a health score that represents the physical health of the resident. As we could not obtain ground-truth labels, we conduct this project as an observational study. Results: We test the first step of our approach (sensor data clustering) on the Aruba dataset, which was acquired from a testbed occupied by a senior resident for more than a year. In this step, GMM achieves its best performance of 0.75 (𝐹1_score) and 0.79 (Rand_index) and outperforms K-means. Qualitative results obtained on our smart home dataset also demonstrate the correlation between the discovered sensor data clusters with resident’s daily routine. The health score derived in the second step of our approach is highly associated with the health events happened to one of our participants. Conclusions: The experimental results demonstrate that the sensor data clusters discovered by standard clustering methods are highly correlated with the ground-truth activities or daily routine. Between the two tested methods, GMM outperforms K-means in all metrics. The health score derived by our two-step unsupervised approach is highly related to the health events happened to the resident. Clinical Trial: The CSIRO Health and Medical Research Human Research Ethics Committee (#12/17).

  • Clinical Videoconferencing: A Systematic Review and Analysis of eHealth Enacted in User Patterns

    From: Journal of Medical Internet Research

    Date Submitted: Jul 19, 2017

    Open Peer Review Period: Jul 19, 2017 - Sep 13, 2017

    Background: Earlier work has described videoconferencing technologies, peripheral equipment, organizational models, human relations, purposes, goals and roles as versatile, multifaceted and used diffe...

    Background: Earlier work has described videoconferencing technologies, peripheral equipment, organizational models, human relations, purposes, goals and roles as versatile, multifaceted and used differently in different clinical practices. Knowledge about benefits and challenges connected to specific characteristics of services are lacking. A 2005 systematic review of published definitions of “eHealth” identified 51 unique definitions and concluded that it had become an accepted neologism despite the lack of clear, precise, agreed-upon definitions. In 2015, the question “What Is eHealth: Time for an Update?” was posed. Objective: Considering videoconferencing as eHealth, the objective of the paper is twofold: to demonstrate and cluster (different) clinical videoconferencing practices and their situated implications and to explore and analyze whether—and how—common features and implications across clusters can contribute to an update of the eHealth concept. Methods: We performed a literature search via the National Center for Biotechnology Information (NCBI), encompassing PubMed and PubMedCentral, for quality reviews and primary studies. This paper reports results for primary studies. We used the terms “videoconferencing” and “clinical practices.” The selection process was based upon clearly defined criteria. We used an electronic proforma to extract data. The analysis was inspired by realist review and “the ten e’s of eHealth”. Results: The search returned 154 reviews and primary studies. This paper considers the primary studies, and eleven were included. We identified three broad clusters; 1) Videoconferencing as singular intstrument within existing organisational frameworks for expert advice, and effectiveness and quality improvement goals; 2) Videoconferencing as multifaceted with novel organisational arrangements, reaching out to homes and family caregivers with the purpose of co-creating improvement; 3) Videoconferencing as an operational instrument for improving administration of triage. The analysis of common features of videoconfeerencing across the clusters that might add to the understanding of eHealth resulted in a proposal to add four d’s to the existing ten e’s. The four d’s are: dynamic, differentiated along services and temporal lines, demanding of fresh resources and (inter) dependent of human and socio economic components. Conclusions: Videoconferencing for clinical work appear as a dynamic of differentiation and adaptation along service and temporal lines, made to work from an ongoing demand for fresh resources. Additionally, videoconferencing is an (inter)dependent assemblage of human, socio economic and technological constituent parts. The four d’s—dynamic, differentiated, demanding and (inter)dependent—can be added as an update of “the ten e’s of eHealth”.

  • Security and Privacy Concerns Regarding Genetic Data in Mobile Health Record Systems: An Empirical Study from Turkey

    From: Journal of Medical Internet Research

    Date Submitted: Jul 19, 2017

    Open Peer Review Period: Jul 19, 2017 - Sep 13, 2017

    Background: In today’s health services, it has become a necessity to keep patients’ health data in electronic format. There are many theories and considerable research on the design of electronic...

    Background: In today’s health services, it has become a necessity to keep patients’ health data in electronic format. There are many theories and considerable research on the design of electronic health record applications. As the use of genetic testing, and applications of bioinformatics is increasing in healthcare, genetic and genomic information needs to be included within these systems. Objective: In this study, we carried out a descriptive survey with 174 participants to acquire their views on the privacy and the security of mobile health record systems and inclusion of their genetic data in these systems. Methods: An online survey and an on-site survey in the two genetic diagnostic centers were conducted to reach patients or relatives of patients that had undergone genetic testing. Descriptive statistics is used to summarize the data. Results: Nearly half of the participants or their relatives (48.9%) had undergone genetic testing. Doctors are the only profession group that people trust for the privacy of their health and genetic information (61.2%); however, people chose to limit even their doctor’s access to their genetic/medical records (52.5%). Majority of the respondents (94%) prefer to keep full access right option only for themselves. The regulations and security measurements are suggested in the questionnaire are found to be acceptable by the majority of the respondents. A significant amount of participants had bad experiences and prejudices about electronic health records: 9.7 % of respondents’ medical records were used or released without their consents, 15.1 % stated that they had avoided being tested because of violation risks, and 3.5 % asked their doctors to enter a less embarrassing health status into their records. Also our analysis showed that participants attribute special importance to their genetic records, as significantly more participants stated that storing genetic records in a mobile system is more risky compared to other health records (P=.00). Conclusions: People have various negative experiences and there are plenty of information disclosure events in the media; hence people have concerns about the privacy and security of their health and genetic data. The results of our survey showed that people would like to see security measurements and regulations to protect their privacy, before they start to use any application to keep track of their health/genetic data. They also would like to have sole control on these applications. Personal Health Record (PHR) applications offers solutions to the data management problem as an electronic system, since they enable the users to have full control over their records.

  • A randomized controlled trial and process evaluation of a web-based therapy plus telephone support by a coach, compared with information about web-based resources, in depressed patients referred to secondary mental health care

    From: JMIR Mental Health

    Date Submitted: Jul 19, 2017

    Open Peer Review Period: Jul 20, 2017 - Sep 14, 2017

    Background: The evidence for the effectiveness of web-based therapies comes mainly from non-clinical populations with a few studies in primary care. There is little evidence from patients referred to...

    Background: The evidence for the effectiveness of web-based therapies comes mainly from non-clinical populations with a few studies in primary care. There is little evidence from patients referred to secondary mental health care with depression. A problem with web-based therapies is that a high proportion of people fail to complete the courses. One way to address this is to create a new health service role – an e-coach – to guide people through the therapy which has been shown to increase adherence. Objective: The objective was to test in people referred to secondary care with depression if a web-based therapy (The Journal www.depression.org.nz) supported by an e-coach plus usual care would be more effective in reducing depression compared with usual care plus an information leaflet about on-line resources after twelve weeks. Methods: We conducted a randomized controlled trial with two parallel arms and a process evaluation. The e-coach had a background in occupational therapy. Participants were recruited face to face. Results: We recruited 63 people into the trial (intervention 35 control 28). There were no statistically significant differences in the change in PHQ-9 scores at 12 weeks comparing The Journal with usual care (mean change in PHQ-9 score 9.4 in the intervention group and 7.1 in the control group t-test 1.05 p=0.3; mean difference 2.3, 95% confidence interval -2.1 to 6.7). People who were offered The Journal attended on average about one less out-patient appointment compared with usual care although this difference was not statistically significant (intervention mean number of visits 2.8 (SD 5.5) compared with 4.1 (SD 6.7) in the control group t=- 0.80 p=0.43; mean difference 1.3 95% confidence interval -4.5 to 2.0). The process evaluation found that the mean number of lessons completed in the intervention group was 2.5 SD 1.9 (with a range of 0 to 6) and the number of contacts with the e-coach was a mean of 8.1 SD 4.4 (range 0 to 17). The qualitative interviews highlighted the problem of engaging clinicians in the research and their resistance to recruitment; technical difficulties with The Journal which prevented people logging in easily; difficulty accessing The Journal as it was not available at the time on smartphones or tablets; participants finding lesson three difficult; and participants saying they were too busy to complete the sessions. Conclusions: The study demonstrated that is feasible to use an e-coach in this setting, that people found it helpful and that it did not conflict with other care that participants were receiving. In the future trials need to engage clinicians at an early stage to articulate where web-based therapies fit into existing clinical pathways; web-based therapies should be available on mobile devices; and logging in should be easy. The role of the e-coach should be explored in larger trials. Clinical Trial: Australian and New Zealand Clinical Trials Registry ACTRN: ACTRN12613000015741

  • Text-Message Self-Regulation Support to Reduce Alcohol Consumption among Non-Treatment-Seeking Young Adults

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 22, 2017

    Open Peer Review Period: Jul 24, 2017 - Sep 18, 2017

    Background: Stand-alone text message-based interventions can reduce heavy drinking episodes among non-treatment seeking young adults, but may not be optimized. Self-regulation support could enhance ef...

    Background: Stand-alone text message-based interventions can reduce heavy drinking episodes among non-treatment seeking young adults, but may not be optimized. Self-regulation support could enhance effectiveness by assisting goal setting and striving, but it remains unknown how to best integrate into text-message interventions. Objective: To evaluate engagement with a text message intervention (TRAC2) focused on reducing weekend alcohol consumption incorporating drinking-limit goal-commitment ecological momentary assessments (EMA) tailored to past 2-week alcohol consumption, intra-weekend goal reminders, self-efficacy EMA with support tailored to goal confidence, and max weekend alcohol consumption EMA with drinking limit goal feedback. Methods: We enrolled 38 non-treatment seeking young adults who screened positive for hazardous drinking in an urban emergency department. Following a 2-week text message assessment-only run-in, participants were given the opportunity to enroll in 4-week intervention blocks. We examined patterns of EMA responses and voluntary re-enrollment. We then examined how goal commitment and goal self-efficacy related to event-level alcohol consumption. Finally, we examined the association of length of TRAC2 exposure with alcohol-related outcomes from baseline to 3-months follow-up. Results: Among a diverse sample of young adults (56% female, 54% black race, 32% college enrolled), response rates to EMA queries were, on average, 82.3% for the first 4-week intervention block, 75.3% for the second 4-week block, and 72.8% for the third 4-week block. There were high rates of event-level drinking limit goal commitment (94%) and goal success (89%). The percentage of subjects being prompted to commit to a drinking limit goal above the binge threshold was 51.7% on week 1 and decreased to 0% by week 4. Low situational confidence was associated with lower goal success. There were reductions in alcohol consumption from baseline to 3-months but reductions were not different by length of intervention exposure. Conclusions: Preliminary evidence suggests that non-treatment seeking young adults will engage with a text message intervention incorporating self-regulation support features, resulting in high rates of weekend drinking limit goal commitment and goal success. Clinical Trial: n/a

  • Mobile health approaches in the management of skin cancer: Lessons from integrative mapping of evidence-based research

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 26, 2017

    Open Peer Review Period: Jul 26, 2017 - Sep 20, 2017

    Background: mHealth, which encompasses mobile health technologies and interventions, is rapidly evolving in various medical specialties, and its impact is evident in oncology. Mobile technologies are...

    Background: mHealth, which encompasses mobile health technologies and interventions, is rapidly evolving in various medical specialties, and its impact is evident in oncology. Mobile technologies are perceived as effective in prevention and as feasible for managing skin cancer, but the diagnostic accuracy of these tools remains in doubt. These drawbacks in the application of mHealth to teledermatology call for intensified research to strengthen its role in dermatology. Objective: The purpose of this review was to describe current trends in research addressing the integration of mHealth into the management of skin cancer by examining evaluations of mHealth and its contributions across the cancer care continuum. Methods: A systematic review framework was applied to the search using the three electronic databases, PubMed, Web of Science, and Embase. We extensively reviewed appropriate studies regarding skin cancer and mobile technology published between 2000 and present. Studies were included if they discussed the role and impact of mobile technology in the management and evaluation of skin cancer. 33 studies were selected for analysis adhering to inclusion and exclusion criteria. Results: Of the 33 studies, 15 studies (45%) assessed the diagnostic accuracy of mobile technology in detecting skin cancer and ten studies (30%) examined the feasibility and acceptability of mobile technology. The remaining studies (24%) concerned skin cancer prevention, early diagnosis, reduced treatment, and follow-up care through mHealth interventions. Not all phases of skin cancer involve mHealth, and not all have been addressed by research. While the focus of current research was skewed toward prevention and diagnosis phases, the treatment and follow-up phases were the least addressed in the literature. Conclusions: The present review extends knowledge not only on the contributions but also on the integration of mHealth technologies in different phases of skin cancer care. To optimize the effectiveness of mHealth in dermatology, larger numbers of robust, evidence-based studies on teledermatology implementations, evenly distributed across the care continuum, should be conducted so that research can be expanded to systematic reviews.

  • Relationship Using multiple linear regression analysis and Bayesian network model analysis of factors affecting bone mineral density of residents in snowy region of Japan

    From: Journal of Medical Internet Research

    Date Submitted: Jul 28, 2017

    Open Peer Review Period: Jul 28, 2017 - Sep 22, 2017

    Background: Since the onset of osteoporosis leads to a decrease in daily living behavior and may lead to bedridden state, efforts to suppress decrease in bone density are necessary. Various studies h...

    Background: Since the onset of osteoporosis leads to a decrease in daily living behavior and may lead to bedridden state, efforts to suppress decrease in bone density are necessary. Various studies have been conducted on the relationship between sex, age, nutrients, exercise habits, etc. and bone mineral density to date. However, for the residents of snowy region, the magnitude of the influence of various factors on bone mineral density and the degree of causal relationship have not been clarified. Objective: In this research, we aimed to clarify the influence degree and the causal relation of factors influencing bone mineral density, based on survey results on health conditions, lifestyle habits etc. for heavy snow areas. Methods: Questionnaires on lifestyle and exercise habits, BDHQ (Brief-type self-administered Diet History Questionnaire), 354 citizens who visited the drug store in the target area, height meter, weight, body composition, bone densitometer and the like were analyzed by multiple regression analysis to calculate the degree of influence on bone density. In addition, a Bayesian network model was constructed, and the causal relation between each factor was calculated as conditional probability. Results: As a result of the Bayesian network analysis, factors influencing bone mineral density were only age and sex, and influence of other nutrients and exercise was not clarified.However, calcium intake and T Score proved to be a factor in the presence or absence of fracture experiences.It was suggested that ingesting calcium is the most important as an approach that can be done to prevent fractures. Conclusions: From the results of the multiple regression analysis, age, sex, history of bone fracture, and calcium intake were selected as models, but the effects of other nutrients and exercise were not assessed. In the results of the Bayesian analysis, the only factors that affected bone density were age and sex; these results also did not show the effects of other nutrients or exercise. However, the fact that calcium intake and T score were shown to affect bone fracture history suggests that calcium intake is an important measure that can be implemented to prevent bone fractures. Overall, these results suggest that measures such as ensuring an environment where bone fractures do not occur and providing nutritional advice for calcium intake are effective for inhibiting bone loss.

  • Development and Pilot Testing of a mHealth Pain Coping Skills Training Intervention Designed for Patients Following Hematopoietic Stem Cell Transplantation

    From: Journal of Medical Internet Research

    Date Submitted: Jul 27, 2017

    Open Peer Review Period: Jul 29, 2017 - Sep 23, 2017

    Background: Pain is a challenge for patients following hematopoietic stem cell transplantation (HCT). Objective: This study aimed to develop and test the feasibility, acceptability, and initial effica...

    Background: Pain is a challenge for patients following hematopoietic stem cell transplantation (HCT). Objective: This study aimed to develop and test the feasibility, acceptability, and initial efficacy of a mobile pain coping skills training (mPCST) protocol designed to address the needs of HCT patients. Methods: Participants had undergone HCT and reported pain following transplant (N=68). To guide intervention development qualitative data was collected from focus group participants (n=25) and participants who completed user testing (n=7). After their input was integrated into the mPCST intervention, a pilot randomized controlled trial (RCT; n=36) was conducted to examine the feasibility, acceptability, and initial efficacy of the intervention. Meaures of acceptability, pain severity, pain disability, pain self-efficacy, fatigue, and physical disability (self-report, two-minute walk test) were collected. Results: Participants in the focus groups and user testing provided qualitative data that was used to iteratively refine the mPCST protocol. Focus group qualitative data included participants’ experiences with pain following transplant, perspectives on ways to cope with pain, and suggestions for pain management for other HCT patients. User testing participants provided feedback on the HCT protocol and information on the use of video-conferencing. The final version of the mPCST intervention was designed to bridge the intensive outpatient (1 in person session) and home settings (5 video-conferencing sessions). A key component of the intervention was a website that provided personalized messages based on daily assessments of pain and activity. The website also provided intervention materials (i.e., electronic handouts, short videos, audio files). Intervention content included pain coping advice from other transplant patients and instructions on how to apply pain coping skills while engaging in meaningful activities and leisure activities. In the RCT phase of this research, HCT patients (N=36) were randomized to receive the mPCST intervention or to treatment as usual. Results revealed that the mPCST participants completed an average of 5/6 sessions. The participants reported that the intervention was highly acceptable (M=3/4), and they found the sessions to be helpful (M=8/10) and easy to understand (M=7/7). mPCST participants demonstrated significant improvements pre- to post-treatment in pain self-efficacy (P=.03, d=0.61) and on the two-minute walk test (P=0.03, d=0.66) while those in the treatment as usual group did not. Significant changes in pain disability and fatigue were found for both groups (ps<0.02); the magnitudes of the effect sizes were larger for the mPCST group than the control group (pain disability: d=0.79 vs 0.69; fatigue: d=0.94 vs. 0.81). There were no significant changes in pain severity in either group. Conclusions: Using focus groups and user testing, we developed a mPCST protocol that was feasible, acceptable, and beneficial for HCT patients with pain. Clinical Trial: ClinicalTrials.gov NCT01984671

  • What is the feasibility of patients using an online forum for reporting progress when engaging with a six-week exercise programme for knee rehabilitation?

    From: JMIR Rehabilitation and Assistive Technologies

    Date Submitted: Jul 30, 2017

    Open Peer Review Period: Jul 31, 2017 - Sep 25, 2017

    Background: The use of e-health and web-based resources for patients with knee pain is expanding. Padlet is an online noticeboard that can facilitate patient interaction by posting virtual ‘sticky n...

    Background: The use of e-health and web-based resources for patients with knee pain is expanding. Padlet is an online noticeboard that can facilitate patient interaction by posting virtual ‘sticky notes'. Objective: The primary aim of this study was to determine feasibility of patients on a six-week, knee-exercise programme using Padlet as an online forum for self-reporting on outcome progression. Methods: Undergraduate manual therapy students were recruited as part of a six week study into knee rehabilitation. Participants were encouraged to post maximum effort readings from quadriceps and gluteal home exercises captured from standard bathroom scales on a bespoke Padlet. Experience and progression reporting were encouraged. Posted data were analysed for association between engagement, entry frequency and participant characteristics. Individual data facilitated single subject, multiple baseline analysis using statistical process control. Experiential narrative was analysed thematically. Results: Nineteen participants were recruited (47% female); ages ranged from 19 to 53. Twelve individuals (63%) opted to engage with the forum (range: 4 - 40 entries), with 5 (42%) reporting across all six weeks. Gender did not influence reporting (OR 0.761, CI 0.06-6.93). No significant difference manifested between BMI and engagement (P=.46); age and entry frequency did not correlate (r2=0.054, CI -0.42 to 0.51, P=.83). Statistically significant conditioning profiles arose in single subjects. Themes of pain, mitigation and response were inducted from the experiences posted. Conclusions: Patients will engage with an online forum for reporting progress when undertaking exercise programmes. In contrast to related literature, no significant association was found with reporting and gender, age or BMI. Individual posted data allowed multiple baseline analysis and experiential induction from participants. Conditioning responses were evident on visual inspection. The importance of individualised visual data to patients and the role of forums in monitoring patients’ progress in symptomatic knee-pain populations need further consideration.

  • Evaluation of a website supporting sensitive religious and cultural advance care planning: ACPTalk

    From: Journal of Medical Internet Research

    Date Submitted: Jul 27, 2017

    Open Peer Review Period: Jul 29, 2017 - Sep 23, 2017

    Background: Advance care planning (ACP), encourages consideration of future health care decision making and fosters collaborative, informed end-of life-care. To meet the needs of multicultural and mul...

    Background: Advance care planning (ACP), encourages consideration of future health care decision making and fosters collaborative, informed end-of life-care. To meet the needs of multicultural and multi-faith populations in Australia, an ACP website, ACPTalk, was funded to support health professionals in conducting conversations within diverse religious and cultural populations. ACPTalk aimed to provide religion-specific ACP content and complement existing resources. Objective: The purpose of this paper was to utilise the Context Input Process Product (CIPP) framework to conduct a formative and summative evaluation of an ACP website, ACPTalk. Methods: Context: health professionals’ solutions for the website were determined through thematic analysis of exploratory key stakeholder interviews. Included religions were determined through an environmental scan, Australian population statistics, and documentary analysis of project steering committee meeting minutes. Input: project implementation and challenges were examined through documentary analysis of project protocols and meeting minutes. Process: to ensure religion-specific content was accurate and appropriate, a website prototype was built with content review and functionality testing by representatives from religious and cultural organizations and other interested health care organizations who completed a web-based survey. Product: Website analytics were used to report utilisation and stakeholder perceptions were captured through interviews and a website survey. Results: Context: Sixteen health professionals (n=7 general practitioners, n=7 primary health nurses, n=2 palliative care nurses) participated in key stakeholder interviews. Website solutions included: religious and cultural information, communication ideas, education and role plays, legal information, downloadable content and web-based accessibility. Both Christian and non-Christian faiths were deemed important to be included in religion-specific content. Input: There were no project delays. Difficulties gaining consensus on religion-specific content were overcome by further state and national religious organizations providing feedback. Process: Thirty-seven content reviewers included representatives of religious and cultural organizations (n=29), health care (n=5) and community organizations (n=3). The majority strongly agree/agree that the content used appropriate language and tone (92%), would support health professionals (89%) and was accurate (83%). Product: Resource usage within the first nine months was 12,957 page views in 4,260 sessions: majority (89%) from Australia. A total of 107 Australian-based users completed the website survey; most felt information was accurate (78%), easy to understand (82%), useful (86%) and appropriate (86%). Twenty nurses (general practice n=10, palliative care n=10, both disciplines n=2) participated in stakeholder interviews. Qualitative findings indicated overall positivity in relation to accessibility, functionality, usefulness, design and increased knowledge of ACP. Recommended improvements included shortened content, a comparable website for patients and families, and multilingual translations. Conclusions: The CIPP framework was effectively applied to evaluate the development and end product of an ACP website. While overall findings were positive, further ACP website development should consider the recommendations derived from this study.

  • Validity and reliability of the Apple Watch for measuring moderate-intensity exercise

    From: JMIR Cardio

    Date Submitted: Jul 27, 2017

    Open Peer Review Period: Jul 27, 2017 - Sep 21, 2017

    Background: Moderate fitness levels and habitual exercise have a protective effect for cardiovascular disease, stroke, type 2 diabetes, and all-cause mortality. The Apple Watch displays exercise compl...

    Background: Moderate fitness levels and habitual exercise have a protective effect for cardiovascular disease, stroke, type 2 diabetes, and all-cause mortality. The Apple Watch displays exercise completed at an intensity of a brisk walk or above using a green ‘exercise’ ring. However, it is unknown if the exercise ring accurately represents an exercise intensity comparable to that defined as moderate-intensity. In order for health professionals to prescribe exercise intensity with confidence, consumer sensor-derived wearables need to accurately reflect that measured within the laboratory if they are to be used as part of a personalized medicine approach to disease management. Objective: The aim of this study was to examine the validity and reliability of the Apple Watch for measuring moderate-intensity exercise, as defined as 40-59% oxygen consumption reserve (VO2R). Methods: Twenty recreationally active participants completed VO2rest and VO2max tests prior to a series of 5-min bouts of treadmill walking while wearing an Apple Watch on both wrists and with oxygen consumption measured continuously. Exercise continued until the Apple Watch advanced the green ‘exercise’ ring by 5 min (inflection speed). Results: The mean (SD) %VO2R at the treadmill inflection speed was 30 (7) % for both Apple Watches. There was a large underestimation of moderate-intensity exercise (left: mean difference -10% [95%CI: -14 to -7], d = -1.4; right: -10% [95%CI: -13 to -7], d = -1.5) when compared to the criterion of 40% VO2R. Conclusions: The Apple Watch under-estimated moderate-intensity exercise which would lead to an over-estimation of moderate-intensity exercise completed throughout the day.

  • M-health tools for self-management of complex patients in primary care settings: Understanding the patient and provider experience

    From: JMIR mHealth and uHealth

    Date Submitted: Aug 3, 2017

    Open Peer Review Period: Aug 4, 2017 - Sep 29, 2017

    Background: Given the complex and evolving needs of individuals with multi-morbidity, the use of m-health tools to support self-management efforts is increasingly being explored, particularly in prima...

    Background: Given the complex and evolving needs of individuals with multi-morbidity, the use of m-health tools to support self-management efforts is increasingly being explored, particularly in primary care settings. The Electronic Patient Reported Outcomes (ePRO) tool was co-developed with patients and providers in an inter-disciplinary primary care team in Toronto, Canada to help facilitate self-management in community-dwelling adults diagnosed with multiple chronic conditions. Objective: Explore the experience and expectations of patients with multi-morbidity and their providers around the role of the ePRO tool in supporting self-management efforts to generate insights into how m-health applications targeted towards helping patients self-manage are perceived by patients and providers. Methods: A 4-week usability trial of the ePRO tool was conducted. Patient and provider experience and expectations were explored through focus groups that were conducted at the end of the usability trial. Thematic analyses were used to assess shared and contrasting perspectives of patients and providers on the role of the ePRO tool in facilitating self-management. Results: Eleven patients and six providers were involved in the usability trial. Findings revealed that both patients and providers emphasized the need for greater personalization and customizability of content to better adapt to the complexity and fluidity of self-management in this particular patient population. Providers recognized the ePRO tool’s value in providing insights into broader patient context and emphasized alignment with existing processes, i.e., goal setting techniques and linkage with electronic medical records. Conclusions: In developing the ePRO tool, a nuanced disconnect emerged between patient and provider expectations around the role of the ePRO tool in enabling self-management, specifically that patients indicated they see the tool ePRO as a supplement to existing interaction rather than a replacement of in-person consults with their providers. In contrast, provider expectations were centered on the ePRO tool’s potential to monitor patient progress remotely. More in-depth inquiry is needed to better understand whether m-health technologies can resolve this gap around expectations between user groups. The adoption of a more patient-centered lens in content and question design, and greater adaptability to accommodate patient complexity and provider workflow were identified as next steps in refining the ePRO tool ahead of full-scale application in a randomized pragmatic trial.

  • Relationship between the medical environment of developing countries and dissemination of IT; Possibility of introducing telemedicine service in Asia and Africa countries

    From: JMIR mHealth and uHealth

    Date Submitted: Jul 28, 2017

    Open Peer Review Period: Jul 28, 2017 - Sep 22, 2017

    Background: In some developing countries where medical resources are scarce despite the advancement of IT, there is a possibility that problems can be solved by introducing telemedicine services. In t...

    Background: In some developing countries where medical resources are scarce despite the advancement of IT, there is a possibility that problems can be solved by introducing telemedicine services. In this study, we examined the status of IT adoption, healthcare environment, as well as the economic situation, respectively, in developing countries; we attempted to visualize the data as basic material for examining the possibility of introducing telemedicine-based services in developing countries. Objective: In this study, we examined the status of IT adoption, healthcare environment, as well as the economic situation, respectively, in developing countries; we attempted to visualize the data as basic material for examining the possibility of introducing telemedicine-based services in developing countries. Methods: The surveyed countries consisted of developing countries in Asia and Africa. In Asia, the study was conducted in nine developing countries after exclusion of those whose data were unavailable; and in Africa, 13 countries were extracted after exclusion of those with a GDP per capita less than USD 1,000, as well as countries where data were unavailable. We set the number of doctors, the number of nurses and midwives as indicators of the medical environment. We used the number of Internet contracts and the number of mobile phone contracts as indicators of IT spreading situation, and set GDP per capita and GDP growth rate as economic indicators. Regarding the medical environment and the IT penetration situation, we conducted a survey separately for Asia and Africa. Furthermore, we integrated the data of Asia and Africa, we performed the principal component analysis and the cluster analysis. Results: The target countries were classified into 5 clusters by economic indicator, medical environment indicator, IT spread index (Cluster A: Algeria, Egypt, Morocco, Indonesia, Ghana, Tunisia, Madagascar, Nigeria, Thailand, Cluster B: Bangladesh, Ethiopia, Kenya, Uganda, India, Pakistan, Cluster C: Sudan, Malaysia, Viet Nam, Tanzania, Philippines, China, Cluster D: South Africa, Cluster E: Japan, Singapore).This study suggested that there is a high possibility of introducing the most telemedicine services in South Africa and that the possibility of introducing telemedicine services are high even in Thailand where the Internet is spreading widely. Conclusions: This study suggested that there is a high possibility of introducing the most remote telemedicine service in South Africa and that the possibility of introducing telemedicine service is high even in Thailand where the Internet spread is advanced.

  • Assessing the Efficacy of mHealth Applications Using the Basic Principles of CBT: A Systematic Review

    From: Journal of Medical Internet Research

    Date Submitted: Jul 28, 2017

    Open Peer Review Period: Jul 28, 2017 - Sep 22, 2017

    Background: CBT in its basic principle has developed itself as a stand-alone, substantial method of therapy. With effective application in therapy for a range of mental health issues the spread of C...

    Background: CBT in its basic principle has developed itself as a stand-alone, substantial method of therapy. With effective application in therapy for a range of mental health issues the spread of CBT therapy methods to online therapy sources is evident. The development of mobile smartphone applications using CBT principles is increasing within the research area. Despite the move to online methods of therapy it is argued that these methods lack the same efficacy of face to face CBT therapy sessions. Objective: This review was conducted in order to assess extent research findings with regards to the effectiveness of CBT related mHealth applications. By assessing only studies employing an RCT design the review aimed to determine app efficacy within the highly regarded method of investigation. Methods: A comprehensive literature search was conducted across several databases. Search results were filter and results were subject to strict inclusion and exclusion criteria due to the nature of the review. Where possible analysis of effect size was calculated and results reported. Results: A total of 8 studies investigating the effectiveness of mHealth CBT related apps across a range of mental health issues were reviewed. 3 studies used the app against a control group and 5 studies used the app intervention against another form of treatment or intervention. A range of effect sizes were seen across all included studies (d=-0.13 – 1.83; 0.03 – 1.44) with the largest effects often being seen when comparing the data from pre- to post-test for the app engaged group. Conclusions: The studies reviewed support the use of mHealth apps containing CBT principles for a range of mental health issues. However the effectiveness over longer time periods should be assessed. Researchers and CBT professionals should seek to collaborate effectively when creating new apps to enhance their effectiveness as a treatment for the general public.

  • Engagement in the Diabetes Online Community Is Associated with Better Glycemic Control, Self-Care and Quality of Life

    From: JMIR Diabetes

    Date Submitted: Jul 29, 2017

    Open Peer Review Period: Jul 29, 2017 - Sep 23, 2017

    Background: Successful diabetes management, usually measured by glycosalyted hemoglobin (A1c) levels, requires ongoing lifelong self-care, and can reqire that individuals with diabetes become experts...

    Background: Successful diabetes management, usually measured by glycosalyted hemoglobin (A1c) levels, requires ongoing lifelong self-care, and can reqire that individuals with diabetes become experts in translating care recommendations into real-life day-to-day diabetes management strategies. The diabetes online community (DOC) comprises multiple websites that include social media sites, blogs, and discussion groups for people with diabetes to chat and exchange information. Online communities can provide disease-specific practical advice, emotional support, allow users to share experiences, and encourage self-advocacy and patient empowerment. However, there has been little research about whether DOC use is associated with better diabetes self-management. Objective: This study surveyed adults with diabetes who participated in a DOC to better understand and describe who is using the DOC, how they are using it, and whether use of a DOC was associated with health indicators. Methods: We recruited, over a 7-month period, adults diagnosed with diabetes who used at least one of four different diabetes-related online communities to complete an online cross-sectional survey. Participants demographics, reported glycosylated hemoglobin (A1c), health-related quality of life (SF-12v2), level of diabetes self-care (Self-Care Inventory Revised), and DOC use (level of intensity and engagement) were collected. We examined the relationships between demographics, DOC use engagement and health indicators (HRQOL, self-care, and A1c levels).We used binary logistic regression to determine the extent to which DOC use predicted an A1C < 7% or ≥ 7% after controlling statistically for other variables in the model. Results: A total of 183 adults participated in this study. Participants were mostly female (71.6%; N=131/183) with a mean age of 44.7 years (SD=14) and diabetes duration of 18.2 years (SD=14.6). Participants had higher diabetes self-care (p<.001, M=72.4, SD=12.1) and better health-related quality of life (physical component summary p<.001, M= 64.8, SD=19; mental component summary p<.001, M= 66.6, SD=21.6) when compared to norms for diabetes. DOC engagement was a strong predictor of A1c, reducing the odds of having an A1c ≥7% by 33.8% for every point increase in DOC engagement (0-5). Our data also indicated that study participants are oftentimes (67.2%; N=123/183) not informing their healthcare providers about their DOC use even though most (91.2%; N=169/183) are seeing their healthcare provider on a regular basis. Conclusions: Our results suggest that individuals highly engaged with the DOC are more likely to have better glycemic control than those with lower engagement. Furthermore, DOC users have high health-related quality of life and diabetes self-care levels. Supplementing usual healthcare activities with DOC use may encourage knowledge and support among a population who need to optimize their diabetes self-management. Further studies are needed to determine how DOC use may affect health outcomes.

  • Healthcare Information Systems and Technology: A Systematic Review

    From: JMIR Medical Informatics

    Date Submitted: Jul 31, 2017

    Open Peer Review Period: Jul 31, 2017 - Sep 25, 2017

    The present article offers a systematic mapping of studies related to information systems and technology in the field of health care. Articles were selected and compiled from prestigious publications...

    The present article offers a systematic mapping of studies related to information systems and technology in the field of health care. Articles were selected and compiled from prestigious publications that combine knowledge related to information systems, science and health. This facilitates establishing a distribution of the available literature, obtaining as a result a map of knowledge that structures the different trends and main areas of research in this area. Finally, we project and propose future research for those trends that stand out because of their interest and the possibility of deepening them.

  • Applicability of a web-based, individualized exercise intervention in patients with liver disease, cystic fibrosis, esophageal cancer, and psychiatric disorders

    From: Journal of Medical Internet Research

    Date Submitted: Aug 2, 2017

    Open Peer Review Period: Aug 3, 2017 - Sep 28, 2017

    Background: Regular physical activity is recommended in different diseases to improve disease related symptoms, to delay the progression of the disease, to enhance postoperative outcomes, and to incre...

    Background: Regular physical activity is recommended in different diseases to improve disease related symptoms, to delay the progression of the disease, to enhance postoperative outcomes, and to increase the physical activity level. In the preoperative context, there has been a paradigm shift in favor of using preconditioning concepts prior to surgery. Web-based interventions seem an innovative and effective tool for delivering general information, tailored exercise recommendations, and peer support. Objective: Our first objective was to assess feasibility of our web-based interventional concept and to analyze similarities and differences in a sustained exercise implementation in different diseases. The second goal was to investigate the overall participants’ satisfaction with our web-based concept. Methods: Study participants were recruited by physicians in the cooperating centers. Four clinical trials are still being carried out, including patients with esophageal carcinoma scheduled for oncologic esophagectomy (iPEP study; internet-based perioperative exercise program), nonalcoholic fatty liver disease (HELP study; hepatic inflammation and physical performance in patients with NASH), depression (EXDEP study; exercise in depression) or cystic fibrosis (COMMED study; cystic fibrosis online mentoring for microbiome, exercise & diet). During the intervention period, the study population had access to the website with disease-specific contents and a disease-specific discussion forum. All participants received weekly individual tailored exercise recommendations from the sports therapist. Results: A total of 20 participants (5 of each trial) were analyzed. During the intervention period, a regular contact and a consequent implementation of exercise prescription were easily achieved in all substudies. Across the four studies, there was a significant decrease in login rates (P <.001) and login durations (P<.001) with time. A detailed view into the different studies shows a significant decrease in login rates and login durations in the HELP study (p=.004; p=.002) and iPEP study (P=.021; P=.001), whereas the EXDEP study (P=.583; P=.378) and COMMED study (P=.867; P=.558) showed no significant over the eight weeks intervention period. There was no significant change in physical activity within all studies (P=.311). Only in the HELP study, the physical activity level increased steadily over the period analyzed (P= .045). Overall, 85% (n=17) felt secure and were not scared of injury, with no major differences in the subtrials. Conclusions: The theoretical framework of the web-based intervention appears to be applicable across the heterogonous collectives of our study patients with regard to age and disease. Although the development of physical activity shows only moderate improvements, flexible communication and tailored support could be easily integrated into patients’ daily routine. Clinical Trial: iPEP study: ClinicalTrials.gov: NCT02478996; https://clinicaltrials.gov/ct2/show/NCT02478996 (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL). HELP study ClinicalTrials.gov: NCT02526732; https://clinicaltrials.gov/ct2/show/NCT02526732 (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL). EXDEP study: ClinicalTrials.gov: NCT02874833; https://clinicaltrials.gov/ct2/show/NCT02874833 (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL).

  • Primary care providers’ response to an online lifestyle modification intervention

    From: Journal of Medical Internet Research

    Date Submitted: Aug 1, 2017

    Open Peer Review Period: Aug 1, 2017 - Sep 26, 2017

    Background: Online tools are a convenient and effective method of delivering lifestyle interventions to obese adult primary care patients. A referral model allows physicians to efficiently direct thei...

    Background: Online tools are a convenient and effective method of delivering lifestyle interventions to obese adult primary care patients. A referral model allows physicians to efficiently direct their patients to the intervention during a primary care visit. However, little is known of physicians’ perspectives and utilization of the referral model for an online lifestyle modification intervention. Objective: To evaluate primary care providers’ (PCP) response to a referral model for implementing a year-long online intervention for weight loss to obese adult patients. Methods: PCPs at six primary care clinics were asked to refer adult obese patients to a year-long online lifestyle intervention providing self-management support for weight loss. Following the one year intervention, all providers at the participating practices were surveyed regarding their views of the program. Respondents completed survey items assessing their attitudes regarding the one-year intensive weight loss intervention and identifying resources they would find helpful for assisting patients with weight loss. Referring physicians were asked about their level of satisfaction with implementing the counseling services using standard electronic health record (EHR) referral processes. Attitudes towards obesity counseling among referring and non-referring providers were compared. Impressions of how smoothly the referral model of obesity treatment integrated with the clinical workflow were also quantified. Results: Non-referring providers were more likely to prefer counseling themselves (P=.04) and to report having sufficient time to do so (P=.03). Non-referring providers were more likely to report that their patients lacked computer skills (77% versus 35%) or had less access to the internet (64% versus 33%). Conclusions: Understanding providers’ views and barriers regarding the integration of online tools will facilitate widespread implementation of an online lifestyle modification intervention.

  • Application of Machine Learning Algorithms to Depression Screening and Attempt at Pattern Extraction of Patient-Reported Outcomes that Negatively Affect Classification Accuracy

    From: Journal of Medical Internet Research

    Date Submitted: Aug 1, 2017

    Open Peer Review Period: Aug 3, 2017 - Sep 28, 2017

    Background: Smartphone applications have recently been used as a breakthrough technology for monitoring mental health conditions in cancer outpatient settings. However, the use of electronic patient-r...

    Background: Smartphone applications have recently been used as a breakthrough technology for monitoring mental health conditions in cancer outpatient settings. However, the use of electronic patient-reported outcomes (ePROs) on mental conditions through smartphone applications raises new concerns, which includes the question of the accuracy of depression screening. Thus, research is essential for improving the depression-screening performance. Objective: This study aims to (1) test whether deep-learning-based algorithms can overcome the limitations of traditional statistical methods in terms of depression screening accuracy. In addition, the study aims to (2) explore ePRO patterns that adversely affect depression screening accuracy. Methods: As a deep learning-based algorithm, a feedforward neural network algorithm was used. As a traditional statistical method, a random intercept logistic regression was employed. To explore the ePRO patterns that negatively impact model accuracy, mental fluctuations, missing data, and compounding effects between mental fluctuations and missing data were tested. The performances of the algorithms and the effects of the ePRO patterns were measured through the receiver operating characteristic comparison test. Results: The results of the study show that the performance of the deep-learning-based models was superior to that of the traditional statistical approach. The study found that mental fluctuations statistically reduced the accuracy of depression-screening models. A weak association between ePRO omissions and screening accuracy was found. Moreover, the compounding effects that had a negative effect on the depression screening accuracy were statistically significant. Conclusions: Although well-trained deep-learning-based models exhibit excellent performance, they still have some limitations. Thus, it is very important to focus on data quality to predict health outcomes when using data that is difficult to quantify, such as mental conditions.

  • Web-based interventions supporting adolescents and young people with depressive symptoms: a systematic review and meta-analysis

    From: JMIR mHealth and uHealth

    Date Submitted: Aug 2, 2017

    Open Peer Review Period: Aug 2, 2017 - Sep 27, 2017

    We conducted a systematic review and meta-analysis of trials to describe the effectiveness of web-based interventions to support adolescents with depression or depressive symptoms, anxiety and stress....

    We conducted a systematic review and meta-analysis of trials to describe the effectiveness of web-based interventions to support adolescents with depression or depressive symptoms, anxiety and stress. We also explored the content of the interventions, as there has previously been a lack of coherent understanding of the detailed content of the web-based interventions supporting adolescents’ mental wellbeing. We included parallel randomized control trials (RCT) targeted at adolescents, or young people between 10 and 24 years old, with symptoms or diagnoses of depression and/or anxi-ety. The interventions were from original studies aimed to support mental health among adolescents, and they were delivered by web-based information and communication technology (ICT). Out of 2,087 records identified, 27 articles (22 studies) met the inclusion criteria. Based on a narrative analysis of 22 studies, a variety of web-based interventions were found; the most commonly used intervention was based on cognitive behavioral therapy. Meta-analysis was further conducted with 15 studies (4,979 participants). At the end of the intervention, a statistically significant improvement was found in the intervention group (10 studies) regarding depressive symptoms (P<.02, median 1.68, 95% CI 3.11-0.25) and after 6 months (3 studies) (P<.01, median 1.78, 95% CI 3.20-0.37). Anxiety symptoms (8 studies) (P<.001, median 1.47, 95% CI 2.36-0.59) and moods and feelings (two studies) (P<.04, median 5.55, 95% CI 10.88-0.22) improved as well in the web-based in-tervention group. However, there was no difference in stress scores. On the other hand, adolescents in the intervention group left the study early more often, both in short-term (10 studies) (P<.01, median 1.33, 95% CI 1.06-1.66) and in mid-term (3 studies) (P<.02, median 1.65, 95% CI 1.09-2.49). We did not find any studies that had assessed the costs of the web-based interventions. Despite widely reported promises that information technology use is beneficial to adolescents with depression, the results of our review showed only short-term effects to adolescents’ mental wellbeing, while long-term effects can be questioned due to the limited number of studies reviewed. Information about the economic benefits of web-based interventions is still lacking. The quality of the studies, especially biases related to attrition rates and selective reporting, still needs serious attention.

  • Few Tweets After Flu Peak: Twitter-based Influenza Detection by Referring Indirect Information

    From: Journal of Medical Internet Research

    Date Submitted: Aug 2, 2017

    Open Peer Review Period: Aug 4, 2017 - Sep 29, 2017

    The recent rise in popularity and scale of social networking services (SNSs) has resulted in an increasing need for SNS-based information extraction systems. A popular application of SNS data is healt...

    The recent rise in popularity and scale of social networking services (SNSs) has resulted in an increasing need for SNS-based information extraction systems. A popular application of SNS data is health surveillance for predicting the outbreak of epidemics by detecting diseases from text messages posted on SNS platforms. Such applications share the same logic: they incorporate SNS users as social sensors. These social sensor approaches also share a common problem: SNS-based surveillance can be reliable if sufficient numbers of users are active, but small inactive populations produce inconsistent results. This paper proposes a novel approach that overcomes this problem using indirect information covering both urban areas and rural areas within the posts. Experiments were conducted using a collection of tweets spanning three years (seven million influenza-related tweets in Japanese). Both direct information and indirect information that mentions other places were used. As indirect information is less reliable (too noisy or too old) than direct information, the indirect information data were not utilized directly but were considered as inhibiting direct information. For example, when indirect information appeared often, it was considered as signifying that everyone already had a known disease, leading to a small amount of direct information. The proposed approach improved the detection performance not only in rural cities, but also in urban cities, thereby demonstrating that it is feasible.

  • Development of a technology assisted behavioral intervention for extending sleep duration among individuals with short sleep duration

    From: JMIR Mental Health

    Date Submitted: Aug 2, 2017

    Open Peer Review Period: Aug 3, 2017 - Sep 28, 2017

    Background: Despite high prevalence of short sleep duration (29.2% of adults sleep <6 hours on weekdays) there are no existing theory based behavioral interventions to extend sleep duration. The popul...

    Background: Despite high prevalence of short sleep duration (29.2% of adults sleep <6 hours on weekdays) there are no existing theory based behavioral interventions to extend sleep duration. The popularity of wearable sleep trackers provides an opportunity to engage users in interventions. Objective: This paper outlines the theoretical foundation and iterative process of designing the “Sleep Bunny”, a technology-assisted sleep extension intervention including a smartphone application, wearable sleep tracker and brief telephone coaching. We conducted a two-step process in the development of this intervention. 1. User testing of the application and 2. A small field trial of participants with short sleep duration and a cardiovascular disease risk factor linked to short sleep duration (BMI>25). Methods: All participants had habitual sleep duration <6.5 verified by 7 days of actigraphy. Six individuals completed initial user testing in the development phase and two participants with sleep duration <6.5 hours and BMI >25 completed field testing. Participants in the user testing and field testing responded to open ended surveys about the design and utility of the application. Participants in the field testing completed the Epworth Sleepiness Scale and also wore and actigraph for a 1 week baseline period and during the 4 week intervention. Results: The feedback suggests users enjoyed the wearable sleep tracker and found the application visually pleasing but suggested improvements to the notifications and reminders. The two participants who completed the field test demonstrated significant improvements in sleep duration and daytime sleepiness. Conclusions: Further testing is needed to determine effects of this intervention in populations at risk for the mental and physical consequences of sleep loss.

  • A Scoping Study on mHealth Initiatives in Vietnam

    From: Journal of Medical Internet Research

    Date Submitted: Aug 6, 2017

    Open Peer Review Period: Aug 7, 2017 - Oct 2, 2017

    Background: MHealth offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity in published information on mHealth in Vietnam. Objective: Th...

    Background: MHealth offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity in published information on mHealth in Vietnam. Objective: The objectives of this scoping study are 1) to summarize the extent, range, and nature of mHealth initiatives in Vietnam and 2) to examine the strengths, weaknesses, opportunities and threats of mHealth utilization in the Vietnamese context. Methods: This scoping study systematically identified and extracted relevant information from 19 past and current mHealth initiatives in Vietnam. The study includes multimodal information sources including published literature, gray literature (i.e., government reports and unpublished literature), conference presentations, online documents, and key informant interviews. Results: Our findings suggest the largest advantage of mHealth in Vietnam is its ability to reach hard-to-reach populations and vulnerable groups. On the other hand, mHealth implementation in Vietnam has been challenged by factors including features unique to the Vietnamese language, sociocultural factors, and technological infrastructure. Conclusions: The largest threats to mHealth moving forward are the absence of government policy, lack of government interest, and heavy dependence on foreign funding. Lastly, while current mHealth initiatives have already demonstrated promising opportunities for alternative models of funding, such as social entrepreneurship or private business models, there have yet to be sustainable mHealth initiatives outside of those funded by external donors.

  • Treatment with creatine monohydrate in spinal and bulbar muscular atrophy: study protocol for a randomized, double-blind, placebo-controlled trial

    From: JMIR Research Protocols

    Date Submitted: Aug 7, 2017

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

    Background: Although spinal and bulbar muscular atrophy (SBMA) has been classified as a motor neuron disease, several reports have indicated the primary involvement of skeletal muscle in the pathogene...

    Background: Although spinal and bulbar muscular atrophy (SBMA) has been classified as a motor neuron disease, several reports have indicated the primary involvement of skeletal muscle in the pathogenesis of this devastating disease. Recent studies reported decreased intramuscular creatine levels in skeletal muscles in both patients with SBMA and transgenic mouse models of SBMA, which appears to contribute to muscle weakness. Objective: The present study aimed to examine the efficacy and safety of oral creatine supplementation to improve motor function in patients with SBMA. Methods: A randomized, double-blind, placebo-controlled, three-armed clinical trial was conducted to assess the safety and efficacy of creatine therapy in patients with SBMA. Patients with SBMA eligible for this study were assigned randomly in a 1:1:1 ratio to each group of placebo, 10 g, or 15 g daily dose of creatine monohydrate in a double-blind fashion. Participants took creatine or placebo orally three times a day for 8 weeks. Outcome measurements were results of neurological assessments, examinations, and questionnaires collected at baseline and at weeks 4, 8, and 16 after a washout period. The primary endpoint was the change in handgrip strength values from baseline to week 8. The secondary endpoints included the following: results of maximum voluntary isometric contraction tests of extremities; tongue pressure; results of the 15-foot timed walk test and the rise from bed test; modified quantitative myasthenia gravis score; respiratory function test results; activities of daily living assessed with the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale and the Spinal and Bulbar Muscular Atrophy Functional Rating Scale; skeletal muscle mass measured with dual-energy X-ray absorptiometry; urinary 8-hydroxydeoxyguanosine levels; and questionnaires examining the quality of life, swallowing function, and fatigue. Results: Participant enrollment in the trial started from June 2014 and follow-up was completed in July 2015. The study is currently being analyzed. Conclusions: This is the first clinical trial evaluating creatine therapy in SBMA. Given that creatine serves as an energy source in skeletal muscles, recovery of intramuscular creatine concentration is expected to improve muscle strength. Clinical Trial: UMIN Clinical Trials Registry as UMIN000012503 on 25-dec-2013

  • Development of an adherence intervention and a protocol for the process evaluation - Motivational interviewing and medication review in coronary heart disease (MIMeRiC)

    From: JMIR Research Protocols

    Date Submitted: Aug 7, 2017

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

    Background: Trials of complex interventions are often criticized for being difficult to interpret because the effects of apparently similar interventions vary across studies dependent on context, targ...

    Background: Trials of complex interventions are often criticized for being difficult to interpret because the effects of apparently similar interventions vary across studies dependent on context, targeted groups and the delivery of the intervention. The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a randomized, controlled trial of an intervention aimed at improving pharmacological secondary prevention. Guidelines for the development and evaluation of complex interventions have recently highlighted the need for better reporting of the development of interventions, including descriptions of how the intervention is assumed to work, how this theory informed the process evaluation, and how the process evaluation relates to the outcome evaluation. Objective: The aim of this paper is to describe how the intervention was designed and developed. The aim of the process evaluation is to better understand how and why the intervention in the MIMeRiC trial was effective or not effective. Methods: The research questions for evaluating the process are based on the conceptual model of change processes assumed in the intervention and will be analyzed by qualitative and/or quantitative methods. Quantitative data are used to evaluate the medication review in terms of drug-related problems, to describe how patients’ beliefs about medicines are affected by the intervention, and to evaluate the quality of Motivational Interviewing. Qualitative data will be used to analyze whether patients experienced the intervention as intended, how cardiologists experienced the collaboration and intervention, and how the intervention affected patients’ overall experience of the care after coronary heart disease. Results: The development and piloting of the intervention are described in relation to the theoretical framework. Data for the process evaluation will be collected until March 2018. Some process evaluation questions will be analyzed before and others will be analyzed after the outcomes of the MIMeRiC RCT are known. Conclusions: This paper describes the framework for the design of the intervention tested in the MIMeRiC trial, development of the intervention from the pilot stage to the complete trial intervention, and the framework and methods for the process evaluation. Providing the protocol of the process evaluation allows pre-specification of the processes that will be evaluated, because we hypothesize that they will determine the outcomes of the MIMeRiC trial. This protocol also constitutes a contribution to the new field of process evaluations as made explicit in health services research and clinical trials of complex interventions. Clinical Trial: Clinical Trials.gov: NCT02102503 https://clinicaltrials.gov/ct2/show/NCT02102503?term=Motivational+interviewing+coronary+heart&rank=2

  • A randomised controlled trial of an intervention delivered by app instant messaging to increase acceptability and use of effective contraception among young women in Bolivia: study protocol

    From: JMIR Research Protocols

    Date Submitted: Aug 9, 2017

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

    Background: Unintended pregnancy is associated with numerous poorer health and outcomes for both women and their children. Fulfilling unmet need for contraception is essential in avoiding unintended p...

    Background: Unintended pregnancy is associated with numerous poorer health and outcomes for both women and their children. Fulfilling unmet need for contraception is essential in avoiding unintended pregnancies, yet millions of women in low and middle income countries continue to face obstacles in realising their fertility desires. In Bolivia, family planning progress has improved in recent decades but lags behind other countries in the region. Unmet need for contraception among women aged 15-19 is estimated to be 38%, with the adolescent fertility rate at 70 per 1,000 women. Mobile phones are an established and popular vehicle in which to deliver health behaviour support. The London School of Hygiene & Tropical Medicine and the Centro de Investigación, Educación y Servicios in Bolivia have partnered to develop and evaluate a contraceptive behavioural intervention for Bolivian young women delivered by mobile phone. The intervention was developed guided by behavioural science and consists of short instant messages sent through an app over four months. Objective: The objective of this study is to evaluate the effect of the intervention on young women’s use of and attitudes towards the most effective contraceptive methods. Methods: 1310 women aged 16-24 with an unmet need for contraception will be allocated with a 1:1 ratio to receive the intervention messages or the control messages about trial participation. The messages are sent through the ‘Tú decides’ app, which contains basic information about contraception. Co-primary outcomes are use and acceptability of at least one effective contraceptive method, both measured at four months. Results: Recruitment commenced 1 March 2017 and was complete on 29 July 2017. The follow-up period is estimated to end in January 2018. Conclusions: This trial will evaluate the effect of the intervention on young women’s use of and attitudes towards the (non-permanent) effective contraception methods available in Bolivia: OC, IUD, the injection, the implant and the patch. Clinical Trial: ClinicalTrials.gov Identifier NCT02905526

  • Leveraging diverse clinical elements to predict unplanned ICU transfers at three large children’s hospitals

    From: Journal of Medical Internet Research

    Date Submitted: Aug 11, 2017

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

    Background: Increased mortality and morbidity is associated with deterioration in patients who require an unplanned transfer from the nursing floor to the ICU (Intensive Care Unit). The mortality rate...

    Background: Increased mortality and morbidity is associated with deterioration in patients who require an unplanned transfer from the nursing floor to the ICU (Intensive Care Unit). The mortality rate associated with unrecognized deterioration that results in a delay of ICU transfer and the need for resuscitation can be as high as 67%.Missing precursors to deterioration reduces the window of opportunity and margin of error for effective intervention and increases the intensity and complexity of the required care. Objective: Machine learning methods that make use of large numbers of predictor variables are now commonplace. This work examines how different types of predictor variables derived from the electronic health record affect the performance of predicting unplanned transfers to the ICU at three large children’s hospitals. Methods: We trained separate models with data from three different institutions from 2011 through 2013 and evaluated models with 2014 data. Cases consisted of patients who transferred from the floor to the intensive care unit (ICU) and met one or more of 5 different a priori defined criteria for suspected unplanned transfers. Controls were patients who never transferred to the ICU. Predictor variables for the models were derived from vitals, labs, acuity scores and nursing assessments. Classification models consisted of L1 and L2 regularized logistic regression and neural network models. We evaluated model performance over prediction horizons ranging from 1-16 hours. Results: Across the three institutions, the c-statistic values for our best models were (0.892 [CI: .875-.904]), (0.902 [CI: .880-.923]) and (0.899 [CI: .879-.919]) for the task of identifying unplanned ICU transfer 6 hours prior to its occurrence and achieved (0.871 [CI: .855 -.888]), (0.872 [CI: .850-.895]) and (0.850 [CI: .825-.875]) for a prediction horizon of 16 hours. For our first model at 80% sensitivity, this resulted in a specificity of 80.5% [CI: 77.4-83.7%] and a positive predictive value of 5.2% [CI: 4.5-6.2%]. Conclusions: Feature-rich models with many predictor variables provide allow for patient deterioration to be predicted accurately, even up to 16 hours in advance.

  • Facebook and Subjective Well-Being: A Systematic Review

    From: JMIR Mental Health

    Date Submitted: Aug 9, 2017

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

    Objective: This systematic review evaluates various theoretical underpinnings, which may contribute to a better understanding of the effects of Facebook use on subjective well-being among college stud...

    Objective: This systematic review evaluates various theoretical underpinnings, which may contribute to a better understanding of the effects of Facebook use on subjective well-being among college students. Methods: The author conducted a PubMed search of experimental studies conducted within a young adult population. Eligible participant data was delimited to undergraduate or graduate students, who were required to be current Facebook users. Results: Six studies were chosen for the review. The findings suggest that Facebook usage may be positively associated with subjective well-being via several theoretical mechanisms founded in social psychology. Conclusions: These findings provide preliminary evidence that Facebook may offer its users unique opportunities to tailor their online self-presentation to assuage the impact of negative psychosocial stimuli presented in real-world environments. Innovative strategies should be conceived to assess the possible relationship between Facebook use and enhanced subjective well-being.

  • Challenges and Opportunities of Implementing a Patient-Reported Measure of Physical Function through an online Electronic Health Record Patient Portal in Routine Rheumatology Practice

    From: Journal of Medical Internet Research

    Date Submitted: Aug 15, 2017

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

    Background: Despite significant interest in the collection of patient-reported outcomes (PROs) to make care more patient-centered, few studies have evaluated implementation efforts to collect PROs fro...

    Background: Despite significant interest in the collection of patient-reported outcomes (PROs) to make care more patient-centered, few studies have evaluated implementation efforts to collect PROs from diverse patient populations. Objective: We assessed the collection of PROs from rheumatoid arthritis (RA) patients in an academic rheumatology clinic, using a paper and an online form through the electronic health record (EHR) patient portal. Methods: We identified patients seen between 2012- 2016 with ≥2 face-to-face encounters with a rheumatology provider and ICD codes for RA, ≥30 days apart. In 2013, our clinic implemented a paper version of the Patient Reported Outcome Measurement Information System (PROMIS) physical function (PF) form that was administered to patients upon their check-in at the clinic; in 2015, an online version of the form became available via the EHR patient portal to patients with active portal accounts. We compared the proportion of visits with documented PROMIS scores across age, race/ethnicity, and language, using chi-square, ANOVA tests, and logistic regression model and examined trends over time using a control chart. Results: We included 1,078 patients with RA with 7,049 in-person encounters at the rheumatology clinic over 4 years, with an average of 168 visits/month. 80.4% of patients (867/1078) were female; mean age was 55 (SD 16). Overall PROMIS PF score documentation increased from 60.4% (1081/1791) of visits in 2013 to 74.4% (905/1217) in 2016. Online score documentation increased from 10.0% (148/1473) in 2015 to 19.3% (235/1217) in 2016. African Americans were less likely to have a PROMIS PF recorded (62.5% (55/88) vs. 80.0% (792/990) for other racial/ethnic groups, P<0.001). Compared with Whites, both African American and Hispanics were less likely to have active online EHR portal accounts (50% (44/88) and 57.3% (90/157) respectively, vs. 83.9% (437/521) of Whites; P<0.001) and, once activated, less likely to use the online survey (13.6% (6/44) and 17.8% (16/90) respectively, vs. 30.9% (135/437) of Whites; P=0.02). There was no significant difference in the proportion of any PROMIS PF recorded between non-English vs. English speakers. No significant differences were found across age or gender. Conclusions: PROMIS PF form completion improved overall from 2012-2016, but lagged among racial/ethnic minorities and non-English speaking patients. Future studies should address issues of portal access, enrollment, satisfaction and persistence, and focus on developing PRO implementation strategies that accommodate the needs and preferences of diverse populations.

  • A systematic review and proposed framework for providing just-in-time feedback in energy balance-related behavior change interventions

    From: Journal of Medical Internet Research

    Date Submitted: Aug 10, 2017

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

    Background: The integration of body-worn sensors with mobile devices presents a tremendous opportunity to enhance the timely, bi-directional communication between study participants and researchers or...

    Background: The integration of body-worn sensors with mobile devices presents a tremendous opportunity to enhance the timely, bi-directional communication between study participants and researchers or patients and health care providers to more effectively influence health behavior changes. Objective: The goal of this systematic review was to synthesize data on the content characteristics of performance feedback used in energy balance-related behavior change interventions and to update a theory-based framework to guide the design of just-in-time performance feedback interventions. Methods: Intervention studies published through 2016 that included just-in-time performance feedback on physical activity, sedentary behavior, and/or dietary intake were eligible for inclusion. Feedback content and efficacy data were synthesized descriptively. Results: Thirty-one intervention studies targeting physical activity (48%), diet and physical activity (42%), or diet only (10%) were included in the review. Feedback in 100% of the studies were timely (by design), 97% were personalized, and 78% were goal-oriented, but only 16% were actionable. The efficacy of providing feedback was tested in 9 studies; 4 studies reported significant effects and 5 studies reported no significant effects for intervention efficacy. Feedback was continuously-available, goal-oriented, and/or actionable in 3 of the 4 studies with significant intervention effects compared to 1, 3, and 2 of 5 studies with non-significant intervention effects, respectively. Conclusions: Performance feedback that is continuously-available, personalized, and actionable relative to a known behavioral objective or goal is prominent in intervention studies with significant behavior change outcomes. Future research using experimental designs such as the multiphase optimization strategy (MOST) and micro-randomization will be useful to optimize just-in-time feedback content and timing and frequency. Clinical Trial: Not applicable

  • A patient-held smartcard with a unique identifier to improve availability of prenatal test results in rural Nigeria

    From: Journal of Medical Internet Research

    Date Submitted: Aug 14, 2017

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

    Background: Community-based strategies to test for HIV, hepatitis B virus (HBV), and sickle cell disease (SCD) have expanded opportunities to increase the proportion of pregnant women who are aware of...

    Background: Community-based strategies to test for HIV, hepatitis B virus (HBV), and sickle cell disease (SCD) have expanded opportunities to increase the proportion of pregnant women who are aware of their diagnosis. In order to use this information to implement evidence-based interventions, these results have to be available to skilled health providers at the point-of-delivery. Most electronic health platforms are dependent on the availability of reliable Internet connectivity and thus, have limited use in many rural and resource-limited settings. Objective: In this study, we explored the possibilities of developing an integrated mobile health (mHealth) platform that is able to capture medical information including test results and encrypt it into a patient-held smartcard that can be read at the point-of-delivery without the need for an Internet connection. Methods: We engaged a team of public health experts and information technology specialists in a focus group and a requirement gathering process to inform the design of a prototype for a platform that utilizes smartcard technology, database deployment, and mobile phone app development. Results: We successfully designed an integrated mHealth platform and deployed it in four health facilities across Benue state, Nigeria. The platform was developed to store test results in a database, securely encrypt the results on a smartcard, and a mobile app was used to read the information on the smartcard, without the need for Internet connectivity. Conclusions: Our findings indicate that it is feasible to develop a patient-held smartcard that contains vital health information that can be read at the point-of-delivery using a mobile phone-based app without Internet connection. Clinical Trial: ClinicalTrials.gov NCT03027258; https://clinicaltrials.gov/ct2/show/NCT03027258 (Archived by WebCite at http://www.webcitation.org/6owR2D0kE)

  • The importance of frequent participation in obesity management through mobile health care programs

    From: JMIR mHealth and uHealth

    Date Submitted: Aug 19, 2017

    Open Peer Review Period: Aug 19, 2017 - Oct 14, 2017

    Background: Due to the prevalence of the westernized dietary pattern and lack of physical activity, the numbers of people overweight or obese are increasing, resulting in a growing health burden becau...

    Background: Due to the prevalence of the westernized dietary pattern and lack of physical activity, the numbers of people overweight or obese are increasing, resulting in a growing health burden because of various related diseases. In managing obesity, a prophylactic approach is more important than a therapeutic approach. In our randomized controlled study conducted in 2015, where we tried to control weight using a SmartCare service in patients with metabolic syndrome, a significant weight loss effect was confirmed. In that study, we supplied mobile smart phones for participants to record anthropometric measurements daily. In addition, a health consultation service using smart phones was available once a week. Active participation was not compulsory, and adherence varied from person to person. There have been many studies demonstrating weight loss effects using a SmartCare service, but there is little research on the effect of active participation on the results. Objective: In this study, we aimed to approach the weight loss effect of using a SmartCare service in terms of adherence and participation. We divided the intervention group of the previous study according to participation level, and analyzed whether there was a significant difference in outcome. Methods: We classified participants into three groups according to their adherence: active participants, less active participants, and a control group who do not use the SmartCare service. The classification criteria were as follows: 1) whether an anthropometric measurement was entered into a mobile smart phone more than three times a week, and; 2) whether a health consultation was performed more than 5 times during a total of 24 weeks. We compared changes in body weight, body mass index (BMI), body fat percentage, waist circumference, and lipid profile among the three groups. Results: There was a statistically significant difference in the improvements of body weight, BMI, body fat percentage, and waist circumference among active participants compared to less active participants and the control group. However, there was no significant difference in lipid profile changes among them. Conclusions: To maximize the effectiveness of the SmartCare service, it is important to encourage active participation since, with better adherence, there is improved health. Clinical Trial: Clinicaltrials.gov NCT01344811; https://clinicaltrials.gov/ct2/show/NCT01344811 (Archived by Webcite at http://www.webcitation.org/6alT2MmIB)

  • The impact of digital health interventions on health-related outcomes in the workplace: a systematic review

    From: Journal of Medical Internet Research

    Date Submitted: Aug 12, 2017

    Open Peer Review Period: Aug 12, 2017 - Oct 7, 2017

    Background: Background: The impact of employee health on productivity in the workplace is generally evidenced through absenteeism and presenteeism. Multicomponent health promotion programs delivered i...

    Background: Background: The impact of employee health on productivity in the workplace is generally evidenced through absenteeism and presenteeism. Multicomponent health promotion programs delivered in the workplace have been shown to effectively modify health risks, in turn impacting medical costs and supporting employees being more effective in their roles. Scalable, cost effective online programs have gained in popularity over the last two decades, due at least in part to their almost limitless scalability and lower cost of implementation. However, little is known about the impact of digital only interventions on health related outcomes in employee groups. Objective: Objective: To assess the impact of purely digital health interventions in the workplace on health-related outcomes. Methods: Methods: Using Scopus (i.e. search engine including databases such as MEDLINE, EMBASE, PubMed, PsycINFO, and CINAHL), literature was reviewed using PRISMA guidelines. Results: Results: Of the initial 1,345 records screened, the final number of eligible studies was 25. Most of these studies were RCTs (n=20) that included control or comparison groups and ran for an average of three months. The interventions within these studies targeted a broad range of health-related outcomes such as sleep, stress, mental health, sedentary behaviors, and physical activity levels, but did not always use standardized measures to quantify impact. All but one study found a significant improvement in at least one health-related outcome. Attrition rates ranged extensively, from 0 to 80%, suggesting program engagement was an issue. In addition, risk of bias assessment was generally unclear for the majority of the studies reviewed. Conclusions: Conclusions: Overall, the review found modest evidence that digital only interventions have a positive impact on health-related outcomes in the workplace. Due to a lack of robustly designed studies within the literature future research should include the evaluation of digital interventions with more RCTs and a focus on issues of engagement and the increased use of standardized measures.

  • Recommended Workflow Methodology in the Creation of an Interactive Application for Patient’s Diagnosed with Pancreatic Cancer

    From: JMIR Research Protocols

    Date Submitted: Aug 11, 2017

    Open Peer Review Period: Aug 12, 2017 - Aug 26, 2017

    Background: Pancreatic cancer is a leading cause of cancer related deaths in the UK. However, public knowledge and understanding of the pancreas is generally poor, therefore pancreatic cancer patients...

    Background: Pancreatic cancer is a leading cause of cancer related deaths in the UK. However, public knowledge and understanding of the pancreas is generally poor, therefore pancreatic cancer patients often have to contend with understanding large quantities of new information at a pivotal time in their lives. Objective: Despite utilisation of digital visualisation techniques in medical education, very rarely are they being used to help clinicians communicate information to their patients. Specifically, there is no literature describing use of an interactive digital application for use by healthcare professionals to aid discussions specific to pancreatic cancer. Therefore, we developed a workflow methodology, and created an interactive application, thus creating a tool that could help clinicians explain pancreatic cancer anatomy, and staging, to their patients. Methods: Three-dimensional (3D) digital models were created using ZBrush and Autodesk 3DS Max, and exported into the Unity game engine. Within Unity, the interactivity of models was maximally utilised, and a simple user interface created. Results: The application centres on anatomically accurate, visually simple, 3D digital models, demonstrating a variety of common scenarios that arise in pancreatic cancer. The design of the application is such that the clinician can select which model is relevant to the patient, and can give an explanation of the anatomy and disease process at a speed and level appropriate to that person. Conclusions: This simple, robust and effective workflow methodology for the development of an application could be useful in any clinical setting that needs visual and interactive tools to enhance patient understanding of a clinical condition.

  • Title: Two Year Assessment of Nurses’ Experience of Health Information Technology: A Longitudinal Qualitative Study

    From: Journal of Medical Internet Research

    Date Submitted: Aug 11, 2017

    Open Peer Review Period: Aug 12, 2017 - Oct 7, 2017

    Background: Nurses are the largest group of HIT users. As such, nurses’ adaptation is critical for HIT implementation success. However, longitudinal approaches to understanding nurses’ perceptions...

    Background: Nurses are the largest group of HIT users. As such, nurses’ adaptation is critical for HIT implementation success. However, longitudinal approaches to understanding nurses’ perceptions of HIT are underexplored. Previous studies of nurses’ perceptions demonstrate that the progress and timing for acceptance and adaptation varies. Objective: the study aims to explore nurses’ experience regarding implementation of health information technology (HIT) over time. Methods: A phenomenological approach was used for this longitudinal qualitative study to explore nurse perceptions of HIT implementation over time, focusing on three time points (rounds) at 3, 9, and 18 months after the implementation of electronic health records (EHR) and bar code medication administration (BCMA). The purposive sample was comprised of clinical nurses who worked on a medical-surgical unit in an academic center. Results: Major findings were categorized into 7 main themes with 53 subthemes. Nurses reported personal-level and organizational-level factors that facilitated HIT adaptation. We also generated network graphs to illustrate the occurrence of themes. Thematic interconnectivity differed due to nurses’ concerns and satisfaction at different time points. Equipment and workflow were the most frequent themes across all three rounds. Nurses were the most dissatisfied about 9 months after HIT implementation. Eighteen months after HIT implementation, nurses’ perceptions appeared more balanced. Conclusions: It is recommended that organizations invest in equipment to improve HIT functionality, refine policies to reflect nursing practice, and improve systems to focus on patient safety. Future research is necessary to confirm patterns of nurses’ adaptation to HIT in other samples.

  • Contents, followers and retweets of CDC Office of Advanced Molecular Detection Twitter profile: a cross-sectional study

    From: JMIR Public Health and Surveillance

    Date Submitted: Aug 12, 2017

    Open Peer Review Period: Aug 15, 2017 - Aug 29, 2017

    Background: The Office of Advanced Molecular Detection, Centers for Disease Control and Prevention (CDC), manages a Twitter profile (@CDC_AMD). No prior study analyzed a CDC Twitter handle’s entire...

    Background: The Office of Advanced Molecular Detection, Centers for Disease Control and Prevention (CDC), manages a Twitter profile (@CDC_AMD). No prior study analyzed a CDC Twitter handle’s entire contents and all followers. Objective: We aimed to describe the contents and followers of the Twitter profile @CDC_AMD and to assess if attaching photos or videos to tweets posted by @CDC_AMD would increase retweet frequency. Methods: Data of @CDC_AMD were retrieved on November 21, 2016. All followers (N=809) were manually categorized. All tweets (N=768) were manually coded for contents and whether photos or videos were attached. Retweet count for each tweet was recorded. Negative binomial regression models were applied to both the original and the retweet corpora. Results: Among the 809 followers, there were 210 (26%) individual health professionals, 94 (12%) non-governmental organizations, 27 (3%) government agencies’ accounts, 27 (3%) accounts of media organizations and journalists, and 7 (1%) academic journals, with 444 (55%) categorized as miscellaneous. Forty-seven percent of @CDC_AMD’s tweets (360/768) referred to the Office’s website and their current research; 18% (135/768) referred to their scientists’ publications. Eighty percent (69/86) of tweets retweeted by @CDC_AMD fell into the miscellaneous category. Forty-three percent (333/768) of the tweets contained photos or videos, while the remaining 57% (435/768) did not. Attaching photos or videos to original tweets increases the number of retweets by 37% (Probability ratio = 1.37, 95 CI, 1.13-1.67, P=.002). Content topics did not explain or modify this association. Conclusions: This study confirms CDC health communicators’ experience that original tweets created by @CDC_AMD Twitter profile sharing images or videos (or their links) received more retweets. The current policy of attaching images to tweets should be encouraged.

  • Using Facebook to recruit young Australian males into a cross-sectional human papillomavirus study

    From: Journal of Medical Internet Research

    Date Submitted: Aug 13, 2017

    Open Peer Review Period: Aug 15, 2017 - Oct 10, 2017

    Background: Young males can be difficult to engage in health research using traditional methods of recruitment. Social networking sites (SNS) are increasingly being used to recruit participants into h...

    Background: Young males can be difficult to engage in health research using traditional methods of recruitment. Social networking sites (SNS) are increasingly being used to recruit participants into health research, due to their cost-effectiveness, overall generalisability and wide reach. Objective: The aim of this study was to determine the feasibility of using Facebook to recruit young Australian males into a human papillomavirus (HPV) prevalence study. Methods: Male, permanent residents of Australia, aged 18–35 years were recruited into the HPV in Young Males (HYM) Study through targeted advertising placed on Facebook. Consenting participants completed an online questionnaire and provided a self-collected penile swab for HPV DNA detection and genotyping. Socio-demographic characteristic of the study population were compared to that of the general Australian male population, based on Australian 2011 Census data. Results: Between February 2015 and February 2017, targeted Facebook advertisements reached 1,523,233 males, resulting in 41,811 clicks through to the study website, with 1,072 (2.6%) converting to lodgement of an expression of interest (EOI). Of these, 681 (63.5%) provided written informed consent and 535 (78.6% of recruited participants) completed all the study requirements. Reasons for participating in the study included altruism, past history of HPV, gaining more knowledge about HPV and/or the vaccine, working in the health industry and the monetary compensation. The average advertising cost per completed study participant was AU$48. Compared with the census population, HYM participants were more likely to be Australian born (P<0.001), be from Victoria or the Australian Capital Territory (P=0.003 and 0.004, respectively), reside in a major city (P<0.001) and have completed undergraduate or postgraduate education (P<0.001 for each). HYM participants were less likely to report being a current smoker (P=0.03), but were more likely to identify as bisexual or homosexual (55.6%, P<0.001), than the general population. Conclusions: Facebook is a feasible and efficient strategy for the recruitment of males from across Australia for HPV testing. This method could be utilised for monitoring the impact of HPV vaccination. Additional targeting may achieve a sample that is broadly demographically representative of the Australian population Future research should explore how the sexual risk behaviour characteristics of populations recruited through Facebook compare with traditional recruitment methods.

  • Smartphone apps for quality of life and wellbeing assessment in breast and prostate cancer patients: A systematic review.

    From: Journal of Medical Internet Research

    Date Submitted: Aug 19, 2017

    Open Peer Review Period: Aug 19, 2017 - Aug 30, 2017

    Background: Smartphone health applications (apps) are increasingly gaining attention in oncological care as potential tools for supporting cancer patients. However, although the number of publications...

    Background: Smartphone health applications (apps) are increasingly gaining attention in oncological care as potential tools for supporting cancer patients. However, although the number of publications and health apps focusing on cancer is increasing, there are still few specifically designed for the most prevalent cancers diagnosed: breast and prostate cancers. There is a need to review the effect of these apps on breast and prostate cancer patients’ quality of life (QoL) and wellbeing. Objective: The purposes of this study were, firstly, to review the scientific literature on smartphone apps targeting breast or prostate cancer patients, and involving QoL and wellbeing (anxiety and depression symptoms), and secondly, to analyze the clinical and technological characteristics, strengths and weaknesses of these apps, as well as patients’ user experience of them. Methods: We conducted a systematic review of peer-reviewed literature from The Cochrane Library, Embase, PsycINFO, Pubmed, Scopus, and MEDLINE to identify studies involving smartphone apps focused on breast and/or prostate cancer patients and QoL and/or wellbeing, published between January 1st, 2000 and July 12th, 2017. Only trial studies which met the inclusion criteria were selected. The systematic review was completed with a critical analysis of the smartphone apps previously identified in the health literature research that were available in the official application stores. Results: The systematic review of the literature yielded 3,862 articles. After removal of duplicates, 3,229 remained and were evaluated on the basis of title and abstract. Of these, 3,211 were discarded as not meeting the inclusion criteria, and 18 records were selected for full text screening. Finally, 5 citations were included in this review, with a total of 644 patients, mean age 52.16 years. The majority of the studies targeted breast cancer patients and only 1 paper was focused on prostate cancer patients. In three studies an app-related intervention was carried out, and two of them reported an improvement on quality of life, while two of the studies only tracked use of the app, and no effect on quality of life or wellbeing was found. Conclusions: Despite the existence hundreds of studies involving cancer-focused smartphone apps, there is a lack of rigorous trials regarding the QoL and/or wellbeing assessment in breast and/or prostate cancer patients. A strong and collective effort should be made by all health care providers to determine those cancer-focused smartphone apps which effectively represent useful, accurate, and reliable tools for cancer patients’ disease management. Clinical Trial: Registration: PROSPERO (Registered on 26/07/2017, ref. 73069)

  • A Dermatologists’ Ammunition in the War Against Smoking

    From: Journal of Medical Internet Research

    Date Submitted: Aug 14, 2017

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

    This viewpoint reviews the perspectives for Dermatology as a specialty to go beyond the substantial impact of smoking on skin disease and claim its responsibility due to the superior impact of skin ch...

    This viewpoint reviews the perspectives for Dermatology as a specialty to go beyond the substantial impact of smoking on skin disease and claim its responsibility due to the superior impact of skin changes on a persons’ self-concept and behavior in the design of effective interventions for smoking prevention and cessation.

  • Telegerontology as a Novel Approach to Optimize Health and Safety among Rural Community-Dwelling Canadians with Dementia: Study Protocol for a Randomized Controlled Trial

    From: JMIR Research Protocols

    Date Submitted: Aug 14, 2017

    Open Peer Review Period: Aug 15, 2017 - Aug 29, 2017

    Background: Telegerontology is an approach using videoconferencing to connect an interdisciplinary team in a regional specialty center to patients in rural communities, which is becoming increasingly...

    Background: Telegerontology is an approach using videoconferencing to connect an interdisciplinary team in a regional specialty center to patients in rural communities, which is becoming increasingly practical for addressing current limitations in rural community-based dementia care. Objective: Using the remotely-delivered expertise of the Telegerontology dementia care team, we aim to enhance the caregiver/patient/physician triad and thereby provide the necessary support for the person with dementia to ‘age in place’. Methods: This is a cluster randomized controlled trial with four rural regions in the province of Newfoundland and Labrador, Canada (2 regions randomly assigned to “intervention” and 2 to “control”). The study population included 22 “dementia triads” that consist of a community-dwelling older Canadian with moderate to late dementia, their family caregivers, and their Primary Care Physician (PCP). Over the 6 month active study period, all participants will be provided an iPad. The intervention is intended as an adjunct to existing PCP care, consisting of weekly Skype-based videoconferencing calls with the Telegerontology physician, and other team members as needed (occupational therapist, physical therapist etc.). Control participants receive usual community-based dementia care with their PCP. A baseline (pre-) assessment will be performed during a home visit with the study team. Post intervention, 12 and 18 month follow up assessments will be collected remotely using specialized dementia monitoring applications and Skype calls. Primary outcomes include admission to Long Term Care, falls, emergency room visits, hospital stays, and caregiver burden. Results: Results will be available in the fall of 2017. Conclusions: Results from this study will demonstrate a novel approach to dementia care that has the potential to impact both rural PCPs, family caregivers, and people with dementia; as well as provide evidence for the utility of Telegerontology in models of e-health-based care. Clinical Trial: N/A

  • Views of indigenous young people about SPARX, a computerized e-mental health program

    From: JMIR Serious Games

    Date Submitted: Aug 16, 2017

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

    Background: Globally, depression is a major health issue. This is true for indigenous adolescents, yet there is little research conducted about the efficacy and development of psychological intervent...

    Background: Globally, depression is a major health issue. This is true for indigenous adolescents, yet there is little research conducted about the efficacy and development of psychological interventions for these populations. In New Zealand there is little known about taitamariki (Māori adolescent) opinions regarding the development and effectiveness of psychological interventions, let alone computerized cognitive behavioural therapy. SPARX is a computerized intervention developed in New Zealand to treat mild to moderate depression in young people. It was designed to appeal to all young people in New Zealand, and incorporates a number of images and concepts that are specifically Māori. Objective: To conduct an exploratory qualitative study of Māori adolescents’ opinions about the SPARX program. This is a follow-up to an earlier study where taitamariki opinions’ were gathered to inform the design of a computerized cognitive behaviour therapy (cCBT) program. Methods: Taitamariki were interviewed using a semi-structured interview once they had completed work the SPARX resource. Six participants agreed to complete the interview; these interviews ranged from 10 to 30 minutes. Results: Taitamariki participating in the interviews found SPARX to be helpful. The Māori designs were appropriate and useful, and the ability to customize the SPARX characters with Māori designs was beneficial and appeared to enhance cultural identity. These helped young people to feel engaged with SPARX which, in turn, assisted with the acquisition of relaxation and cognitive restructuring skills. Overall using SPARX led to improved mood and increased tlevels of hope for the participants. In some instances, SPARX was used by wider whānau (Māori word for family) members with reported good effect. Conclusions: Overall, this small group of taitamariki reported that cultural designs made it easier for them to engage with SPARX, which, in turn, led to an improvement in their mood and gave them hope. Further research is needed about how SPARX could be best used to support the families of taitamariki. Clinical Trial: Ethics approval was granted by the Northern Regional Y committee (NTY/09/01/003) of the New Zealand Ministry of Health.

  • Protocol Psychometric evaluation of a patient-reported Symptom Index for non-muscle invasive bladder cancer: field testing

    From: JMIR Research Protocols

    Date Submitted: Aug 16, 2017

    Open Peer Review Period: Aug 17, 2017 - Aug 31, 2017

    Background: Non-Muscle Invasive Bladder Cancer (NMIBC) is a chronic condition requiring intensive follow-up, repeated endoscopic examinations, tumour resections and intravesical treatments that can be...

    Background: Non-Muscle Invasive Bladder Cancer (NMIBC) is a chronic condition requiring intensive follow-up, repeated endoscopic examinations, tumour resections and intravesical treatments that can be 3-monthly and life-long. In this clinical context, patient-reported outcomes (PROs) are a critical concern for patients and their managing clinicians. PROs have enormous potential to be integral to treatment assessment and recommendations for NMIBC, however, current PRO measures are inadequate for NMIBC because they lack key NMIBC-specific symptoms and side effects associated with contemporary treatments. Objective: The overarching aim of the research is to develop and evaluate a patient-reported Symptom Index (SI) for individuals with NMIBC (the NMIBC-SI) that is acceptable to patients, reliable, valid and responsive to differences between contemporary treatments for NMIBC, and fit for purpose as an endpoint in clinical trials. Methods: The NMIBC-SI will be evaluated in two field tests. Field test 1 is a cross-sectional study design involving 225 adult NMIBC patients recruited while undergoing active treatment or completed final treatment within the last week. Data collected includes patient demographics, clinical features of the tumour, risk category, treatment type, comorbidity and PROs. Field test 2 is a prospective longitudinal study involving 225 newly diagnosed NMIBC-SI patients. Clinical data and patient-completed questionnaires will be collected at four time-points during treatment: before tumour resection; 1-week after resection; end of induction intravesical therapy; and 1-year follow-up. Standard psychometric tests will be performed to assess the reliability, validity, responsiveness, and clinical utility of the NMIBC-SI. Results: Participant recruitment to Field Test 1 commenced in February 2017. Field Test 2 is planned to commence January 2018. Final results are expected to be published in 2019. The NMIBC-SI will be freely available for use via registration. Conclusions: This study protocol contains detailed methods that will be used across multiple international sites. Phase 2 in the development of the NMIBC-SI will enable a comprehensive evaluation of its reliability, validity and responsiveness to ensure that the NMIBC-SI is fit for purpose in clinical research, and provide an evidence-base for the on-going improvement of future therapies for NMIBC. Clinical Trial: ClinicalTrials.gov registration ID: NCT03091764

  • Testing the MD-Link, a low cost mobile electrocardiography (ECG) monitoring device, in patients with cardiovascular diseases: study protocol

    From: JMIR Research Protocols

    Date Submitted: Aug 17, 2017

    Open Peer Review Period: Aug 17, 2017 - Aug 31, 2017

    Background: Having mobile devices that provide patients with the ability to record and monitor the electrical activity of their hearts enhances patient self-care and the early detection of cardiac arr...

    Background: Having mobile devices that provide patients with the ability to record and monitor the electrical activity of their hearts enhances patient self-care and the early detection of cardiac arrhythmia (irregular heartbeat), yet few such devices exist in Vietnam. Challenges exist for introducing mobile electrocardiography (ECG) monitoring devices in Vietnam, including patient accessibility and affordability. A low cost mobile electrocardiography monitoring device designed and developed in Vietnam, that allows patients to easily measure their heart’s electrical activity and navigate recordings may be a solution. Objective: The aim of this project is to assess the usability of a newly developed mobile ECG device, MD-Link, through the comparison of its outputs to the standard printed outputs from a 12-lead electrocardiogram, the Nihon Kohden Cardiofax S Electrocardiograph Model ECG-1250K. Methods: We will conduct this study in two stages: measurement of the ECG signals of patients using the MD-Link and the Nihon Kohden Cardiofax S, and analysis of the selected standard outputs collected from the ECG recordings of the MD-Link and the Nihon Kohden Cardiofax S. The MD-Link consists of (1) a mobile device (e.g. a smartphone), (2) two active dry electrodes as ECG touch sensors enabling convenient recording of ECG signals, and (3) an easy-to-use mobile application interface enabling the upload and accurate display of ECG recordings to patients and their clinicians. Our research team consisting of members from Dartmouth College, the Institute of Health, Population and Development (PHAD), Hanoi University of Science and Technology (HUST), and physicians and nurses from International Clinics Thanh Chan will assist in carrying out this project. Results: We will proceed with a publication plan that includes a project report and ultimately articles for peer-reviewed journals. We also hope to disseminate our work at relevant conferences to provide more coverage and exposure to the MD-Link mobile device. Conclusions: At the end of this project, we will have developed and tested the MD-Link, a low cost mobile ECG monitoring device with some supportive comparisons to standard ECG devices commonly used in heart clinics or hospitals in Vietnam. Our long-term goal is for the MD-Link to be easily accessible, affordable and to fit into a patient’s daily routine, thus increasing the levels of patient cardiovascular health.

  • How do infant feeding apps in China measure up?

    From: Journal of Medical Internet Research

    Date Submitted: Aug 17, 2017

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

    Background: Globally, with the popularization of smartphones, the number of health-related smartphone applications (apps) skyrocketed to 259,000 in 2016. People are changing the way they interact with...

    Background: Globally, with the popularization of smartphones, the number of health-related smartphone applications (apps) skyrocketed to 259,000 in 2016. People are changing the way they interact with health information through their fingertips. In China there are many apps that claim to provide infant feeding and nutrition guidance. However, the quality of information in those apps has not been extensively assessed. Objective: To assess the quality of Chinese infant feeding apps using comprehensive quality assessment criteria and to explore Chinese mothers’ perceptions on apps quality and usability. Methods: We searched for free-to-download Chinese infant feeding apps in the iTunes and Android app stores. A comprehensive assessment of the accountability, scientific basis and accuracy of information relevant to infant feeding, advertising policy, functionality, and a preliminary screening of infant formula advertisements in the apps were carried out. We also carried out exploratory qualitative research through semi-structured interviews with Chinese mothers in Shanghai to elicit their views about the quality of the apps. Results: A total of 4,925 apps were screened, and the 26 apps that met the selection criteria were evaluated. Overall, all 26 apps were developed by commercial entities and the majority of them were rated poorly. The highest total score was 62.2 (out of a possible 100) and the lowest was 16.7. In the four quality domains assessed, none of them fulfilled all the accountability criteria. Only 3 out of 26 apps provided information covering the three practices from the WHO’s infant feeding recommendations. Only one app described its advertising policy in its Terms of Usage. The most common app functionality was a built-in social forum (19/26). Provision of website links was the least common functionality (2/26). 20 of the 26 apps carried infant formula banner advertisements in their homepages. 12 apps included both e-commence stores and featured infant formula advertisements. In total, 21 mothers were interviewed face-to-face. Mothers highly valued immediate access to parenting information and mulita-functionality provided by apps. However, concerns of incredible information and commercial activities in apps, and desire for information and support offered by healthcare professionals were expressed. Conclusions: The findings provide valuable information to the understanding of Chinese infant feeding apps. The results are concerning, particularly with the relative absence of scientific basis and credibility, along with a large amount of commercial advertisements. Apps do seem to be able to provide an opportunity for mothers to access health information and support, but there is a plea for tighter controls on contents and advertisements. Ongoing app research and development should focus on implementation of a standard framework which would drive the development of high-quality apps to support healthy infant feeding, through cooperation among academics, health professionals, app users, app developers and government bodies.

  • mHealth applications impact in improving immunization coverage and maternal-child health in Africa

    From: JMIR mHealth and uHealth

    Date Submitted: Aug 17, 2017

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

    Background: Despite laudable efforts and achievement, maternal and child mortality remains high in Africa. The region accounts for 97% of maternal and 94% of children less than five mortality in 2015....

    Background: Despite laudable efforts and achievement, maternal and child mortality remains high in Africa. The region accounts for 97% of maternal and 94% of children less than five mortality in 2015. Limited resources, lack of infrastructures and shortage of healthcare workers have been identified as the main barriers towards healthcare outcomes improvement. Availability and use of mobile phones is increasing rapidly with 46% of African population having a mobile-cellular subscription in 2015. Mobile health (mHealth) interventions have proven to be beneficial in improving maternal and child health service delivery and outcomes in developed countries and elsewhere. In Africa, only few mhealth pilot research projects and small studies have been conducted, those limiting generalizability Objective: The objective of the project is to provide an overview about the current impact of mHealth applications and innovative strategies in improving large-scale (population-based) immunization coverage and maternal- child health service delivery in African countries Methods: Peer-reviewed papers were identified from Medline/PubMed, Google scholar and mHealthEvidence database via a combination of search terms Results: A total of 1217 articles were found of which only 17 met the inclusion criteria and were included in the project. Our findings indicates that there is some evidence on the potential of mHealth applications benefitsin increasing childhood immunization awareness, retention, coverage and effectiveness as well as maternal- child quality care delivery and outcomes Conclusions: Building robust and resilient government and stakeholders leadership, committed partnerships and platform is crucial in investing on large-scale and sustainable ownership of mhealth policies and programs, adequate infrastructure, building capacity and mHealth/eHealth management implementation in strengthening health systems. Moreover, addressing inherent issues of mhealth interoperatibility, patient data privacy. confidentiality and security is needed for socio-economic benefits, cost-effective digital landscape public health solutions and gains across African countries

  • A tailored advice tool for skiers and snowboarders: design of a randomized controlled trial

    From: JMIR Research Protocols

    Date Submitted: Aug 17, 2017

    Open Peer Review Period: Aug 17, 2017 - Aug 31, 2017

    Background Being active in sports has many positive health effects. The direct effects of engaging in regular physical activity are particularly apparent in the prevention of several chronic diseases...

    Background Being active in sports has many positive health effects. The direct effects of engaging in regular physical activity are particularly apparent in the prevention of several chronic diseases, including: cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis. Besides the beneficial health effects of being active, sports participation is unfortunately also associated with a risk for injuries. In many sports injury, e.g. winter sports, preventive measures are not compulsory. Therefore, a behavioral change in sports participants is necessary to increase the use of effective measures and subsequently prevent or reduce injuries in sports. The evidence-based intervention ‘Wintersportklaar’ is developed to stimulate injury preventive behavior among skiers and snowboarders. In this article the design of the effectiveness study will be described. Methods A randomized controlled trial with a follow-up period of 4 months during the winter sport season will be conducted. The participants consist of unexperienced skiers and snowboarders. At baseline, skiers and snowboarders in the intervention and control group are asked to report the injury preventive measures they usually take during their preparation to their winter sport holiday. One and three months after baseline, skiers and snowboarders are asked to report retrospectively in detail what they have done regarding injury prevention during their current winter sport preparation and winter sport holiday. Descriptive analyses (mean, standard deviation, frequency, range) are conducted for the different baseline variables in both study groups. To evaluate the success of the randomization, baseline values are analyzed for differences between the intervention and control group (Chi Square, independent T-tests and/or Mann-Whitney test). Chi square tests and/or logistic regression analyses are used to analyze behavioral change according to the intention to treat principle. Discussion To conquer the negative side effects of sports participation, the use of injury preventive measures is desirable. As the use of injury prevention is mostly not compulsory in skiing and snowboarding , a behavioral change is necessary to increase the use of effective injury preventive measures in winter sports. Trial Registration NTR6233

  • A Novel Mobile App & Population Management System to Manage Rheumatoid Arthritis Flares

    From: JMIR Research Protocols

    Date Submitted: Aug 17, 2017

    Open Peer Review Period: Aug 17, 2017 - Aug 31, 2017

    Background: Rheumatoid arthritis (RA) flares have a profound effect on patients, causing pain and disability. However, flares often occur between regularly scheduled healthcare provider (HCP) visits a...

    Background: Rheumatoid arthritis (RA) flares have a profound effect on patients, causing pain and disability. However, flares often occur between regularly scheduled healthcare provider (HCP) visits and are, therefore, difficult to monitor and manage. We sought to develop a smartphone application (app) combined with a population management system to help track RA flares between visits. Objective: The objective of this study is to implement a smartphone app + population management system to monitor RA disease activity between scheduled HCP visits over a period of 6-months. Methods: This is a randomized controlled trial that lasts for 6 months for each participant. We aim to recruit 190 patients, randomized 50:50 to the intervention group vs. the control group. The intervention group will be assigned the smartphone app and be prompted to answer daily questionnaires sent to their smartphones. Both groups will be assigned a population manager, who will check in with participants via telephone at 6-weeks and 18-weeks. The population manager will also communicate with participants in the intervention group if/when their responses indicate a sustained increase in RA disease activity. To assess patient satisfaction, the primary outcomes will be scores on the Treatment Satisfaction Questionnaire for Medication (TSQM) and Perceived Efficacy in Patient-Physician Interactions (PEPPI) questionnaire at 6 months. To determine the effect of the smartphone app on RA disease activity, the primary outcome will be the Clinical Disease Activity Index (CDAI) at 6 months. Results: The trial started in November 2016, and an estimated 2.5 years will be necessary to complete the study. Study results are expected to be published by the end of 2019. Conclusions: The completion of this study will provide important data regarding: 1) the assessment of validated outcome measures to assess RA disease activity with a smartphone app between routinely scheduled HCP visits, 2) patient engagement in monitoring their condition, and 3) communication between patients and HCPs through a population management system. Clinical Trial: NCT02822521

  • The importance of trust in the adoption and use of intelligent assistive technology by older adults to support aging in place: A scoping review

    From: JMIR Research Protocols

    Date Submitted: Aug 17, 2017

    Open Peer Review Period: Aug 17, 2017 - Aug 31, 2017

    Background: Background: Intelligent assistive technologies that complement and extend human abilities have proliferated in recent years. Service robots, home automation equipment, and other digital as...

    Background: Background: Intelligent assistive technologies that complement and extend human abilities have proliferated in recent years. Service robots, home automation equipment, and other digital assistant devices possessing artificial intelligence are forms of assistive technologies that have become popular in society. Older adults (≥55 years in age) have been identified by industry, government, and researchers as a demographic who can benefit significantly from the use of intelligent assistive technology to support various activities of daily living. Objective: Objective: The purpose of this scoping review is to synthesize the literature on the importance of the concept of ‘trust’ in the adoption of intelligent assistive technologies to assist aging in place by older adults. Methods: Methods: Using a scoping review methodology, our search strategy will examine the following databases: ACM Digital Library, CINAHL, Medline, Scopus, and Web of Science. Two reviewers (AM, JL) will independently screen the initial titles obtained from the search, and these results will be further inspected by other members (RB, JM) of the research team for inclusion into the review. Results: Results: This review will provide insights into how the concept of trust is actualized in the adoption of intelligent assistive technology by older adults. Preliminary sensitization to the literature suggests that the concept of trust is fluid, non-stable, and intimately tied to the sort of intelligent assistive technology being examined. Further, a wide range of theoretical lens that include elements of trust have been used to examine this concept. Conclusions: Conclusions: This review will describe the concept of trust in the adoption of intelligent assistive technology by older adults, and will provide insights for practitioners, policy makers, and technology vendors for future practice.

  • Use of Patient Generated Health Data collected from consumer wearable devices in clinical care: a systematic review and meta-analysis

    From: JMIR mHealth and uHealth

    Date Submitted: Aug 17, 2017

    Open Peer Review Period: Aug 19, 2017 - Oct 14, 2017

    Background: PGHD (Patient Generated Health Data) are health-related data created or recorded by patients to inform their self-care. The availability of low-cost easy-to-use consumer wearable technolog...

    Background: PGHD (Patient Generated Health Data) are health-related data created or recorded by patients to inform their self-care. The availability of low-cost easy-to-use consumer wearable technologies has facilitated patients’ engagement in their self-care and increased production of PGHD but the uptake of this data in clinical environments has been slow. Studies showing opportunities and challenges affecting PGHD adoption and use in clinical care have not investigated these factors in detail during all stages of the PGHD life cycle. Objective: This study aims to provide deeper insight into various issues influencing the use of PGHD at each stage of its life cycle from the perspectives of key stakeholders including patients, healthcare professionals, and the health IT managers. Methods: A systematic review was undertaken on the scholarly and industry literature published from 2012 to 2017. Thematic analysis of content was applied to uncover perspectives of the key PGHD stakeholders on opportunities and challenges related to all life cycle stages of PGHD from consumer wearables. Results: Thirty-six papers were identified for detailed analysis. Challenges were discussed more frequently than opportunities. Most studies done in real-world settings were limited to the collection stage of PGHD life cycle that captured through consumer wearables. Conclusions: There are many gaps in knowledge on opportunities and challenges affecting PGHD captured through consumer wearables in each stage of its life cycle. A conceptual framework involving all the stakeholders in overcoming various technical, clinical, cultural, and regulatory challenges affecting PGHD during its life cycle could help to advance the integration with and use of PGHD in clinical care.

  • Feasibility and Effectiveness of a Web-Based Portal for delivery of care to home dialysis patients.

    From: Journal of Medical Internet Research

    Date Submitted: Aug 18, 2017

    Open Peer Review Period: Aug 19, 2017 - Oct 14, 2017

    Background: Background: Quality of life in home dialysis patients is low compared to the general population. Improvement in patient satisfaction through shared decision-making and handling of patient...

    Background: Background: Quality of life in home dialysis patients is low compared to the general population. Improvement in patient satisfaction through shared decision-making and handling of patient requests through an online interface has been shown to be beneficial in some studies in other disease populations. Such a system may improve patient satisfaction, reduce health service utilization and potentially improve health outcomes. Objective: Objective: To determine the acceptability, practicality, and implementation of an eHealth patient portal in home dialysis patients. Methods: Methods: Prospective feasibility cohort study among patients receiving either home hemodialysis or peritoneal dialysis over a four-month period. Web-based application allowing patients and healthcare workers to communicate through a secure, password protected online portal and permits visualization of the messaging history by patient and provider. Patients and the home dialysis healthcare team had the ability to send messages related to patient care at any time. Messages could be sent between the healthcare team and patient including proposed changes to medication, instructions after a clinic visit, times of new appointments, upcoming investigations or questions about care. Consumer Quality Index (CQI), Quality of Life using the EuroQol Five Dimensions Questionnaire, acceptability and satisfaction using online Acceptability E-scale and Satisfaction questionnaires. Patients were assessed at baseline and at 6 and 12 months of followup. Results: Results: Of the 41 patients who consented to join the web-based portal, 27 (66%) created an online account. Mean CQI for the Nephrology domain was 3.50 (95%CI: 3.33,3.67) and this did not change significantly over the study period. Quality of life using the EQ-index score was 0.80 (IQR: 0.71-0.83) at baseline and this also did not significantly change over the study period. The web-based portal was easy to use with a median response of 4 (IQR: 4-5). Most were satisfied with a mean score of 6.5±0.6 in overall satisfaction. Conclusions: Conclusions: In this study of home dialysis patients, we identified that an online portal for care-delivery was feasible. We did not find a significant improvement in CQI or QOL, but the portal was felt to be beneficial at addressing some domains of patient care. Clinical Trial: Trial Registration: ClinicalTrials.gov number NCT02128347

  • Understanding Digital Gap among U.S. Adults with Disability: An Analysis of the Health Information National Trends Survey 2013

    From: JMIR Human Factors

    Date Submitted: Aug 18, 2017

    Open Peer Review Period: Aug 19, 2017 - Sep 2, 2017

    Background: Disabilities affect over one in five U.S. adults, and those with disabilities face multiple barriers in accessing healthcare. A “digital gap”, defined as the disparity caused by differ...

    Background: Disabilities affect over one in five U.S. adults, and those with disabilities face multiple barriers in accessing healthcare. A “digital gap”, defined as the disparity caused by differences in the ability to use advanced technologies, is assumed to be prevalent among individuals with disabilities. However, there is limited number of national studies examining the use of technology to obtain health/medical information among U.S. adults with disabilities and a scarcity of data studying psychosocial factors associated with the use at national level. Objective: The objectives of this study were to 1) examine an association between disability with use of the Internet to seek health information, as well as exchanging medical information via information technology (IT) with providers and 2) identify psychosocial factors associated with the use. Methods: The primary database was the 2013 Health Information National Trends Survey (HINTS) 4 Cycle 3. Disability status, the primary study covariate, was based on six questions that captured a wide spectrum of conditions, including impairments in mobility, cognition, independent living, vision, hearing, and self-care. Study covariates included sociodemographic factors, as well as respondents’ trust towards the Internet and provider as information sources, and willingness to exchange medical information via IT with providers. Study outcomes were the use of Internet as the primary health information source, use of healthcare providers as the primary health information source, and use of IT to exchange medical information with providers. We conducted multivariate logistic regressions to examine the association between disability and study outcomes controlling for study covariates. Results: Presence of a disability was associated with decreased odds (Adjusted OR: 0.65, 95% CI: 0.43-0.98) of obtaining health information from the Internet, in particular for those with vision disability (Adjusted OR: 0.27, 95% CI: 0.11-0.65) and those with mobility (Adjusted OR: 0.51, 95% CI: 0.30-0.88). Psychosocial factors including trust towards health information from the Internet (Adjusted OR: 3.62, 95% CI: 2.07, 6.33), and willingness to exchange via IT medical information with a provider (Adjusted OR: 1.88, 95% CI: 1.57-2.24) were significant predictors in seeking and exchanging such information, respectively. Conclusions: A “digital gap” exists among adults with disabilities but this disparity is confounded by other psychosocial factors, such as the willingness to utilize IT and trust towards the information source. Future studies should focus on addressing psychosocial factors associated with IT use and developing tools to improve access to healthcare for those with disabilities.

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