@Article{info:doi/10.2196/publichealth.8507,
author="Vickey, Theodore
and Breslin, G. John",
title="Online Influence and Sentiment of Fitness Tweets: Analysis of Two Million Fitness Tweets",
journal="JMIR Public Health Surveill",
year="2017",
month="Oct",
day="31",
volume="3",
number="4",
pages="e82",
keywords="Twitter",
keywords="physical activity",
keywords="mobile fitness apps",
keywords="fitness tweet classification",
keywords="sentiment",
abstract="Background: Publicly available fitness tweets may provide useful and in-depth insights into the real-time sentiment of a person's physical activity and provide motivation to others through online influence. Objective: The goal of this experimental approach using the fitness Twitter dataset is two-fold: (1) to determine if there is a correlation between the type of activity tweet (either workout or workout+, which contains the same information as a workout tweet but has additional user-generated information), gender, and one's online influence as measured by Klout Score and (2) to examine the sentiment of the activity-coded fitness tweets by looking at real-time shared thoughts via Twitter regarding their experiences with physical activity and the associated mobile fitness app. Methods: The fitness tweet dataset includes demographic and activity data points, including minutes of activity, Klout Score, classification of each fitness tweet, the first name of each fitness tweet user, and the tweet itself. Gender for each fitness tweet user was determined by a first name comparison with the US Social Security Administration database of first names and gender. Results: Over 184 days, 2,856,534 tweets were collected in 23 different languages. However, for the purposes of this study, only the English-language tweets were analyzed from the activity tweets, resulting in a total of 583,252 tweets. After assigning gender to Twitter usernames based on the Social Security Administration database of first names, analysis of minutes of activity by both gender and Klout influence was determined. The mean Klout Score for those who shared their workout data from within four mobile apps was 20.50 (13.78 SD), less than the general Klout Score mean of 40, as was the Klout Score at the 95th percentile (40 vs 63). As Klout Score increased, there was a decrease in the number of overall workout+ tweets. With regards to sentiment, fitness-related tweets identified as workout+ reflected a positive sentiment toward physical activity by a ratio of 4 to 1. Conclusions: The results of this research suggest that the users of mobile fitness apps who share their workouts via Twitter have a lower Klout Score than the general Twitter user and that users who chose to share additional insights into their workouts are more positive in sentiment than negative. We present a novel perspective into the physical activity messaging from within mobile fitness apps that are then shared over Twitter. By moving beyond the numbers and evaluating both the Twitter user and the emotions tied to physical activity, future research could analyze additional relationships between the user's online influence, the enjoyment of the physical activity, and with additional analysis a long-term retention strategy for the use of a fitness app. ",
doi="10.2196/publichealth.8507",
url="http://publichealth.jmir.org/2017/4/e82/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29089294"
}


@Article{info:doi/10.2196/jmir.3390,
author="Miron-Shatz, Talya
and Shatz, Itamar
and Becker, Stefan
and Patel, Jigar
and Eysenbach, Gunther",
title="Promoting Business and Entrepreneurial Awareness in Health Care Professionals: Lessons From Venture Capital Panels at Medicine 2.0 Conferences",
journal="J Med Internet Res",
year="2014",
month="Aug",
day="06",
volume="16",
number="8",
pages="e184",
keywords="start-up",
keywords="entrepreneurship",
keywords="health technology",
keywords="capital funding, telehealth, eHealth, mobile health, health technology, technology transfer",
keywords="health 2.0",
keywords="business pitch",
keywords="entrepreneurship programs",
doi="10.2196/jmir.3390",
url="http://www.jmir.org/2014/8/e184/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25100579"
}


@Article{info:doi/10.2196/jmir.2496,
author="Shaikh, R. Abdul
and Butte, J. Atul
and Schully, D. Sheri
and Dalton, S. William
and Khoury, J. Muin
and Hesse, W. Bradford",
title="Collaborative Biomedicine in the Age of Big Data: The Case of Cancer",
journal="J Med Internet Res",
year="2014",
month="Apr",
day="07",
volume="16",
number="4",
pages="e101",
keywords="biomedical research",
keywords="crowdsourcing",
keywords="health information technology",
keywords="innovation",
keywords="precision medicine",
doi="10.2196/jmir.2496",
url="http://www.jmir.org/2014/4/e101/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24711045"
}


@Article{info:doi/10.2196/jmir.2499,
author="Luciano, S. Joanne
and Cumming, P. Grant
and Wilkinson, D. Mark
and Kahana, Eva",
title="The Emergent Discipline of Health Web Science",
journal="J Med Internet Res",
year="2013",
month="Aug",
day="22",
volume="15",
number="8",
pages="e166",
keywords="Health Web Science",
keywords="Medicine 2.0",
keywords="Web Science",
keywords="health care singularity",
keywords="semantic Web",
keywords="patient engagement",
keywords="citizen science",
keywords="crowd-sourcing",
doi="10.2196/jmir.2499",
url="http://www.jmir.org/2013/8/e166/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23968998"
}


@Article{info:doi/10.2196/jmir.2497,
author="Albrecht, Urs-Vito
and Folta-Schoofs, Kristian
and Behrends, Marianne
and von Jan, Ute",
title="Effects of Mobile Augmented Reality Learning Compared to Textbook Learning on Medical Students: Randomized Controlled Pilot Study",
journal="J Med Internet Res",
year="2013",
month="Aug",
day="20",
volume="15",
number="8",
pages="e182",
keywords="problem-based learning",
keywords="cellular phone",
keywords="education",
keywords="medical",
keywords="emotions",
abstract="Background: By adding new levels of experience, mobile Augmented Reality (mAR) can significantly increase the attractiveness of mobile learning applications in medical education. Objective: To compare the impact of the heightened realism of a self-developed mAR blended learning environment (mARble) on learners to textbook material, especially for ethically sensitive subjects such as forensic medicine, while taking into account basic psychological aspects (usability and higher level of emotional involvement) as well as learning outcomes (increased learning efficiency). Methods: A prestudy was conducted based on a convenience sample of 10 third-year medical students. The initial emotional status was captured using the ``Profile of Mood States'' questionnaire (POMS, German variation); previous knowledge about forensic medicine was determined using a 10-item single-choice (SC) test. During the 30-minute learning period, the students were randomized into two groups: the first group consisted of pairs of students, each equipped with one iPhone with a preinstalled copy of mARble, while the second group was provided with textbook material. Subsequently, both groups were asked to once again complete the POMS questionnaire and SC test to measure changes in emotional state and knowledge gain. Usability as well as pragmatic and hedonic qualities of the learning material was captured using AttrakDiff2 questionnaires. Data evaluation was conducted anonymously. Descriptive statistics for the score in total and the subgroups were calculated before and after the intervention. The scores of both groups were tested against each other using paired and unpaired signed-rank tests. An item analysis was performed for the SC test to objectify difficulty and selectivity. Results: Statistically significant, the mARble group (6/10) showed greater knowledge gain than the control group (4/10) (Wilcoxon z=2.232, P=.03). The item analysis of the SC test showed a difficulty of P=0.768 (s=0.09) and a selectivity of RPB=0.2. For mARble, fatigue (z=2.214, P=.03) and numbness (z=2.07, P=.04) decreased with statistical significance when comparing pre- and post-tests. Vigor rose slightly, while irritability did not increase significantly. Changes in the control group were insignificant. Regarding hedonic quality (identification, stimulation, attractiveness), there were significant differences between mARble (mean 1.179, CI ?0.440 to 0.440) and the book chapter (mean ?0.982, CI ?0.959 to 0.959); the pragmatic quality mean only differed slightly. Conclusions: The mARble group performed considerably better regarding learning efficiency; there are hints for activating components of the mAR concept that may serve to fascinate the participants and possibly boost interest in the topic for the remainder of the class. While the small sample size reduces our study's conclusiveness, its design seems appropriate for determining the effects of interactive eLearning material with respect to emotions, learning efficiency, and hedonic and pragmatic qualities using a larger group. Trial Registration: German Clinical Trial Register (DRKS), DRKS-ID: DRKS00004685; https://drks-neu.uniklinik-freiburg.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00004685. ",
doi="10.2196/jmir.2497",
url="http://www.jmir.org/2013/8/e182/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23963306"
}


@Article{info:doi/10.2196/med20.2767,
author="Schulz, Peter
and Sagheb, Keyvan
and Affeldt, Harald
and Klumpp, Hannah
and Taylor, Kathy
and Walter, Christian
and Al-Nawas, Bilal",
title="Acceptance of E-Learning Devices by Dental Students",
journal="Med 2.0",
year="2013",
month="Aug",
day="14",
volume="2",
number="2",
pages="e6",
keywords="e-learning activity",
keywords="computer",
keywords="tablet PC",
keywords="smartphone, Internet",
abstract="Background: E-Learning programs and their corresponding devices are increasingly employed to educate dental students during their clinical training. Objective: Recent progress made in the development of e-learning software as well as in hardware (computers, tablet PCs, smartphones) caused us to more closely investigate into the habits of dental students in dealing with these learning techniques. Methods: Dental students during their clinical training attended a survey compiled in cooperation with biostatisticians. The questionnaire probands were asked to complete based on previous surveys of similar subjects, allowing single as well as multiple answers. The data, which were obtained with respect to the learning devices students commonly employ, were compared with their internet learning activities. Results: The e-learning devices utilized are of heterogeneous brands. Each student has access to at least one hardware type suitable for e-learning. All students held mobile devices, about 90 percent employed laptops, and about 60 percent possess smartphones. Unexceptional all participants of the survey acknowledged an unlimited internet access. In contrast, only 16 percent of students utilized tablet PCs. A detailed analysis of the survey outcome reveals that an increasing use of mobile devices (tablet PC, smartphone) facilitates internet learning activities while at the same time utilization of computers (desktop, laptop) declines. Conclusions: Dental students overwhelmingly accept e-learning during their clinical training. Students report outstanding preconditions to conduct e-learning as both their access to hardware and to the internet is excellent. Less satisfying is the outcome of our survey regarding the utilization of e-learning programs. Depending of the hardware employed only one-third to barely one-half of students comprise learning programs. ",
doi="10.2196/med20.2767",
url="http://www.medicine20.com/2013/2/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25075241"
}


@Article{info:doi/10.2196/jmir.2441,
author="Cesa, Luca Gian
and Manzoni, Mauro Gian
and Bacchetta, Monica
and Castelnuovo, Gianluca
and Conti, Sara
and Gaggioli, Andrea
and Mantovani, Fabrizia
and Molinari, Enrico
and C{\'a}rdenas-L{\'o}pez, Georgina
and Riva, Giuseppe",
title="Virtual Reality for Enhancing the Cognitive Behavioral Treatment of Obesity With Binge Eating Disorder: Randomized Controlled Study With One-Year Follow-up",
journal="J Med Internet Res",
year="2013",
month="Jun",
day="12",
volume="15",
number="6",
pages="e113",
keywords="virtual reality",
keywords="obesity",
keywords="binge eating disorders",
keywords="allocentric lock hypothesis",
abstract="Background: Recent research identifies unhealthful weight-control behaviors (fasting, vomiting, or laxative abuse) induced by a negative experience of the body, as the common antecedents of both obesity and eating disorders. In particular, according to the allocentric lock hypothesis, individuals with obesity may be locked to an allocentric (observer view) negative memory of the body that is no longer updated by contrasting egocentric representations driven by perception. In other words, these patients may be locked to an allocentric negative representation of their body that their sensory inputs are no longer able to update even after a demanding diet and a significant weight loss. Objective: To test the brief and long-term clinical efficacy of an enhanced cognitive-behavioral therapy including a virtual reality protocol aimed at unlocking the negative memory of the body (ECT) in morbidly obese patients with binge eating disorders (BED) compared with standard cognitive behavior therapy (CBT) and an inpatient multimodal treatment (IP) on weight loss, weight loss maintenance, BED remission, and body satisfaction improvement, including psychonutritional groups, a low-calorie diet (1200 kcal/day), and physical training. Methods: 90 obese (BMI>40) female patients with BED upon referral to an obesity rehabilitation center were randomly assigned to conditions (31 to ECT, 30 to CBT, and 29 to IP). Before treatment completion, 24 patients discharged themselves from hospital (4 in ECT, 10 in CBT, and 10 in IP). The remaining 66 inpatients received either 15 sessions of ECT, 15 sessions of CBT, or no additional treatment over a 5-week usual care inpatient regimen (IP). ECT and CBT treatments were administered by 3 licensed psychotherapists, and patients were blinded to conditions. At start, upon completion of the inpatient treatment, and at 1-year follow-up, patients' weight, number of binge eating episodes during the previous month, and body satisfaction were assessed by self-report questionnaires and compared across conditions. 22 patients who received all sessions did not provide follow-up data (9 in ECT, 6 in CBT, and 7 in IP). Results: Only ECT was effective at improving weight loss at 1-year follow-up. Conversely, control participants regained on average most of the weight they had lost during the inpatient program. Binge eating episodes decreased to zero during the inpatient program but were reported again in all the three groups at 1-year follow-up. However, a substantial regain was observed only in the group who received the inpatient program alone, while both ECT and CBT were successful in maintaining a low rate of monthly binge eating episodes. Conclusions: Despite study limitations, findings support the hypothesis that the integration of a VR-based treatment, aimed at both unlocking the negative memory of the body and at modifying its behavioral and emotional correlates, may improve the long-term outcome of a treatment for obese BED patients. As expected, the VR-based treatment, in comparison with the standard CBT approach, was able to better prevent weight regain but not to better manage binge eating episodes. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 59019572; http://www.controlled-trials.com/ISRCTN59019572 (Archived by WebCite at http://www.webcitation.org/6GxHxAR2G) ",
doi="10.2196/jmir.2441",
url="http://www.jmir.org/2013/6/e113/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23759286"
}


@Article{info:doi/10.2196/jmir.2501,
author="Young, Colleen",
title="Community Management That Works: How to Build and Sustain a Thriving Online Health Community",
journal="J Med Internet Res",
year="2013",
month="Jun",
day="11",
volume="15",
number="6",
pages="e119",
keywords="online community",
keywords="virtual community",
keywords="health",
keywords="patient",
keywords="health care professional, community management",
keywords="community strategy",
keywords="guidelines",
keywords="tutorial",
keywords="peer-to-peer health",
doi="10.2196/jmir.2501",
url="http://www.jmir.org/2013/6/e119/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23759312"
}


@Article{info:doi/10.2196/jmir.2610,
author="Mackey, Ken Tim
and Liang, A. Bryan",
title="Global Reach of Direct-to-Consumer Advertising Using Social Media for Illicit Online Drug Sales",
journal="J Med Internet Res",
year="2013",
month="May",
day="29",
volume="15",
number="5",
pages="e105",
keywords="health policy",
keywords="pharmacies",
keywords="social media",
keywords="Internet",
keywords="social marketing",
keywords="marketing of health services",
keywords="online pharmaceutical services",
abstract="Background: Illicit or rogue Internet pharmacies are a recognized global public health threat that have been identified as utilizing various forms of online marketing and promotion, including social media. Objective: To assess the accessibility of creating illicit no prescription direct-to-consumer advertising (DTCA) online pharmacy social media marketing (eDTCA2.0) and evaluate its potential global reach. Methods: We identified the top 4 social media platforms allowing eDTCA2.0. After determining applicable platforms (ie, Facebook, Twitter, Google+, and MySpace), we created a fictitious advertisement advertising no prescription drugs online and posted it to the identified social media platforms. Each advertisement linked to a unique website URL that consisted of a site error page. Employing Web search analytics, we tracked the number of users visiting these sites and their location. We used commercially available Internet tools and services, including website hosting, domain registration, and website analytic services. Results: Illicit online pharmacy social media content for Facebook, Twitter, and MySpace remained accessible despite highly questionable and potentially illegal content. Fictitious advertisements promoting illicit sale of drugs generated aggregate unique user traffic of 2795 visits over a 10-month period. Further, traffic to our websites originated from a number of countries, including high-income and middle-income countries, and emerging markets. Conclusions: Our results indicate there are few barriers to entry for social media--based illicit online drug marketing. Further, illicit eDTCA2.0 has globalized outside US borders to other countries through unregulated Internet marketing. ",
doi="10.2196/jmir.2610",
url="http://www.jmir.org/2013/5/e105/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23718965"
}


@Article{info:doi/10.2196/jmir.2430,
author="Fiordelli, Maddalena
and Diviani, Nicola
and Schulz, J. Peter",
title="Mapping mHealth Research: A Decade of Evolution",
journal="J Med Internet Res",
year="2013",
month="May",
day="21",
volume="15",
number="5",
pages="e95",
keywords="mHealth",
keywords="systematic review",
keywords="health outcomes",
abstract="Background: For the last decade, mHealth has constantly expanded as a part of eHealth. Mobile applications for health have the potential to target heterogeneous audiences and address specific needs in different situations, with diverse outcomes, and to complement highly developed health care technologies. The market is rapidly evolving, making countless new mobile technologies potentially available to the health care system; however, systematic research on the impact of these technologies on health outcomes remains scarce. Objective: To provide a comprehensive view of the field of mHealth research to date and to understand whether and how the new generation of smartphones has triggered research, since their introduction 5 years ago. Specifically, we focused on studies aiming to evaluate the impact of mobile phones on health, and we sought to identify the main areas of health care delivery where mobile technologies can have an impact. Methods: A systematic literature review was conducted on the impact of mobile phones and smartphones in health care. Abstracts and articles were categorized using typologies that were partly adapted from existing literature and partly created inductively from publications included in the review. Results: The final sample consisted of 117 articles published between 2002 and 2012. The majority of them were published in the second half of our observation period, with a clear upsurge between 2007 and 2008, when the number of articles almost doubled. The articles were published in 77 different journals, mostly from the field of medicine or technology and medicine. Although the range of health conditions addressed was very wide, a clear focus on chronic conditions was noted. The research methodology of these studies was mostly clinical trials and pilot studies, but new designs were introduced in the second half of our observation period. The size of the samples drawn to test mobile health applications also increased over time. The majority of the studies tested basic mobile phone features (eg, text messaging), while only a few assessed the impact of smartphone apps. Regarding the investigated outcomes, we observed a shift from assessment of the technology itself to assessment of its impact. The outcome measures used in the studies were mostly clinical, including both self-reported and objective measures. Conclusions: Research interest in mHealth is growing, together with an increasing complexity in research designs and aim specifications, as well as a diversification of the impact areas. However, new opportunities offered by new mobile technologies do not seem to have been explored thus far. Mapping the evolution of the field allows a better understanding of its strengths and weaknesses and can inform future developments. ",
doi="10.2196/jmir.2430",
url="http://www.jmir.org/2013/5/e95/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23697600"
}


@Article{info:doi/10.2196/jmir.2443,
author="Nazi, M. Kim",
title="The Personal Health Record Paradox: Health Care Professionals' Perspectives and the Information Ecology of Personal Health Record Systems in Organizational and Clinical Settings",
journal="J Med Internet Res",
year="2013",
month="Apr",
day="04",
volume="15",
number="4",
pages="e70",
keywords="personal health record (PHR)",
keywords="health professionals",
keywords="attitudes",
keywords="eHealth",
keywords="electronic health records (EHRs)",
keywords="secure messaging",
keywords="qualitative analysis",
abstract="Background: Despite significant consumer interest and anticipated benefits, overall adoption of personal health records (PHRs) remains relatively low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications for health care professionals and organizational delivery systems; however, these have received less attention. An exclusive focus on the PHR as a tool for consumer empowerment does not adequately take into account the social and organizational context of health care delivery, and the reciprocal nature of patient engagement. Objective: The purpose of this study was to examine the experiences of physicians, nurses, and pharmacists at the Department of Veterans Affairs (VA) using an organizationally sponsored PHR to develop insights into the interaction of technology and processes of health care delivery. The conceptual framework for the study draws on an information ecology perspective, which recognizes that a vibrant dynamic exists among technologies, people, practices, and values, accounting for both the values and norms of the participants and the practices of the local setting. The study explores the experiences and perspectives of VA health care professionals related to patient use of the My HealtheVet PHR portal and secure messaging systems. Methods: In-depth interviews were conducted with 30 VA health care professionals engaged in providing direct patient care who self-reported that they had experiences with at least 1 of 4 PHR features. Interviews were transcribed, coded, and analyzed to identify inductive themes. Organizational documents and artifacts were reviewed and analyzed to trace the trajectory of secure messaging implementation as part of the VA Patient Aligned Care Team (PACT) model. Results: Study findings revealed a variety of factors that have facilitated or inhibited PHR adoption, use, and endorsement of patient use by health care professionals. Health care professionals' accounts and analysis of organizational documents revealed a multidimensional dynamic between the trajectory of secure messaging implementation and its impact on organizational actors and their use of technology, influencing workflow, practices, and the flow of information. In effect, secure messaging was the missing element of complex information ecology and its implementation acted as a catalyst for change. Secure messaging was found to have important consequences for access, communication, patient self-report, and patient/provider relationships. Conclusions: Study findings have direct implications for the development and implementation of PHR systems to ensure adequate training and support for health care professionals, alignment with clinical workflow, and features that enable information sharing and communication. Study findings highlight the importance of clinician endorsement and engagement, and the need to further examine both intended and unintended consequences of use. This research provides an integral step toward better understanding the social and organizational context and impact of PHR and secure messaging use in clinical practice settings. ",
doi="10.2196/jmir.2443",
url="http://www.jmir.org/2013/4/e70/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23557596"
}


@Article{info:doi/10.2196/jmir.2332,
author="Kaonga, Nina Nadi
and Labrique, Alain
and Mechael, Patricia
and Akosah, Eric
and Ohemeng-Dapaah, Seth
and Sakyi Baah, Joseph
and Kodie, Richmond
and Kanter, S. Andrew
and Levine, Orin",
title="Using Social Networking to Understand Social Networks: Analysis of a Mobile Phone Closed User Group Used by a Ghanaian Health Team",
journal="J Med Internet Res",
year="2013",
month="Apr",
day="03",
volume="15",
number="4",
pages="e74",
keywords="mobile health",
keywords="electronic health",
keywords="telehealth",
keywords="sociology",
keywords="social network analysis",
keywords="rural health",
keywords="global health",
keywords="evaluation research",
keywords="Ghana",
abstract="Background: The network structure of an organization influences how well or poorly an organization communicates and manages its resources. In the Millennium Villages Project site in Bonsaaso, Ghana, a mobile phone closed user group has been introduced for use by the Bonsaaso Millennium Villages Project Health Team and other key individuals. No assessment on the benefits or barriers of the use of the closed user group had been carried out. Objective: The purpose of this research was to make the case for the use of social network analysis methods to be applied in health systems research---specifically related to mobile health. Methods: This study used mobile phone voice records of, conducted interviews with, and reviewed call journals kept by a mobile phone closed user group consisting of the Bonsaaso Millennium Villages Project Health Team. Social network analysis methodology complemented by a qualitative component was used. Monthly voice data of the closed user group from Airtel Bharti Ghana were analyzed using UCINET and visual depictions of the network were created using NetDraw. Interviews and call journals kept by informants were analyzed using NVivo. Results: The methodology was successful in helping identify effective organizational structure. Members of the Health Management Team were the more central players in the network, rather than the Community Health Nurses (who might have been expected to be central). Conclusions: Social network analysis methodology can be used to determine the most productive structure for an organization or team, identify gaps in communication, identify key actors with greatest influence, and more. In conclusion, this methodology can be a useful analytical tool, especially in the context of mobile health, health services, and operational and managerial research. ",
doi="10.2196/jmir.2332",
url="http://www.jmir.org/2013/4/e74/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23552721"
}


@Article{info:doi/10.2196/jmir.2442,
author="Kristj{\'a}nsd{\'o}ttir, Birna {\'O}l{\"o}f
and Fors, A. Egil
and Eide, Erlend
and Finset, Arnstein
and Stensrud, Lauritzen Tonje
and van Dulmen, Sandra
and Wigers, H{\o}rven Sigrid
and Eide, Hilde",
title="A Smartphone-Based Intervention With Diaries and Therapist Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain. Part 2: 11-month Follow-up Results of a Randomized Trial",
journal="J Med Internet Res",
year="2013",
month="Mar",
day="28",
volume="15",
number="3",
pages="e72",
keywords="Internet-based personalized feedback",
keywords="widespread chronic pain",
keywords="fibromyalgia",
keywords="pain management",
keywords="eHealth",
keywords="smartphone",
keywords="Internet",
keywords="cognitive therapy",
keywords="catastrophization",
abstract="Background: Internet-based interventions are increasingly used to support self-management of individuals with chronic illnesses. Web-based interventions may also be effective in enhancing self-management for individuals with chronic pain, but little is known about long-term effects. Research on Web-based interventions to support self-management following participation in pain management programs is limited. Objective: The aim is to examine the long-term effects of a 4-week smartphone-intervention with diaries and therapist-written feedback following an inpatient chronic pain rehabilitation program, previously found to be effective at short-term and 5-month follow-ups. Methods: 140 women with chronic widespread pain, participating in a 4-week inpatient rehabilitation program, were randomized into two groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of one face-to-face individual session and 4 weeks of written communication via a smartphone, consisting of three diaries daily to elicit pain-related thoughts, feelings, and activities, as well as daily personalized written feedback based on cognitive behavioral principles from a therapist. Both groups were given access to an informational website to promote constructive self-management. Outcomes were measured with self-reported paper-and-pencil format questionnaires with catastrophizing as the primary outcome measure. Secondary outcomes included daily functioning and symptom levels, acceptance of pain, and emotional distress.  Results: By the 11-month follow-up, the favorable between-group differences previously reported post-intervention and at 5-month follow-up on catastrophizing, acceptance, functioning, and symptom level were no longer evident (P>.10). However, there was more improvement in catastrophizing scores during the follow-up period in the intervention group (M=-2.36, SD 8.41) compared to the control group (M=.40, SD 7.20), P=.045. Also, per protocol within-group analysis showed a small positive effect (Cohen's d=.33) on catastrophizing in the intervention group (P=.04) and no change in the control group from the smartphone intervention baseline to 11-month follow-up. A positive effect (Cohen's d=.73) on acceptance was found within the intervention group (P<.001) but not in the control group. Small to large negative effects were found within the control group on functioning and symptom levels, emotional distress, and fatigue (P=.05) from the intervention baseline to the 11-month follow-up. Conclusion: The long-term results of this randomized trial are ambiguous. No significant between-group effect was found on the study variables at 11-month follow-up. However, the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data, indicated changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group. This study provides modest evidence supporting the long-term effect of the intervention. Trial Registration: Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6FF7KUXo0) ",
doi="10.2196/jmir.2442",
url="http://www.jmir.org/2013/3/e72/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23538392"
}


@Article{info:doi/10.2196/jmir.2350,
author="Stinson, N. Jennifer
and Jibb, A. Lindsay
and Nguyen, Cynthia
and Nathan, C. Paul
and Maloney, Marie Anne
and Dupuis, Lee L.
and Gerstle, Ted J.
and Alman, Benjamin
and Hopyan, Sevan
and Strahlendorf, Caron
and Portwine, Carol
and Johnston, L. Donna
and Orr, Mike",
title="Development and Testing of a Multidimensional iPhone Pain Assessment Application for Adolescents with Cancer",
journal="J Med Internet Res",
year="2013",
month="Mar",
day="08",
volume="15",
number="3",
pages="e51",
keywords="neoplasms",
keywords="pain",
keywords="child",
keywords="adolescent",
keywords="youth",
keywords="cellular phone",
keywords="game",
abstract="Background: Pain is one of the most common and distressing symptoms reported by adolescents with cancer. Despite advancements in pain assessment and management research, pain due to cancer and/or its treatments continues to be poorly managed. Our research group has developed a native iPhone application (app) called Pain Squad to tackle the problem of poorly managed pain in the adolescent with cancer group. The app functions as an electronic pain diary and is unique in its ability to collect data on pain intensity, duration, location, and the impact pain has on an adolescent's life (ie, relationships, school work, sleep, mood). It also evaluates medications and other physical and psychological pain management strategies used. Users are prompted twice daily at configurable times to complete 20 questions characterizing their pain and the app transmits results to a database for aggregate reporting through a Web interface. Each diary entry represents a pain case filed by an adolescent with cancer and a reward system (ie, moving up through law-enforcement team ranks, built-in videotaped acknowledgements from fictitious officers) encourages consistent use of the diary. Objective: Our objective was to design, develop, and test the usability, feasibility, compliance, and satisfaction of a game-based smartphone pain assessment tool for adolescents with cancer. Methods: We used both low- and high-fidelity qualitative usability testing with qualitative semi-structured, audio-taped interviews and iterative cycles to design and refine the iPhone based Pain Squad app. Qualitative thematic analysis of interviews using constant comparative methodology captured emergent themes related to app usability. Content validity was assessed using question importance-rating surveys completed by participants. Compliance and satisfaction data were collected following a 2-week feasibility trial where users were alarmed to record their pain twice daily on the app. Results: Thematic analysis of usability interviews showed the app to be appealing overall to adolescents. Analyses of both low- and high-fidelity testing resulted in minor revisions to the app to refine the theme and improve its usability. Adolescents resoundingly endorsed the game-based nature of the app and its virtual reward system. The importance of app pain diary questions was established by content validity analysis. Compliance with the app, assessed during feasibility testing, was high (mean 81\%, SD 22\%) and adolescents from this phase of the study found the app likeable, easy to use, and not bothersome to complete. Conclusions: A multifaceted usability approach demonstrated how the Pain Squad app could be made more appealing to children and adolescents with cancer. The game-based nature and built-in reward system of the app was appealing to adolescents and may have resulted in the high compliance rates and satisfaction ratings observed during clinical feasibility testing. ",
doi="10.2196/jmir.2350",
url="http://www.jmir.org/2013/3/e51/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23475457"
}