@Article{info:doi/10.2196/48221, author="Valkonen, Paula and H{\"o}ls{\"a}, Sini and Viitanen, Johanna and Leinonen, Sini and Karisalmi, Nina and Rauta, Virpi", title="Illustrating User Needs for eHealth With Experience Map: Interview Study With Chronic Kidney Disease Patients", journal="JMIR Hum Factors", year="2025", month="Mar", day="18", volume="12", pages="e48221", keywords="user need", keywords="chronic illness", keywords="kidney disease", keywords="older adult", keywords="eHealth", keywords="experience map", keywords="human-centered design", keywords="home dialysis", abstract="Background: Chronic kidney disease (CKD) is a common condition worldwide and home dialysis (HD) provides economic, quality of life, and clinical advantages compared to other dialysis modalities. Human-centered design aims to support the development of eHealth solutions with high usability and user experience. However, research on the eHealth needs of patients using HD is scarce. Objective: This study aimed to support the design of eHealth for patients with CKD, particularly for patients using HD, by developing a kidney disease experience map that illustrates user needs, concerns, and barriers. The research questions were (1) what experiences do patients, particularly older adults, have in their everyday lives with CKD? (2) what user needs do patients with CKD have for HD eHealth? (3) how can these needs be illustrated using the experience map technique? The study focused on patients aged >60 years, as they are at a higher risk of chronic conditions. The study was conducted as part of the eHealth in HD project, coordinated by Hospital District of Helsinki and Uusimaa, Finland. Methods: In total, 18 patients in different care modalities participated in retrospective interviews conducted between October 2020 and April 2021. The interviews included a preliminary task with patient journey illustrations and questions about their experiences and everyday lives with CKD. The data analysis was conducted using a thematic analysis approach and the process included several phases. Results: On the basis of the thematic analysis, 5 categories were identified: healthy habits, concerns about and barriers to eHealth use, digital communication, patients' emotions, and everyday life with CKD. These were illustrated in the first version of the kidney disease experience map. The patients had different healthy habits regarding social life, sports, and other activities. They had challenges with poorly functioning eHealth software and experienced other factors, such as a lack of interest and lack of skills for eHealth use. Technical devices do not always meet the emotional or physical needs of their users. This caused feelings of frustration, worry, and fear in patients, yet also fostered situational awareness and hope. Conclusions: The experience map is a promising method for illustrating user needs and communicating the patient's voice for eHealth development. eHealth offers possibilities to support patient's everyday life with chronic disease. The patient's situation and capacity to use eHealth solutions vary with their everyday challenges, opportunities, and their current stage of treatment. The kidney disease experience map will be used and further developed in the ongoing research project ``Better Health at Home---Optimized Human-Centered Care of Predialysis and Home Dialysis Patients'' (2022 to 2026). ", doi="10.2196/48221", url="https://humanfactors.jmir.org/2025/1/e48221" } @Article{info:doi/10.2196/64249, author="Ghorbanian Zolbin, Maedeh and Kujala, Sari and Huvila, Isto", title="Experiences and Expectations of Immigrant and Nonimmigrant Older Adults Regarding eHealth Services: Qualitative Interview Study", journal="J Med Internet Res", year="2025", month="Mar", day="14", volume="27", pages="e64249", keywords="eHealth services", keywords="older adults", keywords="immigrant", keywords="usability", keywords="user experience", keywords="emotion", keywords="self-determination theory", abstract="Background: The emergence of eHealth services could contribute to improving individuals' quality of life by optimizing effective and efficient care. However, various challenges might limit some older adults' use of eHealth services. Objective: This study aimed to understand the perspectives of older adults (aged ?65 years) of different backgrounds regarding eHealth services. We explored the experiences of Iranian immigrant and nonimmigrant older adults with eHealth services to identify their perceived challenges, emotions, and wishes. Immigrants face more challenges, and there is a need to understand their perspectives in addition to those of nonimmigrants. Iranians are one important immigrant group, as their number is limited and their specific needs are less well understood compared to those of the bigger immigrant groups. Methods: This study used a qualitative explorative research design. Semistructured interviews were conducted between February 2023 and May 2023. The participants were 25 older adults: nonimmigrants residing in cities (n=8, 32\%), nonimmigrants residing in rural areas (n=9, 36\%), and Iranian immigrants residing in cities (n=8, 32\%). Data were analyzed through inductive and deductive content analysis and interpreted through self-determination theory. Results: Interacting with eHealth services was challenging for some older adults. They perceived several difficulties, with the most obvious ones being related to values and preferences, as some older adults did not value eHealth services (16/25, 64\%), had insufficient digital skills (15/25, 60\%), and experienced usability issues (15/25, 60\%). The first two challenges were more pronounced among immigrants. In contrast, nonimmigrants from cities, being more familiar with the services, shared more usability issues. These identified challenges prevented older adults from satisfying their basic psychological needs of being competent and autonomous users and having a sense of belonging (aspects of self-determination theory), which were the main source of negative emotions. A common negative feeling was confusion (16/25, 64\%) among those with limited experience using smart devices and those with poor self-reported digital skills. Conversely, older adults' interaction with eHealth services generated positive emotions that were connected to the satisfaction of their basic psychological needs. Being interested in using eHealth services was a common feeling among most participants regardless of their background and was connected to satisfying their need for being competent and autonomous. The positive emotions could be supported by applying older adults' needs to the design of eHealth services (10/25, 40\%) and by supporting their digital skills (19/25, 76\%). Conclusions: Some older adults value eHealth services and see their added benefits. However, various challenges limit their use of these services. The analysis of older adults' needs yielded several practical ideas that could improve the user-friendliness of the services and highlighted the importance of sufficient support services tailored to the cultural needs of specific groups of older adults. ", doi="10.2196/64249", url="https://www.jmir.org/2025/1/e64249" } @Article{info:doi/10.2196/56862, author="Nonaka, Sayuri and Fujii, Susumu and Yamada, Chris Kosuke", title="Purposes of Smartphone Health Care Apps and the Practicality of Their Functions in Disaster Situations: Qualitative Function Assessment Study", journal="JMIR Form Res", year="2025", month="Mar", day="5", volume="9", pages="e56862", keywords="health care", keywords="disaster medicine", keywords="mobile app", keywords="survey", keywords="disaster situations", keywords="self-reliance", keywords="Japan", keywords="disaster response", keywords="mobile phone", abstract="Background: Japan has experienced various natural disasters, including the Great East Japan Earthquake in 2011. It becomes crucial to focus on strengthening self-help measures through health care apps that are used in normal times to help people during disasters. However, little is known about what health care apps would be useful in times of disaster. Objective: This study aimed to investigate the prevalent functionalities and purposes of using health care apps during normalcy, explore their potential utility, and propose strategies for disaster response through their utilization. Methods: We focus on highly ranked health care apps (within the top 100 in the health care category for iPhones by Apple, Inc for a certain period) and reclassify their purpose of use, such as sleep, relaxation, and exercise, in detail. We also investigate the functions within each health care app (measurement, recording, advice, content provision, and guidance to actual services), based on which we determine their potential utilization during disasters and anticipate potential solutions to address disaster-related challenges. We also consider the ideal framework of health care apps in disaster response, exploring possibilities such as the necessity of new disaster-specific apps or the adaptation of existing health care apps for disaster scenarios. Results: Among the 70 free apps, the predominant functions included ``recording'' (n=60 cases, 86\%) and ``measurement'' (n=47 cases, 67\%), primarily encompassing the mechanical functions of wearable devices and smartphones. A similar trend was seen in the 77 paid apps, but ``content provision'' (n=54 cases, 70\%) was the most prevalent. Furthermore, the ``content provision'' function was particularly common in the ``purposes of use'' categories ``sleep'' ($\chi$211=29; P<.001), ``relaxation'' ($\chi$211=14.6; P<.001), and ``exercise'' ($\chi$211=9.3; P=.002). This suggested the possibility of using the content provision function in existing health care apps to support mental and physical health even during a disaster. Conclusions: The widespread use of apps during normal times could minimize hesitation in adopting them during disasters. The findings emphasize the potential for augmenting disaster-specific content within existing apps rather than developing new ones. This approach aligns with the likelihood of preinstalled app use during emergencies, indicating a pragmatic strategy for enhancing disaster response content within prevalent apps. ", doi="10.2196/56862", url="https://formative.jmir.org/2025/1/e56862" } @Article{info:doi/10.2196/63110, author="Beecroft, Ashlyn and Vaikla, Olivia and Engel, Nora and Duchaine, Thomas and Liang, Chen and Pant Pai, Nitika", title="Evidence on Digital HIV Self-Testing From Accuracy to Impact: Updated Systematic Review", journal="J Med Internet Res", year="2025", month="Mar", day="4", volume="27", pages="e63110", keywords="digital HIV self-testing", keywords="impact", keywords="linkage", keywords="outcomes", keywords="HIV", keywords="HIV infection", keywords="HIV self-testing", keywords="self-testing", keywords="digital innovation", keywords="systematic review", keywords="accuracy", keywords="patient-centered", keywords="middle- to high-income countries", keywords="digital health", keywords="mHealth", keywords="health education", keywords="sexually transmitted diseases", keywords="sexual behavior", abstract="Background: HIV self-testing has gained momentum following the approval of self-testing methods and novel technological advancements. Digital HIV self-testing involves completing an oral or blood-based HIV self-test with support from a digital innovation. Objective: We conducted a systematic review on the existing data analyzing digital HIV self-testing accuracy while updating research on digital HIV self-test acceptability, preference, feasibility, and impact. Methods: We searched Embase and PubMed for records on HIV self-testing with digital support. Included studies significantly incorporated a form of digital innovation throughout the HIV self-test process and reported quantitative data. For accuracy measures, the search spanned January 1, 2013, to October 15, 2024; for patient-centered and impact outcomes, we updated existing literature (June 16, 2021, to October 15, 2024) reported in a previous systematic review. Studies' quality was assessed using the QUADAS 2 Tool, Newcastle-Ottawa Scale, and Cochrane Risk of Bias Tool 2. Results: Fifty-five studies (samples ranging 120-21,035, median 1267 participants) were summarized from 19 middle- to high-income countries. Seven studies reported on the accuracy of HIV self-testing with innovations from >5000 participants. Diagnostic performance metrics, including point estimates of specificity, sensitivity, positive predictive value, and negative predictive value were measured (n=3), and ranged from: 96.8\% to 99.9\%, 92.9\% to 100.0\%, 76.5\% to 99.2\%, and 99.2\% to 100.0\%, respectively. The percentage of invalid test results for oral and blood-based self-tests ranged from 0.2\% to 12.7\% (n=4). Fifty-one studies reported data on metrics beyond accuracy, including acceptability, preference, feasibility, and impact outcomes from >30,000 participants. Majority (38/51, 74.5\%) were observational studies, while 25.5\% (13/51) reported data from randomized controlled trials. Acceptability and preference outcomes varied from 64.5\% to 99.0\% (14/51) and 4.6\% to 99.3\% (8/51), respectively. Feasibility outcomes included test uptake (30.9\% to 98.2\%; 28/51), response rate (26.0\% to 94.8\%; 7/51), and visits to web-based providers (43.0\% to 70.7\%; n=4). Impact outcomes assessed new infections (0.0\% to 25.8\%; 31/51), first-time testers (2.0\% to 53.0\%; 26/51), result return proportions (22.1\% to 100.0\%; 24/51), linkage to care as both connections to confirmatory testing and counseling (53.0\% to 100.0\%; 16/51), and referrals for treatment initiation (44.4\% to 98.1\%; 8/51). The quality of studies varied, though they generally demonstrated low risk of bias. Conclusions: Digital innovations improved the accuracy of HIV self-test results, and were well-accepted and preferred by participants. Operationally, they were found to be feasible and reported impacting the HIV self-testing process. These findings are in favor of the use of digital HIV self-test innovations as a promising support tool and suggest that digital HIV self-tests' service delivery models hold promise in not only facilitating HIV testing but also impacting operational outcomes that are crucial to reaching Joint United Nations Program on HIV/AIDS targets in middle- to high-income countries. Trial Registration: PROSPERO CRD42020205025; https://www.crd.york.ac.uk/prospero/CRD42020205025 ", doi="10.2196/63110", url="https://www.jmir.org/2025/1/e63110", url="http://www.ncbi.nlm.nih.gov/pubmed/40053740" } @Article{info:doi/10.2196/55007, author="Agarwal, Payal and Fletcher, George Glenn and Ramamoorthi, Karishini and Yao, Xiaomei and Bhattacharyya, Onil", title="Uses of Virtual Care in Primary Care: Scoping Review", journal="J Med Internet Res", year="2025", month="Feb", day="14", volume="27", pages="e55007", keywords="primary care", keywords="telemedicine", keywords="telehealth", keywords="virtual care", keywords="virtual health", keywords="virtual medicine", keywords="remote consultation", keywords="telephone consultation", keywords="video consultations", keywords="medical informatics", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="COVID-19", keywords="SARS-CoV-2", keywords="coronavirus infections", keywords="PRISMA", abstract="Background: The COVID-19 pandemic catalyzed an uptake in virtual care. However, the rapid shift left unanswered questions about the impact of virtual care on the quality of primary care and its appropriateness and effectiveness. Moving forward, health care providers require guidance on how best to use virtual care to support high-quality primary care. Objective: This study aims to identify and summarize clinical studies and systematic reviews comparing virtual care and in-person care in primary care, with a focus on how virtual care can support key clinical functions such as triage, medical assessment and treatment, counseling, and rehabilitation in addition to the management of particular conditions. Methods: We conducted a scoping review following an established framework. Comprehensive searches were performed across the following databases: Embase, MEDLINE, PsycInfo, Emcare, and Cochrane Database of Systematic Reviews. Other well-known websites were also searched. PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were followed. Articles were selected by considering article type, language, care provided, intervention, mode of care delivery, and sample size. Results: A total of 13,667 articles were screened, and 219 (1.6\%) articles representing 170 studies were included in the review. Of the 170 studies included, 142 (83.5\%) were primary studies, and 28 (16.5\%) were systematic reviews. The studies were grouped by functions of primary care, including triage (16/170, 9.4\%), medical assessment and treatment of particular conditions (63/170, 37.1\%), rehabilitation (17/170, 10\%), and counseling (74/170, 43.5\%). The studies suggested that many primary care functions could appropriately be conducted virtually. Virtual rehabilitation was comparable to in-person care and virtual counseling was found to be equally effective as in-person counseling in several contexts. Some of the studies indicated that many general primary care issues could be resolved virtually without the need for any additional follow-up, but data on diagnostic accuracy were limited. Virtual triage is clinically appropriate and led to fewer in-person visits, but overall impact on efficiency was unclear. Many studies found that virtual care was more convenient for many patients and provided care equivalent to in-person care for a range of conditions. Studies comparing appropriate antibiotic prescription between virtual and in-person care found variable impact by clinical condition. Studies on virtual chronic disease management observed variability in impact on overall disease control and clinical outcomes. Conclusions: Virtual care can be safe and appropriate for triage and seems equivalent to in-person care for counseling and some rehabilitation services; however, further studies are needed to determine specific contexts or medical conditions where virtual care is appropriate for diagnosis, management outcomes, and other functions of primary care. Virtual care needs to be adapted to fit a new set of patient and provider workflows to demonstrate positive impacts on experience, outcomes, and costs of care. ", doi="10.2196/55007", url="https://www.jmir.org/2025/1/e55007" } @Article{info:doi/10.2196/56251, author="Beckett, Darcy and Curtis, Rachel and Szeto, Kimberley and Maher, Carol", title="Changing User Experience of Wearable Activity Monitors Over 7 Years: Repeat Cross-Sectional Survey Study", journal="J Med Internet Res", year="2025", month="Feb", day="13", volume="27", pages="e56251", keywords="cross-sectional survey", keywords="activity tracker", keywords="user experience", keywords="physical activity", keywords="sleep", keywords="diet", keywords="health behaviour", keywords="wearable activity trackers", keywords="cohort", keywords="Apple", keywords="Fitbit", keywords="preferences", keywords="reliability", keywords="accessibility", keywords="lifestyle", keywords="mobile phone", abstract="Background: Lifestyle behaviors, including physical inactivity, sedentary behavior, poor sleep, and unhealthy diet, significantly impact global population health. Wearable activity trackers (WATs) have emerged as tools to enhance health behaviors; however, their effectiveness and continued use depend on their user experience. Objective: This study aims to explore changes in user experiences, preferences, and perceived impacts of WATs from 2016 to 2023. Methods: We conducted a cross-sectional online survey among an international cohort of adults (n=475, comprising 387 current and 88 former WAT users). Results were compared with a 2016 cross-sectional online survey (n=237, comprising 200 current and 37 former WAT users) using descriptive statistics and chi-square tests. The survey examined brand preference, feature usefulness, motivations, perceived health behavior change, social sharing behaviors, and technical issues. Results: In 2023, Apple (210/475, 44\%) and Fitbit (101/475, 21\%) were the most commonly used devices, compared with the 2016 survey where Fitbit (160/237, 68\%) and Garmin devices (39/237, 17\%) were most common. The median usage duration in 2023 was 18 months, significantly longer than the 7 months reported in 2016, with most users planning ongoing use. Users in both survey years reported greater improvements in physical activity than diet or sleep, despite lower improvement in physical activity in 2023 compared with 2016, contrasted with greater perceived improvements in diet and sleep. Social media sharing of WAT data notably rose to 73\% (283/387) in 2023 from 35\% (70/200) in 2016. However, reports of technical issues and discomfort increased, alongside a decrease in overall positive experiences. There was also a noticeable shift in discontinuation reasons, from having learned everything possible in 2016 to dissatisfaction in 2023. Conclusions: The study highlights significant shifts in WAT usage, including extended use and evolving preferences for brands and features. The rise in social media sharing indicates a deeper integration of WATs into everyday life. However, user feedback points to a need for enhanced design and functionality despite technological progress. These findings illustrate WAT's potential in health promotion, emphasizing the need for user-focused design in diverse populations to fully realize their benefits in enhancing health behaviors. ", doi="10.2196/56251", url="https://www.jmir.org/2025/1/e56251" } @Article{info:doi/10.2196/49610, author="Zuidhof, Niek and Peters, Oscar and Verbeek, Peter-Paul and Ben Allouch, Somaya", title="Social Acceptance of Smart Glasses in Health Care: Model Evaluation Study of Anticipated Adoption and Social Interaction", journal="JMIR Form Res", year="2025", month="Feb", day="11", volume="9", pages="e49610", keywords="smart glasses", keywords="technology adoption", keywords="social interaction", keywords="instrument development", keywords="structural equation modeling", abstract="Background: Despite the growing interest in smart glasses, it is striking that they are not widespread among health care professionals. Previous research has identified issues related to social interactions involving the use of smart glasses in public settings, which may differ from those associated with their application in health care contexts. Objective: Assuming that smart glasses mediate contact between the health care provider and patient, the objectives of this research are two-fold: (1) to develop an instrument that combines the adoption and mediation perspectives, and (2) to gain insights into how the intention to use is influenced through aspects of adoption and social interaction. Methods: A questionnaire was administered to a target audience of health care professionals (N=450), with recruitment via MTurk. The sample primarily included male participants from the United States, with the majority aged 42 years or younger. Although a large portion of respondents were medical doctors, the sample also included nurses and other health care professionals. Data were analyzed by structural equation modeling. Results: Regarding the aim of developing an instrument combining adoption and social interaction, the internal consistency was above the aspirational level ($\alpha$>.70) for the instrument. Furthermore, regarding the second objective involving gaining insights into the influential constructs of the anticipated intention to use, the following results were highlighted: in testing the conceptual model, the measurement model generated a good fit and the respecified structural model also generated a good fit. The tested hypotheses confirmed that social interaction constructs could explain a higher variance of users' anticipated intention to use. Perceived social isolation and decreased attentional allocation did not have a significant effect on attitude. Furthermore, the intention to use smart glasses despite nonacceptance of smart glasses by the patient significantly influenced the anticipated intention to use. In summary, constructs that focus on social interaction could contribute to better explanation and prediction of the expected adoption of smart glasses in health care. Conclusions: The empirical findings of this study provide new insights into how the mediation perspective can increase the explained variance compared to existing knowledge about adoption. Against expectations based on previous literature and despite the social issues raised earlier, these social aspects do play important roles for health care professionals but are ultimately not decisive for the intention to use. As a result, there are fewer threats to the adoption of smart glasses from the perspective of health care professionals than might be expected based on the previous literature. Therefore, the use of smart glasses can still be considered as an innovative way of working in health care. ", doi="10.2196/49610", url="https://formative.jmir.org/2025/1/e49610" } @Article{info:doi/10.2196/65974, author="Villain, Patricia and Downham, Laura and Le Bonniec, Alice and Bauquier, Charlotte and Mandrik, Olena and Nadarzynski, Tom and Donelle, Lorie and Murillo, Ra{\'u}l and Tolma, L. Eleni and Johnson, Sonali and Soler-Michel, Patricia and Smith, Robert", title="Impact of Online Interactive Decision Tools on Women's Decision-Making Regarding Breast Cancer Screening: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2025", month="Jan", day="29", volume="27", pages="e65974", keywords="breast cancer screening", keywords="decision-making", keywords="online interactive", keywords="decision aid", keywords="average risk", keywords="shared decision-making", keywords="screening participation", keywords="cognitive determinants", keywords="women", abstract="Background: The online nature of decision aids (DAs) and related e-tools supporting women's decision-making regarding breast cancer screening (BCS) through mammography may facilitate broader access, making them a valuable addition to BCS programs. Objective: This systematic review and meta-analysis aims to evaluate the scientific evidence on the impacts of these e-tools and to provide a comprehensive assessment of the factors associated with their increased utility and efficacy. Methods: We followed the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted a search of MEDLINE, PsycINFO, Embase, CINAHL, and Web of Science databases from August 2010 to April 2023. We included studies reporting on populations at average risk of breast cancer, which utilized DAs or related e-tools, and assessed women's participation in BCS by mammography or other key cognitive determinants of decision-making as primary or secondary outcomes. We conducted meta-analyses on the identified randomized controlled trials, which were assessed using the revised Cochrane Risk of Bias 2 (RoB 2) tool. We further explored intermediate and high heterogeneity between studies to enhance the validity of our results. Results: In total, 22 different e-tools were identified across 31 papers. The degree of tailoring in the e-tools, specifically whether the tool was fully tailored or featured with tailoring, was the most influential factor in women's decision-making regarding BCS. Compared with control groups, tailored e-tools significantly increased women's long-term participation in BCS (risk ratio 1.14, 95\% CI 1.07-1.23, P<.001, I2=0\%). Tailored-to-breast-cancer-risk e-tools increased women's level of worry (mean difference 0.31, 95\% CI 0.13-0.48, P<.001, I2=0\%). E-tools also improved women's adequate knowledge of BCS, with features-with-tailoring e-tools designed and tested with the general population being more effective than tailored e-tools designed for or tested with non-BCS participants ($\chi$21=5.1, P=.02). Features-with-tailoring e-tools increased both the rate of women who intended not to undergo BCS (risk ratio 1.88, 95\% CI 1.43-2.48, P<.001, I2=0\%) and the rate of women who had made an informed choice regarding their intention to undergo BCS (risk ratio 1.60, 95\% CI 1.09-2.33, P=.02, I2=91\%). Additionally, these tools decreased the proportion of women with decision conflict (risk ratio 0.77, 95\% CI 0.65-0.91, P=.002, I2=0\%). Shared decision-making was not formally evaluated. This review is limited by small sample sizes, including only a few studies in the meta-analysis, some with a high risk of bias, and high heterogeneity between the studies and e-tools. Conclusions: Features-with-tailoring e-tools could potentially negatively impact BCS programs by fostering negative intentions and attitudes toward BCS participation. Conversely, tailored e-tools may increase women's participation in BCS but, when tailored to risk, they may elevate their levels of worry. To maximize the effectiveness of e-tools while minimizing potential negative impacts, we advocate for an ``on-demand'' layered approach to their design. ", doi="10.2196/65974", url="https://www.jmir.org/2025/1/e65974" } @Article{info:doi/10.2196/55564, author="Huang, Guohong and Wu, Rongrong and Xu, Xiuzhi and Song, Yongxia and Zheng, Rong and Chen, Xi and Hong, Jingfang", title="Effect of eHealth Interventions on Body Image of Patients With Cancer: Systematic Review", journal="J Med Internet Res", year="2025", month="Jan", day="9", volume="27", pages="e55564", keywords="body image", keywords="cancer", keywords="eHealth", keywords="systematic review", keywords="quality of life", keywords="physical symptom", keywords="emotional distress", keywords="review", keywords="mobile phone", abstract="Background: Body image issues are prevalent among individuals diagnosed with cancer, leading to detrimental effects on their physical and psychological recovery. eHealth has emerged as a promising approach for enhancing the body image of patients with cancer. Objective: The purpose of this study was to evaluate the effectiveness of eHealth interventions on body image and other health outcomes (quality of life, physical symptoms, and emotional distress) among patients with cancer. In addition, the acceptability, engagement, and challenges of eHealth interventions were also assessed. Methods: A total of 11 databases were searched, encompassing PubMed; Embase; Web of Science; MEDLINE (via Ovid); Scopus; the Cochrane Library; CINAHL (via EBSCO); OpenGrey; and 3 prominent Chinese repositories: China National Knowledge Infrastructure, China Wanfang Database, and China VIP Database. The search dates were from the inception of the database to September 25, 2024. The inclusion criteria for this study encompassed research that used randomized controlled trials (RCTs) and quasi-experiments (QEs) to examine the effectiveness of eHealth interventions for patients with cancer. The methodological quality of RCTs and QEs was evaluated using the Cochrane risk of bias tool and the Joanna Briggs Institute Critical Evaluation Checklist, respectively. The review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered with PROSPERO. Results: There were 3548 studies reviewed, and 7 studies were selected. Three studies were RCTs and 4 were QEs, involving a total of 512 patients. Evidence of efficacy for eHealth interventions targeting body image and other health outcomes (physical symptoms and emotional distress) was mixed. Nevertheless, our findings indicate that there was no notable enhancement in quality of life resulting from eHealth interventions. A total of 5/7 (71\%) studies reported the acceptability of eHealth interventions among patients with cancer, and patients perceived eHealth interventions as acceptable. However, the difficulty of operating the software, determination of the most effective course of treatment, and time constraints emerged as the primary challenges associated with electronic interventions. Conclusions: The implementation of eHealth interventions has the potential to enhance body image, physical symptoms, and emotional distress in patients with cancer. Researchers should undertake more rigorous experiments in the future to elucidate the effectiveness of eHealth and address pertinent concerns. ", doi="10.2196/55564", url="https://www.jmir.org/2025/1/e55564" } @Article{info:doi/10.2196/53576, author="Pong, Candelyn and Tseng, Wen Rachel Marjorie Wei and Tham, Chung Yih and Lum, Elaine", title="Current Implementation of Digital Health in Chronic Disease Management: Scoping Review", journal="J Med Internet Res", year="2024", month="Dec", day="12", volume="26", pages="e53576", keywords="digital health", keywords="telemedicine", keywords="chronic disease", keywords="noncommunicable disease", keywords="implementation science", keywords="evidence-based practice", keywords="mobile phone", abstract="Background: Approximately 1 in 3 adults live with multiple chronic diseases. Digital health is being harnessed to improve continuity of care and management of chronic diseases. However, meaningful uptake of digital health for chronic disease management remains low. It is unclear how these innovations have been implemented and evaluated. Objective: This scoping review aims to identify how digital health innovations for chronic disease management have been implemented and evaluated: what implementation frameworks, methods, and strategies were used; how successful these strategies were; key barriers and enablers to implementation; and lessons learned and recommendations shared by study authors. Methods: We used the Joanna Briggs Institute methodology for scoping reviews. Five databases were searched for studies published between January 2015 and March 2023: PubMed, Scopus, CINAHL, PsycINFO, and IEEE Xplore. We included primary studies of any study design with any type of digital health innovations for chronic diseases that benefit patients, caregivers, or health care professionals. We extracted study characteristics; type of digital health innovation; implementation frameworks, strategies, and outcome measures used; barriers and enablers to implementation; lessons learned; and recommendations reported by study authors. We used established taxonomies to synthesize extracted data. Extracted barriers and enablers were grouped into categories for reporting. Descriptive statistics were used to consolidate extracted data. Results: A total of 252 studies were included, comprising mainly mobile health (107/252, 42.5\%), eHealth (61/252, 24.2\%), and telehealth (97/252, 38.5\%), with some studies involving more than 1 innovation. Only 23 studies (23/252, 9.1\%) reported using an implementation science theory, model, or framework; the most common were implementation theories, classic theories, and determinant frameworks, with 7 studies each. Of 252 studies, 144 (57.1\%) used 2 to 5 implementation strategies. Frequently used strategies were ``obtain and use patient or consumer feedback'' (196/252, 77.8\%); ``audit and provide feedback'' (106/252, 42.1\%); and piloting before implementation or ``stage implementation scale-up'' (85/252, 33.7\%). Commonly measured implementation outcomes were acceptability, feasibility, and adoption of the digital innovation. Of 252 studies, 247 studies (98\%) did not measure service outcomes, while patient health outcomes were measured in 89 studies (35.3\%). The main method used to assess outcomes was surveys (173/252, 68.7\%), followed by interviews (95/252, 37.7\%). Key barriers impacting implementation were data privacy concerns and patient preference for in-person consultations. Key enablers were training for health care workers and personalization of digital health features to patient needs. Conclusions: This review generated a summary of how digital health in chronic disease management is currently implemented and evaluated and serves as a useful resource for clinicians, researchers, health system managers, and policy makers planning real-world implementation. Future studies should investigate whether using implementation science frameworks, including how well they are used, would yield better outcomes compared to not using them. ", doi="10.2196/53576", url="https://www.jmir.org/2024/1/e53576" } @Article{info:doi/10.2196/53236, author="Brocklehurst, P. Sarah and Morse, R. Alyssa and Cruwys, Tegan and Batterham, J. Philip and Leach, Liana and Robertson, M. Alysia and Sahib, Aseel and Burke, T. Colette and Nguyen, Jessica and Calear, L. Alison", title="Investigating the Effectiveness of Technology-Based Distal Interventions for Postpartum Depression and Anxiety: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2024", month="Nov", day="19", volume="26", pages="e53236", keywords="postpartum", keywords="depression", keywords="anxiety", keywords="birth", keywords="adoptive", keywords="parents", keywords="mobile phone", abstract="Background: Postpartum anxiety and depression are common in new parents. While effective interventions exist, they are often delivered in person, which can be a barrier for some parents seeking help. One approach to overcoming these barriers is the delivery of evidence-based self-help interventions via websites, smartphone apps, and other digital media. Objective: This study aims to evaluate the effectiveness of technology-based distal interventions in reducing or preventing symptoms of postpartum depression or anxiety in male and female birth and adoptive parents, explore the effectiveness of technology-based distal interventions in increasing social ties, and determine the level of adherence to and satisfaction with technology-based distal interventions. Methods: A systematic review and series of meta-analyses were conducted. Three electronic bibliographic databases (PsycINFO, PubMed, and Cochrane Library) were searched for randomized controlled trials evaluating technology-based distal interventions for postpartum depression or anxiety in birth and adoptive parents. Searches were updated on August 1, 2023, before conducting the final meta-analyses. Data on trial characteristics, effectiveness, adherence, satisfaction, and quality were extracted. Screening and data extraction were conducted by 2 reviewers. Risk of bias was assessed using the Joanna Briggs Institute quality rating scale for randomized controlled trials. Studies were initially synthesized qualitatively. Where possible, studies were also quantitatively synthesized through 5 meta-analyses. Results: Overall, 18 articles met the inclusion criteria for the systematic review, with 14 (78\%) providing sufficient data for a meta-analysis. A small significant between-group effect on depression favored the intervention conditions at the postintervention (Cohen d=--0.28, 95\% CI --0.41 to --0.15; P<.001) and follow-up (Cohen d=--0.27, 95\% CI --0.52 to --0.02; P=.03) time points. A small significant effect on anxiety also favored the intervention conditions at the postintervention time point (Cohen d=--0.29, 95\% CI --0.48 to --0.10; P=.002), with a medium effect at follow-up (Cohen d=--0.47, 95\% CI --0.88 to --0.05; P=.03). The effect on social ties was not significant at the postintervention time point (Cohen d=0.04, 95\% CI --0.12 to 0.21; P=.61). Effective interventions tended to be web-based cognitive behavioral therapy programs with reminders. Adherence varied considerably between studies, whereas satisfaction tended to be high for most studies. Conclusions: Technology-based distal interventions are effective in reducing symptoms of postpartum depression and anxiety in birth mothers. Key limitations of the reviewed evidence include heterogeneity in outcome measures, studies being underpowered to detect modest effects, and the exclusion of key populations from the evidence base. More research needs to be conducted with birth fathers and adoptive parents to better ascertain the effectiveness of interventions in these populations, as well as to further assess the effect of technology-based distal interventions on social ties. Trial Registration: PROSPERO CRD42021290525; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=290525 ", doi="10.2196/53236", url="https://www.jmir.org/2024/1/e53236" } @Article{info:doi/10.2196/55400, author="Song, Faying and Gong, Xue and Yang, Yuting and Guo, Rui", title="Comparing the Quality of Direct-to-Consumer Telemedicine Dominated and Delivered by Public and Private Sector Platforms in China: Standardized Patient Study", journal="J Med Internet Res", year="2024", month="Nov", day="14", volume="26", pages="e55400", keywords="telemedicine", keywords="direct-to-consumer telemedicine", keywords="standardized patient", keywords="China", keywords="public", keywords="private", keywords="platform", keywords="objective evaluation", keywords="quality of care", keywords="effectiveness", keywords="safety", keywords="timeliness", keywords="regression model", keywords="management", abstract="Background: Telemedicine is expanding rapidly, with public direct-to-consumer (DTC) telemedicine representing 70\% of the market. A key priority is establishing clear quality distinctions between the public and private sectors. No studies have directly compared the quality of DTC telemedicine in the public and private sectors using objective evaluation methods. Objective: Using a standardized patient (SP) approach, this study aimed to compare the quality of DTC telemedicine provided by China's public and private sectors. Methods: We recruited 10 SPs presenting fixed cases (urticaria and childhood diarrhea), with 594 interactions between them and physicians. The SPs evaluated various aspects of the quality of care, effectiveness, safety, patient-centeredness (PCC), efficiency, and timeliness using the Institute of Medicine (IOM) quality framework. Ordinary least-squares (OLS) regression models with fixed effects were used for continuous variables, while logistic regression models with fixed effects were used for categorical variables. Results: Significant quality differences were observed between public and private DTC telemedicine. Physicians from private platforms were significantly more likely to adhere to clinical checklists (adjusted $\beta$ 15.22, P<.001); provide an accurate diagnosis (adjusted odds ratio [OR] 3.85, P<.001), an appropriate prescription (adjusted OR 3.87, P<.001), and lifestyle modification advice (adjusted OR 6.82, P<.001); ensure more PCC (adjusted $\beta$ 3.34, P<.001); and spend more time with SPs (adjusted $\beta$ 839.70, P<.001), with more responses (adjusted $\beta$ 1.33, P=.001) and more words (adjusted $\beta$ 50.93, P=.009). However, SPs on private platforms waited longer for the first response (adjusted $\beta$ 505.87, P=.001) and each response (adjusted $\beta$ 168.33, P=.04) and paid more for the average visit (adjusted $\beta$ 40.03, P<.001). Conclusions: There is significant quality inequality in different DTC telemedicine platforms. Private physicians might provide a higher quality of service regarding effectiveness and safety, PCC, and response times and words. However, private platforms have longer wait times for their first response, as well as higher costs. Refining online reviews, establishing standardized norms and pricing, enhancing the performance evaluation mechanism for public DTC telemedicine, and imposing stricter limitations on the first response time for private physicians should be considered practical approaches to optimizing the management of DTC telemedicine. ", doi="10.2196/55400", url="https://www.jmir.org/2024/1/e55400" } @Article{info:doi/10.2196/51594, author="Zhou, Xinyi and Hao, Xinyu and Chen, Yuhang and Deng, Hui and Fang, Ling and Zhang, Lingyun and Yan, Xiaotao and Zheng, Pinpin and Wang, Fan", title="Social Media Marketing Strategies for Electronic Cigarettes: Content Analysis of Chinese Weibo Accounts", journal="J Med Internet Res", year="2024", month="Nov", day="7", volume="26", pages="e51594", keywords="e-cigarette", keywords="marketing strategy", keywords="social media", keywords="teenagers", keywords="content analysis", abstract="Background: E-cigarettes have gained popularity among teenagers due to extensive marketing strategies on social media platforms. This widespread promotion is a risk factor, as it fosters more positive attitudes toward e-cigarette use among teenagers and increases the perception that using e-cigarettes is normal. Therefore, the marketing of e-cigarettes on social media is a serious global health concern, and its strategies and impact should be clearly identified. Objective: This study examined how e-cigarette companies popularize their products via Weibo and identified the specific strategies influencing the effectiveness of their marketing. Methods: In phase 1, we conducted a search on Qcc.com and identified 32 e-cigarette brands with active Weibo accounts between October 1 and December 31, 2020, along with 863 Weibo posts. The data were investigated through content analysis. The codebook was developed into four categories: (1) product and features, (2) sales and promotions, (3) social contact and interaction, and (4) restrictions and warnings. To further understand the factors influencing e-cigarette brand marketing, we conducted a multiple linear regression analysis. Results: Marketing tactics by e-cigarette companies on Chinese social media were documented, including emphasizing attractive product features, using trendy characters, implicit promotions, downplaying health concerns, and engaging with Weibo users in various ways. Out of 863 posts, 449 (52\%) mentioned product characteristics. In 313 (36.3\%) posts, visible figures were used to attract attention. Product promotion was absent in 762 (88.3\%) posts, and purchase channels were not mentioned in 790 (98.3\%) posts. Social interaction--related posts received attention (n=548, 63.5\%), particularly those featuring hashtag content (n=538, 62.3\%). Most posts did not include claims for restrictions on teenagers' purchases or use (n=687, 79.6\%) or information on health warnings (n=839, 97.2\%). Multiple linear regression analysis identified marketing strategies that effectively increase the exposure of e-cigarette posts on Weibo. Posts including engagement via posts encouraging reposts, comments, and likes (P<.001) and engagement topics related to e-cigarette brands were positively correlated with the number of reposts (P=.009). Posts highlighting nonmonetary incentives (P=.004), posts with age restriction statements (P<.001), engaging via stories and idea collection (P<.001), and engagement topics related to products (P<.001) and current affairs (P=.002) had a positive effect on the number of comments. Engagement topics related to brands (P<.001) or interactive sweepstakes (P<.001) had a positive effect on the number of likes. Conclusions: E-cigarette posts on Weibo that focus on product features and social interaction attract public attention, especially from teenagers. Stricter regulations and monitoring should be adopted to restrict the social media marketing of e-cigarettes. ", doi="10.2196/51594", url="https://www.jmir.org/2024/1/e51594" } @Article{info:doi/10.2196/54859, author="Jabour, Abdulrahman", title="Integrating Health and Disability Data Into Academic Information Systems: Workflow Optimization Study", journal="JMIR Hum Factors", year="2024", month="Sep", day="4", volume="11", pages="e54859", keywords="disability", keywords="health data", keywords="student health", keywords="health measures", keywords="disability data", keywords="university setting", keywords="university system", keywords="student system", keywords="academic system", keywords="health informatics", keywords="health-related", keywords="health information", keywords="support", keywords="well-being", keywords="user-centered", keywords="data collection", keywords="analysis", keywords="development", keywords="privacy", keywords="confidentiality", keywords="timely communication", keywords="task automation", keywords="resources", keywords="quality of life", keywords="wellness", keywords="advisor", keywords="advisors", keywords="support system", keywords="interview", keywords="interviews", keywords="administrative staff", keywords="admin staff", keywords="physician", keywords="physicians", keywords="faculty", keywords="student", keywords="students", keywords="thematic analysis", keywords="focus group", abstract="Background: Integrating health information into university information systems holds significant potential for enhancing student support and well-being. Despite the growing body of research highlighting issues faced by university students, including stress, depression, and disability, little has been done in the informatics field to incorporate health technologies at the institutional level. Objective: This study aims to investigate the current state of health information integration within university systems and provide design recommendations to address existing gaps and opportunities. Methods: We used a user-centered approach to conduct interviews and focus group sessions with stakeholders to gather comprehensive insights and requirements for the system. The methodology involved data collection, analysis, and the development of a suggested workflow. Results: The findings of this study revealed the shortcomings in the current process of handling health and disability data within university information systems. In our results, we discuss some requirements identified for integrating health-related information into student information systems, such as privacy and confidentiality, timely communication, task automation, and disability resources. We propose a workflow that separates the process into 2 distinct components: a health and disability system and measures of quality of life and wellness. The proposed workflow highlights the vital role of academic advisors in facilitating support and enhancing coordination among stakeholders. Conclusions: To streamline the workflow, it is vital to have effective coordination among stakeholders and redesign the university information system. However, implementing the new system will require significant capital and resources. We strongly emphasize the importance of increased standardization and regulation to support the information system requirements for health and disability. Through the adoption of standardized practices and regulations, we can ensure the smooth and effective implementation of the required support system. ", doi="10.2196/54859", url="https://humanfactors.jmir.org/2024/1/e54859" } @Article{info:doi/10.2196/56664, author="Kim, Hyun Soo and Kim, Kyoung-A and Chu, Hui Sang and Kim, Hyunji and Joo, Jin Dong and Lee, Geun Jae and Choi, JiYeon", title="Self-Management Using eHealth Technologies for Liver Transplant Recipients: Scoping Review", journal="J Med Internet Res", year="2024", month="Jul", day="4", volume="26", pages="e56664", keywords="liver transplantation", keywords="self-management", keywords="transplant management", keywords="eHealth", keywords="eHealth technology", keywords="digital health", keywords="review", keywords="mobile phone", keywords="liver transplant", keywords="liver disease", keywords="scoping review", abstract="Background: Liver transplantation has become increasingly common as a last-resort treatment for end-stage liver diseases and liver cancer, with continually improving success rates and long-term survival rates. Nevertheless, liver transplant recipients face lifelong challenges in self-management, including immunosuppressant therapy, lifestyle adjustments, and navigating complex health care systems. eHealth technologies hold the potential to aid and optimize self-management outcomes, but their adoption has been slow in this population due to the complexity of post--liver transplant management. Objective: This study aims to examine the use of eHealth technologies in supporting self-management for liver transplant recipients and identify their benefits and challenges to suggest areas for further research. Methods: Following the Arksey and O'Malley methodology for scoping reviews, we conducted a systematic search of 5 electronic databases: PubMed, CINAHL, Embase, PsycINFO, and Web of Science. We included studies that (1) examined or implemented eHealth-based self-management, (2) included liver transplant recipients aged ?18 years, and (3) were published in a peer-reviewed journal. We excluded studies that (1) were case reports, conference abstracts, editorials, or letters; (2) did not focus on the posttransplantation phase; (3) did not focus on self-management; and (4) did not incorporate the concept of eHealth or used technology solely for data collection. The quality of the selected eHealth interventions was evaluated using (1) the Template for Intervention Description and Replication guidelines and checklist and (2) the 5 core self-management skills identified by Lorig and Holman. Results: Of 1461 articles, 15 (1.03\%) studies were included in the final analysis. Our findings indicate that eHealth-based self-management strategies for adult liver transplant recipients primarily address lifestyle management, medication adherence, and remote monitoring, highlighting a notable gap in alcohol relapse interventions. The studies used diverse technologies, including mobile apps, videoconferencing, and telehealth platforms, but showed limited integration of decision-making or resource use skills essential for comprehensive self-management. The reviewed studies highlighted the potential of eHealth in enhancing individualized health care, but only a few included collaborative features such as 2-way communication or tailored goal setting. While adherence and feasibility were generally high in many interventions, their effectiveness varied due to diverse methodologies and outcome measures. Conclusions: This scoping review maps the current literature on eHealth-based self-management support for liver transplant recipients, assessing its potential and challenges. Future studies should focus on developing predictive models and personalized eHealth interventions rooted in patient-generated data, incorporating digital human-to-human interactions to effectively address the complex needs of liver transplant recipients. This review emphasizes the need for future eHealth self-management research to address the digital divide, especially with the aging liver transplant recipient population, and ensure more inclusive studies across diverse ethnicities and regions. ", doi="10.2196/56664", url="https://www.jmir.org/2024/1/e56664" } @Article{info:doi/10.2196/54769, author="Rahbeni, Al Tahani and Satapathy, Prakasini and Itumalla, Ramaiah and Marzo, Rillera Roy and Mugheed, L. Khalid A. and Khatib, Nazli Mahalaqua and Gaidhane, Shilpa and Zahiruddin, Syed Quazi and Rabaan, A. Ali and Alrasheed, A. Hayam and Al-Subaie, F. Maha and Al Kaabil, A. Nawal and Alissa, Mohammed and Ibrahim, L. Amani Ahmed A. and Alsaif, Abdulkhaliq Hussain and Naser, Habeeb Israa and Rustagi, Sarvesh and Kukreti, Neelima and Dziedzic, Arkadiusz", title="COVID-19 Vaccine Hesitancy: Umbrella Review of Systematic Reviews and Meta-Analysis", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="30", volume="10", pages="e54769", keywords="COVID-19", keywords="vaccine acceptance", keywords="vaccine hesitancy", keywords="umbrella review", keywords="systematic review", keywords="meta-analysis", keywords="vaccine", keywords="hesitancy", keywords="global perceptions", keywords="perception", keywords="random effect model", keywords="synthesis", keywords="healthcare workers", keywords="patients", keywords="patient", keywords="chronic disease", keywords="pregnant women", keywords="parents", keywords="child", keywords="children", abstract="Background: The unprecedented emergence of the COVID-19 pandemic necessitated the development and global distribution of vaccines, making the understanding of global vaccine acceptance and hesitancy crucial to overcoming barriers to vaccination and achieving widespread immunization. Objective: This umbrella review synthesizes findings from systematic reviews and meta-analyses to provide insights into global perceptions on COVID-19 vaccine acceptance and hesitancy across diverse populations and regions. Methods: We conducted a literature search across major databases to identify systematic reviews and meta-analysis that reported COVID-19 vaccine acceptance and hesitancy. The AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) criteria were used to assess the methodological quality of included systematic reviews. Meta-analysis was performed using STATA 17 with a random effect model. The data synthesis is presented in a table format and via a narrative. Results: Our inclusion criteria were met by 78 meta-analyses published between 2021 and 2023. Our analysis revealed a moderate vaccine acceptance rate of 63\% (95\% CI 0.60\%-0.67\%) in the general population, with significant heterogeneity (I2 = 97.59\%). Higher acceptance rates were observed among health care workers and individuals with chronic diseases, at 64\% (95\% CI 0.57\%-0.71\%) and 69\% (95\% CI 0.61\%-0.76\%), respectively. However, lower acceptance was noted among pregnant women, at 48\% (95\% CI 0.42\%-0.53\%), and parents consenting for their children, at 61.29\% (95\% CI 0.56\%-0.67\%). The pooled vaccine hesitancy rate was 32\% (95\% CI 0.25\%-0.39\%) in the general population. The quality assessment revealed 19 high-quality, 38 moderate-quality, 15 low-quality, and 6 critically low-quality meta-analyses. Conclusions: This review revealed the presence of vaccine hesitancy globally, emphasizing the necessity for population-specific, culturally sensitive interventions and clear, credible information dissemination to foster vaccine acceptance. The observed disparities accentuate the need for continuous research to understand evolving vaccine perceptions and to address the unique concerns and needs of diverse populations, thereby aiding in the formulation of effective and inclusive vaccination strategies. Trial Registration: PROSPERO CRD42023468363; https://tinyurl.com/2p9kv9cr ", doi="10.2196/54769", url="https://publichealth.jmir.org/2024/1/e54769", url="http://www.ncbi.nlm.nih.gov/pubmed/38687992" } @Article{info:doi/10.2196/51145, author="von Wolff, Michael and Germeyer, Ariane and B{\"o}ttcher, Bettina and Magaton, Martha Isotta and Marcu, Irene and Pape, Janna and S{\"a}nger, Nicole and Nordhoff, Verena and Roumet, Marie and Weidlinger, Susanna", title="Evaluation of the Gonadotoxicity of Cancer Therapies to Improve Counseling of Patients About Fertility and Fertility Preservation Measures: Protocol for a Retrospective Systematic Data Analysis and a Prospective Cohort Study", journal="JMIR Res Protoc", year="2024", month="Mar", day="20", volume="13", pages="e51145", keywords="fertility", keywords="fertility preservation", keywords="cancer", keywords="gonadotoxicity", keywords="FertiPROTEKT", keywords="FertiTOX", keywords="data analysis", keywords="cohort study", keywords="internet", keywords="platform", keywords="internet-based", keywords="data", abstract="Background: Cytotoxic treatments such as chemo- and radiotherapy and immune therapies are required in cancer diseases. These therapies have the potential to cure patients but may also have an impact on gonadal function and, therefore, on fertility. Consequently, fertility preservation treatments such as freezing of gametes and gonadal tissue might be required. However, as detailed data about the necessity to perform fertility preservation treatment are very limited, this study was designed to fill this data gap. Objective: Primary objective of this study is to analyze the impact of cancer therapies and chemotherapies on the ovarian reserve and sperm quality. Secondary objectives are to analyze the (1) impact of cancer therapies and chemotherapies on other fertility parameters and (2) probability of undergoing fertility preservation treatments in relation to specific cancer diseases and treatment protocols and the probability to use the frozen gametes and gonadal tissue to achieve pregnancies. Methods: First, previously published studies on the gonadotoxicity of chemo- and radiotherapies among patients with cancer will be systematically analyzed. Second, a prospective cohort study set up by approximately 70 centers in Germany, Switzerland, and Austria will collect the following data: ovarian function by analyzing anti-M{\"u}llerian hormone (AMH) concentrations and testicular function by analyzing sperm parameters and total testosterone immediately before and around 1 year after gonadotoxic therapies (short-term fertility). A follow-up of these fertility parameters, including history of conceptions, will be performed 5 and 10 years after gonadotoxic therapies (long-term fertility). Additionally, the proportion of patients undergoing fertility-preserving procedures, their satisfaction with these procedures, and the amount of gametes and gonadal tissue and the children achieved by using the frozen material will be analyzed. Third, the data will be merged to create the internet-based data platform FertiTOX. The platform will be structured in accordance with the ICD (International Classification of Diseases) classification of cancer diseases and will be easily be accessible using a specific App. Results: Several funding bodies have funded this study. Ten systematic reviews are in progress and the first one has been accepted for publication. All Swiss and many German and Austrian ethics committees have provided their approval for the prospective cohort study. The study registry has been set up, and a study website has been created. In total, 50 infertility centers have already been prepared for data collection, which started on December 1, 2023. Conclusions: The study can be expected to bridge the data gap regarding the gonadotoxicity of cancer therapies to better counsel patients about their infertility risk and their need to undergo fertility preservation procedures. Initial data are expected to be uploaded on the FertiTOX platform in 2026. Trial Registration: ClinicalTrials.gov NCT05885048; https://clinicaltrials.gov/study/NCT05885048 International Registered Report Identifier (IRRID): DERR1-10.2196/51145 ", doi="10.2196/51145", url="https://www.researchprotocols.org/2024/1/e51145", url="http://www.ncbi.nlm.nih.gov/pubmed/38506900" } @Article{info:doi/10.2196/49198, author="AlMeshrafi, Azzam and AlHamad, F. Arwa and AlKuraidees, Hamoud and AlNasser, A. Lubna", title="Arabic Web-Based Information on Oral Lichen Planus: Content Analysis", journal="JMIR Form Res", year="2024", month="Mar", day="19", volume="8", pages="e49198", keywords="oral lichen planus", keywords="health information", keywords="Arabic", keywords="medical information", keywords="information seeking", keywords="quality", keywords="online information", keywords="Arab", keywords="oral", keywords="inflammatory", keywords="inflammation", keywords="chronic", keywords="mouth", keywords="mucous membrane", keywords="mucous membranes", keywords="reliable", keywords="reliability", keywords="credible", keywords="credibility", keywords="periodontology", keywords="dental", keywords="dentist", keywords="dentistry", abstract="Background: The use of web-based health information (WBHI) is on the rise, serving as a valuable tool for educating the public about health concerns and enhancing treatment adherence. Consequently, evaluating the availability and quality of context-specific WBHI is crucial to tackle disparities in health literacy and advance population health outcomes. Objective: This study aims to explore and assess the quality of the WBHI available and accessible to the public on oral lichen planus (OLP) in Arabic. Methods: The Arabic translation of the term OLP and its derivatives were searched in three general search platforms, and each platform's first few hundred results were reviewed for inclusion. We excluded content related to cutaneous LP, content not readily accessible to the public (eg, requiring subscription fees or directed to health care providers), and content not created by health care providers or organizations (ie, community forums, blogs, and social media). We assessed the quality of the Arabic WBHI with three standardized and validated tools: DISCERN, Journal of the American Medical Association (JAMA) benchmarks, and Health On the Net (HON). Results: Of the 911 resources of WBHI reviewed for eligibility, 49 were included in this study. Most WBHI resources were provided by commercial affiliations (n=28, 57.1\%), with the remainder from academic or not-for-profit affiliations. WBHI were often presented with visual aids (ie, images; n=33, 67.4\%). DISCERN scores were highest for WBHI resources that explicitly stated their aim, while the lowest scores were for providing the effect of OLP (or OLP treatment) on the quality of life. One-quarter of the resources (n=11, 22.4\%) met all 4 JAMA benchmarks, indicating the high quality of the WBHI, while the remainder of the WBHI failed to meet one or more of the JAMA benchmarks. HON scores showed that one-third of WBHI sources had scores above 75\%, indicating higher reliability and credibility of the WBHI source, while one-fifth of the sources scored below 50\%. Only 1 in 7 WBHI resources scored simultaneously high on all three quality instruments. Generally, WBHI from academic affiliations had higher quality scores than content provided by commercial affiliations. Conclusions: There are considerable variations in the quality of WBHI on OLP in Arabic. Most WBHI resources were deemed to be of moderate quality at best. Providers of WBHI could benefit from increasing collaboration between commercial and academic institutions in creating WBHI and integrating guidance from international quality assessment tools to improve the quality and, hopefully, the utility of these valuable WBHI resources. ", doi="10.2196/49198", url="https://formative.jmir.org/2024/1/e49198", url="http://www.ncbi.nlm.nih.gov/pubmed/38502161" } @Article{info:doi/10.2196/52150, author="Holl, Felix and Kircher, Jennifer and Hertelendy, J. Attila and Sukums, Felix and Swoboda, Walter", title="Tanzania's and Germany's Digital Health Strategies and Their Consistency With the World Health Organization's Global Strategy on Digital Health 2020-2025: Comparative Policy Analysis", journal="J Med Internet Res", year="2024", month="Mar", day="18", volume="26", pages="e52150", keywords="digital health strategies", keywords="comparative policy analysis", keywords="DHS", keywords="eHealth", keywords="digital health", keywords="strategy", keywords="strategies", keywords="policy", keywords="policies", keywords="document analysis", keywords="document analyses", keywords="GSDH", keywords="Germany", keywords="Europe", keywords="Africa", keywords="Tanzania", abstract="Background: In recent years, the fast-paced adoption of digital health (DH) technologies has transformed health care delivery. However, this rapid evolution has also led to challenges such as uncoordinated development and information silos, impeding effective health care integration. Recognizing these challenges, nations have developed digital health strategies (DHSs), aligning with their national health priorities and guidance from global frameworks. The World Health Organization (WHO)'s Global Strategy on Digital Health 2020-2025 (GSDH) guides national DHSs. Objective: This study analyzes the DHSs of Tanzania and Germany as case studies and assesses their alignment with the GSDH and identifies strengths, shortcomings, and areas for improvement. Methods: A comparative policy analysis was conducted, focusing on the DHSs of Tanzania and Germany as case studies, selected for their contrasting health care systems and cooperative history. The analysis involved a three-step process: (1) assessing consistency with the GSDH, (2) comparing similarities and differences, and (3) evaluating the incorporation of emergent technologies. Primary data sources included national eHealth policy documents and related legislation. Results: Both Germany's and Tanzania's DHSs align significantly with the WHO's GSDH, incorporating most of its 35 elements, but each missing 5 distinct elements. Specifically, Tanzania's DHS lacks in areas such as knowledge management and capacity building for leaders, while Germany's strategy falls short in engaging health care service providers and beneficiaries in development phases and promoting health equity. Both countries, however, excel in other aspects like collaboration, knowledge transfer, and advancing national DHSs, reflecting their commitment to enhancing DH infrastructures. The high ratings of both countries on the Global Digital Health Monitor underscore their substantial progress in DH, although challenges persist in adopting the rapidly advancing technologies and in the need for more inclusive and comprehensive strategies. Conclusions: This study reveals that both Tanzania and Germany have made significant strides in aligning their DHSs with the WHO's GSDH. However, the rapid evolution of technologies like artificial intelligence and machine learning presents challenges in keeping strategies up-to-date. This study recommends the development of more comprehensive, inclusive strategies and regular revisions to align with emerging technologies and needs. The research underscores the importance of context-specific adaptations in DHSs and highlights the need for broader, strategic guidelines to direct the future development of the DH ecosystem. The WHO's GSDH serves as a crucial blueprint for national DHSs. This comparative analysis demonstrates the value and challenges of aligning national strategies with global guidelines. Both Tanzania and Germany offer valuable insights into developing and implementing effective DHSs, highlighting the importance of continuous adaptation and context-specific considerations. Future policy assessments require in-depth knowledge of the country's health care needs and structure, supplemented by stakeholder input for a comprehensive evaluation. ", doi="10.2196/52150", url="https://www.jmir.org/2024/1/e52150", url="http://www.ncbi.nlm.nih.gov/pubmed/38498021" } @Article{info:doi/10.2196/49173, author="Guilcher, T. Sara J. and Cimino, R. Stephanie and Tadrous, Mina and McCarthy, M. Lisa and Riad, Jessica and Tricco, C. Andrea and Hagens, Simon and Lien, Jennifer and Tharmalingam, Sukirtha and Gomes, Tara", title="Experiences and Outcomes of Using e-Prescribing for Opioids: Rapid Scoping Review", journal="J Med Internet Res", year="2023", month="Dec", day="28", volume="25", pages="e49173", keywords="e-prescribing", keywords="opioid prescription", keywords="opioid use", keywords="rapid scoping review", abstract="Background: e-Prescribing is designed to assist in facilitating safe and appropriate prescriptions for patients. Currently, it is unknown to what extent e-prescribing for opioids influences experiences and outcomes. To address this gap, a rapid scoping review was conducted. Objective: This rapid scoping review aims to (1) explore how e-prescribing has been used clinically; (2) examine the effects of e-prescribing on clinical outcomes, the patient or clinician experience, service delivery, and policy; and (3) identify current gaps in the present literature to inform future studies and recommendations. Methods: A rapid scoping review was conducted following the guidance of the JBI 2020 scoping review methodology and the World Health Organization guide to rapid reviews. A comprehensive literature search was completed by an expert librarian from inception until November 16, 2022. Three databases were electronically searched: MEDLINE (Ovid), Embase (Ovid), and Scopus (Elsevier). The search criteria were as follows: (1) e-prescribing programs targeted to the use or misuse of opioids, including those that were complemented or accompanied by clinically focused initiatives, and (2) a primary research study of experimental, quasi-experimental, observational, qualitative, or mixed methods design. An additional criterion of an ambulatory component of e-prescribing (eg, e-prescribing occurred upon discharge from acute care) was added at the full-text stage. No language limitations or filters were applied. All articles were double screened by trained reviewers. Gray literature was manually searched by a single reviewer. Data were synthesized using a descriptive approach. Results: Upon completing screening, 34 articles met the inclusion criteria: 32 (94\%) peer-reviewed studies and 2 (6\%) gray literature documents (1 thesis study and 1 report). All 33 studies had a quantitative component, with most highlighting e-prescribing from acute care settings to community settings (n=12, 36\%). Only 1 (3\%) of the 34 articles provided evidence on e-prescribing in a primary care setting. Minimal prescriber, pharmacist, and clinical population characteristics were reported. The main outcomes identified were related to opioid prescribing rates, alerts (eg, adverse drug events and drug-drug interactions), the quantity and duration of opioid prescriptions, the adoption of e-prescribing technology, attitudes toward e-prescribing, and potential challenges with the implementation of e-prescribing into clinical practice. e-Prescribing, including key features such as alerts and dose order sets, may reduce prescribing errors. Conclusions: This rapid scoping review highlights initial promising results with e-prescribing and opioid therapy management. It is important that future work explores the experience of prescribers, pharmacists, and patients using e-prescribing for opioid therapy management with an emphasis on prescribers in the community and primary care. Developing a common set of quality indicators for e-prescribing of opioids will help build a stronger evidence base. Understanding implementation considerations will be of importance as the technology is integrated into clinical practice and health systems. ", doi="10.2196/49173", url="https://www.jmir.org/2023/1/e49173", url="http://www.ncbi.nlm.nih.gov/pubmed/38153776" } @Article{info:doi/10.2196/45197, author="Shah, Ali Hurmat and Househ, Mowafa", title="Understanding Loneliness in Younger People: Review of the Opportunities and Challenges for Loneliness Interventions", journal="Interact J Med Res", year="2023", month="Nov", day="2", volume="12", pages="e45197", keywords="health informatics", keywords="loneliness informatics", keywords="loneliness theory", keywords="health effects", keywords="loneliness interventions", keywords="information and communication technology", keywords="ICT-based interventions", keywords="social-media--based interventions", keywords="social media", keywords="ICT", keywords="lonely", keywords="loneliness", keywords="social isolation", keywords="mental health", keywords="psychological", doi="10.2196/45197", url="https://www.i-jmr.org/2023/1/e45197", url="http://www.ncbi.nlm.nih.gov/pubmed/37917125" } @Article{info:doi/10.2196/47550, author="Hunsbedt Fjells{\aa}, Marie Hilde and Huseb{\o}, Lunde Anne Marie and Braut, Harald and Mikkelsen, Aslaug and Storm, Marianne", title="Older Adults' Experiences With Participation and eHealth in Care Coordination: Qualitative Interview Study in a Primary Care Setting", journal="J Particip Med", year="2023", month="Oct", day="2", volume="15", pages="e47550", keywords="care coordination", keywords="older adults", keywords="participation", keywords="eHealth", keywords="primary health care", abstract="Background: Owing to the demographic changes in the elderly population worldwide, delivering coordinated care at home to multimorbid older adults is of great importance. Older adults living with multiple chronic conditions need information to manage and coordinate their care. eHealth can be effective for gaining sufficient information, communicating, and self-managing chronic conditions. However, incorporating older adults' health preferences and ensuring active involvement remain challenging. More knowledge is needed to ensure successful participation and eHealth use in care coordination. Objective: This study aimed to explore multimorbid older adults' experiences with participation and eHealth in care coordination with general practitioners (GPs) and district nurses (DNs). Methods: The study had a qualitative explorative approach. Data collection included semistructured interviews with 20 older adults with multimorbidity receiving primary care services from their GPs and DNs. The participants were included by their GPs or nurses at a local intermunicipal acute inpatient care unit. The data analysis was guided by systematic text condensation. Results: We identified 2 categories: (1) older adults in charge of and using eHealth in care coordination, and (2) older adults with a loss of control in care coordination. The first category describes how communication with GPs and DNs can facilitate participation, the importance of managing own medication, and how eHealth can support older adults' information needs. The second category focuses on older adults who depend on guidance and help from their GPs and DNs to manage their health, describing how a lack of capacity and system support to be involved makes these adults lose control of their care coordination. Conclusions: Being in charge of care coordination is important for older multimorbid adults. The results show that older adults are willing to use eHealth to be informed and to seek information, which ensures high levels of participation in care coordination. Future research should investigate how older adults can be involved in electronic information sharing with health care providers. ", doi="10.2196/47550", url="https://jopm.jmir.org/2023/1/e47550", url="http://www.ncbi.nlm.nih.gov/pubmed/37782538" } @Article{info:doi/10.2196/42474, author="Bakema, Robbert and Smirnova, Daria and Biri, Despina and Kocks, H. Janwillem W. and Postma, J. Maarten and de Jong, A. Lisa", title="The Use of eHealth for Pharmacotherapy Management With Patients With Respiratory Disease, Cardiovascular Disease, or Diabetes: Scoping Review", journal="J Med Internet Res", year="2023", month="Sep", day="26", volume="25", pages="e42474", keywords="telemedicine", keywords="polypharmacy", keywords="pharmacotherapy", keywords="diabetes mellitus", keywords="cardiovascular diseases", keywords="asthma", keywords="pulmonary disease, chronic obstructive", keywords="interventions e-health", abstract="Background: eHealth is increasingly considered an important tool for supporting pharmacotherapy management. Objective: We aimed to assess the (1) use of eHealth in pharmacotherapy management with patients with asthma or chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD); (2) effectiveness of these interventions on pharmacotherapy management and clinical outcomes; and (3) key factors contributing to the success of eHealth interventions for pharmacotherapy management. Methods: We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review) statement. Databases searched included Embase, MEDLINE (PubMed), and Cochrane Library. Screening was conducted by 2 independent researchers. Eligible articles were randomized controlled trials and cohort studies assessing the effect of an eHealth intervention for pharmacotherapy management compared with usual care on pharmacotherapy management or clinical outcomes in patients with asthma or COPD, CVD, or diabetes. The interventions were categorized by the type of device, pharmacotherapy management, mode of delivery, features, and domains described in the conceptual model for eHealth by Shaw at al (Health in our Hands, Interacting for Health, Data Enabling Health). The effectiveness on pharmacotherapy management outcomes and patient- and clinician-reported clinical outcomes was analyzed per type of intervention categorized by number of domains and features to identify trends. Results: Of 63 studies, 16 (25\%), 31 (49\%), 13 (21\%), and 3 (5\%) included patients with asthma or COPD, CVD, diabetes, or CVD and diabetes, respectively. Most (38/63, 60\%) interventions targeted improving medication adherence, often combined for treatment plan optimization. Of the 16 asthma or COPD interventions, 6 aimed to improve inhaled medication use. The majority (48/63, 76\%) of the studies provided an option for patient feedback. Most (20/63, 32\%) eHealth interventions combined all 3 domains by Shaw et al, while 25\% (16/63) combined Interacting for Health with Data Enabling Health. Two-thirds (42/63, 67\%) of the studies showed a positive overall effect. Respectively, 48\% (23/48), 57\% (28/49), and 39\% (12/31) reported a positive effect on pharmacotherapy management and clinician- and patient-reported clinical outcomes. Pharmacotherapy management and patient-reported clinical outcomes, but not clinician-reported clinical outcomes, were more often positive in interventions with ?3 features. There was a trend toward more studies reporting a positive effect on all 3 outcomes with more domains by Shaw et al. Of the studies with interventions providing patient feedback, more showed a positive clinical outcome, compared with studies with interventions without feedback. This effect was not seen for pharmacotherapy management outcomes. Conclusions: There is a wide variety of eHealth interventions combining various domains and features to target pharmacotherapy management in asthma or COPD, CVD, and diabetes. Results suggest feedback is key for a positive effect on clinician-reported clinical outcomes. eHealth interventions become more impactful when combining domains. ", doi="10.2196/42474", url="https://www.jmir.org/2023/1/e42474", url="http://www.ncbi.nlm.nih.gov/pubmed/37751232" } @Article{info:doi/10.2196/49968, author="Zhang, Yanting and Rumgay, Harriet and Li, Mengmeng and Cao, Sumei and Chen, Wanqing", title="Nasopharyngeal Cancer Incidence and Mortality in 185 Countries in 2020 and the Projected Burden in 2040: Population-Based Global Epidemiological Profiling", journal="JMIR Public Health Surveill", year="2023", month="Sep", day="20", volume="9", pages="e49968", keywords="nasopharyngeal cancer", keywords="incidence", keywords="mortality", keywords="epidemiology", keywords="worldwide", abstract="Background: Nasopharyngeal cancer (NPC) is one of the most common head and neck cancers. Objective: This study describes the global epidemiological profiles of NPC incidence and mortality in 185 countries in 2020 and the projected burden in 2040. Methods: The estimated numbers of NPC cases and deaths were retrieved from the GLOBOCAN 2020 data set. Age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) were calculated using the world standard. The future number of NPC cases and deaths by 2040 were estimated based on global demographic projections. Results: Globally, approximately 133,354 cases and 80,008 deaths from NPC were estimated in 2020 corresponding to ASIRs and ASMRs of 1.5 and 0.9 per 100,000 person-years, respectively. The largest numbers of both global cases and deaths from NPC occurred in Eastern Asia (65,866/133,354, 49.39\% and 36,453/80,008, 45.56\%, respectively), in which China contributed most to this burden (62,444/133,354, 46.82\% and 34,810/80,008, 43.50\%, respectively). The ASIRs and ASMRs in men were approximately 3-fold higher than those in women. Incidence rates varied across world regions, with the highest ASIRs for both men and women detected in South-Eastern Asia (7.7 and 2.5 per 100,000 person-years, respectively) and Eastern Asia (3.9 and 1.5 per 100,000 person-years, respectively). The highest ASMRs for both men and women were found in South-Eastern Asia (5.4 and 1.5 per 100,000 person-years, respectively). By 2040, the annual number of cases and deaths will increase to 179,476 (46,122/133,354, a 34.58\% increase from the year 2020) and 113,851 (33,843/80,008, a 42.29\% increase), respectively. Conclusions: Disparities in NPC incidence and mortality persist worldwide. Our study highlights the urgent need to develop and accelerate NPC control initiatives to tackle the NPC burden in certain regions and countries (eg, South-Eastern Asia, China). ", doi="10.2196/49968", url="https://publichealth.jmir.org/2023/1/e49968", url="http://www.ncbi.nlm.nih.gov/pubmed/37728964" } @Article{info:doi/10.2196/25959, author="Xie, Zhenzhen and Chen, Jiayin and Or, Kalun Calvin", title="Consumers' Willingness to Pay for eHealth and Its Influencing Factors: Systematic Review and Meta-analysis", journal="J Med Internet Res", year="2022", month="Sep", day="14", volume="24", number="9", pages="e25959", keywords="systematic review", keywords="meta-analysis", keywords="willingness to pay", keywords="eHealth", keywords="contingent valuation", keywords="discrete choice experiment", keywords="mobile phone", abstract="Background: Despite the great potential of eHealth, substantial costs are involved in its implementation, and it is essential to know whether these costs can be justified by its benefits. Such needs have led to an increased interest in measuring the benefits of eHealth, especially using the willingness to pay (WTP) metric as an accurate proxy for consumers' perceived benefits of eHealth. This offered us an opportunity to systematically review and synthesize evidence from the literature to better understand WTP for eHealth and its influencing factors. Objective: This study aimed to provide a systematic review of WTP for eHealth and its influencing factors. Methods: This study was performed and reported as per the Cochrane Collaboration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, CINAHL Plus, Cochrane Library, EconLit, and PsycINFO databases were searched from their inception to April 19, 2022. We conducted random-effects meta-analyses to calculate WTP values for eHealth (at 2021 US dollar rates) and meta-regression analyses to examine the factors affecting WTP. Results: A total of 30 articles representing 35 studies were included in the review. We found that WTP for eHealth varied across studies; when expressed as a 1-time payment, it ranged from US \$0.88 to US \$191.84, and when expressed as a monthly payment, it ranged from US \$5.25 to US \$45.64. Meta-regression analyses showed that WTP for eHealth was negatively associated with the percentages of women ($\beta$=?.76; P<.001) and positively associated with the percentages of college-educated respondents ($\beta$=.63; P<.001) and a country's gross domestic product per capita (multiples of US \$1000; $\beta$=.03; P<.001). Compared with eHealth provided through websites, people reported a lower WTP for eHealth provided through asynchronous communication ($\beta$=?1.43; P<.001) and a higher WTP for eHealth provided through medical devices ($\beta$=.66; P<.001), health apps ($\beta$=.25; P=.01), and synchronous communication ($\beta$=.58; P<.001). As for the methods used to measure WTP, single-bounded dichotomous choice ($\beta$=2.13; P<.001), double-bounded dichotomous choice ($\beta$=2.20; P<.001), and payment scale ($\beta$=1.11; P<.001) were shown to obtain higher WTP values than the open-ended format. Compared with ex ante evaluations, ex post evaluations were shown to obtain lower WTP values ($\beta$=?.37; P<.001). Conclusions: WTP for eHealth varied significantly depending on the study population, modality used to provide eHealth, and methods used to measure it. WTP for eHealth was lower among certain population segments, suggesting that these segments may be at a disadvantage in terms of accessing and benefiting from eHealth. We also identified the modalities of eHealth that were highly valued by consumers and offered suggestions for the design of eHealth interventions. In addition, we found that different methods of measuring WTP led to significantly different WTP estimates, highlighting the need to undertake further methodological explorations of approaches to elicit WTP values. ", doi="10.2196/25959", url="https://www.jmir.org/2022/9/e25959", url="http://www.ncbi.nlm.nih.gov/pubmed/36103227" } @Article{info:doi/10.2196/32396, author="Schnoor, Kyma and Versluis, Anke and Bakema, Robbert and van Luenen, Sanne and Kooij, J. Marcel and van den Heuvel, Maurik J. and Teichert, Martina and Honkoop, J. Persijn and van Boven, M. Job F. and Chavannes, H. Niels and Aardoom, J. Jiska", title="A Pharmacy-Based eHealth Intervention Promoting Correct Use of Medication in Patients With Asthma and COPD: Nonrandomized Pre-Post Study", journal="J Med Internet Res", year="2022", month="Jun", day="8", volume="24", number="6", pages="e32396", keywords="asthma", keywords="COPD", keywords="medication adherence", keywords="exacerbations", keywords="pharmacy", keywords="eHealth", abstract="Background: Asthma and chronic obstructive pulmonary disease (COPD) affect millions of people worldwide. While medication can control and improve disease symptoms, incorrect use of medication is a common problem. The eHealth intervention SARA (Service Apothecary Respiratory Advice) aims to improve participants' correct use of inhalation medication by providing information and as-needed tailored follow-up support by a pharmacist. Objective: The primary aim of this study was to investigate the effect of SARA on exacerbation rates in participants with asthma and COPD. Secondary aims were to investigate its effects in terms of adherence to maintenance medication and antimycotic treatment. Methods: In this nonrandomized pre-post study, medication dispensing data from 382 Dutch community pharmacies were included. Exacerbation rates were assessed with dispensed short-course oral corticosteroids. Medication adherence between new and chronic users was assessed by calculating the proportion of days covered from dispensed inhalation maintenance medication. Antimycotic treatment was investigated from dispensed oral antimycotics in participants who were also dispensed inhaled corticosteroids (ICS). Outcomes were assessed 1 year before and 1 year after implementation of SARA and were compared between SARA participants and control participants. More specifically, for exacerbation rates and medication adherence, a difference score was calculated (ie, 1 year after SARA minus 1 year before SARA) and was subsequently compared between the study groups with independent-samples t tests. For antimycotics, the relative number of participants who were dispensed antimycotics was calculated and subsequently analyzed with a mixed-effects logistic regression. Results: The study population comprised 9452 participants, of whom 2400 (25.39\%) were SARA participants. The mean age of the population was 60.8 (15.0) years, and approximately two-thirds (n=5677, 60.06\%) were female. The results showed an increase in mean exacerbation rates over time for both study groups (SARA: 0.05; control: 0.15). However, this increase in exacerbation rates was significantly lower for SARA participants (t9450=3.10, 95\% CI 0.04-0.16; P=.002; Cohen d=0.06). Chronic users of inhalation medication in both study groups showed an increase in mean medication adherence over time (SARA: 6.73; control: 4.48); however, this increase was significantly higher for SARA participants (t5886=--2.74, 95\% CI --3.86 to --0.84; P=.01; Cohen d=--0.07). Among new users of inhalation medication, results showed no significant difference in medication adherence between SARA and control participants in the year after implementation of SARA (t1434=--1.85, 95\% CI --5.60 to 0.16; P=.06; Cohen d=--0.10). Among ICS users, no significant differences between the study groups were found over time in terms of the proportion of participants who were dispensed antimycotics (t5654=0.29, 95\% CI --0.40 to 0.54; P=.76; Cohen d=0). Conclusions: This study provides preliminary evidence that the SARA eHealth intervention might have the potential to decrease exacerbation rates and improve medication adherence among patients with asthma and COPD. ", doi="10.2196/32396", url="https://www.jmir.org/2022/6/e32396", url="http://www.ncbi.nlm.nih.gov/pubmed/35675120" } @Article{info:doi/10.2196/26015, author="Stewart, Elizabeth and Milton, Alyssa and Yee, Frances Hannah and Song, Jae Michael and Roberts, Anna and Davenport, Tracey and Hickie, Ian", title="eHealth Tools That Assess and Track Health and Well-being in Children and Young People: Systematic Review", journal="J Med Internet Res", year="2022", month="May", day="12", volume="24", number="5", pages="e26015", keywords="eHealth", keywords="children", keywords="young people", keywords="health", keywords="technology", keywords="mobile phone", abstract="Background: eHealth tools that assess and track health outcomes in children or young people are an emerging type of technology that has the potential to reform health service delivery and facilitate integrated, interdisciplinary care. Objective: The aim of this review is to summarize eHealth tools that have assessed and tracked health in children or young people to provide greater clarity around the populations and settings in which they have been used, characteristics of digital devices (eg, health domains, respondents, presence of tracking, and connection to care), primary outcomes, and risks and challenges of implementation. Methods: A search was conducted in PsycINFO, PubMed or MEDLINE, and Embase in April 2020. Studies were included if they evaluated a digital device whose primary purpose was to assess and track health, focused on children or young people (birth to the age of 24 years), reported original research, and were published in peer-reviewed journals in English. Results: A total of 39 papers were included in this review. The sample sizes ranged from 7 to 149,329 participants (median 163, mean 5155). More studies were conducted in urban (18/39, 46\%) regions than in rural (3/39, 8\%) regions or a combination of urban and rural areas (8/39, 21\%). Devices were implemented in three main settings: outpatient health clinics (12/39, 31\%), hospitals (14/39, 36\%), community outreach (10/39, 26\%), or a combination of these settings (3/39, 8\%). Mental and general health were the most common health domains assessed, with a single study assessing multiple health domains. Just under half of the devices tracked children's health over time (16/39, 41\%), and two-thirds (25/39, 64\%) connected children or young people to clinical care. It was more common for information to be collected from a single informant (ie, the child or young person, trained health worker, clinician, and parent or caregiver) than from multiple informants. The health of children or young people was assessed as a primary or secondary outcome in 36\% (14/39) of studies; however, only 3\% (1/39) of studies assessed whether using the digital tool improved the health of users. Most papers reported early phase research (formative or process evaluations), with fewer outcome evaluations and only 3 randomized controlled trials. Identified challenges or risks were related to accessibility, clinical utility and safety, uptake, data quality, user interface or design aspects of the device, language proficiency or literacy, sociocultural barriers, and privacy or confidentiality concerns; ways to address these barriers were not thoroughly explored. Conclusions: eHealth tools that assess and track health in children or young people have the potential to enhance health service delivery; however, a strong evidence base validating the clinical utility, efficacy, and safety of tools is lacking, and more thorough investigation is needed to address the risks and challenges of using these emerging technologies in clinical care. At present, there is greater potential for the tools to facilitate multi-informant, multidomain assessments and longitudinally track health over time and room for further implementation in rural or remote regions and community settings around the world. ", doi="10.2196/26015", url="https://www.jmir.org/2022/5/e26015", url="http://www.ncbi.nlm.nih.gov/pubmed/35550285" } @Article{info:doi/10.2196/32101, author="Guglani, Sheena and Liddy, Clare and Afkham, Amir and Mitchell, Rhea and Keely, Erin", title="The Ontario Electronic Consultation (eConsult) Service: Cross-sectional Analysis of Utilization Data for 2 Models", journal="JMIR Form Res", year="2022", month="Apr", day="22", volume="6", number="4", pages="e32101", keywords="eConsult", keywords="access to care", keywords="utilization", keywords="consultation", keywords="primary care provider", keywords="direct-to-specialist", keywords="Ontario", keywords="healthcare system", abstract="Background: The Ontario electronic consultation (eConsult) service allows a primary care provider (PCP) to access specialist advice through 2 models: the direct-to-specialist (DTS) model, where PCPs select a specialist from a directory, and the Building Access to Specialists Through eConsultation (BASE)--managed specialty service, where PCPs choose a specialty group and are assigned a specialist from a qualified pool based on availability. Objective: The aim of this study is to examine patterns of use between the 2 models of eConsult delivery. Methods: We conducted a cross-sectional analysis of utilization data collected from eConsults completed between October 2018 and September 2019. Cases were grouped based on the model used for submission (ie, BASE or DTS). Each model was assessed for the number of cases over time, specialty distribution, proportion resulting in new or additional information, impact on PCPs' decisions to refer, and billing time. Results: PCPs submitted 26,121 eConsults during the study period. The monthly case volume increased by 43\% over the duration of the study, primarily in the BASE model (66\% compared to 6\% for DTS). PCPs were able to confirm a course of action that they originally had in mind in 41.4\% (6373/15,376) of BASE cases and 41.3\% (3363/8136) of DTS cases and received advice for a new or additional course of action in 54.7\% (8418/15,376) of BASE cases and 56.3\% (4582/8136) of DTS cases. A referral was originally contemplated but avoided in 51.3\% (7887/15,376) of BASE cases and 53.3\% (4336/8136) of DTS cases, originally contemplated and still needed in 19.4\% (2986/15,376) of BASE cases and 17.7\% (1438/8136) of DTS cases, and neither originally contemplated nor needed in 21.7\% (3334/15,376) of BASE cases and 21.9\% (1781/8136) of DTS cases. Conclusions: Both eConsult models had strong uptake. Use patterns varied between models, with the majority of growth occurring under BASE, but survey responses showed that both models provided similar outcomes in terms of new information offered and impact on decision to refer. ", doi="10.2196/32101", url="https://formative.jmir.org/2022/4/e32101", url="http://www.ncbi.nlm.nih.gov/pubmed/35451985" } @Article{info:doi/10.2196/29385, author="Alexander, George and Bahja, Mohammed and Butt, Farook Gibran", title="Automating Large-scale Health Care Service Feedback Analysis: Sentiment Analysis and Topic Modeling Study", journal="JMIR Med Inform", year="2022", month="Apr", day="11", volume="10", number="4", pages="e29385", keywords="natural language processing", keywords="topic modeling", keywords="National Health Service", keywords="latent Dirichlet allocation", keywords="reviews", keywords="patient feedback", keywords="automated solutions", keywords="large-scale health service", keywords="free-text", keywords="unstructured data", abstract="Background: Obtaining patient feedback is an essential mechanism for health care service providers to assess their quality and effectiveness. Unlike assessments of clinical outcomes, feedback from patients offers insights into their lived experiences. The Department of Health and Social Care in England via National Health Service Digital operates a patient feedback web service through which patients can leave feedback of their experiences in structured and free-text report forms. Free-text feedback, compared with structured questionnaires, may be less biased by the feedback collector and, thus, more representative; however, it is harder to analyze in large quantities and challenging to derive meaningful, quantitative outcomes. Objective: The aim of this study is to build a novel data analysis and interactive visualization pipeline accessible through an interactive web application to facilitate the interrogation of and provide unique insights into National Health Service patient feedback. Methods: This study details the development of a text analysis tool that uses contemporary natural language processing and machine learning models to analyze free-text clinical service reviews to develop a robust classification model and interactive visualization web application. The methodology is based on the design science research paradigm and was conducted in three iterations: a sentiment analysis of the patient feedback corpus in the first iteration, topic modeling (unigram and bigram)--based analysis for topic identification in the second iteration, and nested topic modeling in the third iteration that combines sentiment analysis and topic modeling methods. An interactive data visualization web application for use by the general public was then created, presenting the data on a geographic representation of the country, making it easily accessible. Results: Of the 11,103 possible clinical services that could be reviewed across England, 2030 (18.28\%) different services received a combined total of 51,845 reviews between October 1, 2017, and September 30, 2019. Dominant topics were identified for the entire corpus followed by negative- and positive-sentiment topics in turn. Reviews containing high- and low-sentiment topics occurred more frequently than reviews containing less polarized topics. Time-series analysis identified trends in topic and sentiment occurrence frequency across the study period. Conclusions: Using contemporary natural language processing techniques, unstructured text data were effectively characterized for further analysis and visualization. An efficient pipeline was successfully combined with a web application, making automated analysis and dissemination of large volumes of information accessible. This study represents a significant step in efforts to generate and visualize useful, actionable, and unique information from free-text patient reviews. ", doi="10.2196/29385", url="https://medinform.jmir.org/2022/4/e29385", url="http://www.ncbi.nlm.nih.gov/pubmed/35404254" } @Article{info:doi/10.2196/33787, author="Smits, Merlijn and Kim, Mi Chan and van Goor, Harry and Ludden, S. Geke D.", title="From Digital Health to Digital Well-being: Systematic Scoping Review", journal="J Med Internet Res", year="2022", month="Apr", day="4", volume="24", number="4", pages="e33787", keywords="well-being", keywords="design", keywords="evaluation", keywords="technology assessment", keywords="digital health", keywords="eHealth", keywords="mHealth", keywords="telehealth", keywords="mobile phone", abstract="Background: Digital health refers to the proper use of technology for improving the health and well-being of people and enhancing the care of patients through the intelligent processing of clinical and genetic data. Despite increasing interest in well-being in both health care and technology, there is no clear understanding of what constitutes well-being, which leads to uncertainty in how to create well-being through digital health. In an effort to clarify this uncertainty, Brey developed a framework to define problems in technology for well-being using the following four categories: epistemological problem, scope problem, specification problem, and aggregation problem. Objective: This systematic scoping review aims to gain insights into how to define and address well-being in digital health. Methods: We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Papers were identified from 6 databases and included if they addressed the design or evaluation of digital health and reported the enhancement of patient well-being as their purpose. These papers were divided into design and evaluation papers. We studied how the 4 problems in technology for well-being are considered per paper. Results: A total of 117 studies were eligible for analysis (n=46, 39.3\% design papers and n=71, 60.7\% evaluation papers). For the epistemological problem, the thematic analysis resulted in various definitions of well-being, which were grouped into the following seven values: healthy body, functional me, healthy mind, happy me, social me, self-managing me, and external conditions. Design papers mostly considered well-being as healthy body and self-managing me, whereas evaluation papers considered the values of healthy mind and happy me. Users were rarely involved in defining well-being. For the scope problem, patients with chronic care needs were commonly considered as the main users. Design papers also regularly involved other users, such as caregivers and relatives. These users were often not involved in evaluation papers. For the specification problem, most design and evaluation papers focused on the provision of care support through a digital platform. Design papers used numerous design methods, whereas evaluation papers mostly considered pre-post measurements and randomized controlled trials. For the aggregation problem, value conflicts were rarely described. Conclusions: Current practice has found pragmatic ways of circumventing or dealing with the problems of digital health for well-being. Major differences exist between the design and evaluation of digital health, particularly regarding their conceptualization of well-being and the types of users studied. In addition, we found that current methodologies for designing and evaluating digital health can be improved. For optimal digital health for well-being, multidisciplinary collaborations that move beyond the common dichotomy of design and evaluation are needed. ", doi="10.2196/33787", url="https://www.jmir.org/2022/4/e33787", url="http://www.ncbi.nlm.nih.gov/pubmed/35377328" } @Article{info:doi/10.2196/36910, author="Gupta, Megha and Malik, Tanya and Sinha, Chaitali", title="Delivery of a Mental Health Intervention for Chronic Pain Through an Artificial Intelligence--Enabled App (Wysa): Protocol for a Prospective Pilot Study", journal="JMIR Res Protoc", year="2022", month="Mar", day="31", volume="11", number="3", pages="e36910", keywords="chronic pain", keywords="AI-enabled mental health assistant", keywords="digital health intervention", keywords="mental health conversational agent", keywords="artificial intelligence", keywords="depression", keywords="mental health", keywords="anxiety", keywords="health care cost", keywords="conversational agent", keywords="chatbot", keywords="digital health", abstract="Background: Patients with chronic pain often experience coexisting, long-term and debilitating mental health comorbidities such as depression and anxiety. Artificial intelligence--supported cognitive behavioral therapy (AI-CBT) interventions could offer cost-effective, accessible, and potentially effective resources to address this problem. However, there is not enough research conducted about the efficacy of AI-CBT interventions for chronic pain. Objective: This prospective cohort study aims to examine the efficacy and use of an AI-CBT intervention for chronic pain (Wysa for Chronic Pain app, Wysa Inc) using a conversational agent (with no human intervention). To the best of our knowledge, this is the first such study for chronic pain using a fully-automated, free-text--based conversational agent. Methods: Participants with self-reported chronic pain (n=500) will be recruited online on a rolling basis from April 2022 through posts on US-based internet communities within this prospective cohort. Informed consent is received from participants within the app, and the Wysa for Chronic Pain intervention is delivered remotely for 8 weeks. Outcome measures including a numeric pain rating scale and Patient-Reported Outcomes Measurement Information System--Pain Interference, Generalized Anxiety Disorder--7, and Patient Health Questionnaire--9 questionnaires administered to test the effectiveness of the intervention on reducing levels of pain interference, depression, and anxiety. The therapeutic alliance created with the conversational agent will be assessed through the Working Alliance Inventory--Short Revised instrument. Retention and use statistics will be observed for adherence and engagement. Results: The study will open for recruitment in April 2022, and data collection is expected to be completed by August 2022. The results for the primary outcomes are expected to be published by late 2022. Conclusions: Mental health conversational agents driven by artificial intelligence could be effective in helping patients with chronic pain learn to self-manage their pain and common comorbidities like depression and anxiety. The Wysa for Chronic Pain app is one such digital intervention that can potentially serve as a solution to the problems of affordability and scalability associated with interventions that include a human therapist. This prospective study examines the efficacy of the app as a treatment solution for chronic pain. It aims to inform future practices and digital mental health interventions for individuals with chronic pain. International Registered Report Identifier (IRRID): PRR1-10.2196/36910 ", doi="10.2196/36910", url="https://www.researchprotocols.org/2022/3/e36910", url="http://www.ncbi.nlm.nih.gov/pubmed/35314423" } @Article{info:doi/10.2196/26450, author="Lang, Michael and Lemieux, S{\'e}bastien and H{\'e}bert, Jos{\'e}e and Sauvageau, Guy and Zawati, H. Ma'n", title="Legal and Ethical Considerations for the Design and Use of Web Portals for Researchers, Clinicians, and Patients: Scoping Literature Review", journal="J Med Internet Res", year="2021", month="Nov", day="11", volume="23", number="11", pages="e26450", keywords="medical ethics", keywords="web portal", keywords="scoping review", keywords="eHealth", keywords="portal", abstract="Background: This study aims to identify a novel potential use for web portals in health care and health research: their adoption for the purposes of rapidly sharing health research findings with clinicians, scientists, and patients. In the era of precision medicine and learning health systems, the translation of research findings into targeted therapies depends on the availability of big data and emerging research results. Web portals may work to promote the availability of novel research, working in tandem with traditional scientific publications and conference proceedings. Objective: This study aims to assess the potential use of web portals, which facilitate the sharing of health research findings among researchers, clinicians, patients, and the public. It also summarizes the potential legal, ethical, and policy implications associated with such tools for public use and in the management of patient care for complex diseases. Methods: This study broadly adopts the methods for scoping literature reviews outlined by Arskey and O'Malley in 2005. Raised by the integration of web portals into patient care for complex diseases, we systematically searched 3 databases, PubMed, Scopus, and WestLaw Next, for sources describing web portals for sharing health research findings among clinicians, researchers, and patients and their associated legal, ethical, and policy challenges. Of the 719 candidate source citations, 22 were retained for the review. Results: We found varied and inconsistent treatment of web portals for sharing health research findings among clinicians, researchers, and patients. Although the literature supports the view that portals of this kind are potentially highly promising, they remain novel and are not yet widely adopted. We also found a wide range of discussions on the legal, ethical, and policy issues related to the use of web portals to share research data. Conclusions: We identified 5 important legal and ethical challenges: privacy and confidentiality, patient health literacy, equity, training, and decision-making. We contend that each of these has meaningful implications for the increased integration of web portals into clinical care. ", doi="10.2196/26450", url="https://www.jmir.org/2021/11/e26450", url="http://www.ncbi.nlm.nih.gov/pubmed/34762055" } @Article{info:doi/10.2196/29136, author="Abd-Alrazaq, Alaa and Hassan, Asmaa and Abuelezz, Israa and Ahmed, Arfan and Alzubaidi, Saleh Mahmood and Shah, Uzair and Alhuwail, Dari and Giannicchi, Anna and Househ, Mowafa", title="Overview of Technologies Implemented During the First Wave of the COVID-19 Pandemic: Scoping Review", journal="J Med Internet Res", year="2021", month="Sep", day="14", volume="23", number="9", pages="e29136", keywords="technologies", keywords="digital tools", keywords="COVID-19", keywords="novel coronavirus", keywords="scoping review", keywords="digital health", keywords="telemedicine", abstract="Background: Technologies have been extensively implemented to provide health care services for all types of clinical conditions during the COVID-19 pandemic. While several reviews have been conducted regarding technologies used during the COVID-19 pandemic, they were limited by focusing either on a specific technology (or features) or proposed rather than implemented technologies. Objective: This review aims to provide an overview of technologies, as reported in the literature, implemented during the first wave of the COVID-19 pandemic. Methods: We conducted a scoping review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. Studies were retrieved by searching 8 electronic databases, checking the reference lists of included studies and relevant reviews (backward reference list checking), and checking studies that cited included studies (forward reference list checking). The search terms were chosen based on the target intervention (ie, technologies) and the target disease (ie, COVID-19). We included English publications that focused on technologies or digital tools implemented during the COVID-19 pandemic to provide health-related services regardless of target health condition, user, or setting. Two reviewers independently assessed the eligibility of studies and extracted data from eligible papers. We used a narrative approach to synthesize extracted data. Results: Of 7374 retrieved papers, 126 were deemed eligible. Telemedicine was the most common type of technology (107/126, 84.9\%) implemented in the first wave of the COVID-19 pandemic, and the most common mode of telemedicine was synchronous (100/108, 92.6\%). The most common purpose of the technologies was providing consultation (75/126, 59.5\%), followed by following up with patients (45/126, 35.7\%), and monitoring their health status (22/126, 17.4\%). Zoom (22/126, 17.5\%) and WhatsApp (12/126, 9.5\%) were the most commonly used videoconferencing and social media platforms, respectively. Both health care professionals and health consumers were the most common target users (103/126, 81.7\%). The health condition most frequently targeted was COVID-19 (38/126, 30.2\%), followed by any physical health conditions (21/126, 16.7\%), and mental health conditions (13/126, 10.3\%). Technologies were web-based in 84.1\% of the studies (106/126). Technologies could be used through 11 modes, and the most common were mobile apps (86/126, 68.3\%), desktop apps (73/126, 57.9\%), telephone calls (49/126, 38.9\%), and websites (45/126, 35.7\%). Conclusions: Technologies played a crucial role in mitigating the challenges faced during the COVID-19 pandemic. We did not find papers describing the implementation of other technologies (eg, contact-tracing apps, drones, blockchain) during the first wave. Furthermore, technologies in this review were used for other purposes (eg, drugs and vaccines discovery, social distancing, and immunity passport). Future research on studies on these technologies and purposes is recommended, and further reviews are required to investigate technologies implemented in subsequent waves of the pandemic. ", doi="10.2196/29136", url="https://www.jmir.org/2021/9/e29136", url="http://www.ncbi.nlm.nih.gov/pubmed/34406962" } @Article{info:doi/10.2196/23649, author="Hayman, Melanie and Alfrey, Kristie-Lee and Cannon, Summer and Alley, Stephanie and Rebar, L. Amanda and Williams, Susan and Short, E. Camille and Altazan, Abby and Comardelle, Natalie and Currie, Sinead and Denton, Caitlin and Harrison, L. Cheryce and Lamerton, Tayla and Mena, P. Gabriela and Moran, Lisa and Mottola, Michelle and Nagpal, S. Taniya and Vincze, Lisa and Schoeppe, Stephanie", title="Quality, Features, and Presence of Behavior Change Techniques in Mobile Apps Designed to Improve Physical Activity in Pregnant Women: Systematic Search and Content Analysis", journal="JMIR Mhealth Uhealth", year="2021", month="Apr", day="7", volume="9", number="4", pages="e23649", keywords="pregnancy", keywords="exercise", keywords="physical activity", keywords="mobile health (mHealth)", keywords="applications", keywords="MARS", keywords="behavior change techniques", keywords="mobile phone", abstract="Background: Physical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity. Objective: The aim of this study was to conduct a systematic search and content analysis of app quality, features, and the presence of BCTs in apps designed to promote physical activity among pregnant women. Methods: A systematic search in the Australian App Store and Google Play store using search terms relating to exercise and pregnancy was performed. App quality and features were assessed using the 19-item Mobile App Rating Scale (MARS), and a taxonomy of BCTs was used to determine the presence of BCTs (26 items). BCTs previously demonstrating efficacy in behavior changes during pregnancy were also identified from a literature review. Spearman correlations were used to investigate the relationships between app quality, app features, and number of BCTs identified. Results: Nineteen exercise apps were deemed eligible for this review and they were accessed via Google Play (n=13) or App Store (n=6). The MARS overall quality scores indicated moderate app quality (mean 3.5 [SD 0.52]). Functionality was the highest scoring MARS domain (mean 4.2 [SD 0.5]), followed by aesthetics (mean 3.7 [SD 0.6]) and information quality (mean 3.16 [SD 0.42]). Subjective app quality (mean 2.54 [SD 0.64]) and likelihood for behavioral impact (mean 2.5 [SD 0.6]) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (mean 4.74, SD 2.51; range 2-10). However, only 11 apps included BCTs that previously demonstrated efficacy for behavior change during pregnancy, the most common being provide opportunities for social comparison (n=8) and prompt self-monitoring of behavior (n=7). There was a significant positive correlation between the number of BCTs with engagement and aesthetics scores, but the number of BCTs was not significantly correlated with functionality, information quality, total MARS quality, or subjective quality. Conclusions: Our findings showed that apps designed to promote physical activity among pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with limited prevalence of BCTs previously demonstrating efficacy in behavior change during pregnancy. Future app development should identify and adopt factors that enhance and encourage user engagement, including the use of BCTs, especially those that have demonstrated efficacy for promoting physical activity behavior change among pregnant women. ", doi="10.2196/23649", url="https://mhealth.jmir.org/2021/4/e23649", url="http://www.ncbi.nlm.nih.gov/pubmed/33825693" } @Article{info:doi/10.2196/17672, author="Tian, Jaminal Peter George and Harris, Richard Jeffrey and Seikaly, Hadi and Chambers, Thane and Alvarado, Sara and Eurich, Dean", title="Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan", journal="JMIR Form Res", year="2021", month="Feb", day="23", volume="5", number="2", pages="e17672", keywords="telephone consultations", keywords="teleconsultations", keywords="remote consultations", keywords="telemedicine", keywords="eHealth", keywords="environmental scan", abstract="Background: Telephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings. Objective: As part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries. Methods: We searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search. Results: The literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance. Conclusions: Telephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use.\emspace ", doi="10.2196/17672", url="https://formative.jmir.org/2021/2/e17672", url="http://www.ncbi.nlm.nih.gov/pubmed/33620325" } @Article{info:doi/10.2196/14738, author="Rezende, Castro Karina Bilda De and Cunha, Alves Antonio Jos{\'e} Ledo and Amim Jr, Joffre and Oliveira, Moraes Wescule De and Le{\~a}o, Belloti Maria Eduarda and Menezes, Alves Mariana Oliveira and Jardim, Andrade Ana Alice Marques Ferraz De and Bornia, Gu{\'e}rios Rita", title="Performance of Fetal Medicine Foundation Software for Pre-Eclampsia Prediction Upon Marker Customization: Cross-Sectional Study", journal="J Med Internet Res", year="2019", month="Nov", day="22", volume="21", number="11", pages="e14738", keywords="decision support techniques", keywords="mass screening", keywords="pre-eclampsia", keywords="ethnicity", keywords="algorithms", abstract="Background: FMF2012 is an algorithm developed by the Fetal Medicine Foundation (FMF) to predict pre-eclampsia on the basis of maternal characteristics combined with biophysical and biochemical markers. Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian setting. Objective: This study aimed to analyze the performance of pre-eclampsia prediction software by customization of maternal ethnicity. Methods: This was a cross-sectional observational study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers, and they were presented as the risk for early pre-eclampsia (PE34) and preterm pre-eclampsia (PE37). The following steps were followed: (1) identification of women characterized as black ethnicity; (2) calculation of early and preterm pre-eclampsia risk, reclassifying them as white, which generated a new score; (3) comparison of the proportions of women categorized as high risk between the original and new scores; (4) construction of the receiver operator characteristic curve; (5) calculation of the area under the curve, sensitivity, and false positive rate; and (6) comparison of the area under the curve, sensitivity, and false positive rate of the original with the new risk by chi-square test. Results: A total of 1531 cases were included in the final sample, with 219 out of 1531 cases (14.30; 95\% CI 12.5-16.0) and 182 out of 1531 cases (11.88\%; 95\% CI 10.3-13.5) classified as high risk for pre-eclampsia development, originally and after recalculating the new risk, respectively. The comparison of FMF2012 predictive model performance between the originally estimated risks and the estimated new risks showed that the difference was not significant for sensitivity and area under the curve, but it was significant for false positive rate. Conclusions: We conclude that black ethnicity classification of Brazilian pregnant women by the FMF2012 algorithm increases the false positive rate. Suppressing ethnicity effect did not improve the test sensitivity. By modifying demographic characteristics, it is possible to improve some performance aspects of clinical prediction tests. ", doi="10.2196/14738", url="http://www.jmir.org/2019/11/e14738/", url="http://www.ncbi.nlm.nih.gov/pubmed/31755874" } @Article{info:doi/10.2196/14464, author="Gardezi, Safdar Syed Jamal and Elazab, Ahmed and Lei, Baiying and Wang, Tianfu", title="Breast Cancer Detection and Diagnosis Using Mammographic Data: Systematic Review", journal="J Med Internet Res", year="2019", month="Jul", day="26", volume="21", number="7", pages="e14464", keywords="breast cancer", keywords="lesion classification", keywords="malignant tumor", keywords="machine learning", keywords="convolutional neural networks", keywords="deep learning", abstract="Background: Machine learning (ML) has become a vital part of medical imaging research. ML methods have evolved over the years from manual seeded inputs to automatic initializations. The advancements in the field of ML have led to more intelligent and self-reliant computer-aided diagnosis (CAD) systems, as the learning ability of ML methods has been constantly improving. More and more automated methods are emerging with deep feature learning and representations. Recent advancements of ML with deeper and extensive representation approaches, commonly known as deep learning (DL) approaches, have made a very significant impact on improving the diagnostics capabilities of the CAD systems. Objective: This review aimed to survey both traditional ML and DL literature with particular application for breast cancer diagnosis. The review also provided a brief insight into some well-known DL networks. Methods: In this paper, we present an overview of ML and DL techniques with particular application for breast cancer. Specifically, we search the PubMed, Google Scholar, MEDLINE, ScienceDirect, Springer, and Web of Science databases and retrieve the studies in DL for the past 5 years that have used multiview mammogram datasets. Results: The analysis of traditional ML reveals the limited usage of the methods, whereas the DL methods have great potential for implementation in clinical analysis and improve the diagnostic capability of existing CAD systems. Conclusions: From the literature, it can be found that heterogeneous breast densities make masses more challenging to detect and classify compared with calcifications. The traditional ML methods present confined approaches limited to either particular density type or datasets. Although the DL methods show promising improvements in breast cancer diagnosis, there are still issues of data scarcity and computational cost, which have been overcome to a significant extent by applying data augmentation and improved computational power of DL algorithms. ", doi="10.2196/14464", url="http://www.jmir.org/2019/7/e14464/", url="http://www.ncbi.nlm.nih.gov/pubmed/31350843" } @Article{info:doi/10.2196/11322, author="Hansen, Helen Anne and Broz, Jan and Claudi, Tor and {\AA}rsand, Eirik", title="Relations Between the Use of Electronic Health and the Use of General Practitioner and Somatic Specialist Visits in Patients With Type 1 Diabetes: Cross-Sectional Study", journal="J Med Internet Res", year="2018", month="Nov", day="07", volume="20", number="11", pages="e11322", keywords="eHealth", keywords="internet", keywords="health care utilization", keywords="general practitioners", keywords="specialist", keywords="cross-sectional study", keywords="diabetes mellitus, type 1", keywords="Norway", abstract="Background: The prevalence of diabetes and the use of electronic health (eHealth) are increasing. People with diabetes need frequent monitoring and follow-up of health parameters, and eHealth services can be of great value. However, little is known about the association between the use of eHealth and provider-based health care services among people with diabetes. Objective: The objective of this study was to investigate the use of 4 different eHealth platforms (apps, search engines, video services, and social media sites) and associations with the use of provider-based health care visits among people diagnosed with type 1 diabetes mellitus (T1DM). Methods: We used email survey data collected from 1250 members of the Norwegian Diabetes Association (aged 18 to 89 years) in 2018. Eligible for analyses were the 523 respondents with T1DM. Using descriptive statistics, we estimated the use of eHealth and the use of general practitioners (GPs) and somatic specialist outpatient services. By logistic regressions, we studied the associations between the use of these provider-based health services and the use of eHealth, adjusted for gender, age, education, and self-rated health. Results: Of the sample of 523 people with T1DM, 90.7\% (441/486) had visited a GP once or more, and 61.0\% (289/474) had visited specialist services during the previous year. Internet search engines (such as Google) were used for health purposes sometimes or often by 84.0\% (431/513), apps by 55.4\% (285/514), social media (such as Facebook) by 45.2\% (232/513), and video services (such as YouTube) by 23.3\% (118/506). Participants aged from 18 to 39 years used all forms of eHealth more than people aged 40 years and older, with the exception of social media. The use of search engines was positively associated with the use of somatic specialist services (odds ratio 2.43, 95\% CI 1.33-4.45). GP visits were not associated with any kind of eHealth use. Conclusions: eHealth services are now widely used for health support and health information by people with T1DM, primarily in the form of search engines but often in the form of apps and social media as well. We found a positive association between the use of search engines and specialist visits and that people with T1DM are frequent users of eHealth, GPs, and specialist services. We found no evidence that eHealth reduces the use of provider-based health care; these services seem to be additional rather than alternative. Future research should focus on how health care services can meet and adapt to the high prevalence of eHealth use. Our results also indicate that many patients with T1DM do not visit specialist clinics once a year as recommended. This raises questions about collaboration in health care services and needs to be followed up in future research. ", doi="10.2196/11322", url="http://www.jmir.org/2018/11/e11322/", url="http://www.ncbi.nlm.nih.gov/pubmed/30404766" } @Article{info:doi/10.2196/mhealth.4202, author="Eckhoff, Peter Randall and Kizakevich, Nicholas Paul and Bakalov, Vesselina and Zhang, Yuying and Bryant, Patrice Stephanie and Hobbs, Ann Maria", title="A Platform to Build Mobile Health Apps: The Personal Health Intervention Toolkit (PHIT)", journal="JMIR mHealth uHealth", year="2015", month="Jun", day="01", volume="3", number="2", pages="e46", keywords="intervention studies", keywords="mHealth", keywords="mobile apps", keywords="platform", keywords="software engineering", keywords="telemedicine", keywords="tool", keywords="toolkit", doi="10.2196/mhealth.4202", url="http://mhealth.jmir.org/2015/2/e46/", url="http://www.ncbi.nlm.nih.gov/pubmed/26033047" }