@Article{info:doi/10.2196/60766, author="Trinh, Simon and Skoll, Devin and Saxon, Ann Leslie", title="Health Care 2025: How Consumer-Facing Devices Change Health Management and Delivery", journal="J Med Internet Res", year="2025", month="Apr", day="23", volume="27", pages="e60766", keywords="decentralized", keywords="digital health", keywords="consumer", keywords="health care", keywords="COVID-19", keywords="wearables", keywords="medical devices", keywords="health management", keywords="mHealth", keywords="wearable", keywords="well-being", keywords="care delivery", doi="10.2196/60766", url="https://www.jmir.org/2025/1/e60766" } @Article{info:doi/10.2196/60681, author="Li, Huanhuan and Zhao, Yanjie and Li, Wei and Wang, Wenxia and Zhi, Shengze and Wu, Yifan and Zhong, Qiqing and Wang, Rui and Sun, Jiao", title="A WeChat-Based Decision Aid Intervention to Promote Informed Decision-Making for Family Members Regarding the Genetic Testing of Patients With Colorectal Cancer: Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Apr", day="21", volume="27", pages="e60681", keywords="decision aid", keywords="genetic testing", keywords="hereditary colorectal cancer", keywords="informed decision-making", keywords="RCT", keywords="WeChat based", abstract="Background: Identifying patients with inherited colorectal cancer (CRC) syndromes offers many potential benefits. However, individuals often experience decisional conflict regarding genetic testing for CRC, and the uptake rate remains low. Given the growing popularity of genetic testing and the increasing demands on genetic service providers, strategies are needed to promote informed decision-making, increase genetic testing uptake among at-risk individuals, and ensure the rational use of genetic service resources. Objective: This study aims to determine whether a decision aid (DA) tool could promote informed decision-making among family members regarding the genetic testing of a patient with CRC. Methods: A single-center, parallel-group, randomized controlled trial was conducted. We randomized 82 family members of patients with CRC, who were involved in major medical decision-making for the patient, to either a DA intervention or usual care. The primary outcome was informed decision-making, assessed through measures of knowledge, decisional conflict, decision self-efficacy, and preparation for decision-making. Secondary outcomes included patients' uptake of genetic counseling and testing, participants' CRC screening behavior, healthy lifestyle scores, anxiety and depression levels, quality of life, and satisfaction with the intervention. Data were collected at baseline (T0), after the intervention (T1), and 3 months after the baseline survey (T2). The DA intervention and outcome assessments at T1 and T2 were delivered via WeChat. The effects of the intervention were analyzed using generalized estimating equation models. Results: Statistically significant improvements were observed in knowledge (T1: $\beta$=2.049, P<.001; T2: $\beta$=3.317, P<.001), decisional conflict (T1: $\beta$=--11.660, P<.001; T2: $\beta$=--17.587, P<.001), and decision self-efficacy (T1: $\beta$=15.353, P<.001; T2: $\beta$=22.337, P<.001) in the DA group compared with the usual care group at both T1 and T2. Additionally, the DA group showed significantly greater improvement in processed and red meat intake ($\beta$=--1.494, P<.001) at T1 and in healthy lifestyle scores ($\beta$=1.073, P=.03) at T2. No differences were found between the groups for other outcomes. Conclusions: A DA tool may be a safe, effective, and resource-efficient approach to facilitate informed decision-making about genetic testing. However, the current DA tool requires optimization and further evaluation---for example, by leveraging more advanced technology than WeChat to develop a simpler and more intelligent DA system. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100048051; https://www.chictr.org.cn/showproj.html?proj=129054 ", doi="10.2196/60681", url="https://www.jmir.org/2025/1/e60681" } @Article{info:doi/10.2196/65674, author="Huaju, Tian and Rendie, Xie and Lu, Xiao and Mei, Li and Yue, Luo and Daiying, Zhang and Yanhua, Chen and Jianlan, Ren", title="The Effect of a Brief Video-Based Intervention to Improve AIDS Prevention in Older Men: Randomized Controlled Trial", journal="JMIR Public Health Surveill", year="2025", month="Apr", day="18", volume="11", pages="e65674", keywords="older men", keywords="AIDS prevention", keywords="video", keywords="video-based intervention", keywords="HIV", keywords="AIDS", abstract="Background: The AIDS epidemic among older people is becoming more serious. Evidence-based, acceptable, and effective preventive interventions are urgently needed. Video-based interventions have become an innovative way to change behaviors, and we have developed a brief video-based intervention named Sunset Without AIDS. Objective: In this study, we tested the effectiveness of a brief video-based intervention targeting older men's understanding of AIDS prevention. Methods: A randomized controlled trial was conducted from June 20 to July 3, 2023. In total, 100 older men were randomly divided into the intervention group (n=50) and the control group (n=50) using the envelope extraction method. The intervention group was shown the Sunset Without AIDS video; the control group viewed a standard AIDS education video. A questionnaire was used to measure the effect of Sunset Without AIDS after 2 interventions. AIDS-related high-risk behaviors were followed up 1 and 3 months after the intervention. The difference was statistically significant at P?.05. Results: After 2 interventions, the total awareness rates (\%) of AIDS-related knowledge in the intervention and control groups were 84\% (42/50) and 66\% (33/50), respectively (P=.04). The mean stigma attitude scores of the 2 groups were 2.53 (SD 0.45) and 2.58 (SD 0.49), respectively (P=.55), but there was a statistically significant difference in the first dimension (fear of infection) between the 2 groups (P<.001). The mean positive scores of attitudes of AIDS-related high-risk behaviors of the 2 groups were 83.33 (SD 21.56) and 75.67 (SD 26.77), respectively (P=.58). In addition, 82\% reported that they were satisfied with the educational content within the Sunset Without AIDS video. At 1- and 3-month follow-ups conducted after the intervention, participants in the 2 groups did not report AIDS-related high-risk behaviors. After watching the 2 videos, more people accepted and were satisfied with Sunset Without AIDS. Conclusions: Sunset Without AIDS could improve the ability of older men in China to follow best practices for AIDS prevention and provide a certain basis for the innovation of AIDS education in the older adult population. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2100045708; https://www.chictr.org.cn/showproj.html?proj=125478 ", doi="10.2196/65674", url="https://publichealth.jmir.org/2025/1/e65674" } @Article{info:doi/10.2196/66846, author="King, Akilah and Omoniyi, Tayo and Zasadzinski, Lindsay and Gaspard, Cynthia and Gorman, Denesha and Saunders, Milda", title="Interactive Computer-Adaptive Chronic Kidney Disease (I-C-CKD) Education for Hospitalized African American Patients: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Apr", day="17", volume="14", pages="e66846", keywords="chronic kidney disease", keywords="computerized adaptive education", keywords="end-stage kidney disease", keywords="end-stage renal disease", keywords="glomerular filtration rate", keywords="kidney failure", keywords="usual hospital care", keywords="inpatient", abstract="Background: End-stage kidney disease (ESKD) or kidney failure is a condition where the kidneys lose the ability to function. African American individuals are 4 times as likely to develop ESKD compared to White American individuals. In addition, African American patients are less likely to have an optimal dialysis start and to choose renal replacement therapy modalities that align with their goals and values. Our prior work shows that culturally tailored, in-person education improves patient outcomes. This is the foundation for our innovative intervention using an African American virtual patient educator as an option for hospitalized patients with chronic kidney disease (CKD). Objective: The Interactive Computer-Adaptive Chronic Kidney Disease (I-C-CKD) study will determine whether the computerized adaptive education and usual hospital care impact the health literacy of African American patients with kidney disease. It will also assess how patients' lifestyle and commitment to health goals are impacted by the method of health literacy education. Methods: We will screen, recruit, and enroll hospitalized patients who self-identify as African American and have advanced CKD based on their estimated glomerular filtration rate. Eligible patients who verbally consented will be randomly assigned into either the computerized adaptive education intervention group or the control group (usual hospital care). Patients in the intervention group will receive a culturally tailored, adaptive education module. To analyze pretest, posttest, and follow-up survey results on patient CKD knowledge, ESKD treatment options, and health goals, we will use a paired, 2-tailed t test with a Bonferroni adjustment for multiple comparisons. Results: Recruitment for the I-C-CKD study began on May 2, 2023. We are currently recruiting and have enrolled 96 patients who completed both pretest and posttest surveys as of December 2024. This includes 50 patients in the control group and 46 patients in the intervention group. Data analysis has not occurred. Conclusions: African American individuals often receive less patient education about self-care and treatment options for CKD. We hope this study provides a solution to increase hospitalized African American patients' knowledge of CKD and motivation for CKD self-care through computerized adaptive education, reduce disparities, and improve patient outcomes. Trial Registration: ClinicalTrials.gov NCT06364358; https://clinicaltrials.gov/study/NCT06364358 International Registered Report Identifier (IRRID): DERR1-10.2196/66846 ", doi="10.2196/66846", url="https://www.researchprotocols.org/2025/1/e66846" } @Article{info:doi/10.2196/67956, author="Dorsch, P. Michael and Flynn, J. Allen and Greer, M. Kaitlyn and Ganai, Sabah and Barnes, D. Geoffrey and Zikmund-Fisher, Brian", title="A Web-Based Tool to Perform a Values Clarification for Stroke Prevention in Patients With Atrial Fibrillation: Design and Preliminary Testing Study", journal="JMIR Cardio", year="2025", month="Apr", day="11", volume="9", pages="e67956", keywords="digital health", keywords="atrial fibrillation", keywords="stroke prevention", keywords="shared decision-making", keywords="values clarification", abstract="Background: Atrial fibrillation (AF) is associated with an increased risk of stroke. Oral anticoagulation (OAC) is used for stroke prevention in AF, but it also increases bleeding risk. Clinical guidelines do not definitively recommend for or against OAC for patients with borderline stroke risk. Decision-making may benefit from values clarification exercises to communicate risk trade-offs. Objective: This study aimed to evaluate if a visual with a values clarification alters the understanding of the trade-offs of anticoagulation in AF. Methods: Participants aged 45?64 years were recruited across the United States via an online survey. While answering the survey, they were asked to imagine they were newly diagnosed with AF with a CHA2DS2-VASc (congestive heart failure; hypertension; age ?75 years [doubled]; type 2 diabetes; previous stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65 to 75 years; and sex category) score of 1 for men and 2 for women. Eligibility criteria included no diagnosis of AF and no prior OAC use. Participants were randomized to one of three conditions: (1) standard text-based information only (n=255), (2) visual aids showing stroke-risk probabilities (n=218), or (3) visual aids plus a values clarification exercise (visual+VC; n=200). Participants were subrandomized within the 2 visual-based groups to view either a gauge display or an icon array representing stroke risk. All participants read a hypothetical scenario of being newly diagnosed with AF and hypertension. The primary outcome was decision confidence as measured by the SURE (Sure of Myself; Understand Information; Risk-Benefit Ratio; Encouragement) test. Secondary measures included participants' perceived stroke risk reduction, worry about stroke or bleeding, and likelihood to choose OAC. Results: A total of 673 participants completed the survey. The overall SURE test was 61.2\% (156/255) for the standard, 66.5\% (145/218) for the visual, and 67\% (134/200) for the visual+VC group (visual vs standard P=.23; visual+VC vs standard P=.20). Participants were less likely to choose OAC in the visual groups (standard: mean 58.3, SD 30; visual: mean 51.4, SD 32; visual+VC: 51.9, SD 28; P=.03). Participants felt the reduction in stroke risk from an OAC was less in the visual groups (standard: mean 63.8, SD 22; visual: mean 54.2, SD 28; visual+VC: mean 58.6, SD 25; P<.001). Visualization methods (gauge vs icon array) showed no significant differences in overall SURE test results. Participants were less likely to choose OAC and perceived a smaller stroke risk reduction with gauge than icon array (OAC choice: gauge 48.8, icon array 55.4; P=.03; stroke risk reduction: gauge 52.1, icon array 60.4; P=.001). Conclusions: Visual aids can modestly affect decision confidence and perceptions regarding the benefits of OAC but do not significantly alter decision certainty in a scenario where the guidelines do not recommend for or against OAC. Future work should determine the role of a gauge versus icon array visual for decision-making in stroke prevention in AF. ", doi="10.2196/67956", url="https://cardio.jmir.org/2025/1/e67956" } @Article{info:doi/10.2196/55248, author="Clapham, Eleanor and Picone, Dean and Carmichael, Samuel and Bonner, Carissa and Chapman, Niamh", title="Appropriateness of Web-Based Resources for Home Blood Pressure Measurement and Their Alignment With Guideline Recommendations, Readability, and End User Involvement: Environmental Scan of Web-Based Resources", journal="JMIR Infodemiology", year="2025", month="Apr", day="3", volume="5", pages="e55248", keywords="readability", keywords="online resources", keywords="blood pressure guidelines", keywords="end user", keywords="home blood pressure measurement", keywords="patient education", keywords="educational resource", keywords="self-education", keywords="hypertension", abstract="Background: High blood pressure (?140/90 mm Hg) is the most prominent mortality risk factor worldwide. Home blood pressure measurement (HBPM) is recommended for blood pressure (BP) management. HBPM is most effective to improve BP management when delivered with patient education. It is unknown whether web-based resources are appropriate for patient education for HBPM. Patient education should provide accurate, evidence-based information, communicate at an eighth grade reading level, and involve end users in development to meet the needs of adults of all health literacy levels. Using these criteria, this study aimed to determine the appropriateness of web-based HBPM resources. Objective: This study aimed to determine whether web-based resources are appropriate for HBPM education based on three research questions: (1) Do web-based resources provide evidence-based information that aligns with guideline recommendations? (2) Do they communicate at an appropriate reading level? (3) Do they involve end users in their development? Methods: An environmental scan of web-based resources for HBPM was conducted on Google (October 2022) using search terms developed with consumers (n=6). Resources were included if they were identified on the first page of the search findings, not paywalled, and in English. Resource appropriateness was appraised based on three criteria: (1) alignment of resource content to 23 recommendations for HBPM from 6 international guidelines, (2) being at an appropriate grade reading level as determined by a health literacy assessment software, and (3) having evidence of end user involvement in resource development. Results: None of the identified resources (n=24) aligned with all 23 of the guideline recommendations. All resources aligned with the recommendation to measure BP when seated, while few aligned with the recommendation to use a validated BP device (n=9, 38\%). All resources exceeded the recommended eighth grade reading level (mean 11.8, range 8.8-17.0) and none reported evidence of patient end user involvement in development. Conclusions: None of the web-based resources met the criteria for appropriate education to support adults to measure BP at home. Resources should be developed with end users using health literacy tools and multimodal communication methods to ensure they are appropriate to meet the needs of patients. ", doi="10.2196/55248", url="https://infodemiology.jmir.org/2025/1/e55248" } @Article{info:doi/10.2196/64028, author="Schmieding, L. Malte and Kopka, Marvin and Bolanaki, Myrto and Napierala, Hendrik and Altendorf, B. Maria and Kuschick, Doreen and Piper, K. Sophie and Scatturin, Lennart and Schmidt, Konrad and Schorr, Claudia and Thissen, Alica and W{\"a}scher, Cornelia and Heintze, Christoph and M{\"o}ckel, Martin and Balzer, Felix and Slagman, Anna", title="Impact of a Symptom Checker App on Patient-Physician Interaction Among Self-Referred Walk-In Patients in the Emergency Department: Multicenter, Parallel-Group, Randomized, Controlled Trial", journal="J Med Internet Res", year="2025", month="Apr", day="2", volume="27", pages="e64028", keywords="digital health", keywords="triage", keywords="symptom checker", keywords="patient-centered care", keywords="eHealth apps", keywords="mobile phone", keywords="decision support systems", keywords="consumer health information", keywords="health literacy", keywords="randomized controlled trials", keywords="null results", keywords="emergency care", keywords="patient-physician-interaction", keywords="patient satisfaction", abstract="Background: Symptom checker apps (SCAs) are layperson-facing tools that advise on whether and where to seek care, or possible diagnoses. Previous research has primarily focused on evaluating the accuracy, safety, and usability of their recommendations. However, studies examining SCAs' impact on clinical care, including the patient-physician interaction and satisfaction with care, remain scarce. Objective: This study aims to evaluate the effects of an SCA on satisfaction with the patient-physician interaction in acute care settings. Additionally, we examined its influence on patients' anxiety and trust in the treating physician. Methods: This parallel-group, randomized controlled trial was conducted at 2 emergency departments of an academic medical center and an emergency practice in Berlin, Germany. Low-acuity patients seeking care at these sites were randomly assigned to either self-assess their health complaints using a widely available commercial SCA (Ada Health) before their first encounter with the treating physician or receive usual care. The primary endpoint was patients' satisfaction with the patient-physician interaction, measured by the Patient Satisfaction Questionnaire (PSQ). The secondary outcomes were patients' satisfaction with care, their anxiety levels, and physicians' satisfaction with the patient-physician interaction. We used linear mixed models to assess the statistical significance of primary and secondary outcomes. Exploratory descriptive analyses examined patients' and physicians' perceptions of the SCA's utility and the frequency of patients questioning their physician's authority. Results: Between April 11, 2022, and January 25, 2023, we approached 665 patients. A total of 363 patients were included in the intention-to-treat analysis of the primary outcome (intervention: n=173, control: n=190). PSQ scores in the intervention group were similar to those in the control group (mean 78.5, SD 20.0 vs mean 80.8, SD 19.6; estimated difference --2.4, 95\% CI --6.3 to 1.1, P=.24). Secondary outcomes, including patients' and physicians' satisfaction with care and patient anxiety, showed no significant group differences (all P>.05). Patients in the intervention group were more likely to report that the SCA had a beneficial (66/164, 40.2\%) rather than a detrimental (3/164, 1.8\%) impact on the patient-physician interaction, with most reporting no effect (95/164, 57.9\%). Similar patterns were observed regarding the SCA's perceived effect on care. In both groups, physicians rarely reported that their authority had been questioned by a patient (intervention: 2/188, 1.1\%; control: 4/184, 2.2\%). While physicians more often found the SCA helpful rather than unhelpful, the majority indicated it was neither helpful nor unhelpful for the encounter. Conclusions: We found no evidence that the SCA improved satisfaction with the patient-physician interaction or care in an acute care setting. By contrast, both patients and their treating physicians predominantly described the SCA's impact as beneficial. Our study did not identify negative effects of SCA use commonly reported in the literature, such as increased anxiety or diminished trust in health care professionals. Trial Registration: German Clinical Trial Register DRKS00028598; https://drks.de/search/en/trial/DRKS00028598/entails International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06688-w ", doi="10.2196/64028", url="https://www.jmir.org/2025/1/e64028" } @Article{info:doi/10.2196/68560, author="Yun, Sun Hye and Bickmore, Timothy", title="Online Health Information--Seeking in the Era of Large Language Models: Cross-Sectional Web-Based Survey Study", journal="J Med Internet Res", year="2025", month="Mar", day="31", volume="27", pages="e68560", keywords="online health information--seeking", keywords="large language models", keywords="eHealth", keywords="internet", keywords="consumer health information", abstract="Background: As large language model (LLM)--based chatbots such as ChatGPT (OpenAI) grow in popularity, it is essential to understand their role in delivering online health information compared to other resources. These chatbots often generate inaccurate content, posing potential safety risks. This motivates the need to examine how users perceive and act on health information provided by LLM-based chatbots. Objective: This study investigates the patterns, perceptions, and actions of users seeking health information online, including LLM-based chatbots. The relationships between online health information--seeking behaviors and important sociodemographic characteristics are examined as well. Methods: A web-based survey of crowd workers was conducted via Prolific. The questionnaire covered sociodemographic information, trust in health care providers, eHealth literacy, artificial intelligence (AI) attitudes, chronic health condition status, online health information source types, perceptions, and actions, such as cross-checking or adherence. Quantitative and qualitative analyses were applied. Results: Most participants consulted search engines (291/297, 98\%) and health-related websites (203/297, 68.4\%) for their health information, while 21.2\% (63/297) used LLM-based chatbots, with ChatGPT and Microsoft Copilot being the most popular. Most participants (268/297, 90.2\%) sought information on health conditions, with fewer seeking advice on medication (179/297, 60.3\%), treatments (137/297, 46.1\%), and self-diagnosis (62/297, 23.2\%). Perceived information quality and trust varied little across source types. The preferred source for validating information from the internet was consulting health care professionals (40/132, 30.3\%), while only a very small percentage of participants (5/214, 2.3\%) consulted AI tools to cross-check information from search engines and health-related websites. For information obtained from LLM-based chatbots, 19.4\% (12/63) of participants cross-checked the information, while 48.4\% (30/63) of participants followed the advice. Both of these rates were lower than information from search engines, health-related websites, forums, or social media. Furthermore, use of LLM-based chatbots for health information was negatively correlated with age ($\rho$=--0.16, P=.006). In contrast, attitudes surrounding AI for medicine had significant positive correlations with the number of source types consulted for health advice ($\rho$=0.14, P=.01), use of LLM-based chatbots for health information ($\rho$=0.31, P<.001), and number of health topics searched ($\rho$=0.19, P<.001). Conclusions: Although traditional online sources remain dominant, LLM-based chatbots are emerging as a resource for health information for some users, specifically those who are younger and have a higher trust in AI. The perceived quality and trustworthiness of health information varied little across source types. However, the adherence to health information from LLM-based chatbots seemed more cautious compared to search engines or health-related websites. As LLMs continue to evolve, enhancing their accuracy and transparency will be essential in mitigating any potential risks by supporting responsible information-seeking while maximizing the potential of AI in health contexts. ", doi="10.2196/68560", url="https://www.jmir.org/2025/1/e68560" } @Article{info:doi/10.2196/58529, author="Pitrou, Isabelle and Petrangelo, Adriano and Besson, Charlotte and Pepe, Carmela and Waschke, Helen Annika and Agulnik, Jason and Gonzalez, V. Anne and Ezer, Nicole", title="Lung Cancer Screening in Family Members and Peers of Patients With Lung Cancer: Protocol for a Prospective Cohort Study", journal="JMIR Res Protoc", year="2025", month="Mar", day="28", volume="14", pages="e58529", keywords="lung cancer", keywords="low-dose CT", keywords="chest tomography", keywords="lung cancer screening", keywords="patient advocacy", keywords="early detection of cancer", keywords="referral and consultation", keywords="cohort study", keywords="patient empowerment", keywords="patient experience", abstract="Background: Low-dose computed tomography (LDCT) screening is promising for the early detection of lung cancer (LC) and the reduction of LC-related mortality. Despite the implementation of LC screening programs worldwide, recruitment is challenging. While recruitment for LC screening is based on physician referrals and mass advertising, novel recruitment strategies are needed to improve the enrollment of high-risk individuals into LC screening. Objective: We aim to identify whether patients with LC can act as advocates to enroll their family members and close contacts into LC screening and whether this strategy increases screening uptake at the population level. Methods: We designed a prospective cohort study comprising 2 cohorts constituted between June 2023 and January 2024 with a prospective follow-up of 18 months. Patients with LC (cohort 1) are approached at clinics of the McGill University Health Centre, educated on tools for communicating with family members and close contacts about the benefits of LC screening, and invited to refer their close ones. Referred individuals (cohort 2) are directed to this study's web-based questionnaire to assess their LC risk score with the PLCOm2012 (Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial) prediction model. Individuals meeting the eligibility criteria for LC screening (PLCOm2012 score ?2\% and aged 55-74 years) are directed toward the Quebec LC screening program. Data collected include sociodemographic characteristics, health literacy and smoking status (all participants), patient activation (cohort 1), perceived risk of LC, and generalized anxiety at baseline and at 28 days (cohort 2). LDCT completion within 18 months from referral is assessed from health records. Focus groups will identify the barriers and facilitators in the uptake of LC screening and preventative behaviors based on perceived genetic and clinical LC risks. The primary outcomes are the number of referred participants per survivor of LC and the mean risk of LC of the referred population based on PLCOm2012 scores. The secondary outcomes are the proportion of (1) participants eligible for LC screening; (2) participants eligible for screening who complete LDCT screening within 18 months of referral from a survivor of LC; (3) participants showing interest in genetic testing to inform LC risk; and (4) participants showing interest in a smoking cessation program. Multivariable logistic regression will identify the predictive factors of being referred for LC screening. PLCOm2012 scores will be compared for referred participants and controls from the provincial LC screening program. Results: Overall, 25 survivors of LC and 84 close contacts were enrolled from June 2023 to January 2024, with followed up through July 2025. The results are expected by the end of 2025. Conclusions: We describe an approach to LC screening referral, leveraging patients with LC as advocates to increase screening awareness and uptake among their family and peers. Trial Registration: ClinicalTrials.gov NCT05645731; https://clinicaltrials.gov/ct2/show/NCT05645731 International Registered Report Identifier (IRRID): DERR1-10.2196/58529 ", doi="10.2196/58529", url="https://www.researchprotocols.org/2025/1/e58529" } @Article{info:doi/10.2196/65114, author="Seel, Mariella and Mihalic, Alexander Julian and Froschauer, Mathias Stefan and Holzner, Bernhard and Meier, Jens and Gotterbarm, Tobias and Holzbauer, Matthias", title="Changes in Health Education Literacy After Structured Web-Based Education Versus Self-Directed Online Information Seeking in Patients Undergoing Carpal Tunnel Release Surgery: Nonrandomized, Controlled Study", journal="JMIR Form Res", year="2025", month="Mar", day="25", volume="9", pages="e65114", keywords="carpal tunnel release surgery", keywords="patient education", keywords="structured web-based education", keywords="online information", keywords="health education literacy", keywords="web-based", keywords="health education", keywords="information seeking", keywords="carpal tunnel release", keywords="carpal tunnel surgery", keywords="non-randomized", keywords="controlled study", keywords="self-management", keywords="perioperative", keywords="online health information", keywords="health literacy", keywords="day surgery", keywords="online search", keywords="carpal tunnel", keywords="carpal", abstract="Background: With advancements in anesthesiologic and surgical techniques, many surgeries are now performed as day-surgery procedures, requiring greater responsibilities for self-management from patients during the perioperative process. Online health information often lacks reliability and comprehensibility, posing risks for patients with low health literacy. Carpal tunnel release (CTR) surgery, a common day-surgery procedure, necessitates effective patient education for optimal recovery and self-management. Objective: This study introduces the CTS Academy, a web-based education program designed for patients undergoing CTR day surgery. The study aimed to evaluate the CTS Academy's impact on patients' health education literacy (HEL) compared with self-directed online information seeking. Methods: A scoping review on education programs focusing on the perioperative process of CTR was conducted before this study. In a nonrandomized controlled study, 60 patients scheduled for CTR were assigned to 2 groups based on the patients' preferences; the test group used the CTS Academy, while the control group performed self-directed online searches. HEL was assessed using the Health Education Literacy of Patients with chronic musculoskeletal diseases (HELP) questionnaire, focusing on patients's comprehension of medical information (COMPR), patients's ability to apply health-related information in an everyday life (APPLY), and patient's ability to communicate with health care professional (COMM). Secondary outcomes included content comprehensibility, patient preferences, platform usability, and clinical carpal tunnel syndrome (CTS)--related parameters. Results: In the scoping review, 17 studies could be identified and included for full-text analysis. Eighteen patients each were included in the test group (13 women and 5 men) and in the control group (11 women and 7 men). The average time spent in the study was 167 and 176 days for the test and control groups, respectively. The test group showed significant improvements in APPLY (mean 28, SD 7.99 vs mean 24, SD 5.14; P<.05) and COMM (mean 30, SD 10.52 vs mean 25, SD 6.01; P=.02) after using the CTS Academy in a longitudinal analysis. No significant changes were observed in the control group. In a comparison between groups, the test group had significantly higher APPLY scores at follow-up (mean 24, SD 5.14 vs mean 33, SD 14.78; P=.044) and fewer comprehension issues at baseline (mean 38, SD 16.60 vs mean 50, SD 19.00; P=.03). The CTS-related knowledge assessment yielded 92\% (66/72) versus 90\% (65/72) correct answers in the test and control groups, respectively. The test group rated the CTS Academy highly in usability (6.22 of 7.00 points) and utility (6.13 of 7.00 points). Preferences leaned toward using CTS Academy alongside doctor consultations (16/18, 89\%) and over self-directed searches (15/18, 84\%). No significant differences were found in CTS-related symptoms between groups. Conclusions: The CTS Academy effectively enhanced patients' HEL, especially in applying and communicating medical information. The platform's usability and utility were rated favorably, and patients preferred it over independent online information seeking. This suggests that structured, web-based education enhances patient self-management during the day surgery process. ", doi="10.2196/65114", url="https://formative.jmir.org/2025/1/e65114" } @Article{info:doi/10.2196/67361, author="Amoozegar, B. Jacqueline and Williams, Peyton and Giombi, C. Kristen and Richardson, Courtney and Shenkar, Ella and Watkins, L. Rebecca and O'Donoghue, C. Amie and Sullivan, W. Helen", title="Consumer Engagement With Risk Information on Prescription Drug Social Media Pages: Findings From In-Depth Interviews", journal="J Med Internet Res", year="2025", month="Mar", day="25", volume="27", pages="e67361", keywords="social media", keywords="prescription drugs", keywords="risk information", keywords="safety information", keywords="Facebook", keywords="Instagram", keywords="prescription", keywords="risk", keywords="information", keywords="safety", keywords="interview", keywords="consumer engagement", keywords="digital", keywords="drug promotion", keywords="user experience", keywords="promotion", abstract="Background: The volume of digital drug promotion has grown over time, and social media has become a source of information about prescription drugs for many consumers. Pharmaceutical companies currently present risk information about prescription drugs they promote in a variety of ways within and across social media platforms. There is scarce research on consumers' interactions with prescription drug promotion on social media, particularly on which features may facilitate or inhibit consumers' ability to find, review, and comprehend drug information. This is concerning because it is critical for consumers to know and weigh drug benefits and risks to be able to make informed decisions regarding medical treatment. Objective: We aimed to develop an understanding of the user interface (UI) and user experience (UX) of social media pages and posts created by pharmaceutical companies to promote drugs and how UI or UX design features impact consumers' interactions with drug information. Methods: We conducted in-person interviews with 54 consumers segmented into groups by device type (laptop or mobile phone), social media platform (Facebook or Instagram), and age. Interviewers asked participants to navigate to and review a series of 4 pages and 3 posts on their assigned device and platform. Interviewers encouraged participants to ``think aloud,'' as they interacted with the stimuli during a brief observation period. Following each observation period, participants were asked probing questions. An analyst reviewed video recordings of the observation periods to abstract quantitative interaction data on whether a participant clicked on or viewed risk information at each location it appeared on each page. Participants' responses were organized in a metamatrix, which we used to conduct thematic analysis. Results: Observational data revealed that 59\% of participants using Facebook and 70\% of participants using Instagram viewed risk information in at least 1 possible location on average across all pages tested during the observation period. There was not a single location across the Facebook pages that participants commonly clicked on to view risk information. However, a video with scrolling risk information attracted more views than other features. On Instagram, at least half of the participants consistently clicked on the highlighted story with risk information across the pages. Although thematic analysis showed that most participants were able to identify the official pages and risk information for each drug, auto-scrolling text and text size posed barriers to identification and comprehensive review for some participants. Participants generally found it more difficult to identify the drugs' indications than risks. Participants using Instagram more frequently reported challenges identifying risks and indications compared to those using Facebook. Conclusions: UI or UX design features can facilitate or pose barriers to users' identification, review, and comprehension of the risk information provided on prescription drugs' social media pages and posts. ", doi="10.2196/67361", url="https://www.jmir.org/2025/1/e67361" } @Article{info:doi/10.2196/60647, author="Koch, Roland and Steffen, Marie-Theres and Wetzel, Anna-Jasmin and Preiser, Christine and Klemmt, Malte and Ehni, Hans-J{\"o}rg and Mueller, Regina and Joos, Stefanie", title="Exploring Laypersons' Experiences With a Mobile Symptom Checker App as an Interface Between eHealth Literacy, Health Literacy, and Health-Related Behavior: Qualitative Interview Study", journal="JMIR Form Res", year="2025", month="Mar", day="21", volume="9", pages="e60647", keywords="symptom checker apps", keywords="health literacy", keywords="eHealth literacy", keywords="qualitative research", keywords="interview study", keywords="artificial intelligence", keywords="AI", abstract="Background: Symptom checkers aim to help users recognize medical symptoms and recommend actions. However, they are not yet reliable for self-triage or diagnostics. Health literacy plays a role in their use, but the process from symptom recognition to health care consultation remains unclear. Objective: This qualitative observatory study explored how laypersons use symptom checkers, focusing on the process of use, entry points and outcomes, and the role of health literacy. Laypersons are defined as individuals who are neither medical professionals nor developers of such apps. Three research questions were addressed: (1) How do such users describe the process of using symptom checkers? (2) What are entry points and possible outcomes of symptom checker app use? (3) How are health literacy and eHealth literacy expressed during the use of symptom checker apps? Methods: As part of the Ethical, Legal, and Social Implications of Symptom Checker Apps in Primary Health Care project, 15 laypersons (n=9, 60\% female and n=6, 40\% male; mean age 30.7, SD 13.6 years) were interviewed about their experiences with the symptom checker Ada. The interviews were analyzed using an integrative approach combining social positioning, agency, and the Rubicon model as a heuristic framework. Results: App use follows a cyclic process comprising 4 steps: motivation (influenced by biography and context), intention formation (assigning a purpose), intention implementation (recruiting resources), and evaluation (transforming interactions into health-related insights). Biographical, social, and contextual factors shape process initiation. Users use symptom checkers for 3 main purposes: understanding their condition, receiving recommendations for action, and documenting or communicating health-related information. Each purpose requires specific planning and integration into health-related behaviors drawing on personal, social, and technological resources. Evaluation depends on contextual factors, app outputs, and the outcomes of users' health-related actions. Users assess whether the app aligns with their expectations, condition severity, and previous experiences, with health literacy playing a critical role in validation processes. Conclusions: Symptom checker use is a complex, cyclic process shaped by context, biography, and health literacy. Users are motivated by health concerns influenced by personal, social, and contextual factors, with trust and attitudes impacting initial engagement. Intention formation reflects a balance between user skills and context, where app outputs inform decisions but may not always lead to action, especially in ambiguous situations. Users rely on personal resources and social networks to integrate app use into health-related behaviors, highlighting the limitations of symptom checkers in providing social or empathetic support. Symptom checkers have the potential to serve as an interface between users and health care, but future development must address the complexity of their use to unlock this potential. International Registered Report Identifier (IRRID): RR2-10.2196/34026 ", doi="10.2196/60647", url="https://formative.jmir.org/2025/1/e60647" } @Article{info:doi/10.2196/64186, author="Rainer, Crissi and Schnall, Rebecca and Tanner, R. Mary and Galindo, A. Carla and Hoover, W. Karen and Naar, Sylvie and Brin, Maeve and Martinez, Andres and Jia, Haomiao and Mendoza, Maria and Hightow-Weidman, Lisa", title="Developing and Implementing Provider-Training and Evidence-Based Tools to Support Pre-exposure Prophylaxis (PrEP) Decision-Making and Increase PrEP Adherence Among Young Men Who Have Sex With Men: Protocol for the PrEP Choice Longitudinal Cohort Study", journal="JMIR Res Protoc", year="2025", month="Mar", day="20", volume="14", pages="e64186", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="PrEP cohort", keywords="young men who have sex with men", keywords="YMSM", keywords="digital health", keywords="evidence-based tools", keywords="motivational interviewing", abstract="Background: Despite the availability of highly effective HIV pre-exposure prophylaxis (PrEP), uptake and adherence to PrEP among young men who have sex with men (YMSM) remains low, limiting its impact on the prevention of HIV infection. Strategies that incorporate an array of prevention options and provide YMSM and their providers with tailored education and support tools, including tools to support shared decision-making, are needed. Objective: The goals of the Centers for Disease Control and Prevention (CDC)--funded PrEP Choice study include the development and deployment of CDC guideline--consistent PrEP provider training and the implementation of evidence-based provider- and client-facing PrEP education and support tools. Under this initiative, the CDC funded 2 research projects, Florida State University (the Expanding PrEP in Communities of Color [EPICC] project), and Columbia University (the mChoice project). Methods: Providers from both projects will complete the PrEP Choice online training, which was developed to educate providers on PrEP options and how to engage clients in open discussions around sexual health and PrEP options. EPICC project providers will also attend online tailored motivational interviewing (TMI) training sessions, and mChoice project providers will view a training video on cultural competency and humility in PrEP care. Following training, each project will enroll a cohort of 400 participants receiving care from study providers and follow them for 12-18 months. Participants will complete online surveys every 3 months and provide biomarkers to assess PrEP adherence. Electronic health record (EHR) data will be collected every 6 months to provide additional information on clinic attendance, PrEP prescriptions, and HIV/sexually transmitted infection (STI) testing. Each project will provide cohort participants with a unique digital health tool to support the PrEP choice and ongoing adherence. The study will assess the effectiveness of training and educational and support tools in practice and the critical factors associated with the successful uptake of and adherence to PrEP by participants. The study will also monitor patterns of PrEP use among YMSM, including types of PrEP and switching between types. Results: Formative work to develop and prepare the tools for implementation was completed in 2023. The EPICC project began provider training in early 2024, and the mChoice project began in spring 2024. Cohort enrollment for both projects began after provider training began. Conclusions: Given the changing PrEP landscape, implementation of provider education and tools to maximize uptake and adherence is needed. By delivering culturally competent and interactive provider training on PrEP options, the study will help providers counsel and guide participants on the effective and safe use of PrEP. The digital health tools created will support participant adherence to help them optimize PrEP benefits. Through the cohort design, the PrEP Choice study will provide real-world data about PrEP use that will be critical for informing future guidelines and tools. International Registered Report Identifier (IRRID): DERR1-10.2196/64186 ", doi="10.2196/64186", url="https://www.researchprotocols.org/2025/1/e64186" } @Article{info:doi/10.2196/60588, author="Carr, L. Alaina and Jenkins, M. Angela and Jonklaas, Jacqueline and Gabriel, Kate and Miller, E. Kristen and Graves, D. Kristi", title="Patient and Provider Perspectives of a Web-Based Intervention to Support Symptom Management After Radioactive Iodine Treatment for Differentiated Thyroid Cancer: Qualitative Study", journal="JMIR Form Res", year="2025", month="Mar", day="19", volume="9", pages="e60588", keywords="iodine radioisotopes", keywords="person-based approach", keywords="self-management", keywords="Social Cognitive Theory", keywords="survivorship", keywords="symptom burden", keywords="thyroid neoplasms", keywords="web-based intervention", keywords="radioactive iodine treatment", keywords="radiotherapy", keywords="thyroid cancer", keywords="qualitative", keywords="quality of life", keywords="survivorship care", keywords="supportive care", keywords="patient with cancer", keywords="QoL", keywords="cancer", keywords="carcinoma", keywords="malignancy", keywords="tumor", keywords="malignant", keywords="oncology", keywords="neoplasm", keywords="benign", keywords="neoplasia", keywords="thyroid", abstract="Background: Patients diagnosed with differentiated thyroid cancer (DTC) who receive radioactive iodine (RAI) treatment experience acute, medium, and late treatment effects. The timing and severity of these effects vary by individual; common posttreatment effects include dry mouth, salivary gland swelling, dry eyes, and nose bleeds. The nature of symptoms that patients experience after RAI treatment can significantly and negatively impact health-related quality of life. Adequate information during the postprimary treatment phase remains an unmet need among the population of patients diagnosed with DTC. Objective: This qualitative study aimed to identify and understand self-management strategies for RAI-specific symptom burden from the perspectives of patients and stakeholders (cancer care providers and patient advocates). An additional aim included assessing features and functionalities desirable in the development of a web-based intervention to engage patients in their self-management and thyroid cancer survivorship care. Methods: Following the Social Cognitive Theory framework and person-based principles, we conducted six focus groups with 22 patients diagnosed with DTC who completed RAI treatment and individual interviews with 12 stakeholders in DTC care. The interviews focused on participants' perspectives on current self-management strategies and mockups of a symptom management web-based intervention. Before focus groups and interviews, participants completed a demographics survey. Focus group discussions and interviews were transcribed and coded using content analysis. Interrater reliability was satisfactory (?=.88). Results: A total of 34 individuals (patients and stakeholders) participated in the study; the mean age was 45 (SD 13.4) and 45.3 (SD 13) years, respectively. Three domains emerged from qualitative interviews: (1) difficult-to-manage RAI symptoms: short, medium, and late treatment effects; (2) key intervention structure and content feedback on mockups; and (3) intervention content to promote RAI symptom management and survivorship care. Focus group participants identified the most prevalent RAI symptoms that were difficult to manage as: dry mouth (11/22, 50\%), salivary gland swelling (8/22, 36\%), and changes in taste (12/22, 55\%). Feedback elicited from both groups found education and symptom management mockup videos to be helpful in patient self-management of RAI symptoms, whereas patients and stakeholders provided mixed feedback on the benefits of a draft frequently asked questions page. Across focus groups and stakeholder interviews, nutrition-based symptom management strategies, communication with family members, and practical survivorship follow-up information emerged as helpful content to include in a future web-based supportive care intervention. Conclusions: Results suggest education and symptom management videos can empower patients with DTC to self-manage mild to moderate RAI symptoms on a web-based platform. Findings emphasized the need for additional information for patients related to ongoing care following RAI treatment including social support and thyroid cancer surveillance. The findings provide insights for theoretically informed interventions and recommendations for refinements in thyroid cancer survivorship from patient and provider perspectives. ", doi="10.2196/60588", url="https://formative.jmir.org/2025/1/e60588" } @Article{info:doi/10.2196/63347, author="{\vS}uto Pavi{\v c}i{\'c}, Jelena and Maru{\vs}i{\'c}, Ana and Buljan, Ivan", title="Using ChatGPT to Improve the Presentation of Plain Language Summaries of Cochrane Systematic Reviews About Oncology Interventions: Cross-Sectional Study", journal="JMIR Cancer", year="2025", month="Mar", day="19", volume="11", pages="e63347", keywords="health literacy", keywords="patient education", keywords="health communication", keywords="ChatGPT", keywords="neoplasms", keywords="Cochrane", keywords="oncology", keywords="plain language", keywords="medical information", keywords="decision-making", keywords="large language model", keywords="artificial intelligence", keywords="AI", abstract="Background: Plain language summaries (PLSs) of Cochrane systematic reviews are a simple format for presenting medical information to the lay public. This is particularly important in oncology, where patients have a more active role in decision-making. However, current PLS formats often exceed the readability requirements for the general population. There is still a lack of cost-effective and more automated solutions to this problem. Objective: This study assessed whether a large language model (eg, ChatGPT) can improve the readability and linguistic characteristics of Cochrane PLSs about oncology interventions, without changing evidence synthesis conclusions. Methods: The dataset included 275 scientific abstracts and corresponding PLSs of Cochrane systematic reviews about oncology interventions. ChatGPT-4 was tasked to make each scientific abstract into a PLS using 3 prompts as follows: (1) rewrite this scientific abstract into a PLS to achieve a Simple Measure of Gobbledygook (SMOG) index of 6, (2) rewrite the PLS from prompt 1 so it is more emotional, and (3) rewrite this scientific abstract so it is easier to read and more appropriate for the lay audience. ChatGPT-generated PLSs were analyzed for word count, level of readability (SMOG index), and linguistic characteristics using Linguistic Inquiry and Word Count (LIWC) software and compared with the original PLSs. Two independent assessors reviewed the conclusiveness categories of ChatGPT-generated PLSs and compared them with original abstracts to evaluate consistency. The conclusion of each abstract about the efficacy and safety of the intervention was categorized as conclusive (positive/negative/equal), inconclusive, or unclear. Group comparisons were conducted using the Friedman nonparametric test. Results: ChatGPT-generated PLSs using the first prompt (SMOG index 6) were the shortest and easiest to read, with a median SMOG score of 8.2 (95\% CI 8?8.4), compared with the original PLSs (median SMOG score 13.1, 95\% CI 12.9?13.4). These PLSs had a median word count of 240 (95\% CI 232?248) compared with the original PLSs' median word count of 364 (95\% CI 339?388). The second prompt (emotional tone) generated PLSs with a median SMOG score of 11.4 (95\% CI 11.1?12), again lower than the original PLSs. PLSs produced with the third prompt (write simpler and easier) had a median SMOG score of 8.7 (95\% CI 8.4?8.8). ChatGPT-generated PLSs across all prompts demonstrated reduced analytical tone and increased authenticity, clout, and emotional tone compared with the original PLSs. Importantly, the conclusiveness categorization of the original abstracts was unchanged in the ChatGPT-generated PLSs. Conclusions: ChatGPT can be a valuable tool in simplifying PLSs as medically related formats for lay audiences. More research is needed, including oversight mechanisms to ensure that the information is accurate, reliable, and culturally relevant for different audiences. ", doi="10.2196/63347", url="https://cancer.jmir.org/2025/1/e63347" } @Article{info:doi/10.2196/58855, author="Liu, Jinpei and Qiu, Yifan and Liu, Yilong and Xu, Wenping and Ning, Weichen and Shi, Peimei and Yuan, Zongli and Wang, Fang and Shi, Yihai", title="The Reliability and Quality of Videos as Guidance for Gastrointestinal Endoscopy: Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Mar", day="11", volume="27", pages="e58855", keywords="gastrointestinal endoscopy", keywords="YouTube", keywords="patient education", keywords="social media gastrointestinal", keywords="large language model", keywords="LLM", keywords="reliability", keywords="quality", keywords="video", keywords="cross-sectional study", keywords="endoscopy-related videos", keywords="health information", keywords="endoscopy", keywords="gastroscopy", keywords="colonoscopy", abstract="Background: Gastrointestinal endoscopy represents a useful tool for the diagnosis and treatment of gastrointestinal diseases. Video platforms for spreading endoscopy-related knowledge may help patients understand the pros and cons of endoscopy on the premise of ensuring accuracy. However, videos with misinformation may lead to adverse consequences. Objective: This study aims to evaluate the quality of gastrointestinal endoscopy-related videos on YouTube and to assess whether large language models (LLMs) can help patients obtain information from videos more efficiently. Methods: We collected information from YouTube videos about 3 commonly used gastrointestinal endoscopes (gastroscopy, colonoscopy, and capsule endoscopy) and assessed their quality (rated by the modified DISCERN Tool, mDISCERN), reliability (rated by the Journal of the American Medical Association), and recommendation (rated by the Global Quality Score). We tasked LLM with summarizing the video content and assessed it from 3 perspectives: accuracy, completeness, and readability. Results: A total of 167 videos were included. According to the indicated scoring, the quality, reliability, and recommendation of the 3 gastrointestinal endoscopy-related videos on YouTube were overall unsatisfactory, and the quality of the videos released by patients was particularly poor. Capsule endoscopy yielded a significantly lower Global Quality Score than did gastroscopy and colonoscopy. LLM-based summaries yielded accuracy scores of 4 (IQR 4-5), completeness scores of 4 (IQR 4-5), and readability scores of 2 (IQR 1-2). Conclusions: The quality of gastrointestinal endoscope-related videos currently on YouTube is poor. Moreover, additional regulatory and improvement strategies are needed in the future. LLM may be helpful in generalizing video-related information, but there is still room for improvement in its ability. ", doi="10.2196/58855", url="https://www.jmir.org/2025/1/e58855" } @Article{info:doi/10.2196/58882, author="Kramer, L. Melissa and Polo, Medina Jose and Kumar, Nishant and Mulgirigama, Aruni and Benkiran, Amina", title="Living With and Managing Uncomplicated Urinary Tract Infection: Mixed Methods Analysis of Patient Insights From Social Media", journal="J Med Internet Res", year="2025", month="Mar", day="11", volume="27", pages="e58882", keywords="acute cystitis", keywords="bladder infection", keywords="HCP interactions", keywords="urology", keywords="patient experience", keywords="patient insights", keywords="social media", keywords="uncomplicated urinary tract infection", keywords="urinary tract infection", keywords="urinary", keywords="women", keywords="quality of life", keywords="disease management", keywords="cystitis", keywords="healthcare professional", keywords="self-management", keywords="patient behavior", keywords="UTI", abstract="Background: Uncomplicated urinary tract infections (uUTIs) affect more than half of women in their lifetime and can impact on quality of life. We analyzed social media posts discussing uUTIs to gather insights into the patient experience, including aspects of their disease management journey and associated opinions and concerns. Objective: This study aims to gather patient experience insights by analyzing social media posts that discussed uUTI. Methods: A search string (``urinary tract infection'' [UTI] or ``bladder infection'' or ``cystitis'' or ``UTI'' not ``interstitial cystitis'') was used to identify posts from public blogs and patient forums (June 2021 to June 2023). Posts were excluded if they were not written in English or discussed complicated UTI (posts that mentioned ``pregnancy'' or ``pregnant'' or ``trimester'' or ``catheter'' or ``interstitial''). Posts were limited to publicly available sources and anonymized. The primary objective was to gather patient perspectives on key elements of the uUTI experience, including health care professional (HCP) interactions, diagnosis, treatment, and recurrence. Results: In total, more than 42,000 unique posts were identified (mostly from reddit.com; 29,506/42,265, 70\%) and >3600 posts were analyzed. Posts were most commonly from users in the United States (6707/11,180, 60\%), the United Kingdom (2261/11,180, 20\%), Canada (509/11,180, 5\%), Germany (356/11,180, 3\%), or India (320/11,180, 3\%). Six main themes were identified: symptom awareness and information seeking, HCP interactions, diagnosis and management challenges, management with antibiotics, self-management, and challenges with recurrent UTI. Most posts highlighted the importance of seeking professional medical advice, while some patients raised concerns regarding their HCP interactions and lack of shared decision-making. Patients searched for advice and guidance on the web prior to consulting an HCP, described their symptoms, and discussed lifestyle adjustments. Most patients tried self-management and shared their experiences with nonprescribed treatment options. There was general agreement among posts that antibiotics are necessary to cure UTIs and prevent associated complications. Conclusions: Social media posts provide valuable insight into the experiences and opinions of patients with uUTIs in Canada, Germany, India, the United Kingdom, and the United States. The insights from this study provide a more complete picture of patient behaviors and highlight the potential for HCP and patient education, as well as better communication through shared decision-making to improve care. ", doi="10.2196/58882", url="https://www.jmir.org/2025/1/e58882" } @Article{info:doi/10.2196/57881, author="Muscat, M. Danielle and Hinton, Rachael and Kuruvilla, Shyama and Nutbeam, Don", title="``Your Life, Your Health: Tips and Information for Health and Well-Being'': Development of a World Health Organization Digital Resource to Support Universal Access to Trustworthy Health Information", journal="JMIR Form Res", year="2025", month="Mar", day="6", volume="9", pages="e57881", keywords="health communication", keywords="health literacy", keywords="consumer health information", keywords="digital health", keywords="universal health care", abstract="Background: Access to trustworthy, understandable, and actionable health information is a key determinant of health and is an essential component of universal health coverage and primary health care. The World Health Organization has developed a new digital resource for the general public to improve health and well-being across different life phases and to support people in caring for themselves, their families, and their communities. The goal was to make trustworthy health information accessible, understandable, and actionable for the general public in a digital format and at the global scale. Objective: The aim of this paper was to describe the multistage approach and methodology used to develop the resource Your life, your health: Tips and information for health and well-being (hereafter, Your life, your health). Methods: A 5-step process was used to develop Your life, your health, including (1) reviewing and synthesizing existing World Health Organization technical guidance, member state health and health literacy plans, and international human rights frameworks to identify priority messages; (2) developing messages and graphics that are accessible, understandable, and actionable for the public using health literacy principles; (3) engaging with experts and stakeholders to refine messages and message delivery; (4) presenting priority content in an accessible digital format; and (5) adapting the resource based on feedback and new evidences. Results: The Your life, your health online resource adopts a life-course approach to organize health information based on priority actions and rights that support peoples' health and well-being across different life stages and specific health topics. The resource promotes health literacy by offering advice on asking questions to health workers, making informed decisions about personal and family health, and effectively using digital media to obtain reliable health information. Additionally, it reflects the ambitions of the Sustainable Development Goals by providing essential information on the social determinants of health and clarifies the distinct roles of individuals, frontline workers, governments, and the media in promoting and protecting health. Conclusions: Making health information available---including to the public---is an essential step in strengthening the global health information system. The development process for the Your life, your health online resource outlined in this article offers a structured approach to translate technical health guidelines into accessible, understandable, and actionable health information for the general public. ", doi="10.2196/57881", url="https://formative.jmir.org/2025/1/e57881" } @Article{info:doi/10.2196/66634, author="Haughey, Marketa and Neyens, M. David and Hopkins, S. Casey and Gonzaga, Christofer and Harman, Melinda", title="Identifying Strategies for Home Management of Ostomy Care: Content Analysis of YouTube", journal="JMIR Hum Factors", year="2025", month="Mar", day="6", volume="12", pages="e66634", keywords="medical device usability", keywords="digital health", keywords="online support groups", keywords="living with chronic medical conditions", keywords="ostomy self-care", keywords="YouTube", keywords="patient education", keywords="user needs assessment", keywords="users experience", keywords="social media", keywords="ostomates", keywords="colostomy", keywords="ileostomy", keywords="usability", keywords="usefulness", keywords="utility", keywords="wearable device", keywords="medical device", keywords="support group", keywords="socials", keywords="social network", keywords="ostomy", keywords="digital", keywords="digital technology", keywords="digital intervention", abstract="Background: The social media platform YouTube is a recognized educational resource for health information, but few studies have explored its value for conveying the lived experience of individuals managing chronic health conditions and end users' interactions with medical device technology. Our study explores self-care strategies and end user needs of people living with a stoma because patient education and engagement in ostomy self-care are essential for avoiding ostomy-related complications. Ostomy surgery creates a stoma (an opening) in the abdomen to alter the route of excreta from digestive and urinary organs into a detachable external pouching system. After hospital discharge, people who have undergone ostomies perform critical self-care tasks including frequent ostomy appliance changes and stomal and peristomal skin maintenance. Objective: The purpose of this study was to systematically assess YouTube videos narrated by people who have undergone ostomies about their ostomy self-care in home (nonhospital) settings with a focus on identifying end user needs and different strategies used by people who have undergone ostomies during critical self-care tasks. Methods: Using predefined search terms and clear inclusion and exclusion criteria, we identified YouTube videos depicting narrators who have undergone ostomies and their ostomy self-care in home settings. Using a consensus coding approach among 3 independent reviewers, all videos were analyzed to collect metadata, data of narrators who have undergone ostomies, and specific content data. Results: There were 65 user-generated YouTube videos that met the inclusion and exclusion criteria. These videos were posted by 28 unique content creators representing a broad range of ages who used a variety of supplies. The common challenges discussed were peristomal skin complications, inadequate appliance adhesion and subsequent leakage, and supplies-related challenges. Narrators who have undergone ostomies discussed various expert tricks and tips to successfully combat these challenges. Conclusions: This study used a novel approach to gain insights about end user interactions with medical devices while performing ostomy self-care, which are difficult to gain using traditional behavioral techniques. The analysis revealed that people who have undergone ostomies are willing to share their personal experience with ostomy self-care on the web and that these videos are viewed by the public. User-generated videos demonstrated a variety of supplies used, end user needs, and different strategies for performing ostomy self-care. Future research should examine how these findings connect to YouTube ostomy self-care content generated by health care professionals and organizations and to guidelines for ostomy self-care. ", doi="10.2196/66634", url="https://humanfactors.jmir.org/2025/1/e66634", url="http://www.ncbi.nlm.nih.gov/pubmed/40053741" } @Article{info:doi/10.2196/64724, author="Johnson, Rose Anna and Longfellow, Anne Grace and Lee, N. Clara and Ormseth, Benjamin and Skolnick, B. Gary and Politi, C. Mary and Rivera, M. Yonaira and Myckatyn, Terence", title="Social Media as a Platform for Cancer Care Decision-Making Among Women: Internet Survey-Based Study on Trust, Engagement, and Preferences", journal="JMIR Cancer", year="2025", month="Mar", day="5", volume="11", pages="e64724", keywords="shared decision-making", keywords="SDM", keywords="decision aids", keywords="cancer treatment", keywords="breast cancer", keywords="digital health", keywords="social media", keywords="health communication", keywords="online decision aids", keywords="health information-seeking behavior", keywords="trust in health information", keywords="healthcare accessibility", keywords="mhealth", abstract="Background: Decision aids improve patient and clinician decision-making but are underused and often restricted to clinical settings. Objective: Given limited studies analyzing the feasibility of disseminating decision aids through social media, this study aimed to evaluate the acceptability, trust, and engagement of women with social media as a tool to deliver online decision aids for cancer treatment. Methods: To prepare for potential dissemination of a breast cancer decision aid via social media, a cross-sectional survey in February 2023 was conducted via Prime Panels, an online market research platform, of women aged 35-75 years in the United States. Demographics, health, cancer information-seeking behaviors, social media use, trust in social media for health information, as well as the likelihood of viewing cancer-related health information and clicking on decision aids through social media, were assessed. Statistical analyses included descriptive statistics, correlations, and multivariable ordinal regression. Results: Of 607 respondents, 397 (65.4\%) had searched for cancer information, with 185 (46.6\%) using the internet as their primary source. Facebook (Meta) was the most popular platform (511/607, 84.2\%). Trust in social media for health information was higher among Black (14/72, 19.4\%) and Asian respondents (7/27, 25.9\%) than among White respondents (49/480, 10.2\%; P=.003). Younger respondents aged 35-39 years (17/82, 20.7\%) showed higher trust than those aged 70-79 years (12/70, 17.1\%; P<.001). Trust in social media for health information was linked to a higher likelihood of viewing cancer information and accessing a decision aid online (P<.001). Participants who rated social media as ``Trustworthy'' (n=73) were more likely to view cancer information (61/73, 83.6\%) and click on decision aids (61/73, 83.6\%) than those who found it ``Untrustworthy'' (n=277; view: 133/277, 48.0\%; click: 125/277, 45.1\%). Engagement with social media positively correlated with viewing online cancer information (Spearman $\rho$=0.20, P<.001) and willingness to use decision aids ($\rho$=0.21, P<.001). Multivariable ordinal regression analyses confirmed that perception of social media's trustworthiness is a significant predictor of engagement with decision aids (untrustworthy vs trustworthy $\beta$=--1.826, P<.001; neutral vs trustworthy $\beta$=--0.926, P=.007) and of viewing cancer information (untrustworthy vs trustworthy $\beta$=--1.680, P<.001, neutral vs trustworthy $\beta$=--0.581, P=.098), while age and employment status were not significant predictors. Conclusions: This exploratory study suggests that social media platforms may increase access to health information and decision aids. No significant differences were observed between demographic variables and the use or trust in social media for health information. However, trust in social media emerged as a mediating factor between demographics and engagement with cancer information online. Before disseminating decision aids on social media, groups should identify existing trust and engagement patterns with different platforms within their target demographic. ", doi="10.2196/64724", url="https://cancer.jmir.org/2025/1/e64724", url="http://www.ncbi.nlm.nih.gov/pubmed/40053770" } @Article{info:doi/10.2196/55341, author="Guo, XiaoRui and Xiao, Liang and Liu, Xinyu and Chen, Jianxia and Tong, Zefang and Liu, Ziji", title="Enhancing Doctor-Patient Shared Decision-Making: Design of a Novel Collaborative Decision Description Language", journal="J Med Internet Res", year="2025", month="Mar", day="4", volume="27", pages="e55341", keywords="shared decision-making", keywords="speech acts", keywords="agent", keywords="argumentation", keywords="interaction protocol", abstract="Background: Effective shared decision-making between patients and physicians is crucial for enhancing health care quality and reducing medical errors. The literature shows that the absence of effective methods to facilitate shared decision-making can result in poor patient engagement and unfavorable decision outcomes. Objective: In this paper, we propose a Collaborative Decision Description Language (CoDeL) to model shared decision-making between patients and physicians, offering a theoretical foundation for studying various shared decision scenarios. Methods: CoDeL is based on an extension of the interaction protocol language of Lightweight Social Calculus. The language utilizes speech acts to represent the attitudes of shared decision-makers toward decision propositions, as well as their semantic relationships within dialogues. It supports interactive argumentation among decision makers by embedding clinical evidence into each segment of decision protocols. Furthermore, CoDeL enables personalized decision-making, allowing for the demonstration of characteristics such as persistence, critical thinking, and openness. Results: The feasibility of the approach is demonstrated through a case study of shared decision-making in the disease domain of atrial fibrillation. Our experimental results show that integrating the proposed language with GPT can further enhance its capabilities in interactive decision-making, improving interpretability. Conclusions: The proposed novel CoDeL can enhance doctor-patient shared decision-making in a rational, personalized, and interpretable manner. ", doi="10.2196/55341", url="https://www.jmir.org/2025/1/e55341", url="http://www.ncbi.nlm.nih.gov/pubmed/40053763" } @Article{info:doi/10.2196/49507, author="van der Smissen, Doris and Schreijer, A. Maud and van Gemert-Pijnen, C. Lisette J. E. W. and Verdaasdonk, M. Rudolf and van der Heide, Agnes and Korfage, J. Ida and Rietjens, C. Judith A.", title="Implementation of a Web-Based Program for Advance Care Planning and Evaluation of its Complexity With the Nonadoption, Abandonment, Scale-Up, Spread, And Sustainability (NASSS) Framework: Qualitative Evaluation Study", journal="JMIR Aging", year="2025", month="Mar", day="4", volume="8", pages="e49507", keywords="eHealth", keywords="web-based intervention", keywords="implementation", keywords="sustainability", keywords="advance care planning", keywords="NASSS framework", keywords="nonadoption, abandonment, scale-up, spread, and sustainability framework", keywords="health communication", keywords="patient education", keywords="patient-centered care", abstract="Background: The implementation of eHealth applications often fails. The NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework aims to identify complexities in eHealth applications; the more complex, the more risk of implementation failure. Objective: This study aimed to analyze the implementation of the web-based advance care planning (ACP) program ``Explore Your Preferences for Treatment and Care'' using the NASSS framework. Methods: The NASSS framework enables a systematic approach to improve the implementation of eHealth tools. It is aimed at generating a rich and situated analysis of complexities in multiple domains, based on thematic analysis of existing and newly collected data. It also aims at supporting individuals and organizations to handle these complexities. We used 6 of 7 domains of the NASSS framework (ie, condition, technology, value proposition, adopters, external context, and embedding and adaptation over time) leaving out ``organization,'' and analyzed the multimodal dataset of a web-based ACP program, its development and evaluation, including peer-reviewed publications, notes of stakeholder group meetings, and interviews with stakeholders. Results: This study showed that the web-based ACP program uses straightforward technology, is embedded in a well-established web-based health platform, and in general appears to generate a positive value for stakeholders. A complexity is the rather broad target population of the program. A potential complexity considers the limited insight into the extent to which health care professionals adopt the program. Awareness of the relevance of the web-based ACP program may still be improved among target populations of ACP and among health care professionals. Furthermore, the program may especially appeal to those who value individual autonomy, self-management, and an explicit and direct communicative approach. Conclusions: Relatively few complexities were identified considering the implementation of the web-based ACP program ``Explore Your Preferences for Treatment and Care.'' The program is evidence-based, freestanding, and well-maintained, with straightforward, well-understood technology. The program is expected to generate a positive value for different stakeholders. Complexities include the broad target population of the program and sociocultural factors. People with limited digital literacy may need support to use the program. Its uptake might be improved by increasing awareness of ACP and the program among a wider population of potential users and among health care professionals. Addressing these issues may guide future use and sustainability of the program. ", doi="10.2196/49507", url="https://aging.jmir.org/2025/1/e49507", url="http://www.ncbi.nlm.nih.gov/pubmed/40053753" } @Article{info:doi/10.2196/63763, author="Duguay, V{\'e}ronique and Comeau, Dominique and Turgeon, Tiffany and Bouhamdani, Nadia and Belanger, Mathieu and Weston, Lyle and Johnson, Tammy and Manzer, Nicole and Giberson, Melissa and Chamard-Witkowski, Ludivine", title="Evaluating the Knowledge and Information-Seeking Behaviors of People Living With Multiple Sclerosis: Cross-Sectional Questionnaire Study", journal="J Med Internet Res", year="2025", month="Feb", day="25", volume="27", pages="e63763", keywords="multiple sclerosis", keywords="chronic illness", keywords="misinformation", keywords="web-based searches", keywords="education", keywords="health information", keywords="social media", keywords="health literacy", keywords="patient-doctor relationship", keywords="health-related information", keywords="information-seeking behavior", abstract="Background: The internet has emerged as a primary source of health-related information for people living with multiple sclerosis (MS). However, given the abundance of misinformation found on the web, this behavior may pose a significant threat to internet users. Objective: This study aims to explore the knowledge and information-seeking behavior of people living with MS followed at a specialized MS clinic where education is a cornerstone of care. Methods: This cross-sectional survey--based study comprised 20 true or false statements, covering both scientific facts and popular misinformation about MS treatments. A ``scientific fact score'' and a ``misinformation score'' were calculated by attributing a scoring system to each point in the survey: +1 point was attributed to correct answers, --1 point was attributed to incorrect answers, and 0 point was attributed to ``I don't know.'' Furthermore, the survey inquired about participants' health-seeking behaviors. Results: The mean age of the 69 participants was 48.4 (SD 10.9) years, 78\% (54/69) were female, 81\% (56/69) were highly educated, 90\% (62/69) were receiving a disease-modifying therapy, and 52\% (30/58) had experimented with alternative therapies. The mean score for answering the scientific and misinformation questions correctly was 69\% (SD 2.4\%) and 22\% (SD 4.5\%), respectively (P<.001). Notably, when questioned about misinformation, answering correctly dropped significantly (P<.001), while indecision (P<.001) and answering incorrectly (P=.02) increased. Sociodemographic factors and medical questions were not significantly associated with scientific and misinformation scores (all P>.05); however, misinformation scores did significantly correlate with levels of education (P=.04). The main sources of health-related information were from expert-led MS websites (48/58, 82\%) and health care professionals (34/58, 59\%). Low-reliability sources were less used; however, word of mouth seemed to be prevalent (14/58, 24\%), followed by Facebook (10/58, 17\%). On average, people with MS reported having consulted 3 high- to moderate-quality sources and only 1 low-quality source. Conclusions: Education at the clinic and consulting primarily moderate- to high-quality sources did not safeguard against misinformation, indicating a need for more misinformation-geared education at the clinic. Notably, there is a need to proactively educate patients about misinformation commonly found on the web, and more importantly, create space for them to discuss the information without prejudice. As novel educational methods may be relatively more time-consuming, implementing change may be challenging. Furthermore, age, sex, education level, and health literacy might not safeguard against misinformation. Herein, we were unable to identify correlations associated with scores obtained on the questionnaire other than educational level. Although the educational level did seem to impact the misinformation score, this did not stop participants from experimenting with alternative therapies. Although studies are exploring novel ways to effectively deal with health misinformation on the web, more research is needed to fully understand this highly complex social phenomenon. ", doi="10.2196/63763", url="https://www.jmir.org/2025/1/e63763", url="http://www.ncbi.nlm.nih.gov/pubmed/39998866" } @Article{info:doi/10.2196/59956, author="Pierce, H. Joni and Weir, Charlene and Taft, Teresa and Richards II, William and McFarland, M. Mary and Kawamoto, Kensaku and Del Fiol, Guilherme and Butler, M. Jorie", title="Shared Decision-Making Tools Implemented in the Electronic Health Record: Scoping Review", journal="J Med Internet Res", year="2025", month="Feb", day="21", volume="27", pages="e59956", keywords="shared decision-making", keywords="patient engagement", keywords="decision support", keywords="electronic health records", abstract="Background: Patient-centered care promotes the involvement of patients in decision-making related to their health care. The adoption and implementation of shared decision-making (SDM) into routine care are constrained by several obstacles, including technical and time constraints, clinician and patient attitudes and perceptions, and processes that exist outside the standardized clinical workflow. Objective: We aimed to understand the integration and implementation characteristics of reported SDM interventions integrated into an electronic health record (EHR) system. Methods: We conducted a scoping review using the methodological framework by Arksey and O'Malley with guidance from the Joanna Briggs Institute. Eligibility criteria included original research and reviews focusing on SDM situations in a real-world clinical setting and EHR integration of SDM tools and processes. We excluded retrospective studies, conference abstracts, simulation studies, user design studies, opinion pieces, and editorials. To identify eligible studies, we searched the following databases on January 11, 2021: MEDLINE, Embase, CINAHL Complete, Cochrane Library including CENTRAL, PsycINFO, Scopus, and Web of Science Core Collection. We systematically categorized descriptive data and key findings in a tabular format using predetermined data charting forms. Results were summarized using tables and associated narratives related to the review questions. Results: Of the 2153 studies, 18 (0.84\%) were included in the final review. There was a high degree of variation across studies, including SDM definitions, standardized measures, technical integration, and implementation strategies. SDM tools that targeted established health care processes promoted their use. Integrating SDM templates and tools into an EHR appeared to improve the targeted outcomes of most (17/18, 94\%) studies. Most SDM interventions were designed for clinicians. Patient-specific goals and values were included in 56\% (10/18) of studies. The 2 most common study outcome measures were SDM-related measures and SDM tool use. Conclusions: Understanding how to integrate SDM tools directly into a clinician's workflow within the EHR is a logical approach to promoting SDM into routine clinical practice. This review contributes to the literature by illuminating features of SDM tools that have been integrated into an EHR system. Standardization of SDM tools and processes, including the use of patient decision aids, is needed for consistency across SDM studies. The implementation approaches for SDM applications showed varying levels of planning and effort to promote SDM intervention awareness. Targeting accepted and established clinical processes may enhance the adoption and use of SDM tools. Future studies designed as randomized controlled trials are needed to expand the quality of the evidence base. This includes the study of integration methods into EHR systems as well as implementation methods and strategies deployed to operationalize the uptake of the SDM-integrated tools. Emphasizing patients' goals and values is another key area for future studies. ", doi="10.2196/59956", url="https://www.jmir.org/2025/1/e59956" } @Article{info:doi/10.2196/53087, author="Krewulak, Karla and Strayer, Kathryn and Jaworska, Natalia and Spence, Krista and Foster, Nadine and Kupsch, Scotty and Sauro, Khara and Fiest, M. Kirsten", title="Evaluation of the Quality of Delirium Website Content for Patient and Family Education: Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Feb", day="20", volume="27", pages="e53087", keywords="education", keywords="health information", keywords="internet", keywords="delirium", keywords="patient", keywords="caregiver", keywords="brain lesions", keywords="confusion", keywords="inattentiveness", keywords="disorientation", keywords="family education", keywords="information seeking", keywords="readability", keywords="high-quality websites", keywords="accessibility", abstract="Background: Patients and families who have experienced delirium may seek information about delirium online, but the quality and reliability of online delirium-related websites are unknown. Objective: This study aimed to identify and evaluate online delirium-related websites that could be used for patient and family education. Methods: We searched Microsoft Bing, Google, and Yahoo using the keywords ``delirium'' and the misspelled ``delerium'' to identify delirium-related websites created to inform patients, families, and members of the public about delirium. The quality of identified delirium-related website content was evaluated by 2 authors using the validated DISCERN tool and the JAMA (Journal of the American Medical Association) benchmark criteria. Readability was assessed with the Simple Measure of Gobbledygook, the Flesch Reading Ease score, and the Flesch Kincaid grade level. Each piece of website content was assessed for its delirium-related information using a checklist of items co-designed by a working group, which included patients, families, researchers, and clinicians. Results: We identified 106 websites targeted toward patients and families, with most hospital-affiliated (21/106, 20\%) from commercial websites (20/106, 19\%), government-affiliated organizations (19/106, 18\%), or from a foundation or advocacy group (16/106, 15\%). The median time since the last content update was 3 (IQR 2-5) years. Most websites' content (101/106, 95\%) was written at a reading level higher than the recommended grade 6 level. The median DISCERN total score was 42 (IQR 33-50), with scores ranging from 20 (very poor quality) to 78 (excellent quality). The median delirium-related content score was 8 (IQR 6-9), with scores ranging from 1 to 12. Many websites lacked information on the short- and long-term outcomes of delirium as well as how common it is. The median JAMA benchmark score was 1 (IQR 1-3), indicating the quality of the websites' content had poor transparency. Conclusions: We identified high-quality websites that could be used to educate patients, families, or the public about delirium. While most delirium-related website content generally meets quality standards based on DISCERN and JAMA benchmark criteria, high scores do not always ensure patient and family-friendliness. Many of the top-rated delirium content were text-heavy and complex in layout, which could be overwhelming for users seeking clear, concise information. Future efforts should prioritize the development of websites with patients and families, considering usability, accessibility, and cultural relevance to ensure they are truly effective for delirium education. ", doi="10.2196/53087", url="https://www.jmir.org/2025/1/e53087", url="http://www.ncbi.nlm.nih.gov/pubmed/39977019" } @Article{info:doi/10.2196/63364, author="Abdulai, Abdul-Fatawu and Duong, Cam and Stroulia, Eleni and Czerniak, Efrat and Chiu, Rachel and Mehta, Aashay and Koike, Ken and Norman, V. Wendy", title="A Health Professional Mentorship Platform to Improve Equitable Access to Abortion: Development, Usability, and Content Evaluation", journal="JMIR Hum Factors", year="2025", month="Feb", day="19", volume="12", pages="e63364", keywords="medication abortion", keywords="mifepristone", keywords="web-based platform", keywords="user-centered design", keywords="underserved populations", keywords="abortion", keywords="equitable", keywords="accessibility", keywords="open-access website", keywords="gender-affirming", keywords="user-centered", keywords="Canada", keywords="unwanted pregnancy", keywords="framework", abstract="Background: Access to safe abortion care is a reproductive right for all individuals across Canada. Underserved populations are overrepresented among those with unintended pregnancies and particularly those seeking abortion. Yet, few resources exist to help health care and allied helping professionals provide culturally competent and gender-affirming abortion care to such a population group. Objective: This project aimed to redesign and adapt an existing subscription-based medication abortion mentorship platform into a culturally appropriate and gender-affirming open-access website of curated health professional resources to promote equitable, accessible, high-quality abortion care, particularly for underserved populations. Methods: We drew on a user-centered design framework to redesign the web platform in 5 iterative phases. Health care and allied helping professionals were engaged in each stage of the development process including the initial design of the platform, curation of the resources, review of the content, and evaluation of the wireframes and the end product. Results: This project resulted in an open-access bilingual (English and French) web-based platform containing comprehensive information and resources on abortion care for health care providers (physicians, nurse practitioners, and pharmacists) and allied helping professionals (midwives, medical officers, community workers, and social workers). The website incorporated information on clinical, logistical, and administrative guidance, including culturally competent and gender-affirming toolkits that could equip health care professionals with the requisite knowledge to provide abortion care for underserved populations. Conclusions: This platform contains resources that can increase the competencies of health care professionals to initiate and sustain culturally and contextually appropriate abortion care for underserved groups while clarifying myths and misconceptions that often militate against initiating abortion. Our resource also has the potential to support equitable access to high-quality abortion care, particularly for those among underserved populations who may have the greatest unmet need for abortion services yet face the greatest barriers to accessing care. ", doi="10.2196/63364", url="https://humanfactors.jmir.org/2025/1/e63364" } @Article{info:doi/10.2196/56038, author="Li, Xiancheng and Vaghi, Emanuela and Pasi, Gabriella and Coulson, S. Neil and De Simoni, Anna and Viviani, Marco and ", title="Understanding the Engagement and Interaction of Superusers and Regular Users in UK Respiratory Online Health Communities: Deep Learning--Based Sentiment Analysis", journal="J Med Internet Res", year="2025", month="Feb", day="13", volume="27", pages="e56038", keywords="social media", keywords="online health communities", keywords="social network analysis", keywords="sentiment analysis", keywords="bio-bidirectional encoder representations from transformers", keywords="asthma", keywords="chronic obstructive pulmonary disease", abstract="Background: Online health communities (OHCs) enable people with long-term conditions (LTCs) to exchange peer self-management experiential information, advice, and support. Engagement of ``superusers,'' that is, highly active users, plays a key role in holding together the community and ensuring an effective exchange of support and information. Further studies are needed to explore regular users' interactions with superusers, their sentiments during interactions, and their ultimate impact on the self-management of LTCs. Objective: This study aims to gain a better understanding of sentiment distribution and the dynamic of sentiment of posts from 2 respiratory OHCs, focusing on regular users' interaction with superusers. Methods: We conducted sentiment analysis on anonymized data from 2 UK respiratory OHCs hosted by Asthma UK (AUK), and the British Lung Foundation (BLF) charities between 2006-2016 and 2012-2016, respectively, using the Bio-Bidirectional Encoder Representation from Transformers (BioBERT), a pretrained language representation model. Given the scarcity of health-related labeled datasets, BioBERT was fine-tuned on the COVID-19 Twitter Dataset. Positive, neutral, and negative sentiments were categorized as 1, 0, and --1, respectively. The average sentiment of aggregated posts by regular users and superusers was then calculated. Superusers were identified based on a definition already used in our previous work (ie, ``the 1\% users with the largest number of posts over the observation period'') and VoteRank, (ie, users with the best spreading ability). Sentiment analyses of posts by superusers defined with both approaches were conducted for correlation. Results: The fine-tuned BioBERT model achieved an accuracy of 0.96. The sentiment of posts was predominantly positive (60\% and 65\% of overall posts in AUK and BLF, respectively), remaining stable over the years. Furthermore, there was a tendency for sentiment to become more positive over time. Overall, superusers tended to write shorter posts characterized by positive sentiment (63\% and 67\% of all posts in AUK and BLF, respectively). Superusers defined by posting activity or VoteRank largely overlapped (61\% in AUK and 79\% in BLF), showing that users who posted the most were also spreaders. Threads initiated by superusers typically encouraged regular users to reply with positive sentiments. Superusers tended to write positive replies in threads started by regular users whatever the type of sentiment of the starting post (ie, positive, neutral, or negative), compared to the replies by other regular users (62\%, 51\%, 61\% versus 55\%, 45\%, 50\% in AUK; 71\%, 62\%, 64\% versus 65\%, 56\%, 57\% in BLF, respectively; P<.001, except for neutral sentiment in AUK, where P=.36). Conclusions: Network and sentiment analyses provide insight into the key sustaining role of superusers in respiratory OHCs, showing they tend to write and trigger regular users' posts characterized by positive sentiment. ", doi="10.2196/56038", url="https://www.jmir.org/2025/1/e56038" } @Article{info:doi/10.2196/62750, author="Wallraf, Simon and K{\"o}themann, Sara and Wiesemann, Claudia and W{\"o}hlke, Sabine and Dierks, Marie-Luise and Schmidt, Andrea Marion and van Gils-Schmidt, Jasper Henk and Lander, Jonas", title="Digital Transformation in Patient Organizations: Interview and Focus Group Study", journal="J Med Internet Res", year="2025", month="Feb", day="13", volume="27", pages="e62750", keywords="patient organization", keywords="patient support", keywords="digitalization", keywords="digital transformation", keywords="health research", abstract="Background: Patient organizations (POs) are an integral part of the health care landscape, serving as advocates and support systems for patients and their families. As the digitalization of health care accelerates, POs are challenged to adapt their diverse roles to digital formats. However, the extent and form of POs' digital adaptation and the challenges POs encounter in their digital transformation remain unexplored. Objective: This study aims to investigate the digital transformation processes within POs. We examined the types of digital activities and processes implemented, people involved in respective tasks, challenges encountered, and attitudes toward the digitalization of POs. Methods: The study was carried out by the multicenter interdisciplinary research network Pandora. We adopted a qualitative exploratory approach by conducting 37 semistructured interviews and 2 focus groups with representatives and members of POs in Germany. Results were obtained using a deductive-inductive approach based on a qualitative content analysis. Methods and results were reported in accordance with the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Results: POs primarily apply basic digital tools to engage in communication, health education, and information dissemination. Some also develop specific mobile apps and collect health data through patient registries. Volunteers cover a considerable part of the workload. Sometimes, POs collaborate with external partners, such as health professionals or other nonprofit organizations. Furthermore, many (13/46, 28\%) interviewees referred to the importance of involving members in digitalization efforts to better meet their needs. However, they described the actual practices used to involve members in, for example, developing digital services as limited, passive, or implicit. When evaluating digital transformation processes, representatives and members of POs expressed generally positive attitudes and acknowledged their potential to improve the accessibility of support services, management efficiency, and outreach. Still, resource constraints; the complexity of digital initiatives; and accessibility issues for certain demographic groups, especially older persons, were frequently mentioned as challenges. Several (15/46, 33\%) interviewees highlighted POs' increasing responsibility to support their members' digital competencies and digital health literacy. Conclusions: POs are actively involved in the digital transformation of health services. To navigate challenges and further shape and sustain digital activities and processes, POs may benefit from governance frameworks, that is, a clear plan outlining with whom, how, and with what objectives digital projects are being realized. Support from public, scientific, and policy institutions to enhance the process through training, mentorship, and fostering collaborative networks seems warranted. ", doi="10.2196/62750", url="https://www.jmir.org/2025/1/e62750", url="http://www.ncbi.nlm.nih.gov/pubmed/39946181" } @Article{info:doi/10.2196/56533, author="Smith, R. Abigail and Mueller, R. Elizabeth and Lewis, E. Cora and Markland, Alayne and Smerdon, Caroline and Smith, L. Ariana and Sutcliffe, Siobhan and Wyman, F. Jean and Low, Kane Lisa and Miller, M. Janis and ", title="Assessment of Environmental, Sociocultural, and Physiological Influences on Women's Toileting Decisions and Behaviors Using ``Where I Go'': Pilot Study of a Mobile App", journal="JMIR Mhealth Uhealth", year="2025", month="Feb", day="12", volume="13", pages="e56533", keywords="ecological momentary assessment", keywords="time location factors", keywords="voiding diary", keywords="voiding behaviors", keywords="population studies", keywords="mobile application", keywords="app", keywords="bladder health", keywords="data collection tool", keywords="decision support", abstract="Background: Little is known about women's decisions around toileting for urination and how those decisions influence moment-to-moment behaviors to manage bladder needs. The new smartphone app ``Where I Go'' captures such nuanced and granular data in real-world environments. Objective: This study aims to describe participant engagement with ``Where I Go'', variation in novel parameters collected, and readiness for the data collection tool's use in population-based studies. Methods: ``Where I Go'' has three components: (1) real-time data, (2) short look-back periods (3?4 h), and (3) event location (GPS recorded at each interaction). The sample size was 44 women. Recording of real-time toileting events and responding to look-back questions was measured over 2 days of data collection. The participant's self-entered location descriptions and the automatic GPS recordings were compared. Results: A total of 44 women with an average age of 44 (range 21-85) years interacted with the app. Real-time reporting of at least 1 toileting event per day was high (38/44, 86\%, on day 1 and 40/44, 91\%, on day 2) with a median of 5 (IQR 3-7 on day 1 and IQR 3-8 on day 2) toileting events recorded each day. Toileting most commonly occurred at home (85/140, 61\%, on day 1 and 129/171, 75\%, on day 2) due to a need to go (114/140, 66\%, on day 1 and 153/171, 74\%, on day 2). The most common reasons for delaying toileting were ``work duties'' (33/140, 21\%, on day 1 and 21/171, 11\%, on day 2) and ``errands or traveling'' (19/140, 12\%, on day 1 and 19/171, 10\%, on day 2). Response to at least 1 look-back notification was similarly high (41/44, 93\%, on day 1 and 42/44, 95\%, on day 2), with number of responses higher on average on day 2 compared with day 1 (mean on day 1=3.2, 95\% CI 3.0-3.5; mean on day 2=4.3, 95\% CI 3.9-4.7; P<.001). Median additional toileting events reported on the look-back survey were 1 (IQR 1-2) and 2 (IQR 1-2) on days 1 and 2, respectively. Overall concordance between self-reported location recording and GPS was 76\% (188/247). Participants reported lower urge ratings when at home versus away when reporting real-time toileting (median rating 61, IQR 41-84 vs 72, IQR 56-98), and daily fluid intake showed a small to medium positive correlation with toileting frequency (day 1 r=0.3, day 2 r=0.24). Toileting frequency reported in ``Where I Go'' showed a small positive correlation with the frequency item from the International Consultation on Incontinence Questionnaire (r=0.31 with day 1 toileting frequency and r=0.21 with day 2 toileting frequency). Conclusions: ``Where I Go'' has potential to increase the understanding of factors that affect women's toileting decisions and long-term bladder health. We anticipate its use as a data collection tool in population-based studies. International Registered Report Identifier (IRRID): RR2-10.2196/54046 ", doi="10.2196/56533", url="https://mhealth.jmir.org/2025/1/e56533" } @Article{info:doi/10.2196/48775, author="Bhavnani, K. Suresh and Zhang, Weibin and Bao, Daniel and Raji, Mukaila and Ajewole, Veronica and Hunter, Rodney and Kuo, Yong-Fang and Schmidt, Susanne and Pappadis, R. Monique and Smith, Elise and Bokov, Alex and Reistetter, Timothy and Visweswaran, Shyam and Downer, Brian", title="Subtyping Social Determinants of Health in the ``All of Us'' Program: Network Analysis and Visualization Study", journal="J Med Internet Res", year="2025", month="Feb", day="11", volume="27", pages="e48775", keywords="social determinants of health", keywords="All of Us", keywords="bipartite networks", keywords="financial resources", keywords="health care", keywords="health outcomes", keywords="precision medicine", keywords="decision support", keywords="health industry", keywords="clinical implications", keywords="machine learning methods", abstract="Background: Social determinants of health (SDoH), such as financial resources and housing stability, account for between 30\% and 55\% of people's health outcomes. While many studies have identified strong associations between specific SDoH and health outcomes, little is known about how SDoH co-occur to form subtypes critical for designing targeted interventions. Such analysis has only now become possible through the All of Us program. Objective: This study aims to analyze the All of Us dataset for addressing two research questions: (1) What are the range of and responses to survey questions related to SDoH? and (2) How do SDoH co-occur to form subtypes, and what are their risks for adverse health outcomes? Methods: For question 1, an expert panel analyzed the range of and responses to SDoH questions across 6 surveys in the full All of Us dataset (N=372,397; version 6). For question 2, due to systematic missingness and uneven granularity of questions across the surveys, we selected all participants with valid and complete SDoH data and used inverse probability weighting to adjust their imbalance in demographics. Next, an expert panel grouped the SDoH questions into SDoH factors to enable more consistent granularity. To identify the subtypes, we used bipartite modularity maximization for identifying SDoH biclusters and measured their significance and replicability. Next, we measured their association with 3 outcomes (depression, delayed medical care, and emergency room visits in the last year). Finally, the expert panel inferred the subtype labels, potential mechanisms, and targeted interventions. Results: The question 1 analysis identified 110 SDoH questions across 4 surveys covering all 5 domains in Healthy People 2030. As the SDoH questions varied in granularity, they were categorized by an expert panel into 18 SDoH factors. The question 2 analysis (n=12,913; d=18) identified 4 biclusters with significant biclusteredness (Q=0.13; random-Q=0.11; z=7.5; P<.001) and significant replication (real Rand index=0.88; random Rand index=0.62; P<.001). Each subtype had significant associations with specific outcomes and had meaningful interpretations and potential targeted interventions. For example, the Socioeconomic barriers subtype included 6 SDoH factors (eg, not employed and food insecurity) and had a significantly higher odds ratio (4.2, 95\% CI 3.5-5.1; P<.001) for depression when compared to other subtypes. The expert panel inferred implications of the results for designing interventions and health care policies based on SDoH subtypes. Conclusions: This study identified SDoH subtypes that had statistically significant biclusteredness and replicability, each of which had significant associations with specific adverse health outcomes and with translational implications for targeted SDoH interventions and health care policies. However, the high degree of systematic missingness requires repeating the analysis as the data become more complete by using our generalizable and scalable machine learning code available on the All of Us workbench. ", doi="10.2196/48775", url="https://www.jmir.org/2025/1/e48775", url="http://www.ncbi.nlm.nih.gov/pubmed/39932771" } @Article{info:doi/10.2196/67289, author="Elkourdi, Farah and Asan, Onur", title="Community Caregivers' Perspectives on Health IT Use for Children With Medical Complexity: Qualitative Interview Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="10", volume="8", pages="e67289", keywords="pediatric care", keywords="children with medical complexity", keywords="family-centered care", keywords="health information technology", keywords="health care software solutions", keywords="mobile phone", keywords="artificial intelligence", abstract="Background: Children with medical complexity represent a unique pediatric population requiring extensive health care needs and care coordination. Children with medical complexities have multiple significant chronic health problems that affect multiple organ systems and result in functional limitations and high health care needs or use. Often, there is a need for medical technology and total care for activities of daily living, much of which is provided at home by family and caregivers. Health IT (HIT) is a broad term that includes various technologies, such as patient portals, telemedicine, and mobile health apps. These tools can improve the care of children with medical complexity by enhancing communication, information exchange, medical safety, care coordination, and shared decision-making. In this study, we identified children with medical complexity as children aged <21 years who have >3 chronic health conditions. Community caregivers contribute to the care management of children with medical complexity, serving as advocates and coordinators, primary sources of information about children's needs, and facilitators of access to care. They are often the first point of contact for the families of children with medical complexity, particularly in vulnerable communities, including families in rural areas, low-income households, and non--English-speaking immigrant populations. Objective: This study aims to introduce the HIT needs and preferences for children with medical complexity from the perspective of community caregivers. By including their perspective on HIT development, we can better appreciate the challenges they face, the insights they offer, and the ways in which they bridge gaps in care, support, and resources. Methods: We conducted semistructured interviews (n=12) with formal community caregivers of children with medical complexity populations from a parent advocacy network on the US East Coast. Interviews were audio recorded via Zoom and then transcribed. An inductive thematic analysis was conducted to reveal HIT challenges and preferences for improving the care of children with medical complexity. Results: We categorized the interview results into themes and subthemes. There are four main themes: (1) telehealth transforming care for children with medical complexity during the COVID-19 pandemic, (2) suggested tools and technologies for care for children with medical complexity, (3) HIT feature preferences, and (4) transition to adult care. Each theme had multiple subthemes capturing all details related to design features of needed technologies. Conclusions: The study emphasizes the need to develop and enhance HIT for the care of children with medical complexity. The identified themes can serve as design guidelines for designers by establishing a foundation for user-centered HIT tools to effectively support children with medical complexity and their families. Telehealth and mobile health apps could improve care management and quality of life for children with medical complexity. ", doi="10.2196/67289", url="https://pediatrics.jmir.org/2025/1/e67289" } @Article{info:doi/10.2196/60862, author="Hao, Haijing and Lee, W. Yang and Sharko, Marianne and Li, Qilu and Zhang, Yiye", title="Privacy Concerns Versus Personalized Health Content---Pregnant Individuals' Willingness to Share Personal Health Information on Social Media: Survey Study", journal="JMIR Form Res", year="2025", month="Feb", day="10", volume="9", pages="e60862", keywords="privacy concerns", keywords="trust", keywords="pregnancy", keywords="health information seeking", keywords="pregnant women", keywords="maternal", keywords="maternity", keywords="childbearing", keywords="web-based information", keywords="health information", keywords="mental health", keywords="internet", keywords="social support", keywords="technology", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="health informatics", keywords="social media", abstract="Background: Often lacking immediate access to care providers, pregnant individuals frequently turn to web-based sources for information to address their evolving physical and mental health needs. Social media has gained increasing prominence as a source of news and information despite privacy concerns and unique risks posed to the pregnant population. Objectives: This study investigated the extent to which patients may be willing to disclose personal health information to social media companies in exchange for more personalized health content. Methods: We designed and deployed an electronic survey to pregnant individuals worldwide electronically in 2023. We used the classical Internet Users' Information Privacy Concerns (IUIPC) model to examine how privacy concerns modulate pregnant individuals' behaviors and beliefs regarding risk and trust when using social media for health purposes. Results were analyzed using partial least squares structural equation modeling. Results: Among 317 respondents who initiated the survey, 84\% (265/317) of the respondents remained in the study, providing complete responses. Among them, 54.7\% (145/265) indicated willingness to provide their personalized health information for receiving personalized health content via social media, while 26\% (69/265) were uncertain and 19.3\% (51/265) were opposed. Our estimated IUIPC model results are statistically significant and qualitatively align with the classic IUIPC model for the general population, which was previously found in an e-commerce context. The structural model revealed that privacy concerns (IUIPC) negatively affected trusting beliefs ($\beta$=?0.408; P<.001) and positively influenced risk beliefs ($\beta$=0.442; P<.001). Trusting beliefs negatively impacted risk beliefs ($\beta$=?o.362; P<.001) and positively affected the intention to disclose personal health information ($\beta$=o.266; P<.001). Risk beliefs negatively influenced the intention to disclose ($\beta$=?0.281; P<.001). The model explained 41.5\% of the variance in the intention to disclose personal health information (R{\texttwosuperior}=0.415). In parallel with pregnant individuals' willingness to share, we find that they have heightened privacy concerns and their use of social media for information seeking is largely impacted by their trust in the platforms. This heightened concern significantly affects both their trusting beliefs, making them less inclined to trust social media companies, and their risk beliefs, leading them to perceive greater risks in sharing personal health information. However, within this population, an increase in trust toward social media companies leads to a more substantial decrease in perceived risks than what has been previously observed in the general population. Conclusions: We find that more than half of the pregnant individuals are open to sharing their personal health information to receive personalized content about health via social media, although they have more privacy concerns than the general population. This study emphasizes the need for policy regarding the protection of health data on social media for the pregnant population and beyond. ", doi="10.2196/60862", url="https://formative.jmir.org/2025/1/e60862" } @Article{info:doi/10.2196/66440, author="Khalighi, Mehraneh and Thomas, C. Amy and Brown, J. Karl and Ritchey, C. Katherine", title="Agreement Between Provider-Completed and Patient-Completed Preoperative Frailty Screening Using the Clinical Risk Analysis Index: Cross-Sectional Questionnaire Study", journal="JMIR Perioper Med", year="2025", month="Feb", day="10", volume="8", pages="e66440", keywords="Risk Analysis Index", keywords="preoperative screening", keywords="questionnaire", keywords="frailty", keywords="self-reported", keywords="veteran", keywords="hip", keywords="knee", keywords="arthroplasty", keywords="elective surgery", keywords="cross-sectional", keywords="quality improvement", abstract="Background: Frailty is associated with postoperative morbidity and mortality. Preoperative screening and management of persons with frailty improves postoperative outcomes. The Clinical Risk Analysis Index (RAI-C) is a validated provider-based screening tool for assessing frailty in presurgical populations. Patient self-screening for frailty may provide an alternative to provider-based screening if resources are limited; however, the agreement between these 2 methods has not been previously explored. Objective: The objective of our study was to examine provider-completed versus patient-completed RAI-C assessments to identify areas of disagreement between the 2 methods and inform best practices for RAI-C screening implementation. Methods: Orthopedic physicians and physician assistants completed the RAI-C assessment on veterans aged 65 years and older undergoing elective total joint arthroplasty (eg, total hip or knee arthroplasty) and documented scores into the electronic health record during their preoperative clinic evaluation. Participants were then mailed the same RAI-C form after preoperative evaluation and returned responses to study coordinators. Agreement between provider-completed and patient-completed RAI-C assessments and differences within individual domains were compared. Results: A total of 49 participants aged 65 years and older presenting for total joint arthroplasty underwent RAI-C assessment between November 2022 and August 2023. In total, 41\% (20/49) of participants completed and returned an independent postvisit RAI-C assessment before surgery and within 180 days of their initial evaluation. There was a moderate but statistically significant correlation between provider-completed and patient-completed RAI-C assessments (r=0.62; 95\% CI 0.25-0.83; P=.003). Provider-completed and patient-completed RAI-C assessments resulted in the same frailty classification in 60\% (12/20) of participants, but 40\% (8/20) of participants were reclassified to a more frail category based on patient-completed assessment. Agreement was the lowest between provider-completed and patient-completed screening questions regarding memory and activities of daily living. Conclusions: RAI-C had moderate agreement when completed by providers versus the participants themselves, with more than a third of patient-completed screens resulting in a higher frailty classification. Future studies will need to explore the differences between and accuracy of RAI-C screening approaches to inform best practices for preoperative RAI-C assessment implementation. ", doi="10.2196/66440", url="https://periop.jmir.org/2025/1/e66440", url="http://www.ncbi.nlm.nih.gov/pubmed/39928399" } @Article{info:doi/10.2196/59665, author="Wong, Po Ka and Teh, Pei-Lee and Lim, Marc Weng and Lee, Huey Shaun Wen", title="Enhancing Older Adults' Lives Through Positive Aging Perception, Quality-of-Life Enhancement, and Social Support to Drive Acceptance and Readiness Toward Indoor Assistive Technology: Cross-Sectional Study", journal="JMIR Aging", year="2025", month="Feb", day="5", volume="8", pages="e59665", keywords="indoor assistive technology", keywords="positive aging perceptions", keywords="quality of life", keywords="social support", keywords="technology acceptance", keywords="technology readiness", abstract="Background: The growing aging population faces increasing mobility limitations, highlighting the need for assistive technologies as potential solutions. These technologies support the independence and well-being of older adults and individuals with mobility challenges. Indoor mobility is essential for daily activities and significantly impacts their lives. Limited indoor mobility can reduce quality of life and heighten the risk of falls. Objective: This study explores how positive aging perceptions, quality-of-life enhancements, and social support influence the acceptance and readiness of indoor assistive technologies among older adults. Methods: A cross-sectional study was conducted at a gerontechnology laboratory, requiring participants to visit the facility in person. Each 60-minute session included demonstrations of various indoor assistive technologies and the completion of a questionnaire. The assistive technologies showcased encompassed a wide range of devices. Participants' positive aging perceptions, quality-of-life enhancements, social support, technology acceptance, and readiness were measured using validated scales. Data were analyzed with AMOS (version 28; IBM Corp) and SPSS (version 28; IBM Corp), using structural equation modeling and multivariate analysis of covariance to assess the effects of predictors while controlling for demographic factors. Results: A total of 104 older adults aged 60 years and older participated, with a mean age of 67.92 (SD 5.68) years. Structural equation modeling indicated that positive aging perception has a significant influence on older adults' control beliefs (P=.095), comfort (P=.047), and confidence (P<.001) in gerontechnology. Multivariate analysis revealed significant combined effects of quality-of-life enhancement (P=.01) and social support (P=.03) on technology acceptance and readiness, wherein quality-of-life enhancement (P=.001) and social support (P=.008) negatively impacted security perception. Among demographic variables, educational level significantly impacted gerontechnology confidence (P=.004) while ethnicity influenced optimism (P=.003). Conclusions: This study sheds light on key factors affecting older adults' acceptance and readiness to adopt indoor assistive technologies. Findings highlight the importance of fostering positive aging perceptions through these technologies. Addressing issues related to control beliefs, comfort, and confidence in gerontechnology is essential to enhance technology acceptance and readiness among older adults. Future research should investigate the underlying mechanisms and create targeted interventions to support successful technology adoption in this population. ", doi="10.2196/59665", url="https://aging.jmir.org/2025/1/e59665" } @Article{info:doi/10.2196/66666, author="Rudin, S. Robert and Herman, M. Patricia and Vining, Robert", title="Addressing the ``Black Hole'' of Low Back Pain Care With Clinical Decision Support: User-Centered Design and Initial Usability Study", journal="JMIR Form Res", year="2025", month="Feb", day="4", volume="9", pages="e66666", keywords="low back pain", keywords="clinical decision support", keywords="user-centered design", keywords="usability", keywords="back pain", keywords="low back pain care", keywords="pain", keywords="clinical decision", keywords="societal burden", keywords="substantial", keywords="burden", keywords="evidence-based", keywords="treatment", keywords="diagnosis", keywords="support tool", keywords="clinicians", keywords="chiropractic", keywords="chiropractor", keywords="reviews", keywords="scenario-based interviews", keywords="interviews", abstract="Background: Low back pain (LBP) is a highly prevalent problem causing substantial personal and societal burden. Although there are specific types of LBP, each with evidence-based treatment recommendations, most patients receive a nonspecific diagnosis that does not facilitate evidence-based and individualized care. Objectives: We designed, developed, and initially tested the usability of a LBP diagnosis and treatment decision support tool based on the available evidence for use by clinicians who treat LBP, with an initial focus on chiropractic care. Methods: Our 3-step user-centered design approach consisted of identifying clinical requirements through the analysis of evidence reviews, iteratively identifying task-based user requirements and developing a working web-based prototype, and evaluating usability through scenario-based interviews and the System Usability Scale. Results: The 5 participating users had an average of 18.5 years of practicing chiropractic medicine. Clinical requirements included 44 patient interview and examination items. Of these, 13 interview items were enabled for all patients and 13 were enabled conditional on other input items. One examination item was enabled for all patients and 16 were enabled conditional on other items. One item was a synthesis of interview and examination items. These items provided evidence of 12 possible working diagnoses of which 3 were macrodiagnoses and 9 were microdiagnoses. Each diagnosis had relevant treatment recommendations and corresponding patient educational materials. User requirements focused on tasks related to inputting data, and reviewing and selecting working diagnoses, treatments, and patient education. User input led to key refinements in the design, such as organizing the input questions by microdiagnosis, adding a patient summary screen that persists during data input and when reviewing output, adding more information buttons and graphics to input questions, and providing traceability by highlighting the input items used by the clinical logic to suggest a working diagnosis. Users believed that it would be important to have the tool accessible from within an electronic health record for adoption within their workflows. The System Usability Scale score for the prototype was 84.75 (range: 67.5?95), considered as the top 10th percentile. Users believed that the tool was easy to use although it would require training and practice on the clinical content to use it effectively. With such training and practice, users believed that it would improve care and shed light on the ``black hole'' of LBP diagnosis and treatment. Conclusions: Our systematic process of defining clinical requirements and eliciting user requirements to inform a clinician-facing decision support tool produced a prototype application that was viewed positively and with enthusiasm by clinical users. With further planned development, this tool has the potential to guide clinical evaluation, inform more specific diagnosis, and encourage patient education and individualized treatment planning for patients with LBP through the application of evidence at the point of care. ", doi="10.2196/66666", url="https://formative.jmir.org/2025/1/e66666" } @Article{info:doi/10.2196/62670, author="Heaney-Huls, Krysta and Shams, Rida and Nwefo, Ruth and Kane, Rachel and Gordon, Janna and Laffan, M. Alison and Stare, Scott and Dullabh, Prashila", title="Electronic Health Record Data Collection Practices to Advance Standardization and Interoperability of Patient Preferences for Interpretation Services: Qualitative Study", journal="J Med Internet Res", year="2025", month="Jan", day="31", volume="27", pages="e62670", keywords="health information exchange", keywords="interoperability", keywords="electronic health records", keywords="interpreter", keywords="limited English proficiency", keywords="communication barriers", abstract="Background: Poor health outcomes are well documented among patients with a non-English language preference (NELP). The use of interpreters can improve the quality of care for patients with NELP. Despite a growing and unmet need for interpretation services in the US health care system, rates of interpreter use in the care setting are consistently low. Standardized collection and exchange of patient interpretation needs can improve access to appropriate language assistance services. Objective: This study aims to examine current practices for collecting, documenting, and exchanging information on a patient's self-reported preference for an interpreter in the electronic health record (EHR) and the implementation maturity and adoption level of available data standards. The paper identifies standards implementation; data collection workflows; use cases for collecting, documenting, and exchanging information on a patient's self-reported preference for an interpreter; challenges to data collection and use; and opportunities to advance standardization of the interpreter needed data element to facilitate patient-centered care. Methods: We conducted a narrative review to describe the availability of terminology standards to facilitate health care organization documentation of a patient's self-reported preference for an interpreter in the EHR. Key informant discussions with EHR developers, health systems, clinicians, a practice-based research organization, a national standards collaborative, a professional health care association, and Federal agency representatives filled in gaps from the narrative review. Results: The findings indicate that health care organizations value standardized collection and exchange of patient language assistance service needs and preferences. Informants identified three use cases for collecting, documenting, and exchanging information on a patient's self-reported preference for an interpreter, which are (1) person-centered care, (2) transitions of care, and (3) health care administration. The discussions revealed that EHR developers provide a data field for documenting interpreter needed data, which are routinely collected across health care organizations through commonly used data collection workflows. However, this data element is not mapped to standard terminologies, such as Logical Observation Identifiers Names and Codes (LOINC) or Systematized Medical Nomenclature for Medicine--Clinical Terminology (SNOMED-CT), consequently limiting the opportunities to electronically share these data between health systems and community-based organizations. The narrative review and key informant discussions identified three potential challenges to using information on a patient's self-reported preference for an interpreter for person-centered care and quality improvement, which are (1) lack of adoption of available data standards, (2) limited electronic exchange, and (3) patient mistrust. Conclusions: Collecting and documenting patient's self-reported interpreter preferences can improve the quality of services provided, patient care experiences, and equitable health care delivery without invoking a significant burden on the health care system. Although there is routine collection and documentation of patient interpretation needs, the lack of standardization limits the exchange of this information among health care and community-based organizations. ", doi="10.2196/62670", url="https://www.jmir.org/2025/1/e62670", url="http://www.ncbi.nlm.nih.gov/pubmed/39888652" } @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/10.2196/62931, author="Moumjid, Nora and Gotte, Constance and Hommey, Sophie and Poupon Bourdy, St{\'e}phanie and Haesebaert, Julie and Durieu, Isabelle and Reynaud, Quitterie", title="Mixed Comparative Evaluation of a Training Program Dedicated to Cystic Fibrosis Reference Centers: Protocol for the Pilot Implementation of Shared Decision-Making in the Treatment of Diabetes in Adult Patients With Cystic Fibrosis", journal="JMIR Res Protoc", year="2025", month="Jan", day="28", volume="14", pages="e62931", keywords="shared decision-making", keywords="implementation", keywords="training", keywords="decision aid", keywords="cystic fibrosis", abstract="Background: Diabetes affects half of the patients with cystic fibrosis who are aged 30 years and older. Diabetes progresses asymptomatically over a long period of time. Two treatment options are possible: start insulin as soon as cystic fibrosis diagnosis is made with the additional constraints of cystic fibrosis or wait while monitoring the patient's clinical condition and start insulin when diabetes symptoms develop and therefore later. This situation is particularly well suited to shared decision-making (SDM) between the physician (health care team) and patient/relatives. Objective: The aim of this study was to perform qualitative and quantitative analyses for evaluating the outcomes and experience of SDM implementation between the physician/health care team trained for SDM and patients/their relatives for cystic fibrosis--related diabetes. Methods: A quasi-experimental with a comparison study will be developed. Three cystic fibrosis reference centers (CFRCs) will be trained in SDM by using a web-based training, including a validated decision aid and coaching for physicians and the medical team. Two control CFRCs will maintain their usual practices. A qualitative analysis through observation of consultations, individual semistructured interviews with patients, and focus groups in CFRCs will be conducted based on a thematic content analysis. Questionnaires related to decision-making and experience of decision-making with and without SDM implementation will be administered to patients and physicians. Results: Forty patients will be included (8 patients in each center), that is, 60 consultation observations (2 consultations per patient in the intervention groups given the modalities of the SDM process) will be conducted in 2025. Eight focus groups will be conducted in the 5 centers (2 groups in each intervention CFRC and 1 group in each control CFRC). This qualitative corpus plus responses to the patient and physician questionnaires will make it possible to know whether the practice of SDM in CFRCs is increased by an implementation strategy and to analyze the experience of patients and their relatives regarding decision-making modalities. Analysis of the outcomes and experience of the implementation of SDM are of importance to identify the facilitators and barriers to SDM from patients' and CFRCs' point of views. Conclusions: Our study will give us keys to adapt, improve, and disseminate SDM more widely in the context of cystic fibrosis therapy. SDM could thus be used in routine clinical practice in CFRCs at the national level. Trial Registration: ClinicalTrials.gov NCT04891159; https://clinicaltrials.gov/study/NCT04891159?id=NCT04891159 International Registered Report Identifier (IRRID): PRR1-10.2196/62931 ", doi="10.2196/62931", url="https://www.researchprotocols.org/2025/1/e62931" } @Article{info:doi/10.2196/60829, author="Karasek, Deborah and Williams, C. Jazzmin and Taylor, A. Michaela and De La Cruz, M. Monica and Arteaga, Stephanie and Bell, Sabra and Castillo, Esperanza and Chand, A. Maile and Coats, Anjeanette and Hubbard, M. Erin and Love-Goodlett, Latriece and Powell, Breezy and Spellen, Solaire and Malawa, Zea and Gomez, Manchikanti Anu", title="Designing the First Pregnancy Guaranteed Income Program in the United States: Qualitative Needs Assessment and Human-Centered Design to Develop the Abundant Birth Project", journal="JMIR Form Res", year="2025", month="Jan", day="27", volume="9", pages="e60829", keywords="maternal and child health", keywords="economics", keywords="public health", keywords="qualitative research methods", keywords="programs (evaluation and funding)", keywords="community-centered", keywords="pregnancy", keywords="first pregnancy", keywords="behavioral interventions", keywords="racial health", keywords="financial stress", keywords="Abundant Birth Project", keywords="infant health", keywords="infant", keywords="Black", abstract="Background: Racial inequities in pregnancy outcomes persist despite investments in clinical, educational, and behavioral interventions, indicating that a new approach is needed to address the root causes of health disparities. Guaranteed income during pregnancy has the potential to narrow racial health inequities for birthing people and infants by alleviating financial stress. Objective: We describe community-driven formative research to design the first pregnancy-guaranteed income program in the United States---the Abundant Birth Project (ABP). Informed by birth equity and social determinants of health perspectives, ABP targets upstream structural factors to improve racial disparities in maternal and infant health. Methods: The research team included community researchers, community members with lived experience as Black or Pacific Islander pregnant, and parenting people in the San Francisco Bay Area. The team conducted needs assessment interviews and facilitated focus groups with participants using human-centered design methods. Needs assessment participants later served as co-designers of the ABP program and research, sharing their experiences with financial hardships and government benefits programs and providing recommendations on key program elements, including fund disbursement, eligibility, and amount. Results: Housing affordability and the high cost of living in San Francisco emerged as significant sources of stress in pregnancy. Participants reported prohibitively low income eligibility thresholds and burdensome enrollment processes as challenges or barriers to existing social services. These insights guided the design of prototypes of ABP's program components, which were used in a design sprint to determine the final components. Based on this design process, the ABP program offered US \$1000/month for 12 months to pregnant Black and Pacific Islander people, selected through a lottery called an abundance drawing. Conclusions: The formative design process maximized community input and shared decision-making to co-design a guaranteed income program for Black and Pacific Islander women and people. Our upstream approach and community research model can inform the development of public health and social service programs. ", doi="10.2196/60829", url="https://formative.jmir.org/2025/1/e60829" } @Article{info:doi/10.2196/63818, author="Barbazi, Neda and Shin, Youn Ji and Hiremath, Gurumurthy and Lauff, Anne Carlye", title="Developing Assessments for Key Stakeholders in Pediatric Congenital Heart Disease: Qualitative Pilot Study to Inform Designing of a Medical Education Toy", journal="JMIR Form Res", year="2025", month="Jan", day="27", volume="9", pages="e63818", keywords="assessment", keywords="congenital heart disease", keywords="children health literacy", keywords="health education", keywords="caregiving", keywords="patient-centered care", keywords="design", keywords="qualitative pilot", keywords="children health", keywords="educational interventions", abstract="Background: Congenital heart disease (CHD) is a birth defect of the heart that requires long-term care and often leads to additional health complications. Effective educational strategies are essential for improving health literacy and care outcomes. Despite affecting around 40,000 children annually in the United States, there is a gap in understanding children's health literacy, parental educational burdens, and the efficiency of health care providers in delivering education. Objective: This qualitative pilot study aims to develop tailored assessment tools to evaluate educational needs and burdens among children with CHD, their parents, and health care providers. These assessments will inform the design of medical education toys to enhance health management and outcomes for pediatric patients with CHD and key stakeholders. Methods: Through stakeholder feedback from pediatric patients with CHD, parents, and health care providers, we developed three tailored assessments in two phases: (1) iterative development of the assessment tools and (2) pilot testing. In the first phase, we defined key concepts, conducted a literature review, and created initial drafts of the assessments. During the pilot-testing phase, 12 participants were recruited at the M Health Fairview Pediatric Specialty Clinic for Cardiology---Explorer in Minneapolis, Minnesota, United States. We gathered feedback using qualitative methods, including cognitive interviews such as think-aloud techniques, verbal probing, and observations of nonverbal cues. The data were analyzed to identify the strengths and weaknesses of each assessment item and areas for improvement. Results: The 12 participants included children with CHD (n=5), parents (n=4), and health care providers (n=3). The results showed the feasibility and effectiveness of the tailored assessments. Participants showed high levels of engagement and found the assessment items relevant to their education needs. Iterative revisions based on participant feedback improved the assessments' clarity, relevance, and engagement for all stakeholders, including children with CHD. Conclusions: This pilot study emphasizes the importance of iterative assessment development, focusing on multistakeholder engagement. The insights gained from the development process will guide the creation of tailored assessments and inform the development of child-led educational interventions for pediatric populations with CHD. ", doi="10.2196/63818", url="https://formative.jmir.org/2025/1/e63818" } @Article{info:doi/10.2196/67143, author="Eisinger, Felix and Holderried, Friederike and Mahling, Moritz and Stegemann--Philipps, Christian and Herrmann--Werner, Anne and Nazarenus, Eric and Sonanini, Alessandra and Guthoff, Martina and Eickhoff, Carsten and Holderried, Martin", title="What's Going On With Me and How Can I Better Manage My Health? The Potential of GPT-4 to Transform Discharge Letters Into Patient-Centered Letters to Enhance Patient Safety: Prospective, Exploratory Study", journal="J Med Internet Res", year="2025", month="Jan", day="21", volume="27", pages="e67143", keywords="GPT-4", keywords="patient letters", keywords="health care communication", keywords="artificial intelligence", keywords="patient safety", keywords="patient education", abstract="Background: For hospitalized patients, the discharge letter serves as a crucial source of medical information, outlining important discharge instructions and health management tasks. However, these letters are often written in professional jargon, making them difficult for patients with limited medical knowledge to understand. Large language models, such as GPT, have the potential to transform these discharge summaries into patient-friendly letters, improving accessibility and understanding. Objective: This study aims to use GPT-4 to convert discharge letters into more readable patient-centered letters. We evaluated how effectively and comprehensively GPT-4 identified and transferred patient safety--relevant information from the discharge letters to the transformed patient letters. Methods: Three discharge letters were created based on common medical conditions, containing 72 patient safety--relevant pieces of information, referred to as ``learning objectives.'' GPT-4 was prompted to transform these discharge letters into patient-centered letters. The resulting patient letters were analyzed for medical accuracy, patient centricity, and the ability to identify and translate the learning objectives. Bloom's taxonomy was applied to analyze and categorize the learning objectives. Results: GPT-4 addressed the majority (56/72, 78\%) of the learning objectives from the discharge letters. However, 11 of the 72 (15\%) learning objectives were not included in the majority of the patient-centered letters. A qualitative analysis based on Bloom's taxonomy revealed that learning objectives in the ``Understand'' category (9/11) were more frequently omitted than those in the ``Remember'' category (2/11). Most of the missing learning objectives were related to the content field of ``prevention of complications.'' By contrast, learning objectives regarding ``lifestyle'' and ``organizational'' aspects were addressed more frequently. Medical errors were found in a small proportion of sentences (31/787, 3.9\%). In terms of patient centricity, the patient-centered letters demonstrated better readability than the discharge letters. Compared with discharge letters, they included fewer medical terms (132/860, 15.3\%, vs 165/273, 60/4\%), fewer abbreviations (43/860, 5\%, vs 49/273, 17.9\%), and more explanations of medical terms (121/131, 92.4\%, vs 0/165, 0\%). Conclusions: Our study demonstrates that GPT-4 has the potential to transform discharge letters into more patient-centered communication. While the readability and patient centricity of the transformed letters are well-established, they do not fully address all patient safety--relevant information, resulting in the omission of key aspects. Further optimization of prompt engineering may help address this issue and improve the completeness of the transformation. ", doi="10.2196/67143", url="https://www.jmir.org/2025/1/e67143" } @Article{info:doi/10.2196/64265, author="Beauchemin, P. Melissa and Walker, Desiree and Rosen, Allison and Frazer, Maria and Eisenberger, Meital and Khurana, K. Rhea and Bentlyewski, Edward and Fedorko, Victoria and Basch, H. Corey and Hillyer, C. Grace", title="Insights From Diverse Perspectives on Social Media Messages to Inform Young Adults With Cancer About Clinical Trials: Focus Group Study", journal="JMIR Form Res", year="2025", month="Jan", day="20", volume="9", pages="e64265", keywords="young adults", keywords="adolescent and young adult cancer", keywords="cancer", keywords="cancer treatment", keywords="clinical trials", keywords="clinical trial awareness", keywords="clinical trial enrollment", keywords="clinical trial knowledge", keywords="clinical trial attitudes", keywords="clinical trial enrollment barriers", keywords="social media", keywords="social media messages", keywords="psychosocial", keywords="United States", abstract="Background: Low rates of adolescent and young adult (YA; aged 15-39 y) clinical trial enrollment (CTE), particularly among underserved groups, have resulted in a lack of standardized cancer treatments and follow-up guidelines for this group that may limit improvement in cancer treatments and survival outcomes for YAs. Objective: To understand and address unique barriers to CTE, we conducted focus groups to learn about informational, financial, and psychosocial needs of YAs surrounding CTE and identify strategies to address these barriers. Methods: We conducted 5 focus groups in 2023 among a diverse sample of YA patients from across the United States. An interview guide was developed collaboratively with YA advocates. Specifically, informational needs, financial concerns, and psychosocial issues were explored, and participants were probed to suggest strategies, especially those that leverage technology, to address these barriers. Sessions were audio recorded, transcribed, and coded using direct content analysis. Findings were synthesized through consensus discussions. Results: We confirmed the previously proposed thematic barriers regarding YA CTE and identified 9 subthemes: awareness, lack of clear and accessible CTE information, fear of the unknown, assumptions about costs, insurance coverage, navigating financial responsibilities, clinical trial discussions, clinical trial misconceptions, and desire for a support network. Throughout, YAs mentioned needs that might be addressed through informational outreach leveraging digital technology, the internet, and social media. Conclusions: This study expands knowledge of YA perceived barriers to CTE. These findings suggest that leveraging digital technology to disseminate reliable information to address needs may be an effective strategy to improve clinical trial participation in the YA population. ", doi="10.2196/64265", url="https://formative.jmir.org/2025/1/e64265" } @Article{info:doi/10.2196/56523, author="Bondaronek, Paulina and Li, Jingfeng and Potts, W. Henry W.", title="Public Understanding and Expectations of Digital Health Evidence Generation: Focus Group Study", journal="JMIR Form Res", year="2025", month="Jan", day="20", volume="9", pages="e56523", keywords="mobile apps", keywords="digital health", keywords="public expectations", keywords="evidence of effectiveness", keywords="health risk perception", keywords="effectiveness", keywords="health risk", keywords="health app", keywords="public health", keywords="well-being", keywords="public trust", keywords="diagnostic tools", keywords="safety", keywords="mobile phone", abstract="Background: The rapid proliferation of health apps has not been matched by a comparable growth in scientific evaluations of their effectiveness, particularly for apps available to the public. This gap has prompted ongoing debate about the types of evidence necessary to validate health apps, especially as the perceived risk level varies from wellness tools to diagnostic aids. The perspectives of the general public, who are direct stakeholders, are notably underrepresented in discussions on digital health evidence generation. Objective: This study aimed to explore public understanding and expectations regarding the evidence required to demonstrate health apps' effectiveness, including at varying levels of health risk. Methods: A total of 4 focus group discussions were held with UK residents aged 18 years and older, recruited through targeted advertisements to ensure demographic diversity. Participants discussed their views on evidence requirements for 5 hypothetical health apps, ranging from low-risk wellness apps to high-risk diagnostic tools. Focus groups were moderated using a structured guide, and data were analyzed using reflexive thematic analysis to extract common themes. Results: A total of 5 key themes were established: personal needs, app functionality, social approval, expectations of testing, and authority. Participants relied on personal experiences and social endorsements when judging the effectiveness of low-risk digital health interventions, while making minimal reference to traditional scientific evidence. However, as the perceived risk of an app increased, there was a noticeable shift toward preferring evidence from authoritative sources, such as government or National Health Service endorsements. Conclusions: The public have a preference for evidence that resonates on a personal level, but also show a heightened demand for authoritative guidance as the potential risk of digital health interventions increases. These perspectives should guide developers, regulators, and policy makers as they balance how to achieve innovation, safety, and public trust in the digital health landscape. Engaging the public in evidence-generation processes and ensuring transparency in app functionality and testing can bridge the gap between public expectations and regulatory standards, fostering trust in digital health technologies. ", doi="10.2196/56523", url="https://formative.jmir.org/2025/1/e56523" } @Article{info:doi/10.2196/59301, author="Vanka, Anita and Johnston, T. Katherine and Delbanco, Tom and DesRoches, M. Catherine and Garcia, Annalays and Salmi, Liz and Blease, Charlotte", title="Guidelines for Patient-Centered Documentation in the Era of Open Notes: Qualitative Study", journal="JMIR Med Educ", year="2025", month="Jan", day="20", volume="11", pages="e59301", keywords="open notes", keywords="patient-centered documentation skills", keywords="medical student education", keywords="21st Century Cures Act", abstract="Background: Patients in the United States have recently gained federally mandated, free, and ready electronic access to clinicians' computerized notes in their medical records (``open notes''). This change from longstanding practice can benefit patients in clinically important ways, but studies show some patients feel judged or stigmatized by words or phrases embedded in their records. Therefore, it is imperative that clinicians adopt documentation techniques that help both to empower patients and minimize potential harms. Objective: At a time when open and transparent communication among patients, families, and clinicians can spread more easily throughout medical practice, this inquiry aims to develop informed guidelines for documentation in medical records. Methods: Through a series of focus groups, preliminary guidelines for documentation language in medical records were developed by health professionals and patients. Using a structured focus group decision guide, we conducted 4 group meetings with different sets of 27 participants: physicians experienced with writing open notes (n=5), patients accustomed to reviewing their notes (n=8), medical student educators (n=7), and resident physicians (n=7). To generate themes, we used an iterative coding process. First-order codes were grouped into second-order themes based on the commonality of meanings. Results: The participants identified 10 important guidelines as a preliminary framework for developing notes sensitive to patients' needs. Conclusions: The process identified 10 discrete themes that can help clinicians use and spread patient-centered documentation. ", doi="10.2196/59301", url="https://mededu.jmir.org/2025/1/e59301" } @Article{info:doi/10.2196/68046, author="Lachman, Peter and Fitzsimons, John", title="Transforming Medical Education to Make Patient Safety Part of the Genome of a Modern Health Care Worker", journal="JMIR Med Educ", year="2025", month="Jan", day="17", volume="11", pages="e68046", keywords="patient safety", keywords="psychological safety", keywords="medical curriculum", keywords="professional competence", keywords="clinical competence", doi="10.2196/68046", url="https://mededu.jmir.org/2025/1/e68046" } @Article{info:doi/10.2196/59464, author="Rivera Rivera, N. Jessica and Snir, Moran and Simmons, Emilie and Schmidlen, Tara and Sholeh, Misha and Maconi, Leigh Melinda and Geiss, Carley and Fulton, Hayden and Barton, Laura and Gonzalez, D. Brian and Permuth, Jennifer and Vadaparampil, Susan", title="Developing and Assessing a Scalable Digital Health Tool for Pretest Genetic Education in Patients With Early-Onset Colorectal Cancer: Mixed Methods Design", journal="JMIR Cancer", year="2025", month="Jan", day="17", volume="11", pages="e59464", keywords="genetic education", keywords="genetic testing", keywords="genetic counseling", keywords="digital health", keywords="early-onset colorectal cancer", abstract="Background: National guidelines recommend germline genetic testing (GT) for all patients with early-onset colorectal cancer. With recent advances in targeted therapies and GT, these guidelines are expected to expand to include broader groups of patients with colorectal cancer. However, there is a shortage of genetic professionals to provide the necessary education and support for informed consent. As such, there is a pressing need to identify alternative approaches to facilitate and expedite access to GT. Objective: This study describes the development of a pretest education intervention, Nest-CRC, to facilitate the uptake of germline GT among patients with early-onset colorectal cancer. Patients with early-onset colorectal cancer and health care providers reviewed Nest-CRC, and their reactions and recommendations were captured using a nested mixed methods approach. Methods: Using the learner verification approach, we conducted 2 sequential phases of surveys and interviews with English- and Spanish-speaking patients with early-onset colorectal cancer and health care providers. The surveys assessed participants' experiences with genetic services and provided immediate feedback on the Nest-CRC genetic education modules. Semistructured interviews evaluated participants' perceptions of self-efficacy, attraction, comprehension, cultural acceptability, and usability of Nest-CRC. Survey data were analyzed using descriptive statistics (mean, median, and proportions), while interview data were analyzed through line-by-line coding of the transcribed interviews. After each phase, Nest-CRC was refined based on participants' recommendations. Results: A total of 52 participants, including 39 patients with early-onset colorectal cancer and 13 providers, participated in the study. Of these, 19 patients and 6 providers participated in phase 1 (N=25), and 20 patients and 7 providers participated in phase 2 (N=27). Most participants (phase 1: 23/25, 92\%, to 25/25, 100\%; phase 2: 24/27, 89\%, to 27/27, 100\%) agreed that each of the 5 education modules was easy to understand and helpful; 13 patients reported no history of GT, with 11 (85\%) expressing interest in GT and 2 (15\%) remaining unsure after completing Nest-CRC. Participants reported that Nest-CRC provided sufficient information to help them decide about GT. The tool was deemed acceptable by individuals from diverse backgrounds, and participants found it visually attractive, easy to comprehend, and user-friendly. Conclusions: The findings revealed that Nest-CRC is a promising strategy for facilitating pretest education and promoting GT. Nest-CRC has been refined based on participant recommendations and will be re-evaluated. ", doi="10.2196/59464", url="https://cancer.jmir.org/2025/1/e59464" } @Article{info:doi/10.2196/50060, author="Ramos-Garc{\'i}a, Vanesa and Rivero-Santana, Amado and Pe{\~n}ate-Castro, Wenceslao and {\'A}lvarez-P{\'e}rez, Yolanda and Duarte-D{\'i}az, Andrea and Torres-Casta{\~n}o, Alezandra and Trujillo-Mart{\'i}n, Mar Mar{\'i}a del and Gonz{\'a}lez-Gonz{\'a}lez, Isabel Ana and Serrano-Aguilar, Pedro and Perestelo-P{\'e}rez, Lilisbeth", title="A Brief Web-Based Person-Centered Care Group Training Program for the Management of Generalized Anxiety Disorder: Feasibility Randomized Controlled Trial in Spain", journal="JMIR Med Educ", year="2025", month="Jan", day="16", volume="11", pages="e50060", keywords="person-centered care", keywords="primary care", keywords="shared decision-making", keywords="anxiety disorder", keywords="training program", keywords="SDM", abstract="Background: Shared decision-making (SDM) is a crucial aspect of patient-centered care. While several SDM training programs for health care professionals have been developed, evaluation of their effectiveness is scarce, especially in mental health disorders such as generalized anxiety disorder. Objective: This study aims to assess the feasibility and impact of a brief training program on the attitudes toward SDM among primary care professionals who attend to patients with generalized anxiety disorder. Methods: A feasibility randomized controlled trial was conducted. Health care professionals recruited in primary care centers were randomized to an intervention group (training program) or a control group (waiting list). The intervention consisted of 2 web-based sessions applied by 2 psychologists (VR and YA), based on the integrated elements of the patient-centered care model and including group dynamics and video viewing. The outcome variable was the Leeds Attitudes Towards Concordance scale, second version (LATCon II), assessed at baseline and after the second session (3 months). After the randomized controlled trial phase, the control group also received the intervention and was assessed again. Results: Among 28 randomized participants, 5 withdrew before the baseline assessment. The intervention significantly increased their scores compared with the control group in the total scale (b=0.57; P=.018) and 2 subscales: communication or empathy (b=0.74; P=.036) and shared control (ie, patient participation in decisions: b=0.68; P=.040). The control group also showed significant pre-post changes after receiving the intervention. Conclusions: For a future effectiveness trial, it is necessary to improve the recruitment and retention strategies. The program produced a significant improvement in participants' attitude toward the SDM model, but due to this study's limitations, mainly the small sample size, more research is warranted. ", doi="10.2196/50060", url="https://mededu.jmir.org/2025/1/e50060" } @Article{info:doi/10.2196/60512, author="Song, Mingming and Elson, Joel and Bastola, Dhundy", title="Digital Age Transformation in Patient-Physician Communication: 25-Year Narrative Review (1999-2023)", journal="J Med Internet Res", year="2025", month="Jan", day="16", volume="27", pages="e60512", keywords="health communication", keywords="health IT", keywords="patient empowerment", keywords="shared decision-making", keywords="patient-physician relationship", keywords="trust", abstract="Background: The evolution of patient-physician communication has changed since the emergence of the World Wide Web. Health information technology (health IT) has become an influential tool, providing patients with access to a breadth of health information electronically. While such information has greatly facilitated communication between patients and physicians, it has also led to information overload and the potential for spreading misinformation. This could potentially result in suboptimal health care outcomes for patients. In the digital age, effectively integrating health IT with patient empowerment, strong patient-physician relationships, and shared decision-making could be increasingly important for health communication and reduce these risks. Objective: This review aims to identify key factors in health communication and demonstrate how essential elements in the communication model, such as health IT, patient empowerment, and shared decision-making, can be utilized to optimize patient-physician communication and, ultimately, improve patient outcomes in the digital age. Methods: Databases including PubMed, Web of Science, Scopus, PsycINFO, and IEEE Xplore were searched using keywords related to patient empowerment, health IT, shared decision-making, patient-physician relationship, and health communication for studies published between 1999 and 2023. The data were constrained by a modified query using a multidatabase search strategy. The screening process was supported by the web-based software tool Rayyan. The review methodology involved carefully designed steps to provide a comprehensive summary of existing research. Topic modeling, trend analysis, and synthesis were applied to analyze and evaluate topics, trends, and gaps in health communication. Results: From a total of 389 selected studies, topic modeling analysis identified 3 primary topics: (1) Patient-Physician Relationship and Shared Decision-Making, (2) Patient Empowerment and Education Strategies, and (3) Health Care Systems and Health IT Implementations. Trend analysis further indicated their frequency and prominence in health communication from 1999 to 2023. Detailed examinations were conducted using secondary terms, including trust, health IT, patient-physician relationship, and patient empowerment, derived from the main topics. These terms clarified the collective impact on improving health communication dynamics. The synthesis of the role of health IT in health communication models underscores its critical role in shaping patient-centered health care frameworks. Conclusions: This review highlights the significant contributions of key topics that should be thoroughly investigated and integrated into health communication models in the digital age. While health IT plays an essential role in promoting shared decision-making and patient empowerment, challenges such as usability, privacy concerns, and digital literacy remain significant barriers. Future research should prioritize evaluating these key themes and addressing the challenges associated with health IT in health communication models. Additionally, exploring how emerging technologies, such as artificial intelligence, can support these goals may provide valuable insights for enhancing health communication. ", doi="10.2196/60512", url="https://www.jmir.org/2025/1/e60512" } @Article{info:doi/10.2196/59625, author="Huijgens, Fiorella and Kwakman, Pascale and Hillen, Marij and van Weert, Julia and Jaspers, Monique and Smets, Ellen and Linn, Annemiek", title="How Patients With Cancer Use the Internet to Search for Health Information: Scenario-Based Think-Aloud Study", journal="JMIR Infodemiology", year="2025", month="Jan", day="16", volume="5", pages="e59625", keywords="web-based health information seeking", keywords="think aloud", keywords="scenario based", keywords="cancer", keywords="patient evaluation", keywords="information seeking", keywords="web-based information", keywords="health information", keywords="internet", keywords="pattern", keywords="motivation", keywords="cognitive", keywords="emotional", keywords="response", keywords="patient", keywords="survivor", keywords="caregiver", keywords="interview", keywords="scenario", keywords="women", keywords="men", abstract="Background: Patients with cancer increasingly use the internet to seek health information. However, thus far, research treats web-based health information seeking (WHIS) behavior in a rather dichotomous manner (ie, approaching or avoiding) and fails to capture the dynamic nature and evolving motivations that patients experience when engaging in WHIS throughout their disease trajectory. Insights can be used to support effective patient-provider communication about WHIS and can lead to better designed web-based health platforms. Objective: This study explored patterns of motivations and emotions behind the web-based information seeking of patients with cancer at various stages of their disease trajectory, as well as the cognitive and emotional responses evoked by WHIS via a scenario-based, think-aloud approach. Methods: In total, 15 analog patients were recruited, representing patients with cancer, survivors, and informal caregivers. Imagining themselves in 3 scenarios---prediagnosis phase (5/15, 33\%), treatment phase (5/15, 33\%), and survivor phase (5/15, 33\%)---patients were asked to search for web-based health information while being prompted to verbalize their thoughts. In total, 2 researchers independently coded the sessions, categorizing the codes into broader themes to comprehend analog patients' experiences during WHIS. Results: Overarching motives for WHIS included reducing uncertainty, seeking reassurance, and gaining empowerment. At the beginning of the disease trajectory, patients mainly showed cognitive needs, whereas this shifted more toward affective needs in the subsequent disease stages. Analog patients' WHIS approaches varied from exploratory to focused or a combination of both. They adapted their search strategy when faced with challenging cognitive or emotional content. WHIS triggered diverse emotions, fluctuating throughout the search. Complex, confrontational, and unexpected information mainly induced negative emotions. Conclusions: This study provides valuable insights into the motivations of patients with cancer underlying WHIS and the emotions experienced at various stages of the disease trajectory. Understanding patients' search patterns is pivotal in optimizing web-based health platforms to cater to specific needs. In addition, these findings can guide clinicians in accommodating patients' specific needs and directing patients toward reliable sources of web-based health information. ", doi="10.2196/59625", url="https://infodemiology.jmir.org/2025/1/e59625" } @Article{info:doi/10.2196/60447, author="Rosin, Magda and Ni Mhurchu, Cliona and Umali, Elaine and Mackay, Sally", title="Healthy Kai (Food) Checker Web-Based Tool to Support Healthy Food Policy Implementation: Development and Usability Study", journal="JMIR Form Res", year="2025", month="Jan", day="13", volume="9", pages="e60447", keywords="healthy food policy", keywords="policy implementation", keywords="nutrition", keywords="food environment", keywords="hospital", keywords="workplace", keywords="web-based tool", keywords="digital tool", keywords="database", keywords="user testing", keywords="food", keywords="drink", keywords="nutrition professionals", keywords="acceptability", keywords="usability", abstract="Background: Public health programs and policies can positively influence food environments. In 2016, a voluntary National Healthy Food and Drink Policy was released in New Zealand to improve the healthiness of food and drinks for hospital staff and visitors. However, no resources were developed to support policy implementation. Objective: This study aimed to design, develop, and test a new web-based tool to support food providers implementing the National Healthy Food and Drink Policy in New Zealand. Methods: The Double Diamond model, a structured framework with 4 design phases, was used to design and develop a web-based tool. Findings from our previous research, such as (1) systematic review of barriers and facilitators to workplace healthy food policy implementation; (2) scoping review of current tools and resources available in New Zealand, Australia, and Canada; (3) interviews with food providers and public health nutrition professionals; and (4) food and drink availability audit results in New Zealand hospitals were used in the ``Discover'' (understanding of current gaps) and ``Define'' (prioritizing functions and features) phases. Subsequent phases focused on generating ideas, creating prototypes, and testing a new web-based tool using Figma, a prototyping tool. During the ``Develop'' phase, project stakeholders (11 public health nutrition professionals) provided feedback on the basic content outline of the initial low-fidelity prototype. In the final ``Deliver'' phase, a high-fidelity prototype resembling the appearance and functionality of the final tool was tested with 3 end users (public health nutrition professionals) through interactive interviews, and user suggestions were incorporated to improve the tool. Results: A new digital tool, Healthy Kai (Food) Checker---a searchable database of packaged food and drink products that classifies items according to the Policy's nutritional criteria---was identified as a key tool to support Policy implementation. Of 18 potential functions and features, 11 were prioritized by the study team, including basic and advanced searches for products, sorting list options, the ability to compile a list of selected products, a means to report products missing from the database, and ability to use on different devices. Feedback from interview participants was that the tool was easy to use, was logical to navigate, and had an appealing color scheme. Suggested visual and usability improvements included ensuring that images represented the diverse New Zealand population, reducing unnecessary clickable elements, adding information about the free registration option, and including more frequently asked questions. Conclusions: Comprehensive research informed the development of a new digital tool to support implementation of the National Healthy Food and Drink Policy. Testing with end users identified features that would further enhance the tool's acceptability and usability. Incorporation of more functions and extending the database to include products classified according to the healthy school lunches program policy in the same database would increase the tool's utility. ", doi="10.2196/60447", url="https://formative.jmir.org/2025/1/e60447" } @Article{info:doi/10.2196/60443, author="van den Broek-Altenburg, M. Eline and Atherly, J. Adam", title="The Paradigm Shift From Patient to Health Consumer: 20 Years of Value Assessment in Health", journal="J Med Internet Res", year="2025", month="Jan", day="10", volume="27", pages="e60443", keywords="value assessment", keywords="cost-effectiveness", keywords="quality-adjusted life-years", keywords="QALY", keywords="health consumer", keywords="health technology", keywords="value based", keywords="digital health", keywords="patient centered", keywords="preferences", keywords="health economics", doi="10.2196/60443", url="https://www.jmir.org/2025/1/e60443", url="http://www.ncbi.nlm.nih.gov/pubmed/39793021" } @Article{info:doi/10.2196/55746, author="Kamminga, Willemina Nadia Christina and Lugtenberg, Marjolein and Van den Broek, Annabel Julia and Nijsten, Tamar and Wakkee, Marlies and Tabeau, Kasia", title="Exploring Motives Behind Ideal Melanoma Survivorship Care Plans With Multiple Stakeholders: A Cocreation Study", journal="JMIR Cancer", year="2025", month="Jan", day="2", volume="11", pages="e55746", keywords="cocreation", keywords="survivorship care", keywords="psycho-oncology", keywords="supportive care", keywords="motives", keywords="melanoma", keywords="cancer survivor", keywords="melanoma care", abstract="Background: Survivorship care plans (SCPs), ie, personalized health care plans for cancer survivors, can be used to support the growing group of melanoma survivors throughout their disease trajectory. However, implementation and effectiveness of SCPs are suboptimal and could benefit from the involvement of stakeholders in developing a user-centered design. Objective: The aim of this study was to identify the ideal SCP for patients with melanoma in terms of functions and features to be included according to different stakeholders and to explore their underlying motives. Methods: In total, 3 cocreation sessions were organized with mixed samples of stakeholders, ie, patients with (a history of) melanoma (n=4), health care providers (HCPs) active in melanoma care (n=3), and IT specialists active in hospital IT departments (n=6). They were invited to compose their ideal melanoma SCP based on potential functions and features identified from prior qualitative research. These functions and features belonged to one of the four main categories of survivorship care (SSC): (1) information and education, (2) identification and treatment, (3) oncological follow-up, and (4) coordination. Participants were invited to explain their motives for including functions and features. Ideas were shared between stakeholders, and interaction was promoted. Descriptive statistics were used to determine the ideal SCP per stakeholder group. To analyze underlying motives, all cocreation sessions were audio-taped, transcribed verbatim, and analyzed in a thematic content analysis. Results: With regard to their ideal SCPs, all stakeholders added functions from all 4 SSC categories. Patients assembled a rather compact SCP with category 2 on identification and treatment being most important. Both HCPs and IT professionals constructed a somewhat larger SCP, with category 3 on oncological follow-up being the most important aspect and HCPs also focusing on category 4 on coordination. As for the motives behind their ideal SCP compositions, patients predominantly added functions based on their personal experiences or experiences from fellow patients, whereas both HCPS and IT professionals based their compositions primarily on their respective areas of expertise: HCPs related their additions to their roles as medical practitioners; for example, in providing a complete treatment plan and obtaining informed consent, while IT professionals' contributions were mainly influenced by feasibility and privacy concerns. Conclusions: This cocreation study provides insights into stakeholders' ideal melanoma SCP and the motivations behind them. Considering the diversity in both the preferences and underlying motives regarding SCP composition between patients, HCPs, and IT specialists, it is crucial to develop a broad SCP that extends beyond traditional SCP content, emphasizing personalization. In addition to continued stakeholder involvement, efforts should be focused on addressing potential feasibility and privacy issues to ensure the SCP meets both patients' and HCPs' needs. ", doi="10.2196/55746", url="https://cancer.jmir.org/2025/1/e55746" } @Article{info:doi/10.2196/53205, author="Zhang, Jinbao and Prunty, E. Jonathan and Charles, C. Alison and Forder, Julien", title="Association Between Digital Front Doors and Social Care Use for Community-Dwelling Adults in England: Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Jan", day="2", volume="27", pages="e53205", keywords="social care support", keywords="long term care", keywords="access", keywords="front door", keywords="easy-read", keywords="self-assessment", keywords="system navigation", keywords="digital system", keywords="digital technology", keywords="internet", abstract="Background: Requests for public social care support can be made through an online portal. These digital ``front doors'' can help people navigate complex social care systems and access services. These systems can be set up in different ways, but there is little evidence about the impact of alternative arrangements. Digital front-door systems should help people better access services, particularly low-intensity services (high-intensity care is likely to require a full in-person assessment). Objective: This study aimed to investigate the association between 2 primary digital front door arrangements, easy-read information, and self-assessment tools provided on official websites, and the type of social care support that is offered: ongoing low-level support (OLLS), short-term care (STC) and long-term care (LTC). Methods: Information on front door arrangements was collected from the official websites of 152 English local authorities in 2021. We conducted a cross-sectional analysis using aggregated service use data from official government returns at the local authority level. The independent variables were derived from the policy information collected, specifically focusing on the availability of online digital easy-read information and self-assessment tools for adults and caregivers through official websites. The dependent variables were the rates of using social care support, including OLLS, STC, and LTC, across different age groups: the adult population (aged 18 and older), younger population (aged between 18 and 64 years), and older population (aged 65 and older). Multivariate regression analysis was used to examine the association between digital front door arrangements and access to social care support, controlling for population size, dependency level, and financial need factors. Results: Less than 20\% (27/147) of local authorities provided an integrated digital easy-read format as part of their digital front door system with about 25\% (37/147) adopting digital self-assessment within their system. We found that local authorities that offered an integrated digital easy-read information format showed higher rates of using OLLS ($\beta$ coefficient=0.54; P=.03; but no statistically significant association with LTC and STC). The provision of an online self-assessment system was not associated with service use in the 1-year (2021) cross-sectional estimate, but when 2 years (2020 and 2021) of service-use data were analyzed, a significant positive association was found on OLLS rates ($\beta$ coefficient=0.41; P=.21). Notably, these findings were consistent across different age groups. Conclusions: These findings are consistent with our hypothesis that digital systems with built-in easy-read and self-assessment may make access to (low-intensity) services easier for people. Adoption of these arrangements could potentially help increase the uptake of support among those who are eligible, with expected benefits for their care-related well-being. Given the limited adoption of the digital front door by local authorities in England, expanding their use could improve care-related outcomes and save social care costs. ", doi="10.2196/53205", url="https://www.jmir.org/2025/1/e53205" } @Article{info:doi/10.2196/58306, author="Hansen, Steffen and Jensen, Secher Tue and Schmidt, Mette Anne and Str{\o}m, Janni and Vistisen, Peter and H{\o}ybye, Terp Mette", title="The Effectiveness of Video Animations as a Tool to Improve Health Information Recall for Patients: Systematic Review", journal="J Med Internet Res", year="2024", month="Dec", day="30", volume="26", pages="e58306", keywords="public health", keywords="health information", keywords="patient information", keywords="animation video", keywords="digital health", keywords="visualization", keywords="memory", keywords="recall", keywords="education", keywords="synthesis", keywords="review methods", keywords="review methodology", keywords="systematic", keywords="PRISMA", abstract="Background: Access to clear and comprehensible health information is crucial for patient empowerment, leading to improved self-care, adherence to treatment plans, and overall health outcomes. Traditional methods of information delivery, such as written documents and oral communication, often result in poor memorization and comprehension. Recent innovations, such as animation videos, have shown promise in enhancing patient understanding, but comprehensive investigations into their effectiveness across various health care settings are lacking. Objective: This systematic review aims to investigate the effectiveness of animation videos on health information recall in adult patients across diverse health care sectors, comparing their impact to usual information delivery methods on short-term and long-term recall of health information. Methods: We conducted systematic searches in PubMed, CINAHL, and Embase databases, supplemented by manual searches of reference lists. Included studies were randomized controlled trials involving adult participants (?18 years) that focused on the use of animation videos to provide health information measured against usual information delivery practice. There were no language restrictions. Out of 2 independent reviewers screened studies, extracted data, and assessed the risk of bias using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2), Covidence was used to handle screening and risk of bias process. A narrative synthesis approach was applied to present results. Results: A total of 15 randomized controlled trials---3 in the United States, 2 in France, 2 in Australia, 2 in Canada, and 1 in the United Kingdom, Japan, Singapore, Brazil, Austria, and T{\"u}rkiye, respectively---met the inclusion criteria, encompassing 2,454 patients across various health care settings. The majority of studies (11/15, 73\%) reported statistically significant improvements in health information recall when animation videos were used, compared with usual care. Animation videos ranged from 1 to 15 minutes in duration with the most common length ranging from 1 to 8 minutes (10/15) and used various styles including 2D cartoons, 3D computers, and whiteboard animations. Most studies (12/15) assessed information recall immediately after intervention, with only 3 studies including longer follow-up periods. Most studies exhibited some concerns related to the risk of bias, particularly in domains related to deviations from intended interventions and selection of reported results. Conclusions: Animation videos appear to significantly improve short-term recall of health information among adult patients across various health care settings compared with usual care. This suggests that animation videos could be a valuable tool for informing patients in different health care settings. However, further research is needed to explore the long-term efficacy of these interventions, their impact on diverse populations, and how different animation styles might affect information recall. Future studies should also address methodological limitations identified in current research, including the use of validated outcome measures and longer follow-up periods. Trial Registration: PROSPERO CRD42022380016; http://crd.york.ac.uk/prospero/display\_record.php?RecordID=380016 ", doi="10.2196/58306", url="https://www.jmir.org/2024/1/e58306" } @Article{info:doi/10.2196/55753, author="Backman, Chantal and Papp, Rosie and Tonjock Kolle, Aurelie and Papp, Steve and Visintini, Sarah and Schaefer Ferreira de Mello, L{\'u}cia Ana and de Melo Lanzoni, Marcellino Gabriela and Harley, Anne", title="Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Scoping Review", journal="J Med Internet Res", year="2024", month="Dec", day="30", volume="26", pages="e55753", keywords="platform based", keywords="patient-clinician", keywords="digital health intervention", keywords="care transition", keywords="mobile phone", abstract="Background: Care transitions are complex and can make patients vulnerable to adverse events. Poor communication among clinicians, patients, and their caregivers is a critical gap during these periods of transition. Technology solutions such as platform-based patient-clinician digital health interventions (DHIs) can provide support and education to patients. Objective: The aims of this scoping review were to explore the literature on platform-based patient-clinician DHIs specific to hospital-to-home care transitions and identify the barriers to and enablers of the uptake and implementation of these DHIs. Methods: A scoping review was conducted. A total of 4 databases (MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials) were searched on July 13, 2022. Studies involving patients aged >18 years who used platform-based DHIs during their hospital-to-home transition were included. In total, 2 reviewers independently screened the articles for eligibility using a 2-stage process of title and abstract and full-text screening. Eligible studies underwent data extraction, and the results were analyzed using descriptive and narrative methods. Results: We screened 8322 articles, of which 97 (1.17\%) met our inclusion criteria. DHIs were implemented using a mobile app (59/97, 61\%), a web-based platform (28/97, 29\%), or a combination of both (10/97, 10\%). The 2 most common health conditions related to the DHIs were cardiac disease (22/97, 23\%) and stroke (11/97, 11\%). Outcomes varied greatly but were grouped by health care use, complications, and wellness outcomes. The top 2 barriers were lack of interest (13/97, 13\%) and time constraints to use the DHIs (10/97, 10\%), and the top 2 enablers were the ability to use the DHIs (17/97, 18\%) and their ease of use (11/97, 11\%). The main conflicting theme was access (enabler; 28/97, 29\%) or limited access (barrier; 15/97, 15\%) to technology or the internet. Conclusions: Platform-based DHIs could help improve communication, coordination, and information sharing between clinicians and patients during transition periods. Further research is needed to assess the effectiveness of these platform-based DHIs on patient outcomes. ", doi="10.2196/55753", url="https://www.jmir.org/2024/1/e55753" } @Article{info:doi/10.2196/57833, author="Doyle, A. Tom and Vershaw, L. Samantha and Conboy, Erin and Halverson, E. Colin M.", title="Improving Social Media-Based Support Groups for the Rare Disease Community: Interview Study With Patients and Parents of Children with Rare and Undiagnosed Diseases", journal="JMIR Hum Factors", year="2024", month="Dec", day="30", volume="11", pages="e57833", keywords="social media", keywords="rare disease", keywords="support groups", keywords="pediatric rare disease", keywords="Ehlers-Danlos syndrome", keywords="collagen disease", keywords="fibrillar collagen", keywords="cutis elastica", keywords="connective tissue disorders", keywords="hyperelasticity", keywords="hypermobility of joints, inherited", keywords="genetic disorder", keywords="genetics", keywords="pediatric", abstract="Background: The rarity that is inherent in rare disease (RD) often means that patients and parents of children with RDs feel uniquely isolated and therefore are unprepared or unsupported in their care. To overcome this isolation, many within the RD community turn to the internet, and social media groups in particular, to gather useful information about their RDs. While previous research has shown that social media support groups are helpful for those affected by RDs, it is unclear what these groups are particularly useful or helpful for patients and parents of children with RDs. Objective: This study aimed to identify what specific features of disease-related support groups (DRSGs) the RD community finds particularly useful or supportive and provide a set of recommendations to improve social media--based RD support groups based on this information. Methods: Semistructured qualitative interviews were performed with patients and parents of patients with RDs. Interview participants had to be at least 18 years of age at the time of the interview, be seen by a genetics specialist at a partner health care institution and be proficient in the English language. Social media use was not a prerequisite for participation, so interview participants ranged from extensive users of social media to those who chose to remain off all social media. All interviews were conducted by phone, recorded, and then transcribed. Interview transcripts were then coded using the 6 steps outlined by Braun and Clarke. Three researchers (TAD, SLV, and CMEH) performed initial coding. After this, the study team conducted a review of themes and all members of the team agreed upon a final analysis and presentation of data. Results: We conducted 31 interviews (mean age 40, SD 10.04 years; n=27, 87\% were women; n=30, 97\% were non-Hispanic White). Thematic analysis revealed that social media DRSG users identified the informational usefulness of these groups as being related to the gathering and sharing of specific information about an RD, clarification about the importance and meaning of certain symptoms, and obtaining insight into an RD's progression and prognosis. Participants also identified that DRSGs were useful sources of practical information, such as tips and tricks about managing RD-related issues and concerns. In addition, participants found DRSGs to be a useful space for sharing their disease-related stories but also highlighted a feeling of exhaustion from overexposure and overuse of DRSGs. Conclusions: This study identifies the usefulness of DRSGs for the RD community and provides a set of recommendations to improve future instances of DRSGs. These recommendations can be used to create DRSGs that are less prone to splintering into other DRSGs, thus minimizing the risk of having important RD-related information unhelpfully dispersed amongst a multitude of support groups. ", doi="10.2196/57833", url="https://humanfactors.jmir.org/2024/1/e57833", url="http://www.ncbi.nlm.nih.gov/pubmed/39752188" } @Article{info:doi/10.2196/55300, author="Peerawong, Thanarpan and Phenwan, Tharin and Makita, Meiko and Supanichwatana, Sojirat and Puttarak, Panupong and Siammai, Naowanit and Sunthorn, Prakaidao", title="Evaluating Online Cannabis Health Information for Thai Breast Cancer Survivors Using the Quality Evaluation Scoring Tool (QUEST): Mixed Method Study", journal="JMIR Cancer", year="2024", month="Dec", day="24", volume="10", pages="e55300", keywords="cannabis", keywords="medical cannabis", keywords="Thailand", keywords="critical discourse analysis", keywords="mixed method study", keywords="breast cancer", keywords="digital literacy", keywords="legislation", keywords="health literacy", abstract="Background: Following medical cannabis legalization in Thailand in 2019, more people are seeking medical cannabis--related information, including women living with breast cancer. The extent to which they access cannabis-related information from internet sources and social media platforms and the quality of such content are relatively unknown and need further evaluation. Objective: This study aims to analyze the factors determining cannabis-related content quality for breast cancer care from internet sources and on social media platforms and examine the characteristics of such content accessed and consumed by Thai breast cancer survivors. Methods: A mixed methods study was conducted between January 2021 and May 2022, involving a breast cancer survivor support group. The group identified medical cannabis--related content from frequently accessed internet sources and social media platforms. The contents were categorized based on content creators, platforms, content category, and upload dates. Four researchers used the Quality Evaluation Scoring Tool (QUEST) to assess content quality, with scores ranging from 0 to 28. Contents were expert-rated as either high or poor. The QUEST interobserver reliability was analyzed. Receiver-operating characteristic curve analysis with the Youden index was used to determine the QUEST score cut-off point. Statistical significance was set at P<.05. Fairclough Critical Discourse Analysis was undertaken to examine the underlying discourses around poor-quality content. Results: Sixty-two Thai-language cannabis-related items were evaluated. The content sources were categorized as follows: news channels (21/62, 34\%), government sources (16/62, 26\%), health care providers (12/62, 19\%), and alternative medicine providers (12/62, 19\%). Most of the contents (30/62, 48\%) were uploaded to YouTube, whereas 31\% (19/62) appeared on websites and Facebook. Forty of 62 content items (64\%) were news-related and generic cannabis advertisements while 8 of 62 (13\%) content items had no identifiable date. The interobserver QUEST score correlation was 0.86 (P<.001). The mean QUEST score was 12.1 (SD 7.6). Contents were considered ``high'' when the expert rating was >3. With a QUEST score of 15 as the threshold, the sensitivity and specificity for differentiating between high and poor content quality were 81\% and 98\%, respectively. Content creation was the only significant factor between high- and poor-quality content. Poor-quality contents were primarily created by alternative medicine providers and news channels. Two discourses were identified: advocacy for cannabis use normalization and cannabis romanticization as a panacea. These discourses overly normalize and romanticize the use of cannabis, focusing on indications and instructions for cannabis use, and medical cannabis promotion, while neglecting discussions on cannabis contraindications and potential side effects. Conclusions: The varying quality of medical cannabis--related information on internet sources and social media platforms accessed and shared by Thai breast cancer survivors is an issue of concern. Given that content creators are the sole predictive factors of high content quality, future studies should examine a wider range of cannabis-related sources accessible to both the public and patients to gain a more comprehensive understanding of the issue. ", doi="10.2196/55300", url="https://cancer.jmir.org/2024/1/e55300" } @Article{info:doi/10.2196/63334, author="Dorney, Edwina and Hammarberg, Karin and Rodgers, Raymond and Black, I. Kirsten", title="Optimization of a Web-Based Self-Assessment Tool for Preconception Health in People of Reproductive Age in Australia: User Feedback and User-Experience Testing Study", journal="JMIR Hum Factors", year="2024", month="Dec", day="24", volume="11", pages="e63334", keywords="technology", keywords="internet", keywords="eHealth", keywords="user experience", keywords="patient engagement", keywords="self-assessment tool", keywords="preconception", keywords="health communication", abstract="Background: Good preconception health reduces the incidence of preventable morbidity and mortality for women, their babies, and future generations. In Australia, there is a need to increase health literacy and awareness about the importance of good preconception health. Digital health tools are a possible enabler to increase this awareness at a population level. The Healthy Conception Tool (HCT) is an existing web-based, preconception health self-assessment tool, that has been developed by academics and clinicians. Objective: This study aims to optimize the HCT and to seek user feedback to increase the engagement and impact of the tool. Methods: In-depth interviews were held with women and men aged 18?41 years, who spoke and read English and were residing in Australia. Interview transcripts were analyzed, and findings were used to inform an enhanced HCT prototype. This prototype underwent user-experience testing and feedback from users to inform a final round of design changes to the tool. Results: A total of 20 women and 5 men were interviewed; all wanted a tool that was quick and easy to use with personalized results. Almost all participants were unfamiliar with the term ``preconception care'' and stated they would not have found this tool on the internet with its current title. User-experience testing with 6 women and 5 men identified 11 usability issues. These informed further changes to the tool's title, the information on how to use the tool, and the presentation of results. Conclusions: Web-based self-assessment tools need to be easy to find and should communicate health messages effectively. End users' feedback informed changes to improve the tool's acceptability, engagement, and impact. We expect that the revised tool will have greater reach and prompt more people to prepare well for pregnancy. ", doi="10.2196/63334", url="https://humanfactors.jmir.org/2024/1/e63334" } @Article{info:doi/10.2196/57308, author="Ruggiano, Nicole and Brown, Leslie Ellen and Clarke, J. Peter and Hristidis, Vagelis and Roberts, Lisa and Framil Suarez, Victoria Carmen and Allala, Chaithra Sai and Hurley, Shannon and Kopcsik, Chrystine and Daquin, Jane and Chevez, Hamilton and Chang-Lau, Raymond and Agronin, Marc and Geldmacher, S. David", title="An Evidence-Based IT Program With Chatbot to Support Caregiving and Clinical Care for People With Dementia: The CareHeroes Development and Usability Pilot", journal="JMIR Aging", year="2024", month="Dec", day="23", volume="7", pages="e57308", keywords="Alzheimer disease", keywords="artificial intelligence", keywords="caregivers", keywords="chatbot", keywords="dementia", keywords="mobile applications", keywords="conversational agent", keywords="design", keywords="apps", abstract="Background: There are numerous communication barriers between family caregivers and providers of people living with dementia, which can pose challenges to caregiving and clinical decision-making. To address these barriers, a new web and mobile-enabled app, called CareHeroes, was developed, which promotes the collection and secured sharing of clinical information between caregivers and providers. It also provides caregiver support and education. Objective: The primary study objective was to examine whether dementia caregivers would use CareHeroes as an adjunct to care and gather psychosocial data from those who used the app. Methods: This paper presents the implementation process used to integrate CareHeroes into clinical care at 2 memory clinics and preliminary outcome evaluation. Family caregivers receiving services at clinics were asked to use the app for a 12-month period to collect, track, and share clinical information with the care recipient's provider. They also used it to assess their own mental health symptoms. Psychosocial outcomes were assessed through telephone interviews and user data were collected by the app. Results: A total of 21 caregivers enrolled in the pilot study across the 2 memory clinics. Usage data indicated that caregivers used many of the features in the CareHeroes app, though the chatbot was the most frequently used feature. Outcome data indicated that caregivers' depression was lower at 3-month follow-up (t11=2.03, P=.03). Conclusions: Recruitment and retention of the pilot study were impacted by COVID-19 restrictions, and therefore more testing is needed with a larger sample to determine the potential impact of CareHeroes on caregivers' mental health. Despite this limitation, the pilot study demonstrated that integrating a new supportive app for caregivers as an adjunct to clinical dementia care is feasible. Implications for future technology intervention development, implementation planning, and testing for caregivers of people living with dementia are discussed. ", doi="10.2196/57308", url="https://aging.jmir.org/2024/1/e57308" } @Article{info:doi/10.2196/52651, author="Ahmed, Furqan and Ahmad, Ghufran and Eisinger, Katharina and Khan, Asad Muhammad and Brand, Tilman", title="Promoting Comprehensive Sexuality Education in Pakistan Using a Cocreated Social Media Intervention: Development and Pilot Testing Study", journal="JMIR Form Res", year="2024", month="Dec", day="20", volume="8", pages="e52651", keywords="digital health interventions", keywords="sexuality education", keywords="social media", keywords="influencer marketing", keywords="community readiness", abstract="Background: Comprehensive sexuality education (CSE) is a curriculum-based approach to learning and teaching about sexuality that focuses on the cognitive, emotional, physical, and social domains. The United Nations Educational, Scientific, and Cultural Organization (UNESCO) CSE guideline emphasizes gender issues and is firmly rooted in a human rights--based approach to sexuality. A recent cross-sectional community readiness assessment in Islamabad, Pakistan, found that the community is at the denial or resistant stage when it comes to implementing school-based sexuality education. The reluctance was attributed to a lack of understanding and widespread misconceptions about CSE. Objective: This study aims to use the cocreation process to develop, pilot, and evaluate an intervention based on community readiness level to respond to community resistance by introducing CSE content, its anticipated benefits, and addressing prevalent misconceptions through awareness and promotion content for digital social media platforms. Methods: For the development of the intervention (audio-video content), focus group discussion sessions with key stakeholders were held. Two videos were created in partnership with social media influencers and subsequently shared on Facebook, YouTube, and Instagram. A comprehensive process and performance evaluation of the videos and intervention development phase was conducted to evaluate audience exposure, reach, engagement, demographics, retention, and in-depth insights. The videos were uploaded to social media platforms in June and July 2021, and the data used to assess their performance was obtained in February 2022. Results: With a total reach (number of people who have contact with the videos) of 432,457 and 735,563 for the first and second videos, respectively, on all social media platforms, we concluded that social media platforms provide an opportunity to communicate, promote, and engage with important stakeholders to raise awareness and obtain support for CSE. According to the findings, the public is responsive to CSE promotion content developed for social media platforms, with a total engagement (the number of people who participate in creating, sharing, and using the content) of 11,578. The findings revealed that male viewers predominated across all social media platforms. Punjab province had the largest audience share on Instagram (51.9\% for the first video, 52.7\% for the second) and Facebook (44.3\% for the first video and 48.4\% for the second). YouTube had the highest audience retention, with viewers watching an average of 151 seconds (45\%) of the first video and 163 seconds (38\%) of the second. With a net sentiment score of 0.83 (minimum=?3, maximum=5), end-user participation was also positive, and audience feedback highlighted the reasons for positive and negative criticism. Conclusions: To promote sexuality education in Pakistan, it is vital to overcome opposition through sensitizing the society, and digital social media platforms offer a unique, though underused, chance to do so through reliable influencer marketing. ", doi="10.2196/52651", url="https://formative.jmir.org/2024/1/e52651" } @Article{info:doi/10.2196/57528, author="Davis, Alexis and Martin, Joshua and Cooks, Eric and Vilaro, Melissa and Wilson-Howard, Danyell and Tang, Kevin and Raup Krieger, Janice", title="From English to ``Englishes'': A Process Perspective on Enhancing the Linguistic Responsiveness of Culturally Tailored Cancer Prevention Interventions", journal="J Particip Med", year="2024", month="Dec", day="19", volume="16", pages="e57528", keywords="behavior change", keywords="community-engaged research", keywords="cancer screening", keywords="colorectal cancers", keywords="communication", keywords="communication accommodation", keywords="linguistics", doi="10.2196/57528", url="https://jopm.jmir.org/2024/1/e57528" } @Article{info:doi/10.2196/60117, author="Malhotra, Chetna and Yee, Alethea and Ramakrishnan, Chandrika and Kaurani, Naraindas Sanam and Chua, Ivy and Lakin, R. Joshua and Sim, David and Balakrishnan, Iswaree and Ling, Jin Vera Goh and Weiliang, Huang and Ling, Fong Lee and Pollak, I. Kathryn", title="Development and Usability of an Advance Care Planning Website (My Voice) to Empower Patients With Heart Failure and Their Caregivers: Mixed Methods Study", journal="JMIR Aging", year="2024", month="Dec", day="18", volume="7", pages="e60117", keywords="advance care planning", keywords="decision aid", keywords="heart", keywords="website", keywords="heart failure", keywords="care plan", keywords="caregiver", keywords="usability", keywords="acceptability", abstract="Background: Web-based advance care planning (ACP) interventions offer a promising solution to improve ACP engagement, but none are specifically designed to meet the needs of patients with heart failure and their caregivers. Objective: We aimed to develop and assess the usability and acceptability of a web-based ACP decision aid called ``My Voice,'' which is tailored for patients with heart failure and their caregivers. Methods: This study's team and advisory board codeveloped the content for both patient and caregiver modules in ``My Voice.'' Using a mixed methods approach, we iteratively tested usability and acceptability, incorporating feedback from patients, caregivers, and health care professionals (HCPs). Results: We interviewed 30 participants (11 patients, 9 caregivers, and 10 HCPs). Participants found the website easy to navigate, with simple and clear content facilitating communication of patients' values and goals. They also appreciated that it allowed them to revisit their care goals periodically. The average System Usability Scale score was 74 (SD 14.8; range: 42.5-95), indicating good usability. Over 80\% (8/11) of patients and 87\% (7/8) of caregivers rated the website's acceptability as good or excellent. Additionally, 70\% (7/10) of HCPs strongly agreed or agreed with 11 of the 15 items testing the website's acceptability. Conclusions: ``My Voice'' shows promise as a tool for patients with heart failure to initiate and revisit ACP conversations with HCPs and caregivers. We will evaluate its efficacy in improving patient and caregiver outcomes in a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT06090734; https://clinicaltrials.gov/study/NCT06090734 ", doi="10.2196/60117", url="https://aging.jmir.org/2024/1/e60117" } @Article{info:doi/10.2196/63155, author="Hermansen, Anna and Pollard, Samantha and McGrail, Kimberlyn and Bansback, Nick and Regier, A. Dean", title="Heuristics Identified in Health Data--Sharing Preferences of Patients With Cancer: Qualitative Focus Group Study", journal="J Med Internet Res", year="2024", month="Dec", day="17", volume="26", pages="e63155", keywords="heuristics", keywords="health data sharing", keywords="cancer patients", keywords="decision-making", keywords="real-world data", keywords="altruism", keywords="trust", keywords="control", keywords="data sharing", keywords="focus group", keywords="precision medicine", keywords="clinical data", keywords="exploratory study", keywords="qualitative", keywords="Canada", keywords="thematic analysis", keywords="informed consent", keywords="patient education", keywords="information technology", keywords="healthcare", keywords="medical informatics", abstract="Background: Evaluating precision oncology outcomes requires access to real-world and clinical trial data. Access is based on consent, and consent is based on patients' informed preferences when deciding to share their data. Decision-making is often modeled using utility theory, but a complex decision context calls for a consideration of how heuristic, intuitive thought processes interact with rational utility maximization. Data-sharing decision-making has been studied using heuristic theory, but almost no heuristic research exists in the health data context. This study explores this evidence gap, applying a qualitative approach to probe for evidence of heuristic mechanisms behind the health data-sharing preferences of those who have experienced cancer. Exploring qualitative decision-making reveals the types of heuristics used and how they are related to the process of decision-making to better understand whether consent mechanisms should consider nonrational processes to better serve patient decision-making. Objective: This study aimed to explore how patients with cancer use heuristics when deciding whether to share their data for research. Methods: The researchers conducted a focus group study of Canadians who have experienced cancer. We recruited participants through an online advertisement, screening individuals based on their ability to increase demographic diversity in the sample. We reviewed the literature on data-sharing platforms to develop a semistructured topic guide on concerns about data sharing, incentives to share, and consent and control. Focus group facilitators led the open-ended discussions about data-sharing preferences that revealed underlying heuristics. Two qualitative analysts coded transcripts using a heuristic framework developed from a review of the literature. Transcripts were analyzed for heuristic instances which were grouped according to sociocultural categories. Using thematic analysis, the analysts generated reflexive themes through norming sessions and consultations. Results: A total of 3 focus groups were held with 19 participants in total. The analysis identified 12 heuristics underlying intentions to share data. From the thematic analysis, we identified how the heuristics of social norms and community building were expressed through altruism; the recognition, reputation, and authority heuristics led to (dis)trust in certain institutions; the need for security prompted the illusion of control and transparency heuristics; and the availability and affect heuristics influenced attitudes around risk and benefit. These thematic relationships all had impacts on the participants' intentions to share their health data. Conclusions: The findings provide a novel qualitative understanding of how health data--sharing decisions and preferences may be based on heuristic processing. As patients consider the extent of risks and benefits, heuristic processes influence their assessment of anticipated outcomes, which may not result in rational, truly informed consent. This study shows how considering heuristic processing when designing current consent mechanisms opens up the opportunity for more meaningful and realistic interactions with the complex decision-making context. ", doi="10.2196/63155", url="https://www.jmir.org/2024/1/e63155" } @Article{info:doi/10.2196/64577, author="Lemieux, Mackenzie and Zhou, Cyrus and Cary, Caroline and Kelly, Jeannie", title="Changes in Reproductive Health Information-Seeking Behaviors After the Dobbs Decision: Systematic Search of the Wikimedia Database", journal="JMIR Infodemiology", year="2024", month="Dec", day="16", volume="4", pages="e64577", keywords="abortion", keywords="Dobbs", keywords="internet", keywords="viewer trends", keywords="Wikipedia", keywords="women's health", keywords="contraception", keywords="contraceptive", keywords="trend", keywords="information seeking", keywords="page view", keywords="reproductive", keywords="reproduction", abstract="Background: After the US Supreme Court overturned Roe v. Wade, confusion followed regarding the legality of abortion in different states across the country. Recent studies found increased Google searches for abortion-related terms in restricted states after the Dobbsv. Jackson Women's Health Organization decision was leaked. As patients and providers use Wikipedia (Wikimedia Foundation) as a predominant medical information source, we hypothesized that changes in reproductive health information-seeking behavior could be better understood by examining Wikipedia article traffic. Objective: This study aimed to examine trends in Wikipedia usage for abortion and contraception information before and after the Dobbs decision. Methods: Page views of abortion- and contraception-related Wikipedia pages were scraped. Temporal changes in page views before and after the Dobbs decision were then analyzed to explore changes in baseline views, differences in views for abortion-related information in states with restrictive abortion laws versus nonrestrictive states, and viewer trends on contraception-related pages. Results: Wikipedia articles related to abortion topics had significantly increased page views following the leaked and final Dobbs decision. There was a 103-fold increase in the page views for the Wikipedia article Roe v. Wade following the Dobbs decision leak (mean 372,654, SD 135,478 vs mean 3614, SD 248; P<.001) and a 67-fold increase in page views following the release of the final Dobbs decision (mean 8942, SD 402 vs mean 595,871, SD 178,649; P<.001). Articles about abortion in the most restrictive states had a greater increase in page views (mean 40.6, SD 12.7; 18/51, 35\% states) than articles about abortion in states with some restrictions or protections (mean 26.8, SD 7.3; 24/51, 47\% states; P<.001) and in the most protective states (mean 20.6, SD 5.7; 8/51, 16\% states; P<.001). Finally, views to pages about common contraceptive methods significantly increased after the Dobbs decision. ``Vasectomy'' page views increased by 183\% (P<.001), ``IUD'' (intrauterine device) page views increased by 80\% (P<.001), ``Combined oral contraceptive pill'' page views increased by 24\% (P<.001), ``Emergency Contraception'' page views increased by 224\% (P<.001), and ``Tubal ligation'' page views increased by 92\% (P<.001). Conclusions: People sought information on Wikipedia about abortion and contraception at increased rates after the Dobbs decision. Increased traffic to abortion-related Wikipedia articles correlated to the restrictiveness of state abortion policies. Increased interest in contraception-related pages reflects the increased demand for contraceptives observed after the Dobbs decision. Our work positions Wikipedia as an important source of reproductive health information and demands increased attention to maintain and improve Wikipedia as a reliable source of health information after the Dobbs decision. ", doi="10.2196/64577", url="https://infodemiology.jmir.org/2024/1/e64577" } @Article{info:doi/10.2196/59785, author="Southwick, Lauren and Sharma, Meghana and Rai, Sunny and Beidas, S. Rinad and Mandell, S. David and Asch, A. David and Curtis, Brenda and Guntuku, Chandra Sharath and Merchant, M. Raina", title="Integrating Patient-Generated Digital Data Into Mental Health Therapy: Mixed Methods Analysis of User Experience", journal="JMIR Ment Health", year="2024", month="Dec", day="16", volume="11", pages="e59785", keywords="digital data", keywords="social media", keywords="psychotherapy", keywords="latent Dirichlet allocation", keywords="LDA", keywords="mobile phone", abstract="Background: Therapists and their patients increasingly discuss digital data from social media, smartphone sensors, and other online engagements within the context of psychotherapy. Objective: We examined patients' and mental health therapists' experiences and perceptions following a randomized controlled trial in which they both received regular summaries of patients' digital data (eg, dashboard) to review and discuss in session. The dashboard included data that patients consented to share from their social media posts, phone usage, and online searches. Methods: Following the randomized controlled trial, patient (n=56) and therapist (n=44) participants completed a debriefing survey after their study completion (from December 2021 to January 2022). Participants were asked about their experience receiving a digital data dashboard in psychotherapy via closed- and open-ended questions. We calculated descriptive statistics for closed-ended questions and conducted qualitative coding via NVivo (version 10; Lumivero) and natural language processing using the machine learning tool latent Dirichlet allocation to analyze open-ended questions. Results: Of 100 participants, nearly half (n=48, 49\%) described their experience with the dashboard as ``positive,'' while the other half noted a ``neutral'' experience. Responses to the open-ended questions resulted in three thematic areas (nine subcategories): (1) dashboard experience (positive, neutral or negative, and comfortable); (2) perception of the dashboard's impact on enhancing therapy (accountability, increased awareness over time, and objectivity); and (3) dashboard refinements (additional sources, tailored content, and privacy). Conclusions: Patients reported that receiving their digital data helped them stay ``accountable,'' while therapists indicated that the dashboard helped ``tailor treatment plans.'' Patient and therapist surveys provided important feedback on their experience regularly discussing dashboards in psychotherapy. Trial Registration: ClinicalTrials.gov NCT04011540; https://clinicaltrials.gov/study/NCT04011540 ", doi="10.2196/59785", url="https://mental.jmir.org/2024/1/e59785" } @Article{info:doi/10.2196/64508, author="Arcia, Adriana and Stonbraker, Samantha and Mangal, Sabrina and Lor, Maichou", title="A Practical Guide to Participatory Design Sessions for the Development of Information Visualizations: Tutorial", journal="J Particip Med", year="2024", month="Dec", day="13", volume="16", pages="e64508", keywords="audiovisual aids", keywords="cultural competency", keywords="health communication", keywords="patient participation", keywords="participatory design", keywords="information visualization", keywords="health literacy", keywords="user-centered design", keywords="human-computer interaction", doi="10.2196/64508", url="https://jopm.jmir.org/2024/1/e64508" } @Article{info:doi/10.2196/51701, author="Almenara, A. Carlos and Gulec, Hayriye", title="Uncovering the Top Nonadvertising Weight Loss Websites on Google: A Data-Mining Approach", journal="JMIR Infodemiology", year="2024", month="Dec", day="11", volume="4", pages="e51701", keywords="consumer health informatics", keywords="cyberattack risk", keywords="data mining", keywords="Google", keywords="information seeking", keywords="weight loss", keywords="online health information", keywords="website analysis", keywords="digital health", keywords="internet search", abstract="Background: Online weight loss information is commonly sought by internet users, and it may impact their health decisions and behaviors. Previous studies examined a limited number of Google search queries and relied on manual approaches to retrieve online weight loss websites. Objective: This study aimed to identify and describe the characteristics of the top weight loss websites on Google. Methods: This study gathered 432 Google search queries collected from Google autocomplete suggestions, ``People Also Ask'' featured questions, and Google Trends data. A data-mining software tool was developed to retrieve the search results automatically, setting English and the United States as the default criteria for language and location, respectively. Domain classification and evaluation technologies were used to categorize the websites according to their content and determine their risk of cyberattack. In addition, the top 5 most frequent websites in nonadvertising (ie, nonsponsored) search results were inspected for quality. Results: The results revealed that the top 5 nonadvertising websites were healthline.com, webmd.com, verywellfit.com, mayoclinic.org, and womenshealthmag.com. All provided accuracy statements and author credentials. The domain categorization taxonomy yielded a total of 101 unique categories. After grouping the websites that appeared less than 5 times, the most frequent categories involved ``Health'' (104/623, 16.69\%), ``Personal Pages and Blogs'' (91/623, 14.61\%), ``Nutrition and Diet'' (48/623, 7.7\%), and ``Exercise'' (34/623, 5.46\%). The risk of being a victim of a cyberattack was low. Conclusions: The findings suggested that while quality information is accessible, users may still encounter less reliable content among various online resources. Therefore, better tools and methods are needed to guide users toward trustworthy weight loss information. ", doi="10.2196/51701", url="https://infodemiology.jmir.org/2024/1/e51701" } @Article{info:doi/10.2196/58581, author="Mora Pinzon, Maria and Hills, Ornella and Levy, George and James, T. Taryn and Benitez, Ashley and Lawrence, Sacheen and Ellis, Tiffany and Washington, Venus and Solorzano, Lizbeth and Tellez-Giron, Patricia and Cano Ospina, Fernando and Metoxen, F. Melissa and Gleason, E. Carey", title="Implementation of a Social Media Strategy for Public Health Promotion in Black, American Indian or Alaska Native, and Hispanic or Latino Communities During the COVID-19 Pandemic: Cross-Sectional Study", journal="J Med Internet Res", year="2024", month="Dec", day="10", volume="26", pages="e58581", keywords="health communications", keywords="social media", keywords="Hispanic", keywords="Latino", keywords="Black", keywords="American Indian", keywords="Alaska Native", keywords="minority health", keywords="health disparities", keywords="COVID-19", abstract="Background: Individuals identifying as Black, American Indian or Alaska Native, or Hispanic or Latino lack access to culturally appropriate accurate information and are the target of disinformation campaigns, which create doubt in science and health care providers and might play a role in sustaining health disparities related to the COVID-19 pandemic. Objective: This study aims to create and disseminate culturally and medically appropriate social media messages for Black, Latino, and American Indian or Alaska Native communities in Wisconsin and evaluate their reach and effectiveness in addressing the information needs of these communities. Methods: Our team identified relevant COVID-19 topics based on feedback from their respective community, developed lay format materials, and translated materials into culturally appropriate social media messages that community advocates delivered across their respective communities. Social media metrics (reach, engagement, and impressions) were collected using Sprout Social and Facebook Analytics. We hosted 9 focus groups with community members to learn about their social media use. These data were analyzed using an inductive approach, using NVivo software (release 1.7) to code content. Results: Between August 2021 and January 2023, we created 980 unique social media posts that reached 88,790 individuals and gathered >6700 engagements. Average reach per post was similar across the 3 communities, despite differences in the number of posts and followers on each page: 119.46 (Latino individuals), 111.74 (Black individuals), and 113.11 (Oneida Nation members). The type of posts that had higher engagement rate per reached person (ERR) varied across communities and platforms, with the highest being live videos for the Latino community on Facebook (ERR 9.4\%), videos for the Black community on Facebook (ERR 19.53\%), and social media messages for the Oneida Nation community (ERR 59.01\%). Conclusions: Our project presents a unique and effective model for health messages and highlights the need for tailoring social media messages and approaches for minoritized audiences (eg, age, gender, race, and ethnicity). Further research studies are needed to explore how specific types of information affect the dissemination of information and the implications for health communications. ", doi="10.2196/58581", url="https://www.jmir.org/2024/1/e58581" } @Article{info:doi/10.2196/59234, author="Takura, Tomoyuki and Yokoi, Hiroyoshi and Honda, Asao", title="Factors Influencing Drug Prescribing for Patients With Hospitalization History in Circulatory Disease--Patient Severity, Composite Adherence, and Physician-Patient Relationship: Retrospective Cohort Study", journal="JMIR Aging", year="2024", month="Dec", day="6", volume="7", pages="e59234", keywords="medication adherence", keywords="drug prescription switch", keywords="generic drug", keywords="logistic model", keywords="long-term longitudinal study", keywords="patient severity", keywords="systolic blood pressure", keywords="serum creatinine", keywords="aging", keywords="big data", abstract="Background: With countries promoting generic drug prescribing, their growth may plateau, warranting further investigation into the factors influencing this trend, including physician and patient perspectives. Additional strategies may be needed to maximize the switch to generic drugs while ensuring health care system sustainability, focusing on factors beyond mere low cost. Emphasizing affordability and clarifying other prescription considerations are essential. Objective: This study aimed to provide initial insights into how patient severity, composite adherence, and physician-patient relationships impact generic switching. Methods: This study used a long-term retrospective cohort design by analyzing data from a national health care database. The population included patients of all ages, primarily older adults, who required primary-to-tertiary preventive actions with a history of hospitalization for cardiovascular diseases (ICD-10 [International Statistical Classification of Diseases, Tenth Revision]) from April 2014 to March 2018 (4 years). We focused on switching to generic drugs, with temporal variations in clinical parameters as independent variables. Lifestyle factors (smoking and drinking) were also considered. Adherence was measured as a composite score comprising 11 elements. The physician-patient relationship was established based on the interval between physician change and prescription. Logistic regression analysis and propensity score matching were used, along with complementary analysis of physician-patient relationships, proportion of days covered, and adherence for a subset of the population. Results: The study included 48,456 patients with an average follow-up of 36.1 (SD 8.8) months. The mean age was 68.3\thinspace(SD 9.9)\thinspaceyears; BMI, 23.4\thinspace(SD\thinspace3.4)\thinspacekg/m2; systolic blood pressure, 131.2\thinspace(SD\thinspace15)\thinspacemm Hg; low-density lipoprotein cholesterol level, 116.6\thinspace(SD\thinspace29.3)\thinspacemg/dL; hemoglobin A1c (HbA1c), 5.9\%\thinspace(SD\thinspace0.8\%); and serum creatinine level, 0.9\thinspace(SD\thinspace0.8)\thinspacemg/dL. Logistic regression analysis revealed significant associations between generic switching and systolic blood pressure (odds ratio [OR] 0.996, 95\% CI 0.993-0.999), serum creatinine levels (OR 0.837, 95\% CI 0.729-0.962), glutamic oxaloacetic transaminase levels (OR 0.994, 95\% CI 0.990-0.997), proportion of days covered score (OR 0.959, 95\% CI 0.948-0.97), and adherence score (OR 0.910, 95\% CI 0.875-0.947). In addition, generic drug rates increased with improvements in the HbA1c level band and smoking level (P<.01 and P<.001). The group with a superior physician-patient relationship after propensity score matching had a significantly higher rate of generic drug prescribing (51.6\%, SD 15.2\%) than the inferior relationship group (47.7\%, SD17.7\%; P<.001). Conclusions: Although physicians' understanding influences the choice of generic drugs, patient condition (severity) and adherence also impact this decision. For example, improved creatinine levels are associated with generic drug choice, while stronger physician-patient relationships correlate with higher rates of generic drug use. These findings may contribute to the appropriate prescription of pharmaceuticals if the policy diffusion of generic drugs begins to slow down. Thus, preventing serious illness while building trust may result in clinical benefits and positive socioeconomic outcomes. ", doi="10.2196/59234", url="https://aging.jmir.org/2024/1/e59234" } @Article{info:doi/10.2196/52871, author="B{\'e}chard, Beno{\^i}t and Gramaccia, A. Julie and Gagnon, Dominique and Laouan-Sidi, Anassour Elhadji and Dub{\'e}, {\`E}ve and Ouimet, Mathieu and de Hemptinne, Delphine and Tremblay, S{\'e}bastien", title="The Resilience of Attitude Toward Vaccination: Web-Based Randomized Controlled Trial on the Processing of Misinformation", journal="JMIR Form Res", year="2024", month="Dec", day="4", volume="8", pages="e52871", keywords="attitude toward vaccination", keywords="misinformation", keywords="reinformation", keywords="confidence", keywords="perceived tentativeness", keywords="vaccine hesitancy", keywords="COVID-19", abstract="Background: Before the COVID-19 pandemic, it was already recognized that internet-based misinformation and disinformation could influence individuals to refuse or delay vaccination for themselves, their families, or their children. Reinformation, which refers to hyperpartisan and ideologically biased content, can propagate polarizing messages on vaccines, thereby contributing to vaccine hesitancy even if it is not outright disinformation. Objective: This study aimed to evaluate the impact of reinformation on vaccine hesitancy. Specifically, the goal was to investigate how misinformation presented in the style and layout of a news article could influence the perceived tentativeness (credibility) of COVID-19 vaccine information and confidence in COVID-19 vaccination. Methods: We conducted a web-based randomized controlled trial by recruiting English-speaking Canadians aged 18 years and older from across Canada through the Qualtrics (Silver Lake) paid opt-in panel system. Participants were randomly assigned to 1 of 4 distinct versions of a news article on COVID-19 vaccines, each featuring variations in writing style and presentation layout. After reading the news article, participants self-assessed the tentativeness of the information provided, their confidence in COVID-19 vaccines, and their attitude toward vaccination in general. Results: The survey included 537 participants, with 12 excluded for not meeting the task completion time. The final sample comprised 525 participants distributed about equally across the 4 news article versions. Chi-square analyses revealed a statistically significant association between general attitude toward vaccination and the perceived tentativeness of the information about COVID-19 vaccines included in the news article ($\chi$21=37.8, P<.001). The effect size was small to moderate, with Cramer V=0.27. An interaction was found between vaccine attitude and writing style ($\chi$21=6.2, P=.01), with a small effect size, Cramer V=0.11. In addition, a Pearson correlation revealed a significant moderate to strong correlation between perceived tentativeness and confidence in COVID-19 vaccination, r(523)=0.48, P<.001. The coefficient of determination (r2) was 0.23, indicating that 23\% of the variance in perceived tentativeness was explained by confidence in COVID-19 vaccines. In comparing participants exposed to a journalistic-style news article with those exposed to an ideologically biased article, Cohen d was calculated to be 0.38, indicating a small to medium effect size for the difference in the perceived tentativeness between these groups. Conclusions: Exposure to a news article conveying misinformation may not be sufficient to change an individual's level of vaccine hesitancy. The study reveals that the predominant factor in shaping individuals' perceptions of COVID-19 vaccines is their attitude toward vaccination in general. This attitude also moderates the influence of writing style on perceived tentativeness; the stronger one's opposition to vaccines, the less pronounced the impact of writing style on perceived tentativeness. International Registered Report Identifier (IRRID): RR2-10.2196/41012 ", doi="10.2196/52871", url="https://formative.jmir.org/2024/1/e52871" } @Article{info:doi/10.2196/48882, author="Lungu, Adrian Daniel and R{\o}islien, Jo and Smeets, Ionica and Wiig, Siri and Br{\o}nnick, Kallesten Kolbj{\o}rn", title="Individual Characteristics in the Comprehension of Pandemic Video Communication: Randomized Controlled Between-Subjects Design", journal="J Med Internet Res", year="2024", month="Dec", day="4", volume="26", pages="e48882", keywords="video communication", keywords="COVID-19 pandemic", keywords="comprehension", keywords="health literacy", keywords="video", keywords="videos", keywords="health communication", keywords="psychology", keywords="perception", keywords="comprehend", keywords="understanding", keywords="coronavirus disease 2019", abstract="Background: Video played an important role in health communication throughout the COVID-19 pandemic. It was used to communicate pandemic information to the public, with a variety of formats, presenters, and topics. Evidence regarding the effectiveness of video features is available, while how individual characteristics of recipients influence communication comprehension is still limited. Objective: This study aimed to test 6 individual characteristics and assess their effect on the comprehension of pandemic video communication. Methods: Short health communication videos were presented to a large sample of subjects, receiving questionnaire responses from 1194 participants. Individual characteristics consisted of age, sex, living area, education level, income level, and belief in science. Communication comprehension consisted of both perceived and objective comprehension. The data were analyzed by multiple linear regression. Results: Age had a negative effect on both perceived and objective comprehension---age was negatively associated with comprehension. There were sex differences, with higher perceived comprehension and lower objective comprehension among female than male individuals. Living in an urban or a rural area had no significant effect (all P>.05). The level of education and income had a positive effect on both subjective and objective comprehension. Finally, the belief in science had a positive effect on perceived comprehension (P<.001) but did not have a statistically significant effect on objective comprehension (P=.87). Conclusions: The main differences between those who think they understand pandemic communication and those who comprehend it better are sex (female individuals have a higher perception of having comprehended, while male individuals have higher levels of objective comprehension) and belief in science (higher belief in science leads to higher perceived comprehension, while it does not have any impact on objectively understanding the message conveyed). ", doi="10.2196/48882", url="https://www.jmir.org/2024/1/e48882" } @Article{info:doi/10.2196/62831, author="Miyakoshi, Takashi and Ito, M. Yoichi", title="Association of Blood Glucose Data With Physiological and Nutritional Data From Dietary Surveys and Wearable Devices: Database Analysis", journal="JMIR Diabetes", year="2024", month="Dec", day="3", volume="9", pages="e62831", keywords="PhysioNet", keywords="Empatica", keywords="Dexcom", keywords="acceleration", keywords="heart rate", keywords="temperature", keywords="electrodermal activity", abstract="Background: Wearable devices can simultaneously collect data on multiple items in real time and are used for disease detection, prediction, diagnosis, and treatment decision-making. Several factors, such as diet and exercise, influence blood glucose levels; however, the relationship between blood glucose and these factors has yet to be evaluated in real practice. Objective: This study aims to investigate the association of blood glucose data with various physiological index and nutritional values using wearable devices and dietary survey data from PhysioNet, a public database. Methods: Three analytical methods were used. First, the correlation of each physiological index was calculated and examined to determine whether their mean values or SDs affected the mean value or SD of blood glucose. To investigate the impact of each physiological indicator on blood glucose before and after the time of collection of blood glucose data, lag data were collected, and the correlation coefficient between blood glucose and each physiological indicator was calculated for each physiological index. Second, to examine the relationship between postprandial blood glucose rise and fall and physiological and dietary nutritional assessment indices, multiple regression analysis was performed on the relationship between the slope before and after the peak in postprandial glucose over time and physiological and dietary nutritional indices. Finally, as a supplementary analysis to the multiple regression analysis, a 1-way ANOVA was performed to compare the relationship between the upward and downward slopes of blood glucose and the groups above and below the median for each indicator. Results: The analysis revealed several indicators of interest: First, the correlation analysis of blood glucose and physiological indices indicated meaningful relationships: acceleration SD (r=--0.190 for lag data at --15-minute values), heart rate SD (r=--0.121 for lag data at --15-minute values), skin temperature SD (r=--0.121), and electrodermal activity SD (r=--0.237) for lag data at --15-minute values. Second, in multiple regression analysis, physiological indices (temperature mean: t=2.52, P=.01; acceleration SD: t=--2.06, P=.04; heart rate\_30 SD: t=--2.12, P=.04; electrodermal activity\_90 SD: t=1.97, P=.049) and nutritional indices (mean carbohydrate: t=6.53, P<.001; mean dietary fiber: t=--2.51, P=.01; mean sugar: t=--3.72, P<.001) were significant predictors. Finally, the results of the 1-way ANOVA corroborated the findings from the multiple regression analysis. Conclusions: Similar results were obtained from the 3 analyses, consistent with previous findings, and the relationship between blood glucose, diet, and physiological indices in the real world was examined. Data sharing facilitates the accessibility of wearable data and enables statistical analyses from various angles. This type of research is expected to be more common in the future. ", doi="10.2196/62831", url="https://diabetes.jmir.org/2024/1/e62831" } @Article{info:doi/10.2196/59904, author="Su, Jingyuan and Shen, Ning Kathy and Guo, Xitong", title="Impact of Reverse Empowerment and Proactive Motivations on Physicians' Online Knowledge Sharing in Digital Platforms: Survey Study", journal="J Med Internet Res", year="2024", month="Nov", day="29", volume="26", pages="e59904", keywords="physician behavior", keywords="online knowledge sharing", keywords="proactivity", keywords="patient empowerment", keywords="digital platforms", keywords="health communication", abstract="Background: Digital platforms offer a venue for patients and physicians to exchange health information and provide health care services outside traditional organizational contexts. Previous studies have seldom focused on the factors that drive the proactivity of physicians' online behavior. Additionally, there is limited research exploring the influence of patients on physicians' online behavior, particularly from the perspective of patients possessing power. Objective: This study aims to investigate the effect of patient-empowering behaviors on physicians' online knowledge sharing and uncover the potential mechanisms of proactivity. Based on the proactive motivational model and empowerment theory, we propose the existence of a reverse empowerment process, where empowerment flows from patients to physicians. We suggest that patient-empowering behaviors may drive physicians' online knowledge sharing as a form of proactivity. Specifically, 3 proactive motivational states---knowledge-sharing self-efficacy, sharing meaning, and positive professional affect---mediate this relationship. Additionally, platform extrinsic rewards, as a contextual factor, have a moderating effect. Methods: To validate our proposed research model, we conducted a survey in China using the WJX platform, targeting physicians engaged in online knowledge sharing. The measurement instrument utilizes validated items adapted from prior research, using a 5-point Likert scale. We collected 257 valid responses, ensuring that participation was both anonymous and voluntary. Data analysis was performed in 2 stages. The first stage assessed the measurement model for reliability and validity, using the Harman 1-factor test and confirmatory factor analysis. The second stage used partial least squares-structural equation modeling to examine the direct, moderation, and mediation effects among the constructs, with bootstrapping used for significance testing. This comprehensive approach ensures a robust analysis of the proposed hypotheses and contributes to the overall validity of our research model. Results: Perceived patient-empowering behaviors significantly and positively influence physicians' online knowledge sharing ($\beta$=0.27, P<.001). Knowledge-sharing self-efficacy (effect=0.06, P=.04), sharing meaning (effect=0.12, P<.001), and positive professional affect (effect=0.10, P=.003) each partially mediate the effect of patient-empowering behaviors on physicians' online knowledge sharing. The overall proactive motivational states play a complete mediation role, meaning the entire indirect effect of the model is significant (effect=0.29, P<.001), while the direct effect in the model is nonsignificant (effect=0.07, P=.26). Additionally, platform extrinsic rewards significantly and negatively moderate the effect of sharing meaning on physicians' online knowledge sharing ($\beta$=--0.13, P=.001). Conclusions: This study is the first to recognize and examine proactivity as an alternative mediating mechanism for physicians' online knowledge sharing, highlighting the active role of patients in empowering physicians. It makes a significant contribution to the existing literature on empowerment, eHealth, and proactive behavior. Additionally, the findings offer valuable guidance for designing and managing digital platforms to ensure service sustainability. ", doi="10.2196/59904", url="https://www.jmir.org/2024/1/e59904" } @Article{info:doi/10.2196/50476, author="Ahn, Suhwoo and Lee, Chul-joo and Bae, Inhwan", title="Patients' Use of Electronic Health Records Facilitates Patient-Centered Communication: Findings From the 2017 Health Information National Trends Survey", journal="J Med Internet Res", year="2024", month="Nov", day="25", volume="26", pages="e50476", keywords="electronic health record", keywords="health information efficacy", keywords="patient-centered communication", keywords="social support", keywords="patient-centered care", abstract="Background: Patient-centered communication refers to interaction between patients and health professionals that considers patients' preferences and empowers patients to contribute to their own care. Research suggests that patient-centered communication promotes patients' satisfaction with care, trust in physicians, and competence in their abilities to manage their health. Objective: The study aims to explore the role of patients' use of electronic health records (EHRs) in promoting patient-centered communication. Specifically, we investigated how health information efficacy mediates the association of EHR use with patient-centered communication and whether and how the relationship between EHR use and health information efficacy varies according to patients' perceived social support levels. Methods: We conducted mediation and multigroup analyses using nationally representative data from the Health Information National Trends Survey 5 cycle 1 conducted in the United States (N=3285). Among respondents, we analyzed those who received care from health professionals over the previous year (2823/3285, 85.94\%). Results: EHR use by patients was associated with high levels of health information efficacy (unstandardized coefficient=0.050, SE 0.024; P=.04). In turn, health information efficacy was positively related to patient-centered communication (unstandardized coefficient=0.154, SE 0.024; P<.001). The indirect pathway from EHR use to patient-centered communication, mediated by health information efficacy, was statistically significant (unstandardized coefficient=0.008, SE 0.004; P=.04). Among patients with high social support (2349/2823, 83.21\%), EHR use was not significantly associated with health information efficacy (unstandardized coefficient=0.038, SE 0.026; P=.15), although health information efficacy was linked to high levels of patient-centered communication (unstandardized coefficient=0.151, SE 0.030; P<.001). The indirect relationship in this group was not significant (unstandardized coefficient=0.006, SE 0.004; P=.11). However, among those with low social support (474/2823, 16.79\%), EHR use was positively associated with health information efficacy (unstandardized coefficient=0.155, SE 0.048; P=.001), which in turn relates to high levels of patient-centered communication (unstandardized coefficient=0.137, SE 0.050; P=.01). The indirect pathway was also significant (unstandardized coefficient=0.021, SE 0.010; P=.03). Conclusions: Patients who use EHRs may build health information efficacy, which seems to promote communication between patients and health care providers. This indirect pathway was not detected among patients with high social support. However, among those with low social support, EHR use seems to enhance health information efficacy, which may in turn facilitate patient-centered communication. Given the nature of the dataset used, the findings of this study are more relevant to the United States than other contexts. ", doi="10.2196/50476", url="https://www.jmir.org/2024/1/e50476" } @Article{info:doi/10.2196/64994, author="Butt, L. Michelle and Willett, Jayne Ysabella and Miller, Vicky and Jacobs, Brenda and Ferron, Mae Era and Wright, L. Amy", title="Indigenous Parents' Perspectives of Factors That Facilitate or Impede Engagement in Internet-Based Parenting Support Programs: Interpretive Description Study", journal="JMIR Pediatr Parent", year="2024", month="Nov", day="22", volume="7", pages="e64994", keywords="child", keywords="parenting", keywords="qualitative", keywords="Indigenous health", keywords="support programs", abstract="Background: Parenting support programs enhance parents' health and their child's development. The COVID-19 pandemic necessitated the delivery of these programs over the internet. After the pandemic, internet-based programs are still preferred by some. Objective: We aimed to understand Indigenous parents' experiences engaging in internet-based parenting support programs; thus, an interpretive description study was conducted. Methods: A total of 20 Indigenous (female, male, and Two-Spirit) parents of children aged <5 years participated in semistructured interviews; data underwent collaborative thematic analysis with Indigenous community partners informed by the Two-Eyed Seeing framework and ethical space. Results: Parents' experiences were classified into five themes: (1) Purpose: Program Delivery and Content, (2) Belonging: Building Relationships and Connections, (3) Hope: Cultural Connection, (4) Meaning: New or Improved Parenting Skills and Mental Wellness, and (5) Recommendations for Organizations. Conclusions: The study findings can inform internet-based parenting program delivery to enhance engagement for Indigenous families. ", doi="10.2196/64994", url="https://pediatrics.jmir.org/2024/1/e64994", url="http://www.ncbi.nlm.nih.gov/pubmed/39576680" } @Article{info:doi/10.2196/56473, author="Alomar, Dalia and Almashmoum, Maryam and Eleftheriou, Iliada and Whelan, Pauline and Ainsworth, John", title="The Impact of Patient Access to Electronic Health Records on Health Care Engagement: Systematic Review", journal="J Med Internet Res", year="2024", month="Nov", day="20", volume="26", pages="e56473", keywords="electronic health records", keywords="personal health record", keywords="health care engagement", keywords="empowerment", keywords="patient experience", keywords="patient satisfaction", keywords="health care services", keywords="systematic review", abstract="Background: Health information technologies, including electronic health records (EHRs), have revolutionized health care delivery. These technologies promise to enhance the efficiency and quality of care through improved patient health information management. Despite the transformative potential of EHRs, the extent to which patient access contributes to increased engagement with health care services within different clinical setting remains a distinct and underexplored facet. Objective: This systematic review aims to investigate the impact of patient access to EHRs on health care engagement. Specifically, we seek to determine whether providing patients with access to their EHRs contributes to improved engagement with health care services. Methods: A comprehensive systematic review search was conducted across various international databases, including Ovid MEDLINE, Embase, PsycINFO, and CINAHL, to identify relevant studies published from January 1, 2010, to November 15, 2023. The search on these databases was conducted using a combination of keywords and Medical Subject Heading terms related to patient access to electronic health records, patient engagement, and health care services. Studies were included if they assessed the impact of patient access to EHRs on health care engagement and provided evidence (quantitative or qualitative) for that. The guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement were followed for study selection, data extraction, and quality assessment. The included studies were assessed for quality using the Mixed Methods Appraisal Tool, and the results were reported using a narrative synthesis. Results: The initial search from the databases yielded 1737 studies, to which, after scanning their reference lists, we added 10 studies. Of these 1747 studies, 18 (1.03\%) met the inclusion criteria for the final review. The synthesized evidence from these studies revealed a positive relationship between patient access to EHRs and health care engagement, addressing 6 categories of health care engagement dimensions and outcomes, including treatment adherence and self-management, patient involvement and empowerment, health care communication and relationship, patient satisfaction and health outcomes, use of health care resources, and usability concerns and barriers. Conclusions: The findings suggested a positive association between patient access to EHRs and health care engagement. The implications of these findings for health care providers, policy makers, and patients should be considered, highlighting the potential benefits and challenges associated with implementing and promoting patient access to EHRs. Further research directions have been proposed to deepen our understanding of this dynamic relationship. ", doi="10.2196/56473", url="https://www.jmir.org/2024/1/e56473" } @Article{info:doi/10.2196/58277, author="Malkani, Melina and Madan, Eesha and Malkani, Dillon and Madan, Arav and Singh, Neel and Bamji, Tara and Sabharwal, Harman", title="Rank Ordered Design Attributes for Health Care Dashboards Including Artificial Intelligence: Usability Study", journal="Online J Public Health Inform", year="2024", month="Nov", day="20", volume="16", pages="e58277", keywords="data visualization", keywords="dashboards", keywords="public health", keywords="population health", keywords="informed decisions", keywords="consumer decision-making", keywords="health data", keywords="usability", abstract="Background: On average, people in the United States visit a doctor 4 times a year, and many of them have chronic illnesses. Because of the increased use of technology, people frequently rely on the internet to access health information and statistics. People use health care information to make better-educated decisions for themselves and others. Health care dashboards should provide pertinent and easily understood data, such as information on timely cancer screenings, so the public can make better-informed decisions. In order to enhance health outcomes, effective dashboards should provide precise data in an accessible and easily digestible manner. Objective: This study identifies the top 15 attributes of a health care dashboard. The objective of this research is to enhance health care dashboards to benefit the public by making better health care information available for more informed decisions by the public and to improve population-level health care outcomes. Methods: The authors conducted a survey of health care dashboards with 218 individuals identifying the best practices to consider when creating a public health care dashboard. The data collection was conducted from June 2023 to August 2023. The analyses performed were descriptive statistics, frequencies, and a comparison to a prior study. Results: From May 2023 to June 2023, we collected 3259 responses in multiple different states around the United States from 218 people aged 18 years or older. The features ranking in descending order of importance are as follows: (1) easy navigation, (2) historical data, (3) simplicity of design, (4) high usability, (5) use of clear descriptions, (6) consistency of data, (7) use of diverse chart types, (8) compliance with the Americans with Disabilities Act, (9) incorporated user feedback, (10) mobile compatibility, (11) comparison data with other entities, (12) storytelling, (13) predictive analytics with artificial intelligence, (14) adjustable thresholds, and (15) charts with tabulated data. Conclusions: Future studies can extend the research to other types of dashboards such as bioinformatics, financial, and managerial dashboards as well as confirm these top 15 best practices for medical dashboards with further evidentiary support. The medical informatics community may benefit from standardization to improve efficiency and effectiveness as dashboards can communicate vital information to patients worldwide on critically prominent issues. Furthermore, health care professionals should use these best practices to help increase population health care outcomes by informing health care consumers to make better decisions with better data. ", doi="10.2196/58277", url="https://ojphi.jmir.org/2024/1/e58277", url="http://www.ncbi.nlm.nih.gov/pubmed/39566038" } @Article{info:doi/10.2196/56166, author="Chen, Runnan and Fu, Xiaorong and Liu, Mochi and Liao, Ke and Bai, Lifei", title="Online Depression Communities as a Complementary Approach to Improving the Attitudes of Patients With Depression Toward Medication Adherence: Cross-Sectional Survey Study", journal="J Med Internet Res", year="2024", month="Nov", day="19", volume="26", pages="e56166", keywords="online depression communities", keywords="attitudes", keywords="institution-generated content", keywords="user-generated content", keywords="perceived social support", keywords="antidepressants", keywords="hopelessness", keywords="cross-sectional study", keywords="China", keywords="health care system", keywords="online health community", keywords="depression", keywords="medication adherence", keywords="social support", keywords="health care practitioner", keywords="peer support", abstract="Background: Lack of adherence to prescribed medication is common among patients with depression in China, posing serious challenges to the health care system. Online health communities have been found to be effective in enhancing patient compliance. However, empirical evidence supporting this effect in the context of depression treatment is absent, and the influence of online health community content on patients' attitudes toward medication adherence is also underexplored. Objective: This study aims to explore whether online depression communities (ODCs) can help ameliorate the problem of poor medication taking among patients with depression. Drawing on the stimulus-organism-response and feelings-as-information theories, we established a research model to examine the influence of useful institution-generated content (IGC) and positive user-generated content (UGC) on attitudes toward medication adherence when combined with the mediating role of perceived social support, perceived value of antidepressants, and the moderating role of hopelessness. Methods: A cross-sectional questionnaire survey method was used in this research. Participants were recruited from various Chinese ODCs, generating data for a main study and 2 robustness checks. Hierarchical multiple regression analyses and bootstrapping analyses were adopted as the primary methods to test the hypotheses. Results: We received 1515 valid responses in total, contributing to 5 different datasets: model IGC (n=353, 23.3\%), model UGC (n=358, 23.63\%), model IGC+UGC (n=270, 17.82\%), model IGC-B (n=266, 17.56\%), and model UGC-B (n=268, 17.69\%). Models IGC and UGC were used for the main study. Model IGC+UGC was used for robustness check A. Models IGC-B and UGC-B were used for robustness check B. Useful IGC and positive UGC were proven to have positive impact on the attitudes of patients with depression toward medication adherence through the mediations of perceived social support and perceived value of antidepressants. The findings corroborated the role of hopelessness in weakening or even negating the positive effects of ODC content on the attitudes of patients with depression toward medication adherence. Conclusions: This study provides the first empirical evidence demonstrating the relationship between ODC content and attitudes toward medication adherence, through which we offer a novel solution to the problem of poor medication adherence among patients with depression in China. Our findings also provide suggestions about how to optimize this new approach---health care practitioners should generate online content that precisely matches the informational needs of patients with depression, and ODC service providers should endeavor to regulate the community atmosphere. Nonetheless, we warn that ODC interventions cannot be used as the only approach to addressing the problem of poor medication taking among patients with severe depressive symptoms. ", doi="10.2196/56166", url="https://www.jmir.org/2024/1/e56166" } @Article{info:doi/10.2196/57360, author="Preiser, Christine and Radionova, Natalia and {\"O}g, Eylem and Koch, Roland and Klemmt, Malte and M{\"u}ller, Regina and Ranisch, Robert and Joos, Stefanie and Rieger, A. Monika", title="The Doctors, Their Patients, and the Symptom Checker App: Qualitative Interview Study With General Practitioners in Germany", journal="JMIR Hum Factors", year="2024", month="Nov", day="18", volume="11", pages="e57360", keywords="symptom checker app", keywords="qualitative interviews", keywords="general practice", keywords="perceived work-related psychosocial stress", keywords="job satisfaction", keywords="professional identity", keywords="medical diagnosis", abstract="Background: Symptom checkers are designed for laypeople and promise to provide a preliminary diagnosis, a sense of urgency, and a suggested course of action. Objective: We used the international symptom checker app (SCA) Ada App as an example to answer the following question: How do general practitioners (GPs) experience the SCA in relation to the macro, meso, and micro level of their daily work, and how does this interact with work-related psychosocial resources and demands? Methods: We conducted 8 semistructured interviews with GPs in Germany between December 2020 and February 2022. We analyzed the data using the integrative basic method, an interpretative-reconstructive method, to identify core themes and modes of thematization. Results: Although most GPs in this study were open to digitization in health care and their practice, only one was familiar with the SCA. GPs considered the SCA as part of the ``unorganized stage'' of patients' searching about their conditions. Some preferred it to popular search engines. They considered it relevant to their work as soon as the SCA would influence patients' decisions to see a doctor. Some wanted to see the results of the SCA in advance in order to decide on the patient's next steps. GPs described the diagnostic process as guided by shared decision-making, with the GP taking the lead and the patient deciding. They saw diagnosis as an act of making sense of data, which the SCA would not be able to do, despite the huge amounts of data. Conclusions: GPs took a techno-pragmatic view of SCA. They operate in a health care system of increasing scarcity. They saw the SCA as a potential work-related resource if it helped them to reduce administrative tasks and unnecessary patient contacts. The SCA was seen as a potential work-related demand if it increased workload, for example, if it increased patients' anxiety, was too risk-averse, or made patients more insistent on their own opinions. ", doi="10.2196/57360", url="https://humanfactors.jmir.org/2024/1/e57360" } @Article{info:doi/10.2196/55088, author="Yang, Lin and Guo, Zhen and Xu, Xiaowei and Kang, Hongyu and Lai, Jianqiang and Li, Jiao", title="An Online Multimodal Food Data Exploration Platform for Specific Population Health: Development Study", journal="JMIR Form Res", year="2024", month="Nov", day="15", volume="8", pages="e55088", keywords="Chinese food data", keywords="multimodal knowledge graph", keywords="online platform", keywords="population health promotion", keywords="health promotion", keywords="nutrients", keywords="diet", keywords="pregnant women", abstract="Background: Nutrient needs vary over the lifespan. Improving knowledge of both population groups and care providers can help with healthier food choices, thereby promoting population health and preventing diseases. Providing evidence-based food knowledge online is credible, low cost, and easily accessible. Objective: This study aimed to develop an online multimodal food data exploration platform for easy access to evidence-based diet- and nutrition-related data. Methods: We developed an online platform named Food Atlas in collaboration with a multidisciplinary expert group from the National Institute for Nutrition and Health and Peking Union Medical College Hospital in China. To demonstrate its feasibility for Chinese food for pregnant women, a user-friendly and high-quality multimodal food knowledge graph was constructed, and various interactions with graph-structured data were developed for easy access, including graph-based interactive visualizations, natural language retrieval, and image-text retrieval. Subsequently, we evaluated Food Atlas from both the system perspective and the user perspective. Results: The constructed multimodal food knowledge graph contained a total of 2011 entities, 10,410 triplets, and 23,497 images. Its schema consisted of 11 entity types and 26 types of semantic relations. Compared with 5 other online dietary platforms (Foodwake, Boohee, Xiachufang, Allrecipes, and Yummly), Food Atlas offers a distinct and comprehensive set of data content and system functions desired by target populations. Meanwhile, a total of 28 participants representing 4 different user groups were recruited to evaluate its usability: preparing for pregnancy (n=8), pregnant (n=12), clinicians (n=5), and dietitians (n=3). The mean System Usability Scale index of our platform was 82.5 (SD 9.94; range 40.0-82.5). This above-average usability score and the use cases indicated that Food Atlas is tailored to the needs of the target users. Furthermore, 96\% (27/28) of the participants stated that the platform had high consistency, illustrating the necessity and effectiveness of health professionals participating in online, evidence-based resource development. Conclusions: This study demonstrates the development of an online multimodal food data exploration platform and its ability to meet the rising demand for accessible, credible, and appropriate evidence-based online dietary resources. Further research and broader implementation of such platforms have the potential to popularize knowledge, thereby helping populations at different life stages make healthier food choices. ", doi="10.2196/55088", url="https://formative.jmir.org/2024/1/e55088" } @Article{info:doi/10.2196/60575, author="Cauley, Elaine Christy and Rubio, Atziri and Brindle, Mary and Cooper, Zara and Vranceanu, Ana-Maria and Ritchie, S. Christine", title="A Video-Based Communication Intervention for Fecal Ostomy Surgery (CI-oSurg): Protocol for Open Pilot Testing to Improve Intervention Acceptability and Feasibility", journal="JMIR Res Protoc", year="2024", month="Nov", day="15", volume="13", pages="e60575", keywords="fecal ostomy", keywords="distress", keywords="open pilot", keywords="fecal ostomy surgeryl CI-oSurg", keywords="intervention acceptability", keywords="biopsychosocial outcomes", keywords="psychosocial support", keywords="ostomy care", abstract="Background: Approximately 100,000 patients undergo fecal ostomy operations annually across the United States. This patient population experiences high surgical complication rates and poor biopsychosocial outcomes. Surgical teams are not trained to address the psychosocial needs that often arise during recovery after fecal ostomy surgery. Objective: This study aims to refine and establish the acceptability and usability of the Communication Intervention for fecal ostomy Surgery (CI-oSurg), a web-based communication intervention aimed at reducing distress among patients recovering from ostomy surgery. Methods: We describe the proposed study design, methodology, and training protocol. We will conduct an open pilot (n=24 patients and n=8 clinicians) of video-based training to first identify the level and types of distress patients are experiencing. Next, patients will view web videos that address frequent challenges faced by ostomy patients, considering practical management and emotional and adaptation concerns. Qualitative one-to-one semistructured interviews will be conducted with participants to explore the acceptability and feasibility of the program and refine the intervention and study procedures. Results: This study has been approved by the Mass General Brigham Institutional Review Board. Study funding has been obtained, and recruitment is planned for the fall of 2024. Conclusions: Through this study, we will refine CI-oSurg, a web-based communication intervention focused on reducing distress after ostomy surgery, to improve intervention acceptability and usability. These improvements will allow us to establish the usability and acceptability of the intervention before efficacy testing to determine the ability of this intervention to reduce distress after fecal ostomy surgery. Trial Registration: ClinicalTrials.gov NCT06320002; https://clinicaltrials.gov/study/NCT06320002 International Registered Report Identifier (IRRID): PRR1-10.2196/60575 ", doi="10.2196/60575", url="https://www.researchprotocols.org/2024/1/e60575" } @Article{info:doi/10.2196/53299, author="Perme, Natalie and Reid, Endia and Eluagu, Chinwenwa Macdonald and Thompson, John and Hebert, Courtney and Gabbe, Steven and Swoboda, Marie Christine", title="Development and Usability of the OHiFamily Mobile App to Enhance Accessibility to Maternal and Infant Information for Expectant Families in Ohio: Qualitative Study", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e53299", keywords="health resources", keywords="pregnancy", keywords="patient engagement", keywords="mHealth", keywords="maternal", keywords="mobile health", keywords="app", keywords="focus group", keywords="landscape analysis", keywords="birth", keywords="preterm", keywords="premature", keywords="mortality", keywords="death", keywords="pediatric", keywords="infant", keywords="neonatal", keywords="design", keywords="development", keywords="obstetric", keywords="mobile phone", abstract="Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources. The OHiFamily app includes 3 distinct features, that is, infant care logging (eg, feeding and diaper changes), curated educational resources, and a link to the curated Ohio resource database (CORD). This paper describes the development and assessment of the OHiFamily app as well as CORD. Objective: This study aimed to describe the development of the OHiFamily mobile app and CORD and the qualitative feedback received by the app's intended audience. Methods: The researchers performed a landscape analysis and held focus groups to determine the resources and app features of interest to Ohio families on Medicaid. Results: Participants from several focus groups were interested in an app that could offer community resources with contact information, information about medical providers and information and ways to contact them, health tips, and information about pregnancy and infant development. Feedback was provided by 9 participants through 3 focus group sessions. Using this feedback, the team created a curated resource database and mobile app to help users locate and access resources, as well as access education materials and infant tracking features. Conclusions: OHiFamily offers a unique combination of features and access to local resources for families on Medicaid in Ohio not seen in other smartphone apps. ", doi="10.2196/53299", url="https://formative.jmir.org/2024/1/e53299" } @Article{info:doi/10.2196/55086, author="Chandrasekaran, Ranganathan and Sadiq T, Muhammed and Moustakas, Evangelos", title="Racial and Demographic Disparities in Susceptibility to Health Misinformation on Social Media: National Survey-Based Analysis", journal="J Med Internet Res", year="2024", month="Nov", day="6", volume="26", pages="e55086", keywords="health misinformation", keywords="digital divide", keywords="racial disparities", keywords="social media", keywords="national survey-based analysis", keywords="health information", keywords="interventions", abstract="Background: Social media platforms have transformed the dissemination of health information, allowing for rapid and widespread sharing of content. However, alongside valuable medical knowledge, these platforms have also become channels for the spread of health misinformation, including false claims and misleading advice, which can lead to significant public health risks. Susceptibility to health misinformation varies and is influenced by individuals' cultural, social, and personal backgrounds, further complicating efforts to combat its spread. Objective: This study aimed to examine the extent to which individuals report encountering health-related misinformation on social media and to assess how racial, ethnic, and sociodemographic factors influence susceptibility to such misinformation. Methods: Data from the Health Information National Trends Survey (HINTS; Cycle 6), conducted by the National Cancer Institute with 5041 US adults between March and November 2022, was used to explore associations between racial and sociodemographic factors (age, gender, race/ethnicity, annual household income, marital status, and location) and susceptibility variables, including encounters with misleading health information on social media, difficulty in assessing information truthfulness, discussions with health providers, and making health decisions based on such information. Results: Over 35.61\% (1740/4959) of respondents reported encountering ``a lot'' of misleading health information on social media, with an additional 45\% (2256/4959) reporting seeing ``some'' amount of health misinformation. Racial disparities were evident in comparison with Whites, with non-Hispanic Black (odds ratio [OR] 0.45, 95\% CI 0.33-0.6, P<.01) and Hispanic (OR 0.54, 95\% CI 0.41-0.71, P<.01) individuals reporting lower odds of finding deceptive information, while Hispanic (OR 1.68, 95\% CI 1.48-1.98, P<.05) and non-Hispanic Asian (OR 1.96, 95\% CI 1.21-3.18, P<.01) individuals exhibited higher odds in having difficulties in assessing the veracity of health information found on social media. Hispanic and Asian individuals were more likely to discuss with providers and make health decisions based on social media information. Older adults aged ?75 years exhibited challenges in assessing health information on social media (OR 0.63, 95\% CI 0.43-0.93, P<.01), while younger adults (18-34) showed increased vulnerability to health misinformation. In addition, income levels were linked to higher exposure to health misinformation on social media: individuals with annual household incomes between US \$50,000 and US \$75,000 (OR 1.74, 95\% CI 1.14-2.68, P<.01), and greater than US \$75,000 (OR 1.78, 95\% CI 1.20-2.66, P<.01) exhibited greater odds, revealing complexities in decision-making and information access. Conclusions: This study highlights the pervasive presence of health misinformation on social media, revealing vulnerabilities across racial, age, and income groups, underscoring the need for tailored interventions. ", doi="10.2196/55086", url="https://www.jmir.org/2024/1/e55086" } @Article{info:doi/10.2196/57611, author="Fischer, Lena and Scheibler, F{\"u}l{\"o}p and Schaefer, Corinna and Karge, Torsten and Langer, Thomas and Schewe, Vincent Leon and Florez, D. Ivan and Hutchinson, Andrew and Li, Sheyu and Maes-Carballo, Marta and Munn, Zachary and Perestelo-Perez, Lilisbeth and Puljak, Livia and Stiggelbout, Anne and Pieper, Dawid", title="Fostering Shared Decision-Making Between Patients and Health Care Professionals in Clinical Practice Guidelines: Protocol for a Project to Develop and Test a Tool for Guideline Developers", journal="JMIR Res Protoc", year="2024", month="Nov", day="4", volume="13", pages="e57611", keywords="shared decision-making", keywords="practice guidelines as topic", keywords="decision support techniques", keywords="support", keywords="decision-making", keywords="decisions", keywords="tool", keywords="testing tool", keywords="protocol", keywords="medical decision-making", keywords="patient decision aid", keywords="decision aid", keywords="tool development", abstract="Background: Clinical practice guidelines (CPGs) are designed to assist health care professionals in medical decision-making, but they often lack effective integration of shared decision-making (SDM) principles to reflect patient values and preferences, particularly in the context of preference-sensitive CPG recommendations. To address this shortcoming and foster SDM through CPGs, the integration of patient decision aids (PDAs) into CPGs has been proposed as an important strategy. However, methods for systematically identifying and prioritizing CPG recommendations relevant to SDM and related decision support tools are currently lacking. Objective: The aim of the project is to develop (1) a tool for systematically identifying and prioritizing CPG recommendations for which SDM is considered particularly relevant and (2) a platform for PDAs to support practical SDM implementation. Methods: The project consists of 6 work packages (WPs). It is embedded in the German health care context but has an international focus. In WP 1, we will conduct a scoping review in bibliographic databases and gray literature sources to identify methods used to foster SDM via PDAs in the context of CPGs. In WP 2, we will conduct semistructured interviews with CPG experts to better understand the concepts of preference sensitivity and identify strategies for fostering SDM through CPGs. WP 3, a modified Delphi study including surveys and focus groups with SDM experts, aims to define and operationalize preference sensitivity. Based on the results of the Delphi study, we will develop a methodology for prioritizing key questions in CPGs. In WP 4, the tool will be developed. A list of relevant items to identify CPG recommendations for which SDM is most relevant will be created, tested, and iteratively refined, accompanied by the development of a user manual. In WP 5, a platform for creating and digitizing German-language PDAs will be developed to support the practical application of SDM during clinical encounters. WP 6 will conclude the project by testing the tool with newly developed and revised CPGs. Results: The Brandenburg Medical School Ethics Committee approved the project (165122023-ANF). An international multidisciplinary advisory board is involved to guide the tool development on CPGs and SDM. Patient partners are involved throughout the project, considering the essential role of the patient perspective in SDM. As of February 20, 2024, we are currently assessing literature references to determine eligibility for inclusion in the scoping review (WP 1). We expect the project to be completed by December 31, 2026. Conclusions: The tool will enable CPG developers to systematically incorporate aspects of SDM into CPG development, thereby providing guideline-based support for the patient-practitioner interaction. Together, the tool for CPGs and the platform for PDAs will create a systematic link between CPGs, SDM, and PDAs, which may facilitate SDM in clinical practice. International Registered Report Identifier (IRRID): DERR1-10.2196/57611 ", doi="10.2196/57611", url="https://www.researchprotocols.org/2024/1/e57611", url="http://www.ncbi.nlm.nih.gov/pubmed/39495553" } @Article{info:doi/10.2196/51095, author="Zeng, Jiaqi and Zou, Xiaoyi and Li, Shirong and Tang, Yao and Teng, Sisi and Li, Huanhuan and Wang, Changyu and Wu, Yuxuan and Zhang, Luyao and Zhong, Yunheng and Liu, Jialin and Liu, Siru", title="Assessing the Role of the Generative Pretrained Transformer (GPT) in Alzheimer's Disease Management: Comparative Study of Neurologist- and Artificial Intelligence--Generated Responses", journal="J Med Internet Res", year="2024", month="Oct", day="31", volume="26", pages="e51095", keywords="Alzheimer's disease", keywords="artificial intelligence", keywords="AI", keywords="large language model", keywords="LLM", keywords="Generative Pretrained Transformer", keywords="GPT", keywords="ChatGPT", keywords="patient information", abstract="Background: Alzheimer's disease (AD) is a progressive neurodegenerative disorder posing challenges to patients, caregivers, and society. Accessible and accurate information is crucial for effective AD management. Objective: This study aimed to evaluate the accuracy, comprehensibility, clarity, and usefulness of the Generative Pretrained Transformer's (GPT) answers concerning the management and caregiving of patients with AD. Methods: In total, 14 questions related to the prevention, treatment, and care of AD were identified and posed to GPT-3.5 and GPT-4 in Chinese and English, respectively, and 4 respondent neurologists were asked to answer them. We generated 8 sets of responses (total 112) and randomly coded them in answer sheets. Next, 5 evaluator neurologists and 5 family members of patients were asked to rate the 112 responses using separate 5-point Likert scales. We evaluated the quality of the responses using a set of 8 questions rated on a 5-point Likert scale. To gauge comprehensibility and participant satisfaction, we included 3 questions dedicated to each aspect within the same set of 8 questions. Results: As of April 10, 2023, the 5 evaluator neurologists and 5 family members of patients with AD rated the 112 responses: GPT-3.5: n=28, 25\%, responses; GPT-4: n=28, 25\%, responses; respondent neurologists: 56 (50\%) responses. The top 5 (4.5\%) responses rated by evaluator neurologists had 4 (80\%) GPT (GPT-3.5+GPT-4) responses and 1 (20\%) respondent neurologist's response. For the top 5 (4.5\%) responses rated by patients' family members, all but the third response were GPT responses. Based on the evaluation by neurologists, the neurologist-generated responses achieved a mean score of 3.9 (SD 0.7), while the GPT-generated responses scored significantly higher (mean 4.4, SD 0.6; P<.001). Language and model analyses revealed no significant differences in response quality between the GPT-3.5 and GPT-4 models (GPT-3.5: mean 4.3, SD 0.7; GPT-4: mean 4.4, SD 0.5; P=.51). However, English responses outperformed Chinese responses in terms of comprehensibility (Chinese responses: mean 4.1, SD 0.7; English responses: mean 4.6, SD 0.5; P=.005) and participant satisfaction (Chinese responses: mean 4.2, SD 0.8; English responses: mean 4.5, SD 0.5; P=.04). According to the evaluator neurologists' review, Chinese responses had a mean score of 4.4 (SD 0.6), whereas English responses had a mean score of 4.5 (SD 0.5; P=.002). As for the family members of patients with AD, no significant differences were observed between GPT and neurologists, GPT-3.5 and GPT-4, or Chinese and English responses. Conclusions: GPT can provide patient education materials on AD for patients, their families and caregivers, nurses, and neurologists. This capability can contribute to the effective health care management of patients with AD, leading to enhanced patient outcomes. ", doi="10.2196/51095", url="https://www.jmir.org/2024/1/e51095" } @Article{info:doi/10.2196/64593, author="Oliveira, Almeida Juliana and Eskandar, Karine and Kar, Emre and de Oliveira, Ribeiro Fl{\'a}via and Filho, Silva Agnaldo Lopes da", title="Understanding AI's Role in Endometriosis Patient Education and Evaluating Its Information and Accuracy: Systematic Review", journal="JMIR AI", year="2024", month="Oct", day="30", volume="3", pages="e64593", keywords="endometriosis", keywords="gynecology", keywords="machine learning", keywords="artificial intelligence", keywords="large language models", keywords="natural language processing", keywords="patient-generated health data", keywords="health knowledge", keywords="information seeking", keywords="patient education", abstract="Background: Endometriosis is a chronic gynecological condition that affects a significant portion of women of reproductive age, leading to debilitating symptoms such as chronic pelvic pain and infertility. Despite advancements in diagnosis and management, patient education remains a critical challenge. With the rapid growth of digital platforms, artificial intelligence (AI) has emerged as a potential tool to enhance patient education and access to information. Objective: This systematic review aims to explore the role of AI in facilitating education and improving information accessibility for individuals with endometriosis. Methods: This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to ensure rigorous and transparent reporting. We conducted a comprehensive search of PubMed; Embase; the Regional Online Information System for Scientific Journals of Latin America, the Caribbean, Spain and Portugal (LATINDEX); Latin American and Caribbean Literature in Health Sciences (LILACS); Institute of Electrical and Electronics Engineers (IEEE) Xplore, and the Cochrane Central Register of Controlled Trials using the terms ``endometriosis'' and ``artificial intelligence.'' Studies were selected based on their focus on AI applications in patient education or information dissemination regarding endometriosis. We included studies that evaluated AI-driven tools for assessing patient knowledge and addressed frequently asked questions related to endometriosis. Data extraction and quality assessment were conducted independently by 2 authors, with discrepancies resolved through consensus. Results: Out of 400 initial search results, 11 studies met the inclusion criteria and were fully reviewed. We ultimately included 3 studies, 1 of which was an abstract. The studies examined the use of AI models, such as ChatGPT (OpenAI), machine learning, and natural language processing, in providing educational resources and answering common questions about endometriosis. The findings indicated that AI tools, particularly large language models, offer accurate responses to frequently asked questions with varying degrees of sufficiency across different categories. AI's integration with social media platforms also highlights its potential to identify patients' needs and enhance information dissemination. Conclusions: AI holds promise in advancing patient education and information access for endometriosis, providing accurate and comprehensive answers to common queries, and facilitating a better understanding of the condition. However, challenges remain in ensuring ethical use, equitable access, and maintaining accuracy across diverse patient populations. Future research should focus on developing standardized approaches for evaluating AI's impact on patient education and exploring its integration into clinical practice to enhance support for individuals with endometriosis. ", doi="10.2196/64593", url="https://ai.jmir.org/2024/1/e64593" } @Article{info:doi/10.2196/56390, author="Preuhs, Katharina and Bussink-Voorend, Daphne and van Keulen, M. Hilde and Wildeman, Ilona and Hautvast, Jeannine and Hulscher, Marlies and van Empelen, Pepijn", title="An Online Tailored COVID-19 Vaccination Decision Aid for Dutch Citizens: Development, Dissemination, and Use", journal="JMIR Form Res", year="2024", month="Oct", day="30", volume="8", pages="e56390", keywords="COVID-19", keywords="COVID-19 vaccination", keywords="informed decision-making", keywords="user-centered design", keywords="low literacy", keywords="eHealth", keywords="tailored decision aid", abstract="Background: Since December 2019, COVID-19 led to a pandemic causing many hospitalizations and deaths. Vaccinations were developed and introduced to control viral transmission. In the Dutch context, the decision to accept vaccination is not mandatory. An informed decision is based on sufficient and reliable information, in line with one's attitudes and values, and with consideration of pros and cons. To support people in informed decision-making, we developed an online COVID-19 vaccination decision aid (DA). Objective: This article aims to describe the development, dissemination, and use of the DA. Methods: Building on a previously developed DA, the COVID-19 vaccination DA was developed in 3 phases following a user-centered design approach: (1) definition phase, (2) concept testing, and (3) prototype testing. End users, individuals with low literacy, and experts (with relevant expertise on medical, behavioral, and low literacy aspects) were involved in the iterative development, design, and testing, with their feedback forming the basis for adaptations to the DA. Results: The DA was developed within 14 weeks. The DA consists of 3 modules, namely, Provide Information, Support Decision-Making, and Facilitate Actions Following a Decision. These modules are translated into various information tiles and diverse functionalities such as a knowledge test, a value clarification tool using a decisional balance, and a communication tool. The DA was disseminated for use in May 2021. Users varied greatly regarding age, gender, and location in the Netherlands. Conclusions: This paper elaborates on the development of the COVID-19 vaccination DA in a brief period and its dissemination for use among Dutch adults in the Netherlands. The evaluation of use showed that we were able to reach a large proportion and variety of people throughout the Netherlands. ", doi="10.2196/56390", url="https://formative.jmir.org/2024/1/e56390" } @Article{info:doi/10.2196/62691, author="Fiordelli, Maddalena", title="Transitioning Perspectives in Digital Health Through Phenomenology Integration", journal="J Med Internet Res", year="2024", month="Oct", day="23", volume="26", pages="e62691", keywords="eHealth", keywords="digital health", keywords="phenomenology", keywords="phenomenological", keywords="participatory", keywords="health communication", keywords="health information", keywords="active listening", keywords="lived experience", doi="10.2196/62691", url="https://www.jmir.org/2024/1/e62691" } @Article{info:doi/10.2196/63707, author="Gibson, Irene and Neubeck, Lis and Corcoran, Marissa and Morland, Chris and Donovan, Steve and Jones, Jennifer and Costello, Caroline and Hynes, Lisa and Harris, Aisling and Harrahill, Mary and Lillis, Mary and Atrey, Alison and Ski, F. Chantal and Savickas, Vilius and Byrne, Molly and Murphy, W. Andrew and McEvoy, William John and Wood, David and Jennings, Catriona", title="Development of a Digital Health Intervention for the Secondary Prevention of Cardiovascular Disease (INTERCEPT): Co-Design and Usability Testing Study", journal="JMIR Hum Factors", year="2024", month="Oct", day="23", volume="11", pages="e63707", keywords="cardiovascular disease", keywords="secondary prevention", keywords="digital health", keywords="intervention development", keywords="co-design", keywords="usability testing", keywords="mobile health", keywords="usability", keywords="design", keywords="conline workshop", keywords="social support", keywords="behavioral change", keywords="self-monitoring", abstract="Background: Secondary prevention is an important strategy to reduce the burden of cardiovascular disease (CVD), a leading cause of death worldwide. Despite the growing evidence for the effectiveness of digital health interventions (DHIs) for the secondary prevention of CVD, the majority are designed with minimal input from target end users, resulting in poor uptake and usage. Objective: This study aimed to optimize the acceptance and effectiveness of a DHI for the secondary prevention of CVD through co-design, integrating end users' perspectives throughout. Methods: A theory-driven, person-based approach using co-design was adopted for the development of the DHI, known as INTERCEPT. This involved a 4-phase iterative process using online workshops. In phase 1, a stakeholder team of health care professionals, software developers, and public and patient involvement members was established. Phase 2 involved identification of the guiding principles, content, and design features of the DHI. In phase 3, DHI prototypes were reviewed for clarity of language, ease of navigation, and functionality. To anticipate and interpret DHI usage, phase 4 involved usability testing with participants who had a recent cardiac event (<2 years). To assess the potential impact of usability testing, the System Usability Scale was administered before and after testing. The GUIDED (Guidance for Reporting Intervention Development Studies in Health Research) checklist was used to report the development process. Results: Five key design principles were identified: simplicity and ease of use, behavioral change through goal setting and self-monitoring, personalization, system credibility, and social support. Usability testing resulted in 64 recommendations for the app, of which 51 were implemented. Improvements in System Usability Scale scores were observed when comparing the results before and after implementing the recommendations (61 vs 83; P=.02). Conclusions: Combining behavior change theory with a person-based, co-design approach facilitated the development of a DHI for the secondary prevention of CVD that optimized responsiveness to end users' needs and preferences, thereby potentially improving future engagement. ", doi="10.2196/63707", url="https://humanfactors.jmir.org/2024/1/e63707", url="http://www.ncbi.nlm.nih.gov/pubmed/39441626" } @Article{info:doi/10.2196/58419, author="Pogrebnoy, Dina and Ashton, Lee and Beh, A. Brian and Burke, Meredith and Cullen, Richard and Czerenkowski, Jude and Davey, Julie and Dennett, M. Amy and English, Kevin and Godecke, Erin and Harper, Nicole and Lynch, Elizabeth and MacDonald-Wicks, Lesley and Patterson, Amanda and Ramage, Emily and Schelfhaut, Ben and Simpson, B. Dawn and Zacharia, Karly and English, Coralie", title="Adapting a Telehealth Physical Activity and Diet Intervention to a Co-Designed Website for Self-Management After Stroke: Tutorial", journal="J Med Internet Res", year="2024", month="Oct", day="22", volume="26", pages="e58419", keywords="stroke", keywords="secondary prevention", keywords="co-design", keywords="how-to guide, website development", keywords="accessibility", keywords="navigation", keywords="self-management", doi="10.2196/58419", url="https://www.jmir.org/2024/1/e58419" } @Article{info:doi/10.2196/57698, author="Dhakal, Smita and Merani, Shermeen and Ahluwalia, Vandana and Battistella, Marisa and Borkhoff, M. Cornelia and Hazlewood, Stewart Glen and Lofters, Aisha and Marshall, A. Deborah and MacKay, Crystal and Gagliardi, R. Anna", title="The Quality and Cultural Safety of Online Osteoarthritis Information for Affected Persons and Health Care Professionals: Content Analysis", journal="J Med Internet Res", year="2024", month="Oct", day="18", volume="26", pages="e57698", keywords="osteoarthritis", keywords="women's health", keywords="equity", keywords="educational materials", keywords="internet", keywords="content analysis", keywords="Canada", keywords="persons living with osteoarthritis", keywords="healthcare professionals", keywords="OA care", keywords="ethno-culturally women", keywords="immigrant women", keywords="diverse women", keywords="online materials", keywords="health information", keywords="prevention", keywords="management", keywords="misinformation", keywords="cultural safety", abstract="Background: Osteoarthritis is more prevalent and severe among women than among men, but women are less likely to access early diagnosis and first-line management, particularly racialized immigrant women. Previous research advocated for greater access to culturally safe osteoarthritis information for both diverse women and health care professionals. The internet can reduce disparities by facilitating access to health information, but online materials can vary in quality. Objective: This study aimed to assess the quality and cultural safety of online osteoarthritis materials for persons affected by osteoarthritis and health care professionals. Methods: Content analysis was used to describe publicly available materials on osteoarthritis first-line management developed by Canadian organizations for affected persons or health care professionals. Searching, screening, and data extraction were performed in triplicate. We identified materials by searching Google, MEDLINE, and references of osteoarthritis-relevant guidelines and policies, and consulting our research team and collaborators. We assessed quality using DISCERN (University of Oxford) and a compiled framework for affected persons and health care professionals. We compiled frameworks to assess cultural safety. We derived an overall score, categorized as low (<50\%), moderate (50\%-69\%), or high (?70\%+) for criteria met. Results: After screening 176 items and eliminating 129, we included 47 osteoarthritis materials published between 2013 and 2023. Of those, 43 were for persons with osteoarthritis, most were developed by charities (n=31, 72.1\%), based on expert advice (n=16, 55.2\%), and in the format of booklets (n=15, 34.9\%) or text on web pages (n=10, 23.3\%). Of those, 23.3\% (10/43) low, 46.5\% (20/43) moderate, and 30.2\% (13/43) high scored quality; and 25.6\% (11/43), 48.8\% (21/43), and 25.6\% (11/43) were rated low, moderate, and high cultural safety, respectively. Of the 47 included osteoarthritis materials, 4 were for health care professionals. They were developed by a consortium (2/4, 50\%), a charity (1/4, 25\%), and a professional society (1/4, 25\%), and largely based on expert advice (3/4, 75\%). The format included infographics (3/4, 75\%) and text on web pages (1/4, 25\%). Of those, 25\% (1/4), 25\% (1/4), and 50\% (2/4) were rated low, moderate, and high quality, respectively; and all were rated low for cultural safety. Quality and cultural safety did not appear to be associated with the characteristics of osteoarthritis materials (eg, type of developer, development method, and format). Conclusions: Overall, included osteoarthritis materials for persons with osteoarthritis and health care professionals were of low to moderate quality and cultural safety. These findings reveal the need for further efforts to improve existing or develop new osteoarthritis materials for both affected persons, including ethnoculturally diverse immigrant women, and health care professionals. Further research is needed to assess the quality and cultural safety of osteoarthritis materials developed by organizations outside of Canada and to establish a framework or instrument to assess cultural safety in the osteoarthritis context. ", doi="10.2196/57698", url="https://www.jmir.org/2024/1/e57698", url="http://www.ncbi.nlm.nih.gov/pubmed/39422989" } @Article{info:doi/10.2196/57062, author="Dougherty, Madeline and Tompkins, Tamara and Zibrowski, Elaine and Cram, Jesse and Ashe, C. Maureen and Bhaskar, Le-Tien and Card, George Kiffer and Godfrey, Christina and Hebert, Paul and Lacombe, Ron and Muhl, Caitlin and Mulligan, Kate and Mulvale, Gillian and Nelson, A. Michelle L. and Norman, Myrna and Symes, Bobbi and Teare, Gary and Welch, Vivian and Kothari, Anita", title="Coproduction in Social Prescribing Initiatives: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2024", month="Oct", day="17", volume="13", pages="e57062", keywords="social prescribing", keywords="coproduction", keywords="codevelopment", keywords="policy", keywords="social prescription", keywords="nonmedical need", keywords="social need", keywords="clinical setting", keywords="community programs", keywords="health care system", keywords="pilot-tested", keywords="user involvement", keywords="health education", abstract="Background: Social prescribing (SP) takes a holistic approach to health by linking clients from clinical settings to community programs to address their nonmedical needs. The emerging evidence base for SP demonstrates variability in the design and implementation of different SP initiatives. To effectively address these needs, coproduction among clients, communities, stakeholders, and policy makers is important for tailoring SP initiatives for optimal uptake. Objective: This study aims to explore the role of coproduction in SP initiatives. The research question is as follows: How and for what purpose has coproduction been incorporated across a range of SP initiatives for different clients? Methods: A review of international literature will be conducted following the JBI guidelines for scoping reviews. We will search multiple databases including Scopus, MEDLINE, and the PAIS Index, as well as gray literature, from 2000 to 2023. The primary studies included will describe a nonmedical need for clients, a nonmedical SP program or initiative, coproduction of the SP program, and any follow-up. Review articles and commentaries will be excluded. Titles, abstracts, and full-text articles will be screened, and data will be extracted by at least 2 research team members using Covidence and a pilot-tested extraction template. Clients with lived experience will also participate in the research process. Findings will be descriptively summarized and thematically synthesized to answer the research question. Results: The project was funded in 2023, and the results are expected to be submitted for publication in early 2025. Conclusions: Descriptions of what coproduction is meant to accomplish may differ from theoretical aspirations. Continued understanding of how coproduction has been designed and executed across varied international SP models is important for framing engagement in practice for future SP arrangements and their evaluation. We anticipate this review will guide clients, communities, stakeholders, and policy makers in further developing SP practice within health care systems. Trial Registration: Open Science Framework Registries B8U4Z; https://osf.io/b8u4z International Registered Report Identifier (IRRID): DERR1-10.2196/57062 ", doi="10.2196/57062", url="https://www.researchprotocols.org/2024/1/e57062" } @Article{info:doi/10.2196/60395, author="Korthauer, E. Laura and Rosen, K. Rochelle and Tremont, Geoffrey and Davis, D. Jennifer", title="Intervention Development for Tailored Education for Aging and Cognitive Health (TEACH) for Dementia Prevention in Midlife Adults: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Oct", day="16", volume="13", pages="e60395", keywords="health behavior change", keywords="dementia prevention", keywords="Alzheimer disease", keywords="multidomain health intervention", keywords="intervention development", keywords="dementia", abstract="Background: A total of 12 modifiable risk factors account for 40\% of dementia cases globally, yet population adherence to health behaviors associated with these factors is low. Midlife is a critical window for dementia prevention, as brain pathology often begins to accumulate years or decades before the onset of symptoms. Although multidomain behavioral interventions have been efficacious in reducing the risk of cognitive decline, adherence is low. Intrapersonal factors, such as health beliefs, are known mediators of the relationship between knowledge and health behavior. Objective: In keeping with stage I of the National Institutes of Health (NIH) Stage Model for Behavioral Intervention Development, this study will use mixed methods to (1) develop an enhanced health education intervention, including an explanatory method for communicating information about dementia risk and personal health beliefs, and (2) conduct a pilot randomized controlled trial (n=20 per intervention arm) over 8 weeks to assess the feasibility of delivering the enhanced intervention versus basic health education alone. Methods: Phase 1 will involve focus groups and individual qualitative interviews. Focus groups will be analyzed using (1) a descriptive framework matrix analysis and (2) interpretive data review by the research team. Individual qualitative interviews will be coded using applied thematic analysis using a phenomenographic approach. Phase 2 will involve a pilot randomized controlled trial. Proximal outcomes (measured at baseline, 4 weeks, and 8 weeks) include the perceived threat of Alzheimer disease, dementia awareness, and self-efficacy. Results: This project was funded in August 2022. Data collection began in 2023 and is projected to be completed in 2025. Conclusions: Study findings will reveal the feasibility of delivering an 8-week multidomain health education intervention for primary prevention of dementia in midlife and will provide preliminary evidence of mechanisms of change. Trial Registration: ClinicalTrials.gov NCT05599425; https://clinicaltrials.gov/study/NCT05599425 International Registered Report Identifier (IRRID): DERR1-10.2196/60395 ", doi="10.2196/60395", url="https://www.researchprotocols.org/2024/1/e60395", url="http://www.ncbi.nlm.nih.gov/pubmed/39412840" } @Article{info:doi/10.2196/48154, author="Van Oirschot, Garett and Pomphrey, Amanda and Dunne, Caoimhe and Murphy, Kate and Blood, Karina and Doherty, Cailbhe", title="An Evaluation of the Design of Multimedia Patient Education Materials in Musculoskeletal Health Care: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2024", month="Oct", day="15", volume="11", pages="e48154", keywords="health education", keywords="patient education", keywords="patient education materials", keywords="multimedia", keywords="musculoskeletal diseases", keywords="musculoskeletal pain", keywords="eHealth", keywords="self-management", abstract="Background: Educational multimedia is a cost-effective and straightforward way to administer large-scale information interventions to patient populations in musculoskeletal health care. While an abundance of health research informs the content of these interventions, less guidance exists about optimizing their design. Objective: This study aims to identify randomized controlled trials of patient populations with musculoskeletal conditions that used multimedia-based patient educational materials (PEMs) and examine how design was reported and impacted patients' knowledge and rehabilitation outcomes. Design was evaluated using principles from the cognitive theory of multimedia learning (CTML). Methods: PubMed, CINAHL, PsycINFO, and Embase were searched from inception to September 2023 for studies examining adult patients with musculoskeletal conditions receiving multimedia PEMs compared to any other interventions. The primary outcome was knowledge retention measured via test scores. Secondary outcomes were any patient-reported measures. Retrievability was noted, and PEMs were sourced through search, purchase, and author communication. Results: A total of 160 randomized controlled trials were eligible for inclusion: 13 (8.1\%) included their educational materials and 31 (19.4\%) required a web search, purchase, or direct requests for educational materials. Of these 44 (27.5\%) studies, none fully optimized the design of their educational materials, particularly lacking in the CTML principles of coherence, redundancy, modality, and generative activities for the learner. Of the 160 studies, the remaining 116 (72.5\%) contained interventions that could not be retrieved or appraised. Learning was evaluated in 5 (3.1\%) studies. Conclusions: Musculoskeletal studies should use open science principles and provide their PEMs wherever possible. The link between providing multimedia PEMs and patient learning is largely unexamined, but engagement potential may be maximized when considering design principles such as the CTML. ", doi="10.2196/48154", url="https://rehab.jmir.org/2024/1/e48154", url="http://www.ncbi.nlm.nih.gov/pubmed/39162239" } @Article{info:doi/10.2196/58428, author="Feng, Xiandong and Hu, Yinhuan and Pfaff, Holger and Liu, Sha and Xie, Jinzhu and Zhang, Zemiao", title="Exploring Client Preferences for Psychological Counselors in a Chinese Online Health Community: Longitudinal Study", journal="J Med Internet Res", year="2024", month="Oct", day="10", volume="26", pages="e58428", keywords="signaling theory", keywords="psychological counselor", keywords="online health communities", keywords="clients' choice", abstract="Background: Although online health communities are acknowledged for their role in bridging the supply-demand gap in mental health services, the client decision-making process in these environments remains underexplored. Objective: This study aimed to explore the impact of different signals presented on psychological counselors' home pages on clients' choices. Methods: Adopting signaling theory as the framework, this study classified information into online and offline signals and developed a theoretical model to examine client choice behaviors. We collected data from 487 psychological counselors in a leading Chinese online mental health community during March, June, September, and December 2023. Based on these data, we constructed a 4-period balanced panel dataset. A fixed effects model was used to analyze which signals influence clients' choices of psychological counselors. Results: Regarding online signals, the service price ($\beta$=0.186, P<.001) and online reputation ($\beta$=0.489, P=.002) of psychological counselors positively influence clients' choices. Concerning offline signals, psychological counselors' practical experience ($\beta$=0.007, P<.001) is positively related to clients' choices. Moreover, the results indicate that the relationship between a counselor's prosocial behavior and clients' choices is not linear but rather exhibits an inverted U-shape. Conclusions: This study reveals that the varied information provided by psychological counselors has distinct impacts on clients' choices in online health communities. It broadens the application of signaling theory to online behaviors and emphasizes the importance of both online and offline signals. These insights offer strategic guidance for counselors and online platforms to better meet potential clients' needs by optimizing the information presented on psychological counselors' home pages. ", doi="10.2196/58428", url="https://www.jmir.org/2024/1/e58428" } @Article{info:doi/10.2196/56354, author="Zenone, Marco and van Schalkwyk, May and Hartwell, Greg and Caulfield, Timothy and Maani, Nason", title="Selling Misleading ``Cancer Cure'' Books on Amazon: Systematic Search on Amazon.com and Thematic Analysis", journal="J Med Internet Res", year="2024", month="Oct", day="8", volume="26", pages="e56354", keywords="cancer", keywords="Amazon", keywords="misinformation", keywords="e-commerce", keywords="cancer cure", keywords="cancer misinformation", keywords="misleading", keywords="cancer information", keywords="treatment", keywords="cancer treatment", keywords="thematic analysis", keywords="online information", abstract="Background: While the evidence base on web-based cancer misinformation continues to develop, relatively little is known about the extent of such information on the world's largest e-commerce website, Amazon. Multiple media reports indicate that Amazon may host on its platform questionable cancer-related products for sale, such as books on purported cancer cures. This context suggests an urgent need to evaluate Amazon.com for cancer misinformation. Objective: This study sought to (1) examine to what extent are misleading cancer cure books for sale on Amazon.com and (2) determine how cancer cure books on Amazon.com provide misleading cancer information. Methods: We searched ``cancer cure'' on Amazon.com and retrieved the top 1000 English-language book search results. We reviewed the books' descriptions and titles to determine whether the books provided misleading cancer cure or treatment information. We considered a book to be misleading if it suggested scientifically unsupported cancer treatment approaches to cure or meaningfully treat cancer. Among books coded as misleading, we conducted an inductive latent thematic analysis to determine the informational value the books sought to offer. Results: Nearly half (494/1000, 49.4\%) of the sampled ``cancer cure'' books for sale on Amazon.com appeared to contain misleading cancer treatment and cure information. Overall, 17 (51.5\%) out of 33 Amazon.com results pages had 50\% or more of the books coded as misleading. The first search result page had the highest percentage of misleading books (23/33, 69.7\%). Misleading books (n=494) contained eight themes: (1) claims of efficacious cancer cure strategies (n=451, 91.3\%), (2) oversimplifying cancer and cancer treatment (n=194, 39.3\%), (3) falsely justifying ineffective treatments as science based (n=189, 38.3\%), (4) discrediting conventional cancer treatments (n=169, 34.2\%), (5) finding the true cause of cancer (n=133, 26.9\%), (6) homogenizing cancer (n=132, 26.7\%), (7) discovery of new cancer treatments (n=119, 24.1\%), and (8) cancer cure suppression (n=82, 16.6\%). Conclusions: The results demonstrate that misleading cancer cure books are for sale, visible, and prevalent on Amazon.com, with prominence in initial search hits. These misleading books for sale on Amazon can be conceived of as forming part of a wider, cross-platform, web-based information environment in which misleading cancer cures are often given prominence. Our results suggest that greater enforcement is needed from Amazon and that cancer-focused organizations should engage in preemptive misinformation debunking. ", doi="10.2196/56354", url="https://www.jmir.org/2024/1/e56354" } @Article{info:doi/10.2196/55883, author="Dilimulati, Diliqingna and Shao, Xiaowen and Wang, Lihua and Cai, Meili and Zhang, Yuqin and Lu, Jiayi and Wang, Yao and Liu, Hongying and Kuang, Ming and Chen, Haibing and Zhang, Manna and Qu, Shen", title="Efficacy of WeChat-Based Digital Intervention Versus Metformin in Women With Polycystic Ovary Syndrome: Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Oct", day="2", volume="26", pages="e55883", keywords="polycystic ovary syndrome", keywords="insulin resistance", keywords="digital intervention", keywords="metformin", keywords="women's health", abstract="Background: The first-line treatment for polycystic ovary syndrome (PCOS) is lifestyle modification. However, it is currently unknown whether digital medicine can assist patients with PCOS in maintaining a healthy lifestyle while alleviating PCOS symptoms. Objective: This study aims to evaluate the efficacy of WeChat-based digital intervention versus metformin treatment in women with PCOS and insulin resistance. Methods: A total of 80 women with PCOS and insulin resistance were recruited from an endocrinology clinic and randomly assigned to receive either a WeChat-based digital intervention (n=40, 50\%) or metformin (n=40, 50\%) for 12 weeks. The WeChat-based digital intervention consisted of 3 modules; a coach assisted the patients in using the intervention. The primary outcome was the change in a homeostatic model assessment for insulin resistance. At baseline and after the 12-week intervention, anthropometric parameters, menstruation frequency, sex hormone levels, metabolic factors, and body fat distribution were measured in the clinic. Furthermore, self-assessed web-based questionnaires on diet, exercise, sleep, anxiety, and depression were obtained. Results: A total of 72 participants completed the follow-up (for a 90\% follow-up rate), including 35 of 40 (88\%) participants from the digital intervention group and 37 of 40 (93\%) participants from the metformin group. The homeostatic model assessment for insulin resistance in the digital intervention group was significantly improved after 12 weeks of treatment with a mean change of --0.93 (95\% CI --1.64 to --0.23), but no statistical difference was observed between the groups (least squares mean difference --0.20; 95\% CI --0.98 to 0.58; P=.62). Both digital intervention and metformin treatment significantly improved menstruation frequency (digital intervention: P<.001; metformin: P<.001) and reduced body weight (digital intervention: P<.001; metformin: P<.001) and total fat mass (digital intervention: P<.001; metformin: P<.001). Furthermore, the digital intervention had a significant advantage over metformin in improving waist circumference (least squares mean difference --1.84; 95\% CI --3.44 to --0.24; P=.03), waist-to-hip ratio (least squares mean difference --0.02; 95\% CI --0.03 to 0.00; P=.03), total fat mass (least squares mean difference --1.59; 95\% CI --2.88 to --0.30; P=.02), and dehydroepiandrosterone sulfate (least squares mean difference --69.73; 95\% CI --129.70 to --9.75; P=.02). In terms of safety, the main adverse events were sensations of hunger in the digital intervention group (2/40, 5\%) and gastrointestinal adverse events in the metformin group (12/40, 30\%). Conclusions: Our data suggest that digital intervention is an effective treatment option for patients with PCOS, with an efficacy comparable to that of metformin, and that it can also alleviate the negative effects of medications and make it easier and more efficient to adhere to lifestyle treatments. WeChat-based digital interventions have the potential to provide a new path for the improvement and health of women with PCOS in China. Trial Registration: ClinicalTrials.gov NCT05386706; https://clinicaltrials.gov/study/NCT05386706 ", doi="10.2196/55883", url="https://www.jmir.org/2024/1/e55883" } @Article{info:doi/10.2196/58831, author="Armbruster, Jonas and Bussmann, Florian and Rothhaas, Catharina and Titze, Nadine and Gr{\"u}tzner, Alfred Paul and Freischmidt, Holger", title="``Doctor ChatGPT, Can You Help Me?'' The Patient's Perspective: Cross-Sectional Study", journal="J Med Internet Res", year="2024", month="Oct", day="1", volume="26", pages="e58831", keywords="artificial intelligence", keywords="AI", keywords="large language models", keywords="LLM", keywords="ChatGPT", keywords="patient education", keywords="patient information", keywords="patient perceptions", keywords="chatbot", keywords="chatbots", keywords="empathy", abstract="Background: Artificial intelligence and the language models derived from it, such as ChatGPT, offer immense possibilities, particularly in the field of medicine. It is already evident that ChatGPT can provide adequate and, in some cases, expert-level responses to health-related queries and advice for patients. However, it is currently unknown how patients perceive these capabilities, whether they can derive benefit from them, and whether potential risks, such as harmful suggestions, are detected by patients. Objective: This study aims to clarify whether patients can get useful and safe health care advice from an artificial intelligence chatbot assistant. Methods: This cross-sectional study was conducted using 100 publicly available health-related questions from 5 medical specialties (trauma, general surgery, otolaryngology, pediatrics, and internal medicine) from a web-based platform for patients. Responses generated by ChatGPT-4.0 and by an expert panel (EP) of experienced physicians from the aforementioned web-based platform were packed into 10 sets consisting of 10 questions each. The blinded evaluation was carried out by patients regarding empathy and usefulness (assessed through the question: ``Would this answer have helped you?'') on a scale from 1 to 5. As a control, evaluation was also performed by 3 physicians in each respective medical specialty, who were additionally asked about the potential harm of the response and its correctness. Results: In total, 200 sets of questions were submitted by 64 patients (mean 45.7, SD 15.9 years; 29/64, 45.3\% male), resulting in 2000 evaluated answers of ChatGPT and the EP each. ChatGPT scored higher in terms of empathy (4.18 vs 2.7; P<.001) and usefulness (4.04 vs 2.98; P<.001). Subanalysis revealed a small bias in terms of levels of empathy given by women in comparison with men (4.46 vs 4.14; P=.049). Ratings of ChatGPT were high regardless of the participant's age. The same highly significant results were observed in the evaluation of the respective specialist physicians. ChatGPT outperformed significantly in correctness (4.51 vs 3.55; P<.001). Specialists rated the usefulness (3.93 vs 4.59) and correctness (4.62 vs 3.84) significantly lower in potentially harmful responses from ChatGPT (P<.001). This was not the case among patients. Conclusions: The results indicate that ChatGPT is capable of supporting patients in health-related queries better than physicians, at least in terms of written advice through a web-based platform. In this study, ChatGPT's responses had a lower percentage of potentially harmful advice than the web-based EP. However, it is crucial to note that this finding is based on a specific study design and may not generalize to all health care settings. Alarmingly, patients are not able to independently recognize these potential dangers. ", doi="10.2196/58831", url="https://www.jmir.org/2024/1/e58831" } @Article{info:doi/10.2196/49720, author="Goehringer, Jessica and Kosmin, Abigail and Laible, Natalie and Romagnoli, Katrina", title="Assessing the Utility of a Patient-Facing Diagnostic Tool Among Individuals With Hypermobile Ehlers-Danlos Syndrome: Focus Group Study", journal="JMIR Form Res", year="2024", month="Sep", day="26", volume="8", pages="e49720", keywords="diagnostic tool", keywords="hypermobile Ehlers-Danlos syndrome", keywords="patient experiences", keywords="diagnostic odyssey", keywords="affinity mapping", keywords="mobile health app", keywords="mobile phone", abstract="Background: Hypermobile Ehlers-Danlos syndrome (hEDS), characterized by joint hypermobility, skin laxity, and tissue fragility, is thought to be the most common inherited connective tissue disorder, with millions affected worldwide. Diagnosing this condition remains a challenge that can impact quality of life for individuals with hEDS. Many with hEDS describe extended diagnostic odysseys involving exorbitant time and monetary investment. This delay is due to the complexity of diagnosis, symptom overlap with other conditions, and limited access to providers. Many primary care providers are unfamiliar with hEDS, compounded by genetics clinics that do not accept referrals for hEDS evaluation and long waits for genetics clinics that do evaluate for hEDS, leaving patients without sufficient options. Objective: This study explored the user experience, quality, and utility of a prototype of a patient-facing diagnostic tool intended to support clinician diagnosis for individuals with symptoms of hEDS. The questions included within the prototype are aligned with the 2017 international classification of Ehlers-Danlos syndromes. This study explored how this tool may help patients communicate information about hEDS to their physicians, influencing the diagnosis of hEDS and affecting patient experience. Methods: Participants clinically diagnosed with hEDS were recruited from either a medical center or private groups on a social media platform. Interested participants provided verbal consent, completed questionnaires about their diagnosis, and were invited to join an internet-based focus group to share their thoughts and opinions on a diagnostic tool prototype. Participants were invited to complete the Mobile App Rating Scale (MARS) to evaluate their experience viewing the diagnostic tool. The MARS is a framework for evaluating mobile health apps across 4 dimensions: engagement, functionality, esthetics, and information quality. Qualitative data were analyzed using affinity mapping to organize information and inductively create themes that were categorized within the MARS framework dimensions to help identify strengths and weaknesses of the diagnostic tool prototype. Results: In total, 15 individuals participated in the internet-based focus groups; 3 (20\%) completed the MARS. Through affinity diagramming, 2 main categories of responses were identified, including responses related to the user interface and responses related to the application of the tool. Each category included several themes and subthemes that mapped well to the 4 MARS dimensions. The analysis showed that the tool held value and utility among the participants diagnosed with hEDS. The shareable ending summary sheet provided by the tool stood out as a strength for facilitating communication between patient and provider during the diagnostic evaluation. Conclusions: The results provide insights on the perceived utility and value of the tool, including preferred phrasing, layout and design preferences, and tool accessibility. The participants expressed that the tool may improve the hEDS diagnostic odyssey and help educate providers about the diagnostic process. ", doi="10.2196/49720", url="https://formative.jmir.org/2024/1/e49720", url="http://www.ncbi.nlm.nih.gov/pubmed/39325533" } @Article{info:doi/10.2196/55546, author="Brunton, Lisa and Cotterill, Sarah and Wilson, Paul", title="Evaluating the National Rollout of a Type 2 Diabetes Self-Management Intervention: Qualitative Interview Study With Local National Health Service Leads Responsible for Implementation", journal="J Med Internet Res", year="2024", month="Sep", day="25", volume="26", pages="e55546", keywords="type 2 diabetes", keywords="structured education", keywords="self-management", keywords="digital interventions", keywords="implementation", keywords="qualitative methods", keywords="evaluation", abstract="Background: Approximately 4.5 million people live with type 2 diabetes mellitus (T2DM) in the United Kingdom. Evidence shows that structured education programs can improve glycemic control and reduce the risk of complications from T2DM, but they have low attendance rates. To widen access to T2DM structured education, National Health Service England commissioned a national rollout of Healthy Living, a digital self-management program. Objective: The objectives were to understand the barriers and enablers to adopting, implementing, and integrating Healthy Living into existing T2DM care pathways across England. Methods: We undertook a cross-sectional, qualitative telephone semistructured interview study to address the objectives. In total, 17 local National Health Service leads responsible for implementing Healthy Living across their locality were recruited. We conducted 16 one-time interviews across 16 case sites (1 of the interviews was conducted with 2 local leads from the same case site). Interview data were analyzed using thematic analysis. Results: Three overarching themes were generated: (1) implementation activities, (2) where Healthy Living fits within existing pathways, and (3) contextual factors affecting implementation. Of the 16 sites, 14 (88\%) were implementing Healthy Living; the barrier to not implementing it in 2 case sites was not wanting Healthy Living to compete with their current education provision for T2DM. We identified 6 categories of implementation activities across sites: communication strategies to raise awareness of Healthy Living, developing bespoke local resources to support general practices with referrals, providing financial reimbursement or incentives to general practices, promoting Healthy Living via public events, monitoring implementation across their footprint, and widening access across high-need groups. However, outside early engagement sites, most implementation activities were ``light touch,'' consisting mainly of one-way communications to raise awareness. Local leads were generally positive about Healthy Living as an additional part of their T2DM structured education programs, but some felt it was more suited to specific patient groups. Barriers to undertaking more prolonged, targeted implementation campaigns included implementation not being mandated, sites not receiving data on uptake across their footprint, and confusion in understanding where Healthy Living fit within existing care pathways. Conclusions: A passive process of disseminating information about Healthy Living to general practices rather than an active process of implementation occurred across most sites sampled. This study identified that there is a need for clearer communications regarding the type of patients that may benefit from the Healthy Living program, including when it should be offered and whether it should be offered instead of or in addition to other education programs. No sites other than early engagement sites received data to monitor uptake across their footprint. Understanding variability in uptake across practices may have enabled sites to plan targeted referral campaigns in practices that were not using the service. ", doi="10.2196/55546", url="https://www.jmir.org/2024/1/e55546" } @Article{info:doi/10.2196/54046, author="Miller, M. Janis and Wyman, F. Jean and An, Lawrence and Chu, Haitao and Fok, S. Cynthia and Lavender, Missy and Lewis, Elizabeth Cora and Markland, D. Alayne and Rickey, M. Leslie and Sheng, Ying and Sutcliffe, Siobhan and Low, Kane Lisa and Mueller, R. Elizabeth and ", title="Design of a Tool Capable of Assessing Environmental Sociocultural Physical Factors Influencing Women's Decisions on When and Where to Toilet Within Real-World Settings: Protocol for the Build and Usability Testing of a Mobile App for Use by Community-Dwelling Women", journal="JMIR Res Protoc", year="2024", month="Sep", day="18", volume="13", pages="e54046", keywords="mobile app", keywords="urinary bladder", keywords="woman's health", keywords="toileting", keywords="ecological momentary assessment", keywords="time factors", keywords="population studies", keywords="real-world environment", keywords="mobile phone", abstract="Background: Although surveys and apps are available for women to report urination and bladder symptoms, they do not include their decisions regarding toileting. Real-world factors can interfere with toileting decisions, which may then influence bladder health. This premise lacks data per want of a robust data collection tool. Objective: The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium engaged a transdisciplinary team to build and test WhereIGo, a mobile data collection app for Android and iOS. The design goal was a comprehensive reporting system for capturing environmental, sociocultural, and physical factors that influence women's decisions for toileting. Aims include having (1) an innovative feature for reporting physiologic urge sensation when ``thinking about my bladder'' and shortly before ``I just peed,'' (2) real-time reporting along with short look-back opportunities, and (3) ease of use anywhere. Methods: The development team included a plain language specialist, a usability specialist, creative designers, programming experts, and PLUS scientific content experts. Both real-time and ecological momentary assessments were used to comprehensively capture influences on toileting decisions including perceived access to toileting, degree of busyness or stress or focus, beverage intake amount, urge degree, or a leakage event. The restriction on the maximal number of taps for any screen was six. PLUS consortium investigators did pilot-testing. Formal usability testing relied on the recruitment of community-dwelling women at four PLUS research sites. Women used the app for 2 consecutive days. Outcome measures were the system usability scale (SUS; 0-100 range) and the functional Mobile Application Rating Scale (1-5 range). These scales were embedded at the end of the app. The estimated a priori sample size needed, considering the SUS cut point score set at ?74, was 40 women completing the study. Results: Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases since July 2015. The integrity of the build process was documented through multiple 5-minute videos presented to PLUS Consortium and through WhereIGo screenshots of the final product. Participants included 44 women, with 41 (93\%) completing data collection. Participants ranged in age from 21 to 85 years, were predominantly non-Hispanic White (n=25, 57\%), college-educated (n=25, 57\%), and with incomes below US \$75,000 (n=27, 62\%). The SUS score was 78.0 (SE 1.7), which was higher than 75\% of the 500 products tested by the SUS developers. The mean functional Mobile Application Rating Scale score was 4.4 (SE 0.08). The build and informal acceptability testing were completed in 2019, enrollment for formal usability testing completed by June 2020, and analysis was completed in 2022. Conclusions: WhereIGo is a novel app with good usability for women to report toileting decisions, urination, and fluid intake. Future research using the app could test the influence of real-time factors on bladder health. International Registered Report Identifier (IRRID): RR1-10.2196/54046 ", doi="10.2196/54046", url="https://www.researchprotocols.org/2024/1/e54046" } @Article{info:doi/10.2196/56935, author="McLoughlin, E. Daniel and Moreno Echevarria, M. Fabiola and Badawy, M. Sherif", title="Lessons Learned From Shared Decision-Making With Oral Anticoagulants: Viewpoint on Suggestions for the Development of Oral Chemotherapy Decision Aids", journal="JMIR Cancer", year="2024", month="Sep", day="11", volume="10", pages="e56935", keywords="shared decision-making", keywords="SDM", keywords="decision aids", keywords="decision aids design", keywords="oral chemotherapy", keywords="oral anticoagulants", keywords="drug delivery", keywords="chemotherapy", keywords="chemo", keywords="anticoagulants", keywords="drug deliveries", keywords="cancer", keywords="oncology", keywords="oncologist", keywords="metastases", keywords="literature review", keywords="literature reviews", doi="10.2196/56935", url="https://cancer.jmir.org/2024/1/e56935", url="http://www.ncbi.nlm.nih.gov/pubmed/39187430" } @Article{info:doi/10.2196/56022, author="Lin, Tai-Han and Chung, Hsing-Yi and Jian, Ming-Jr and Chang, Chih-Kai and Perng, Cherng-Lih and Liao, Guo-Shiou and Yu, Jyh-Cherng and Dai, Ming-Shen and Yu, Cheng-Ping and Shang, Hung-Sheng", title="An Advanced Machine Learning Model for a Web-Based Artificial Intelligence--Based Clinical Decision Support System Application: Model Development and Validation Study", journal="J Med Internet Res", year="2024", month="Sep", day="4", volume="26", pages="e56022", keywords="breast cancer recurrence", keywords="artificial intelligence--based clinical decision support system", keywords="machine learning", keywords="personalized treatment planning", keywords="ChatGPT", keywords="predictive model accuracy", abstract="Background: Breast cancer is a leading global health concern, necessitating advancements in recurrence prediction and management. The development of an artificial intelligence (AI)--based clinical decision support system (AI-CDSS) using ChatGPT addresses this need with the aim of enhancing both prediction accuracy and user accessibility. Objective: This study aims to develop and validate an advanced machine learning model for a web-based AI-CDSS application, leveraging the question-and-answer guidance capabilities of ChatGPT to enhance data preprocessing and model development, thereby improving the prediction of breast cancer recurrence. Methods: This study focused on developing an advanced machine learning model by leveraging data from the Tri-Service General Hospital breast cancer registry of 3577 patients (2004-2016). As a tertiary medical center, it accepts referrals from four branches---3 branches in the northern region and 1 branch on an offshore island in our country---that manage chronic diseases but refer complex surgical cases, including breast cancer, to the main center, enriching our study population's diversity. Model training used patient data from 2004 to 2012, with subsequent validation using data from 2013 to 2016, ensuring comprehensive assessment and robustness of our predictive models. ChatGPT is integral to preprocessing and model development, aiding in hormone receptor categorization, age binning, and one-hot encoding. Techniques such as the synthetic minority oversampling technique address the imbalance of data sets. Various algorithms, including light gradient-boosting machine, gradient boosting, and extreme gradient boosting, were used, and their performance was evaluated using metrics such as the area under the curve, accuracy, sensitivity, and F1-score. Results: The light gradient-boosting machine model demonstrated superior performance, with an area under the curve of 0.80, followed closely by the gradient boosting and extreme gradient boosting models. The web interface of the AI-CDSS tool was effectively tested in clinical decision-making scenarios, proving its use in personalized treatment planning and patient involvement. Conclusions: The AI-CDSS tool, enhanced by ChatGPT, marks a significant advancement in breast cancer recurrence prediction, offering a more individualized and accessible approach for clinicians and patients. Although promising, further validation in diverse clinical settings is recommended to confirm its efficacy and expand its use. ", doi="10.2196/56022", url="https://www.jmir.org/2024/1/e56022" } @Article{info:doi/10.2196/48359, author="Brands, R. Martijn and Haverman, Lotte and Muis, J. Jelmer and Driessens, E. Mari{\"e}tte H. and Meijer, Stephan and van der Meer, M. Felix J. and de Jong, Marianne and van der Bom, G. Johanna and Cnossen, H. Marjon and Fijnvandraat, Karin and Gouw, C. Samantha", title="Toward Personalized Care and Patient Empowerment and Perspectives on a Personal Health Record in Hemophilia Care: Qualitative Interview Study", journal="JMIR Hum Factors", year="2024", month="Sep", day="3", volume="11", pages="e48359", keywords="hemophilia", keywords="telemedicine", keywords="health records", keywords="personal", keywords="decision-making", keywords="shared", keywords="patient participation", abstract="Background: To enable personalized treatment and shared decision-making in chronic care, relevant health information is collected. However, health information is often fragmented across hospital information systems, digital health apps, and questionnaire portals. This also pertains to hemophilia care, in which scattered information hampers integrated care. We intend to co-design a nationwide digital personal health record (PHR) for patients to help manage their health information. For this, user perspectives are crucial. Objective: This study aims to assess patients' and health care providers' perspectives regarding the use of a PHR in hemophilia care in the Netherlands, required functionalities, and expectations and concerns. Methods: In this semistructured interview study, 19 pediatric and adult persons with hemophilia, parents, and women with other inherited bleeding disorders, as well as 18 health care providers working within and outside of hemophilia treatment centers, participated. Perspectives of patients and providers were explored separately. To explore requirements, participants were asked to prioritize functionalities. Results: Participants expected a PHR would increase the transparency of health information, improve patients' understanding of their illness, and help the coordination of care between health care providers and institutions. Prioritized functionalities included the integration of relevant health information and patient-entered data. Formulated expectations and concerns focused on 4 themes: usability, safety, inclusiveness, and implementation. While patients expressed worries over medicalization (ie, more confrontational reminders of their illness), providers were concerned about an increased workload. Conclusions: People with hemophilia, their parents, and health care providers welcomed the development of a PHR, as they expected it would result in better coordinated care. Formulated expectations and concerns will contribute to the successful development of a PHR for persons with hemophilia, and ultimately, for all persons with a chronic condition. ", doi="10.2196/48359", url="https://humanfactors.jmir.org/2024/1/e48359" } @Article{info:doi/10.2196/59952, author="Hawkins, T. Alexander and Fa, Andrea and Younan, A. Samuel and Ivatury, Joga Srinivas and Bonnet, Kemberlee and Schlundt, David and Gordon, J. Elisa and Cavanaugh, L. Kerri", title="Decision Aid for Colectomy in Recurrent Diverticulitis: Development and Usability Study", journal="JMIR Form Res", year="2024", month="Sep", day="3", volume="8", pages="e59952", keywords="design sprint", keywords="diverticulitis", keywords="decision aid", keywords="shared decision-making", keywords="colectomy", keywords="decision-making", keywords="diverticular diseases", keywords="gastrointestinal diagnosis", keywords="American", keywords="America", keywords="tools", keywords="tool", keywords="effectiveness", keywords="surgeon", keywords="patients", keywords="patient", keywords="communication", keywords="synopsis", abstract="Background: Diverticular disease is a common gastrointestinal diagnosis with over 2.7 million clinic visits yearly. National guidelines from the American Society of Colon and Rectal Surgeons state that ``the decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis should be individualized.'' However, tools to individualize this decision are lacking. Objective: This study aimed to develop an online educational decision aid (DA) to facilitate effective surgeon and patient communication about treatment options for recurrent left-sided diverticulitis. Methods: We used a modified design sprint methodology to create a prototype DA. We engaged a multidisciplinary team and adapted elements from the Ottawa Personal Decision Guide. We then iteratively refined the prototype by conducting a mixed methods assessment of content and usability testing, involving cognitive interviews with patients and surgeons. The findings informed the refinement of the DA. Further testing included an in-clinic feasibility review. Results: Over a 4-day in-person rapid design sprint, including patients, surgeons, and health communication experts, we developed a prototype of a diverticulitis DA, comprising an interactive website and handout with 3 discrete sections. The first section contains education about diverticulitis and treatment options. The second section clarifies the potential risks and benefits of both clinical treatment options (medical management vs colectomy). The third section invites patients to participate in a value clarification exercise. After navigating the DA, the patient prints a synopsis that they bring to their clinic appointment, which serves as a guide for shared decision-making. Conclusions: Design sprint methodology, emphasizing stakeholder co-design and complemented by extensive user testing, is an effective and efficient strategy to create a DA for patients living with recurrent diverticulitis facing critical treatment decisions. ", doi="10.2196/59952", url="https://formative.jmir.org/2024/1/e59952", url="http://www.ncbi.nlm.nih.gov/pubmed/39226090" } @Article{info:doi/10.2196/55717, author="Funer, Florian and Schneider, Diana and Heyen, B. Nils and Aichinger, Heike and Klausen, Diana Andrea and Tinnemeyer, Sara and Liedtke, Wenke and Salloch, Sabine and Bratan, Tanja", title="Impacts of Clinical Decision Support Systems on the Relationship, Communication, and Shared Decision-Making Between Health Care Professionals and Patients: Multistakeholder Interview Study", journal="J Med Internet Res", year="2024", month="Aug", day="23", volume="26", pages="e55717", keywords="clinical decision support system", keywords="CDSS", keywords="health care professionals", keywords="patients", keywords="relationships", keywords="communication", keywords="shared decision-making", keywords="Germany", abstract="Background: Clinical decision support systems (CDSSs) are increasingly being introduced into various domains of health care. Little is known so far about the impact of such systems on the health care professional--patient relationship, and there is a lack of agreement about whether and how patients should be informed about the use of CDSSs. Objective: This study aims to explore, in an empirically informed manner, the potential implications for the health care professional--patient relationship and to underline the importance of this relationship when using CDSSs for both patients and future professionals. Methods: Using a methodological triangulation, 15 medical students and 12 trainee nurses were interviewed in semistructured interviews and 18 patients were involved in focus groups between April 2021 and April 2022. All participants came from Germany. Three examples of CDSSs covering different areas of health care (ie, surgery, nephrology, and intensive home care) were used as stimuli in the study to identify similarities and differences regarding the use of CDSSs in different fields of application. The interview and focus group transcripts were analyzed using a structured qualitative content analysis. Results: From the interviews and focus groups analyzed, three topics were identified that interdependently address the interactions between patients and health care professionals: (1) CDSSs and their impact on the roles of and requirements for health care professionals, (2) CDSSs and their impact on the relationship between health care professionals and patients (including communication requirements for shared decision-making), and (3) stakeholders' expectations for patient education and information about CDSSs and their use. Conclusions: The results indicate that using CDSSs could restructure established power and decision-making relationships between (future) health care professionals and patients. In addition, respondents expected that the use of CDSSs would involve more communication, so they anticipated an increased time commitment. The results shed new light on the existing discourse by demonstrating that the anticipated impact of CDSSs on the health care professional--patient relationship appears to stem less from the function of a CDSS and more from its integration in the relationship. Therefore, the anticipated effects on the relationship between health care professionals and patients could be specifically addressed in patient information about the use of CDSSs. ", doi="10.2196/55717", url="https://www.jmir.org/2024/1/e55717", url="http://www.ncbi.nlm.nih.gov/pubmed/39178023" } @Article{info:doi/10.2196/50307, author="Marsh, Meghan and Shah, Rafia Syeda and Munce, P. Sarah E. and Perrier, Laure and Lee, Joan Tin-Suet and Colella, F. Tracey J. and Kokorelias, Marie Kristina", title="Characteristics of Existing Online Patient Navigation Interventions: Scoping Review", journal="JMIR Med Inform", year="2024", month="Aug", day="19", volume="12", pages="e50307", keywords="online", keywords="patient navigation", keywords="peer navigation", keywords="patient navigation interventions", keywords="online patient navigation interventions", keywords="scoping review", keywords="patient portals", keywords="social care services", keywords="online medical tools", keywords="eHealth", keywords="telehealth", keywords="personal support", keywords="social care", keywords="patient navigation intervention", abstract="Background: Patient navigation interventions (PNIs) can provide personalized support and promote appropriate coordination or continuation of health and social care services. Online PNIs have demonstrated excellent potential for improving patient knowledge, transition readiness, self-efficacy, and use of services. However, the characteristics (ie, intervention type, mode of delivery, duration, frequency, outcomes and outcome measures, underlying theories or mechanisms of change of the intervention, and impact) of existing online PNIs to support the health and social needs of individuals with illness remain unclear. Objective: This scoping review of the existing literature aims to identify the characteristics of existing online PNIs reported in the literature. Methods: A scoping review based on the guidelines outlined in the Joanna Briggs Institute framework was conducted. A search for peer-reviewed literature published between 1989 and 2022 on online PNIs was conducted using MEDLINE, CINAHL, Embase, PsycInfo, and Cochrane Library databases. Two independent reviewers conducted 2 levels of screening. Data abstraction was conducted to outline key study characteristics (eg, study design, population, and intervention characteristics). The data were analyzed using descriptive statistics and qualitative content analysis. Results: A total of 100 studies met the inclusion criteria. Our findings indicate that a variety of study designs are used to describe and evaluate online PNIs, with literature being published between 2003 and 2022 in Western countries. Of these studies, 39 (39\%) studies were randomized controlled trials. In addition, we noticed an increase in reported online PNIs since 2019. The majority of studies involved White females with a diagnosis of cancer and a lack of participants aged 70 years or older was observed. Most online PNIs provide support through navigation, self-management and lifestyle changes, counseling, coaching, education, or a combination of support. Variation was noted in terms of mode of delivery, duration, and frequency. Only a small number of studies described theoretical frameworks or change mechanisms to guide intervention. Conclusions: To our knowledge, this is the first review to comprehensively synthesize the existing literature on online PNIs, by focusing on the characteristics of interventions and studies in this area. Inconsistency in reporting the country of publication, population characteristics, duration and frequency of interventions, and a lack of the use of underlying theories and working mechanisms to inform intervention development, provide guidance for the reporting of future online PNIs. ", doi="10.2196/50307", url="https://medinform.jmir.org/2024/1/e50307" } @Article{info:doi/10.2196/53509, author="Cheng, Yu-Shan and Lin, Cheng-Pei and Chen, Anny Lu-Yen and Hwang, Wei-Ren and Lin, Yi-Chun and Chen, Yu-Chi", title="Short-Term Effects of an eHealth Care Experiential Learning Program Among Patients With Type 2 Diabetes: Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Aug", day="16", volume="26", pages="e53509", keywords="diabetes", keywords="eHealth literacy", keywords="eHealth", keywords="patient engagement", keywords="experiential learning theory", keywords="experimental learning theory", keywords="type 2 diabetes", keywords="randomized controlled trial", abstract="Background: Type 2 diabetes is a chronic disease with a significant medical burden. eHealth care integrates medicine and technology to enhance the outcomes of such patients; however, adequate eHealth literacy (eHL) is necessary for that to happen. Fostering eHL is crucial for patients with diabetes to engage with eHealth care and receive quality care and timely support. Experiential learning theory can enhance patients' eHL and skills to use eHealth care technology in their daily care. Objective: This study explored the effectiveness of an eHealth care experiential learning program in improving eHL, patient health engagement, and eHealth care use status among patients with type 2 diabetes in 3 months. Methods: In this randomized controlled trial, patients under case management services from various clinics in Taiwan were randomly assigned to either the intervention group receiving the 6-session eHealth care experiential learning program or the control group receiving the usual care. Data were collected using structured questionnaires at 3 time points: pretest, postintervention, and 3 months after the intervention. Descriptive data were presented using frequency distribution, percentage, mean, and SD. The outcomes were analyzed using a generalized estimating equation method by intention-to-treat analysis. Results: A total of 92 participants (46 in each group) were recruited in this study. Of these, 86 completed the course and follow-up evaluations with a mean age of 62.38 (SD 12.91) years. After completing the intervention, the intervention group had significantly higher posttest scores in eHL ($\beta$=19.94, SE 3.52; P<.001), patient health engagement ($\beta$=.28, SE 0.13; P=.04), and eHealth use ($\beta$=3.96, SE 0.42; P<.001) than the control group. Furthermore, the intervention group maintained these significant improvements in eHL ($\beta$=18.19, SE 3.82; P<.001) and eHealth use ($\beta$=3.87, SE 0.49; P<.001) after 3 months. Conclusions: Participating in the eHealth care experiential learning program resulted in significant improvements in eHL, patient health engagement, and eHealth use among patients with type 2 diabetes. Our interventional program can inform future clinical practice and policies to strengthen self-management skills and facilitate the use of health technology in caring for patients with chronic diseases. Trial Registration: ClinicalTrials.gov NCT05180604; https://clinicaltrials.gov/ct2/show/NCT05180604 ", doi="10.2196/53509", url="https://www.jmir.org/2024/1/e53509" } @Article{info:doi/10.2196/50978, author="Landman, Benjamin and Khoury, Elie and Cohen, Alicia and Trebossen, Vincent and Michel, Alexandre and Lefebvre, Aline and Delorme, Richard", title="Acceptance of a French e--Mental Health Information Website (Cl{\'e}Psy) for Families: A Web-Based Survey", journal="JMIR Pediatr Parent", year="2024", month="Aug", day="15", volume="7", pages="e50978", keywords="mental health education", keywords="children", keywords="family", keywords="child", keywords="pediatrics", keywords="pediatric", keywords="mental health", keywords="parent", keywords="parents", keywords="parenting", keywords="psychiatry", keywords="website", keywords="acceptance", keywords="patient education", keywords="online information", keywords="health information", keywords="ease of use", keywords="usefulness", keywords="survey", keywords="surveys", keywords="user", keywords="experience", keywords="questionnaire", keywords="questionnaires", keywords="families", abstract="Background: Childhood mental health issues concern a large amount of children worldwide and represent a major public health challenge. The lack of knowledge among parents and caregivers in this area hinders effective management. Empowering families enhances their ability to address their children's difficulties, boosts health literacy, and promotes positive changes. However, seeking reliable mental health information remains challenging due to fear, stigma, and mistrust of the sources of information. Objective: This study evaluates the acceptance of a website, Cl{\'e}Psy, designed to provide reliable information and practical tools for families concerned about child mental health and parenting. Methods: This study examines user characteristics and assesses ease of use, usefulness, trustworthiness, and attitude toward using the website. Platform users were given access to a self-administered questionnaire by means of mailing lists, social networks, and posters between May and July 2022. Results: Findings indicate that the wide majority of the 317 responders agreed or somewhat agreed that the website made discussions about mental health easier with professionals (n=264, 83.3\%) or with their relatives (n=260, 82.1\%). According to the ANOVA, there was a significant effect between educational level and perceived trust (F6=3.03; P=.007) and between frequency of use and perceived usefulness (F2=4.85; P=.008). Conclusions: The study underlines the importance of user experience and design in web-based health information dissemination and emphasizes the need for accessible and evidence-based information. Although the study has limitations, it provides preliminary support for the acceptability and usefulness of the website. Future efforts should focus on inclusive co-construction with users and addressing the information needs of families from diverse cultural and educational backgrounds. ", doi="10.2196/50978", url="https://pediatrics.jmir.org/2024/1/e50978" } @Article{info:doi/10.2196/55939, author="Gibson, Damien and Jackson, Stuart and Shanmugasundaram, Ramesh and Seth, Ishith and Siu, Adrian and Ahmadi, Nariman and Kam, Jonathan and Mehan, Nicholas and Thanigasalam, Ruban and Jeffery, Nicola and Patel, I. Manish and Leslie, Scott", title="Evaluating the Efficacy of ChatGPT as a Patient Education Tool in Prostate Cancer: Multimetric Assessment", journal="J Med Internet Res", year="2024", month="Aug", day="14", volume="26", pages="e55939", keywords="prostate cancer", keywords="patient education", keywords="large language model", keywords="ChatGPT", keywords="AI language model", keywords="multimetric assessment", keywords="artificial intelligence", keywords="AI", keywords="AI chatbots", keywords="health care professional", keywords="health care professionals", keywords="men", keywords="man", keywords="prostate", keywords="cancer", keywords="decision-making", keywords="prostate specific", keywords="antigen screening", keywords="medical information", keywords="natural language processing", keywords="NLP", abstract="Background: Artificial intelligence (AI) chatbots, such as ChatGPT, have made significant progress. These chatbots, particularly popular among health care professionals and patients, are transforming patient education and disease experience with personalized information. Accurate, timely patient education is crucial for informed decision-making, especially regarding prostate-specific antigen screening and treatment options. However, the accuracy and reliability of AI chatbots' medical information must be rigorously evaluated. Studies testing ChatGPT's knowledge of prostate cancer are emerging, but there is a need for ongoing evaluation to ensure the quality and safety of information provided to patients. Objective: This study aims to evaluate the quality, accuracy, and readability of ChatGPT-4's responses to common prostate cancer questions posed by patients. Methods: Overall, 8 questions were formulated with an inductive approach based on information topics in peer-reviewed literature and Google Trends data. Adapted versions of the Patient Education Materials Assessment Tool for AI (PEMAT-AI), Global Quality Score, and DISCERN-AI tools were used by 4 independent reviewers to assess the quality of the AI responses. The 8 AI outputs were judged by 7 expert urologists, using an assessment framework developed to assess accuracy, safety, appropriateness, actionability, and effectiveness. The AI responses' readability was assessed using established algorithms (Flesch Reading Ease score, Gunning Fog Index, Flesch-Kincaid Grade Level, The Coleman-Liau Index, and Simple Measure of Gobbledygook [SMOG] Index). A brief tool (Reference Assessment AI [REF-AI]) was developed to analyze the references provided by AI outputs, assessing for reference hallucination, relevance, and quality of references. Results: The PEMAT-AI understandability score was very good (mean 79.44\%, SD 10.44\%), the DISCERN-AI rating was scored as ``good'' quality (mean 13.88, SD 0.93), and the Global Quality Score was high (mean 4.46/5, SD 0.50). Natural Language Assessment Tool for AI had pooled mean accuracy of 3.96 (SD 0.91), safety of 4.32 (SD 0.86), appropriateness of 4.45 (SD 0.81), actionability of 4.05 (SD 1.15), and effectiveness of 4.09 (SD 0.98). The readability algorithm consensus was ``difficult to read'' (Flesch Reading Ease score mean 45.97, SD 8.69; Gunning Fog Index mean 14.55, SD 4.79), averaging an 11th-grade reading level, equivalent to 15- to 17-year-olds (Flesch-Kincaid Grade Level mean 12.12, SD 4.34; The Coleman-Liau Index mean 12.75, SD 1.98; SMOG Index mean 11.06, SD 3.20). REF-AI identified 2 reference hallucinations, while the majority (28/30, 93\%) of references appropriately supplemented the text. Most references (26/30, 86\%) were from reputable government organizations, while a handful were direct citations from scientific literature. Conclusions: Our analysis found that ChatGPT-4 provides generally good responses to common prostate cancer queries, making it a potentially valuable tool for patient education in prostate cancer care. Objective quality assessment tools indicated that the natural language processing outputs were generally reliable and appropriate, but there is room for improvement. ", doi="10.2196/55939", url="https://www.jmir.org/2024/1/e55939" } @Article{info:doi/10.2196/53993, author="van der Mee, M. Frederieke A. and Schaper, Fleur and Jansen, Jesse and Bons, P. Judith A. and Meex, R. Steven J. and Cals, L. Jochen W.", title="Enhancing Patient Understanding of Laboratory Test Results: Systematic Review of Presentation Formats and Their Impact on Perception, Decision, Action, and Memory", journal="J Med Internet Res", year="2024", month="Aug", day="12", volume="26", pages="e53993", keywords="electronic health record", keywords="patient access to records", keywords="patient portal", keywords="laboratory test results", keywords="clinical laboratory information systems", keywords="health communication", keywords="health informatics", keywords="patient engagement", keywords="patient involvement", abstract="Background: Direct access of patients to their web-based patient portal, including laboratory test results, has become increasingly common. Numeric laboratory results can be challenging to interpret for patients, which may lead to anxiety, confusion, and unnecessary doctor consultations. Laboratory results can be presented in different formats, but there is limited evidence regarding how these presentation formats impact patients' processing of the information. Objective: This study aims to synthesize the evidence on effective formats for presenting numeric laboratory test results with a focus on outcomes related to patients' information processing, including affective perception, perceived magnitude, cognitive perception, perception of communication, decision, action, and memory. Methods: The search was conducted in 3 databases (PubMed, Web of Science, and Embase) from inception until May 31, 2023. We included quantitative, qualitative, and mixed methods articles describing or comparing formats for presenting diagnostic laboratory test results to patients. Two reviewers independently extracted and synthesized the characteristics of the articles and presentation formats used. The quality of the included articles was assessed by 2 independent reviewers using the Mixed Methods Appraisal Tool. Results: A total of 18 studies were included, which were heterogeneous in terms of study design and primary outcomes used. The quality of the articles ranged from poor to excellent. Most studies (n=16, 89\%) used mock test results. The most frequently used presentation formats were numerical values with reference ranges (n=12), horizontal line bars with colored blocks (n=12), or a combination of horizontal line bars with numerical values (n=8). All studies examined perception as an outcome, while action and memory were studied in 1 and 3 articles, respectively. In general, participants' satisfaction and usability were the highest when test results were presented using horizontal line bars with colored blocks. Adding reference ranges or personalized information (eg, goal ranges) further increased participants' perception. Additionally, horizontal line bars significantly decreased participants' tendency to search for information or to contact their physician, compared with numerical values with reference ranges. Conclusions: In this review, we synthesized available evidence on effective presentation formats for laboratory test results. The use of horizontal line bars with reference ranges or personalized goal ranges increased participants' cognitive perception and perception of communication while decreasing participants' tendency to contact their physicians. Action and memory were less frequently studied, so no conclusion could be drawn about a single preferred format regarding these outcomes. Therefore, the use of horizontal line bars with reference ranges or personalized goal ranges is recommended to enhance patients' information processing of laboratory test results. Further research should focus on real-life settings and diverse presentation formats in combination with outcomes related to patients' information processing. ", doi="10.2196/53993", url="https://www.jmir.org/2024/1/e53993" } @Article{info:doi/10.2196/48584, author="Nare, Matthew and Jurewicz, Katherina", title="Assessing Patient Trust in Automation in Health Care Systems: Within-Subjects Experimental Study", journal="JMIR Hum Factors", year="2024", month="Aug", day="6", volume="11", pages="e48584", keywords="automation", keywords="emergency department", keywords="trust", keywords="health care", keywords="artificial intelligence", keywords="emergency", keywords="perceptions", keywords="attitude", keywords="opinions", keywords="belief", keywords="automated", keywords="trust ratings", abstract="Background: Health care technology has the ability to change patient outcomes for the betterment when designed appropriately. Automation is becoming smarter and is increasingly being integrated into health care work systems. Objective: This study focuses on investigating trust between patients and an automated cardiac risk assessment tool (CRAT) in a simulated emergency department setting. Methods: A within-subjects experimental study was performed to investigate differences in automation modes for the CRAT: (1) no automation, (2) automation only, and (3) semiautomation. Participants were asked to enter their simulated symptoms for each scenario into the CRAT as instructed by the experimenter, and they would automatically be classified as high, medium, or low risk depending on the symptoms entered. Participants were asked to provide their trust ratings for each combination of risk classification and automation mode on a scale of 1 to 10 (1=absolutely no trust and 10=complete trust). Results: Results from this study indicate that the participants significantly trusted the semiautomation condition more compared to the automation-only condition (P=.002), and they trusted the no automation condition significantly more than the automation-only condition (P=.03). Additionally, participants significantly trusted the CRAT more in the high-severity scenario compared to the medium-severity scenario (P=.004). Conclusions: The findings from this study emphasize the importance of the human component of automation when designing automated technology in health care systems. Automation and artificially intelligent systems are becoming more prevalent in health care systems, and this work emphasizes the need to consider the human element when designing automation into care delivery. ", doi="10.2196/48584", url="https://humanfactors.jmir.org/2024/1/e48584", url="http://www.ncbi.nlm.nih.gov/pubmed/39106096" } @Article{info:doi/10.2196/50749, author="Koenig, R. Leah and Ko, Jennifer and Upadhyay, D. Ushma", title="Virtual Clinic Telehealth Abortion Services in the United States One Year After Dobbs: Landscape Review", journal="J Med Internet Res", year="2024", month="Aug", day="5", volume="26", pages="e50749", keywords="medication abortion", keywords="telehealth", keywords="virtual clinics", keywords="abortion", keywords="access", keywords="policy", keywords="health equity", abstract="Background: Telehealth abortion has taken on a vital role in maintaining abortion access since the Dobbs v. Jackson Women's Health Organization Supreme Court decision. However, little remains known about the landscape of new telehealth-only virtual clinic abortion providers that have expanded since telehealth abortion first became widely available in the United States in 2021. Objective: This study aimed to (1) document the landscape of telehealth-only virtual clinic abortion care in the United States, (2) describe changes in the presence of virtual clinic abortion services between September 2022, following the Dobbs decision, and June 2023, and (3) identify structural factors that may perpetuate inequities in access to virtual clinic abortion care. Methods: We conducted a repeated cross-sectional study by reviewing web search results and abortion directories to identify virtual abortion clinics in September 2022 and June 2023 and described changes in the presence of virtual clinics between these 2 periods. In June 2023, we also described each virtual clinic's policies, including states served, costs, patient age limits, insurance acceptance, financial assistance available, and gestational limits. Results: We documented 11 virtual clinics providing telehealth abortion care in 26 states and Washington DC in September 2022. By June 2023, 20 virtual clinics were providing services in 27 states and Washington DC. Most (n=16) offered care to minors, 8 provided care until 10 weeks of pregnancy, and median costs were US \$259. In addition, 2 accepted private insurance and 1 accepted Medicaid, within a limited number of states. Most (n=16) had some form of financial assistance available. Conclusions: Virtual clinic abortion providers have proliferated since the Dobbs decision. We documented inequities in the availability of telehealth abortion care from virtual clinics, including age restrictions that exclude minors, gestational limits for care, and limited insurance and Medicaid acceptance. Notably, virtual clinic abortion care was not permitted in 11 states where in-person abortion is available. ", doi="10.2196/50749", url="https://www.jmir.org/2024/1/e50749" } @Article{info:doi/10.2196/55927, author="Li, Linger and Li, Pengfei and Wang, Kun and Zhang, Liang and Ji, Hongwei and Zhao, Hongqin", title="Benchmarking State-of-the-Art Large Language Models for Migraine Patient Education: Performance Comparison of Responses to Common Queries", journal="J Med Internet Res", year="2024", month="Jul", day="23", volume="26", pages="e55927", keywords="migraine", keywords="large language models", keywords="patient education", keywords="ChatGPT", keywords="Google Bard", keywords="language model", keywords="education", keywords="headache", keywords="accuracy", keywords="OpenAI", keywords="AI", keywords="artificial intelligence", keywords="AI-assisted", keywords="holistic", keywords="migraine management", keywords="management", doi="10.2196/55927", url="https://www.jmir.org/2024/1/e55927" } @Article{info:doi/10.2196/56996, author="Elf, Marie and Norin, Lizette and Meijering, Louise and Pessah-Rasmussen, H{\'e}l{\`e}ne and Suhonen, Riitta and Zingmark, Magnus and Kyl{\'e}n, Maya", title="Rehabilitation at Home With the Development of a Sustainable Model Placing the Person's Needs and Environment at Heart: Protocol for a Multimethod Project", journal="JMIR Res Protoc", year="2024", month="Jul", day="23", volume="13", pages="e56996", keywords="co-design", keywords="early supported discharge", keywords="home", keywords="integrated care", keywords="life space mobility", keywords="multi-methods", keywords="physical environment", keywords="person-centered care", keywords="social environment", keywords="stroke rehabilitation", abstract="Background: Each year, more than 1.5 million people in Europe have a stroke, and many experience disabilities leading to activity and participation restrictions. Home-based rehabilitation is the recommended approach for stroke rehabilitation, in line with the international shift to integrated care. Despite this, rehabilitation often focuses on the person's physical functions, not the whole life situation and opportunities to live an active life. Given that rehabilitation today is often provided in the person's home, there is a need to develop new models that consider the rehabilitation process as situated in the everyday living environment of persons with stroke. This project is grounded in experiences from our ongoing research, where we study the importance of the home environment for health and participation among persons with stroke, rehabilitated at home. This research has shown unmet needs, which lead to suboptimal rehabilitation outcomes. There is a need for studies on how to use environmental resources to optimize stroke rehabilitation in the home setting. Objective: The overarching objective of the project is to develop a new practice model for rehabilitation where the needs of the person are the starting point and where the environment is considered. Methods: The project will be conducted in partnership with persons with stroke, significant others, health care professionals, and care managers. Results from a literature review will form the base for interviews with the stakeholders, followed by co-designing workshops aiming to create a new practice model. Focus groups will be held to refine the outcome of the workshops to a practice model. Results: This 4-year project commenced in January 2023 and will continue until December 2026. The results of the literature review are, as of April 2024, currently being analyzed. The ethics application for the interviews and co-design phase was approved in October 2023 and data collection is ongoing during spring 2024. We aim to develop a practice model with stakeholders and refine it together with care managers and decision makers. The outcome is a new practice model and implementation plan, which will be achieved in autumn 2026. Conclusions: The project contributes with a prominent missing puzzle to optimize the rehabilitation process by adding a strong focus on user engagement combined with integrating different aspects of the environment. The goal is to improve quality of life and increase reintegration in society for the large group of people living with the aftermath of a stroke. By co-designing with multiple stakeholders, we expect the model to be feasible and sustainable. The knowledge from the project will also contribute to an increased awareness of the importance of the physical environment for sustainable health care. The findings will lay the foundation for future upscaling initiatives. International Registered Report Identifier (IRRID): DERR1-10.2196/56996 ", doi="10.2196/56996", url="https://www.researchprotocols.org/2024/1/e56996" } @Article{info:doi/10.2196/54129, author="Posner, Jessica and Ndhlovu, Paxon Adamson and Musangulule, Mushinka Jemmy and Duffy, Malia and Casella, Amy and Madevu-Matson, Caitlin and Davis, Nicole and Sharer, Melissa", title="Evaluating the Preliminary Effectiveness of the Person-Centered Care Assessment Tool (PCC-AT) in Zambian Health Facilities: Protocol for a Mixed Methods Cross-Sectional Study", journal="JMIR Res Protoc", year="2024", month="Jul", day="23", volume="13", pages="e54129", keywords="person-centered care", keywords="HIV", keywords="action plans", keywords="preliminary", keywords="person-centered care assessment tool", keywords="PCC-AT", keywords="assessment tool", keywords="Zambia", keywords="health facility", keywords="exploratory study", keywords="HIV treatment", keywords="inequities", keywords="framework", keywords="practitioners", keywords="health services", abstract="Background: Person-centered care (PCC) within HIV treatment services has demonstrated potential to overcome inequities in HIV service access while improving treatment outcomes. Despite PCC being widely considered a best practice, no consensus exists on its assessment and measurement. This study in Zambia builds upon previous research that informed development of a framework for PCC and a PCC assessment tool (PCC-AT). Objective: This mixed methods study aims to examine the preliminary effectiveness of the PCC-AT through assessing the association between client HIV service delivery indicators and facility PCC-AT scores. We hypothesize that facilities with higher PCC-AT scores will demonstrate more favorable HIV treatment continuity, viral load (VL) coverage, and viral suppression in comparison to those of facilities with lower PCC-AT scores. Methods: We will implement the PCC-AT at 30 randomly selected health facilities in the Copperbelt and Central provinces of Zambia. For each study facility, data will be gathered from 3 sources: (1) PCC-AT scores, (2) PCC-AT action plans, and (3) facility characteristics, along with service delivery data. Quantitative analysis, using STATA, will include descriptive statistics on the PCC-AT results stratified by facility characteristics. Cross-tabulations and/or regression analysis will be used to determine associations between scores and treatment continuity, VL coverage, and/or viral suppression.?Qualitative data will be collected via action planning, with detailed notes collected and recorded into an action plan template. Descriptive coding and emerging themes will be analyzed with NVivo software. Results: As of May 2024, we enrolled 29 facilities in the study and data analysis from the key informant interviews is currently underway. Results are expected to be published by September 2024. Conclusions: Assessment and measurement of PCC within HIV treatment settings is a novel approach that offers HIV treatment practitioners the opportunity to examine their services and identify actions to improve PCC performance. Study results and the PCC-AT will be broadly disseminated for use among all project sites in Zambia as well as other HIV treatment programs, in addition to making the PCC-AT publicly available to global HIV practitioners. International Registered Report Identifier (IRRID): DERR1-10.2196/54129 ", doi="10.2196/54129", url="https://www.researchprotocols.org/2024/1/e54129" } @Article{info:doi/10.2196/51520, author="Teano, L. Anthony and Scott, Ashley and Gipson, Cassandra and Albert, Marilyn and Pettigrew, Corinne", title="Social Media Programs for Outreach and Recruitment Supporting Aging and Alzheimer Disease and Related Dementias Research: Longitudinal Descriptive Study", journal="JMIR Aging", year="2024", month="Jul", day="9", volume="7", pages="e51520", keywords="education", keywords="social media", keywords="outreach", keywords="recruitment", keywords="Alzheimer's disease", keywords="Alzheimer disease", abstract="Background: Social media may be a useful method for research centers to deliver health messages, increase their visibility in the local community, and recruit study participants. Sharing examples of social media--based community outreach and educational programs, and evaluating their outcomes in this setting, is important for understanding whether these efforts have a measurable impact. Objective: The aim of this study is to describe one center's social media activities for community education on topics related to aging, memory loss, and Alzheimer disease and related dementias, and provide metrics related to recruitment into clinical research studies. Methods: Several social media platforms were used, including Facebook, X (formerly Twitter), and YouTube. Objective assessments quantified monthly, based on each platform's native dashboard, included the number of followers, number of posts, post reach and engagement, post impressions, and video views. The number of participants volunteering for research during this period was additionally tracked using a secure database. Educational material posted to social media most frequently included content developed by center staff, content from partner organizations, and news articles or resources featuring center researchers. Multiple educational programs were developed, including social media series, web-based talks, Twitter chats, and webinars. In more recent years, Facebook content was occasionally boosted to increase visibility in the local geographical region. Results: Up to 4 years of page metrics demonstrated continuing growth in reaching social media audiences, as indicated by increases over time in the numbers of likes or followers on Facebook and X/Twitter and views of YouTube videos (growth trajectories). While Facebook reach and X/Twitter impression rates were reasonable, Facebook engagement rates were more modest. Months that included boosted Facebook posts resulted in a greater change in page followers and page likes, and higher reach and engagement rates (all P?.002). Recruitment of participants into center-affiliated research studies increased during this time frame, particularly in response to boosted Facebook posts. Conclusions: These data demonstrate that social media activities can provide meaningful community educational opportunities focused on Alzheimer disease and related dementias and have a measurable impact on the recruitment of participants into research studies. Additionally, this study highlights the importance of tracking outreach program outcomes for evaluating return on investment. ", doi="10.2196/51520", url="https://aging.jmir.org/2024/1/e51520" } @Article{info:doi/10.2196/47785, author="Ortiz, Fernanda and Grasberger, Juulia and Ekstrand, Agneta and Helanter{\"a}, Ilkka and Giunti, Guido", title="Interactive Health Technology Tool for Kidney Living Donor Assessment to Standardize the Informed Consent Process: Usability and Qualitative Content Analysis", journal="JMIR Form Res", year="2024", month="Jul", day="9", volume="8", pages="e47785", keywords="eHealth", keywords="kidney living donor", keywords="informed consent", keywords="telemedicine", keywords="process standardization", keywords="kidney", keywords="donor", keywords="tool", keywords="usability", keywords="psychological impact", keywords="utility", keywords="smartphone", keywords="coping", keywords="surgery", abstract="Background: Kidney living donation carries risks, yet standardized information provision regarding nephrectomy risks and psychological impacts for candidates remains lacking. Objective: This study assesses the benefit of interactive health technology in improving the informed consent process for kidney living donation. Methods: The Kidney Hub institutional open portal offers comprehensive information on kidney disease and donation. Individuals willing to start the kidney living donation process at Helsinki University Hospital (January 2019-January 2022) were invited to use the patient-tailored digital care path (Living Donor Digital Care Path) included in the Kidney Hub. This platform provides detailed donation process information and facilitates communication between health care professionals and patients. eHealth literacy was evaluated via the eHealth Literacy Scale (eHEALS), usability with the System Usability Scale (SUS), and system utility through Likert-scale surveys with scores of 1-5. Qualitative content analysis addressed an open-ended question. Results: The Kidney Hub portal received over 8000 monthly visits, including to its sections on donation benefits (n=1629 views) and impact on donors' lives (n=4850 views). Of 127 living kidney donation candidates, 7 did not use Living Donor Digital Care Path. Users' ages ranged from 20 to 79 years, and they exchanged over 3500 messages. A total of 74 living donor candidates participated in the survey. Female candidates more commonly searched the internet about kidney donation (n=79 female candidates vs n=48 male candidates; P=.04). The mean eHEALS score correlated with internet use for health decisions (r=0.45; P<.001) and its importance (r=0.40; P=.01). Participants found that the Living Donor Digital Care Path was technically satisfactory (mean SUS score 4.4, SD 0.54) and useful but not pivotal in donation decision-making. Concerns focused on postsurgery coping for donors and recipients. Conclusions: Telemedicine effectively educates living kidney donor candidates on the donation process. The Living Donor Digital Care Path serves as a valuable eHealth tool, aiding clinicians in standardizing steps toward informed consent. Trial Registration: ClinicalTrials.gov NCT04791670; https://clinicaltrials.gov/study/NCT04791670 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-051166 ", doi="10.2196/47785", url="https://formative.jmir.org/2024/1/e47785" } @Article{info:doi/10.2196/50086, author="Espinoza Chamorro, Roberto and Santos, O. Luciano H. and Mori, Yukiko and Liu, Chang and Yamamoto, Goshiro and Kuroda, Tomohiro", title="Gamification Approach to Provide Support About the Deferral Experience in Blood Donation: Design and Feasibility Study", journal="JMIR Hum Factors", year="2024", month="Jun", day="14", volume="11", pages="e50086", keywords="blood donation", keywords="deferral experience", keywords="Theory of Planned Behavior", keywords="Self-Determination Theory", keywords="gamification", keywords="ICT design", keywords="motivation", keywords="patient education", keywords="prototype", keywords="feasibility", abstract="Background: Multiple studies have examined the impact of deferral on the motivation of prospective blood donors, proposing various policies and strategies to support individuals who undergo this experience. However, existing information and communications technology systems focused on blood donation have not yet integrated these ideas or provided options to assist with the deferral experience. Objective: This study aims to propose an initial gamified design aimed at mitigating the impact of the deferral experience by addressing the drivers of awareness and knowledge, interaction and validation, and motivation. Additionally, the study explores the feasibility of implementing such a system for potential users. Methods: We conducted a literature review focusing on the dynamics of motivation and intention related to blood donation, as well as the deferral situation and its impact on citizens. Through this review, we identified weak donor identity, lack of knowledge, and reduced motivation as key factors requiring support from appropriate interventions. These factors were then defined as our key drivers. Taking these into account, we proposed a gamification approach that incorporates concepts from the MDA framework. The aim is to stimulate the aforementioned drivers and expand the concept of contribution and identity in blood donation. For a preliminary evaluation, we designed a prototype to collect feedback on usability, usefulness, and interest regarding a potential implementation of our proposed gamification approach. Results: Among the participants, a total of 11 citizens interacted with the app and provided feedback through our survey. They indicated that interacting with the app was relatively easy, with an average score of 4.13 out of 5 when considering the 11 tasks of interaction. The SUS results yielded a final average score of 70.91 from the participants' answers. Positive responses were received when participants were asked about liking the concept of the app (3.82), being likely to download it (3.55), and being likely to recommend it to others (3.64). Participants expressed positivity about the implementation of the design but also highlighted current shortcomings and suggested possible improvements in both functionality and usability. Conclusions: Although deferral is a common issue in blood donation, there is a missed opportunity in existing ICT services regarding how to effectively handle such experiences. Our proposed design and implementation seem to have captured the interest of prospective users due to its perceived positive usefulness and potential. However, further confirmation is needed. Improving the design of activities that currently rely heavily on extrinsic motivation elements and integrating more social components to create an enhanced activity loop for intrinsic motivation could further increase the value of the proposed project. Future research could involve conducting a more specialized and longitudinal design evaluation with a larger sample size. ", doi="10.2196/50086", url="https://humanfactors.jmir.org/2024/1/e50086", url="http://www.ncbi.nlm.nih.gov/pubmed/38875005" } @Article{info:doi/10.2196/50087, author="van Dijk, R. Merle and van der Marel, Anne-Fleur and van Rheenen-Flach, E. Leonie and Ganzevoort, Wessel and Moll, Etelka and Scheele, Fedde and Velzel, Joost", title="YouTube as a Source of Patient Information on External Cephalic Version: Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Jun", day="6", volume="8", pages="e50087", keywords="YouTube", keywords="ECV", keywords="external cephalic version", keywords="breech", keywords="education", keywords="video", keywords="cesarean", keywords="health education", keywords="childbirth", keywords="patient information", keywords="cross-sectional study", keywords="cesarean delivery", keywords="implementation", keywords="usefulness", keywords="medical information", keywords="pregnancy", keywords="pregnant women", keywords="engagement", abstract="Background: With the global increase of cesarean deliveries, breech presentation is the third indication for elective cesarean delivery. Implementation of external cephalic version (ECV), in which the position of the baby is manipulated externally to prevent breech presentation at term, remains suboptimal. Increasing knowledge for caretakers and patients is beneficial in the uptake of ECV implementation. In recent decades, the internet has become the most important source of information for both patients and health care professionals. However, the use and availability of the internet also bring about concerns since the information is often not regulated or reviewed. Information needs to be understandable, correct, and easily obtainable for the patient. Owing to its global reach, YouTube has great potential to both hinder and support spreading medical information and can therefore be used as a tool for shared decision-making. Objective: The objective of this study was to investigate the available information on YouTube about ECV and assess the quality and usefulness of the information in the videos. Methods: A YouTube search was performed with five search terms and the first 35 results were selected for analysis. A quality assessment scale was developed to quantify the accuracy of medical information of each video. The main outcome measure was the usefulness score, dividing the videos into useful, slightly useful, and not useful categories. The source of upload was divided into five subcategories and two broad categories of medical or nonmedical. Secondary outcomes included audience engagement, misinformation, and encouraging or discouraging ECV. Results: Among the 70 videos, only 14\% (n=10) were defined as useful. Every useful video was uploaded by educational channels or health care professionals and 80\% (8/10) were derived from a medical source. Over half of the not useful videos were uploaded by birth attendants and vloggers. Videos uploaded by birth attendants scored the highest on audience engagement. The presence of misinformation was low across all groups. Two-thirds of the vloggers encouraged ECV to their viewers. Conclusions: A minor percentage of videos about ECV on YouTube are considered useful. Vloggers often encourage their audience to opt for ECV. Videos with higher audience engagement had a lower usefulness score compared to videos with lower audience engagement. Sources from medically accurate videos should cooperate with sources with high audience engagement to contribute to the uptake of ECV by creating more awareness and a positive attitude of the procedure, thereby lowering the chance for a cesarean delivery due to breech presentation at term. ", doi="10.2196/50087", url="https://formative.jmir.org/2024/1/e50087", url="http://www.ncbi.nlm.nih.gov/pubmed/38843520" } @Article{info:doi/10.2196/52251, author="Narang, Gaurav and Chen, J. Yaozhu and Wedel, Nicole and Wu, Melody and Luo, Michelle and Atreja, Ashish", title="Development of a Digital Patient Assistant for the Management of Cyclic Vomiting Syndrome: Patient-Centric Design Study", journal="JMIR Form Res", year="2024", month="Jun", day="6", volume="8", pages="e52251", keywords="cyclic vomiting syndrome", keywords="vomiting", keywords="vomit", keywords="emetic", keywords="emesis", keywords="gut", keywords="GI", keywords="gastrointestinal", keywords="internal medicine", keywords="prototype", keywords="prototypes", keywords="iterative", keywords="self-management", keywords="disease management", keywords="gut-brain interaction", keywords="gut-brain", keywords="artificial intelligence", keywords="digital patient assistant", keywords="assistant", keywords="assistants", keywords="design thinking", keywords="design", keywords="patient-centric", keywords="patient centred", keywords="patient centered", keywords="patient-centric approach", keywords="System Usability Scale", keywords="symptom tracking", keywords="digital health solution", keywords="user experience", keywords="usability", keywords="symptom", keywords="symptoms", keywords="tracking", keywords="monitoring", keywords="participatory", keywords="co-design digital health technology", keywords="patient assistance", keywords="patient experience", keywords="mobile phone", abstract="Background: Cyclic vomiting syndrome (CVS) is an enigmatic and debilitating disorder of gut-brain interaction that is characterized by recurrent episodes of severe vomiting and nausea. It significantly impairs patients' quality of life and can lead to frequent medical visits and substantial health care costs. The diagnosis for CVS is often protracted and complex, primarily due to its exclusionary diagnosis nature and the lack of specific biomarkers. This typically leads to a considerable delay in accurate diagnosis, contributing to increased patient morbidity. Additionally, the absence of approved therapies for CVS worsens patient hardship and reflects the urgent need for innovative, patient-centric solutions to improve CVS management. Objective: We aim to develop a digital patient assistant (DPA) for patients with CVS to address their unique needs, and iteratively enhance the technical features and user experience on the initial DPA versions. Methods: The development of the DPA for CVS used a design thinking approach, prioritizing user needs. A literature review and Patient Advisory Board shaped the initial prototype, focusing on diagnostic support and symptom tracking. Iterative development, informed by the design thinking approach and feedback from patients with CVS and caregivers through interviews and smartphone testing, led to significant enhancements in user interaction and artificial intelligence integration. The final DPA's effectiveness was validated using the System Usability Scale and feedback questions, ensuring it met the specific needs of the CVS community. Results: The DPA developed for CVS integrates an introductory bot, daily and weekly check-in bots, and a knowledge hub, all accessible via a patient dashboard. This multicomponent solution effectively addresses key unmet needs in CVS management: efficient symptom and impacts tracking, access to comprehensive disease information, and a digital health platform for disease management. Significant improvements, based on user feedback, include the implementation of artificial intelligence features like intent recognition and data syncing, enhancing the bot interaction and reducing the burden on patients. The inclusion of the knowledge hub provides educational resources, contributing to better disease understanding and management. The DPA achieved a System Usability Scale score of 80 out of 100, indicating high ease of use and relevance. Patient feedback highlighted the DPA's potential in disease management and suggested further applications, such as integration into health care provider recommendations for patients with suspected or confirmed CVS. This positive response underscores the DPA's role in enhancing patient engagement and disease management through a patient-centered digital solution. Conclusions: The development of this DPA for patients with CVS, via an iterative design thinking approach, offers a patient-centric solution for disease management. The DPA development framework may also serve to guide future patient digital support and research scenarios. ", doi="10.2196/52251", url="https://formative.jmir.org/2024/1/e52251", url="http://www.ncbi.nlm.nih.gov/pubmed/38842924" } @Article{info:doi/10.2196/57849, author="So, Hei Jeffrey Tsz and Nambiar, Smita and Byrne, Rebecca and Gallegos, Danielle and Baxter, A. Kimberley", title="Designing Child Nutrition Interventions to Engage Fathers: Qualitative Analysis of Interviews and Co-Design Workshops", journal="JMIR Pediatr Parent", year="2024", month="May", day="30", volume="7", pages="e57849", keywords="co-design", keywords="fathers", keywords="child nutrition", keywords="child feeding", keywords="intervention design", keywords="digital delivery", keywords="parenting", keywords="participatory", keywords="videoconference", keywords="communication technology", abstract="Background: Fathers play a pivotal role in parenting and child feeding, but they remain underrepresented in intervention studies, especially those focused on disadvantaged populations. A better understanding of fathers' experiences and needs regarding support access and child nutrition information in the context of disadvantage can inform future interventions engaging fathers. Objective: This study aims to explore fathers' experiences; perceived enablers; and barriers to accessing support and information related to parenting, child feeding, and nutrition and to co-design principles for tailoring child nutrition interventions to engage fathers. Methods: Australian fathers of children aged 6 months to 5 years with lived experience of disadvantage participated in semistructured interviews and co-design workshops, primarily conducted via videoconference. Creative analogies were used to guide the ideation process in the workshops. Results: A total of 25 interviews and 3 workshops (n=10 participants) were conducted, with data analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation--Behavior model. The interview data illuminated factors influencing fathers' initiation in seeking support for parenting, child feeding, and nutrition, including their experiences. It highlighted fathers' diverse information needs and the importance of an inclusive environment and encouragement. Enablers and barriers in accessing support related to parenting and child nutrition were identified at the individual (eg, personal goals and resource constraints), interpersonal (family support and false beliefs about men's caregiving role), organizational (inadequate fathering support), and systemic levels (father-inclusive practice and policy). Digital data collection methods enabled Australia-wide participation, overcoming work and capacity barriers. Videoconferencing technology was effectively used to engage fathers creatively. Key principles for engaging fathers were co-designed from the workshop data. Interventions and resources need to be father specific, child centered, and culturally appropriate; promote empowerment and collaboration; and provide actionable and accessible strategies on the what and how of child feeding. Fathers preferred multiformat implementation, which harnesses technology-based design (eg, websites and mobile apps) and gamification. It should be tailored to the child's age and targeted at fathers using comprehensive promotion strategies. Conclusions: Fathers faced barriers to accessing support and information related to parenting and feeding that may not adequately address their needs. Future interventions could integrate the co-designed principles to engage fathers effectively. These findings have implications for health service delivery and policy development, promoting father-inclusive practice. ", doi="10.2196/57849", url="https://pediatrics.jmir.org/2024/1/e57849", url="http://www.ncbi.nlm.nih.gov/pubmed/38815260" } @Article{info:doi/10.2196/53098, author="Greeley, Brian and Chung, Seohyeon Sally and Graves, Lorraine and Song, Xiaowei", title="Combating Barriers to the Development of a Patient-Oriented Frailty Website", journal="JMIR Aging", year="2024", month="May", day="28", volume="7", pages="e53098", keywords="frailty", keywords="frailty website", keywords="patient-oriented assessment", keywords="community-dwelling older adults", keywords="internet security", keywords="privacy", keywords="barrier", keywords="barriers", keywords="development", keywords="implementation", keywords="patient-oriented", keywords="internet", keywords="virtual health resource", keywords="community dwelling", keywords="older adult", keywords="older adults", keywords="health care professional", keywords="caregiver", keywords="caregivers", keywords="technology", keywords="real-time", keywords="monitoring", keywords="aging", keywords="ageing", doi="10.2196/53098", url="https://aging.jmir.org/2024/1/e53098" } @Article{info:doi/10.2196/53872, author="Yu, Lin and Gong, Jianmei and Sun, Xiaoting and Zang, Min and Liu, Lei and Yu, Shengmiao", title="Assessing the Content and Effect of Web-Based Decision Aids for Postmastectomy Breast Reconstruction: Systematic Review and Meta-Analysis of Randomized Controlled Trials", journal="J Med Internet Res", year="2024", month="May", day="27", volume="26", pages="e53872", keywords="decision aids", keywords="internet", keywords="postmastectomy breast reconstruction", keywords="decision conflicts", keywords="mobile phone", abstract="Background: Web-based decision aids have been shown to have a positive effect when used to improve the quality of decision-making for women facing postmastectomy breast reconstruction (PMBR). However, the existing findings regarding these interventions are still incongruent, and the overall effect is unclear. Objective: We aimed to assess the content of web-based decision aids and its impact on decision-related outcomes (ie, decision conflict, decision regret, informed choice, and knowledge), psychological-related outcomes (ie, satisfaction and anxiety), and surgical decision-making in women facing PMBR. Methods: This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 6 databases, PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science Core Collection, were searched starting at the time of establishment of the databases to May 2023, and an updated search was conducted on April 1, 2024. MeSH (Medical Subject Headings) terms and text words were used. The Cochrane Risk of Bias Tool for randomized controlled trials was used to assess the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: In total, 7 studies included 579 women and were published between 2008 and 2023, and the sample size in each study ranged from 26 to 222. The results showed that web-based decision aids used audio and video to present the pros and cons of PMBR versus no PMBR, implants versus flaps, and immediate versus delayed PMBR and the appearance and feel of the PMBR results and the expected recovery time with photographs of actual patients. Web-based decision aids help improve PMBR knowledge, decisional conflict (mean difference [MD]=--5.43, 95\% CI --8.87 to --1.99; P=.002), and satisfaction (standardized MD=0.48, 95\% CI 0.00 to 0.95; P=.05) but have no effect on informed choice (MD=--2.80, 95\% CI --8.54 to 2.94; P=.34), decision regret (MD=--1.55, 95\% CI --6.00 to 2.90 P=.49), or anxiety (standardized MD=0.04, 95\% CI --0.50 to 0.58; P=.88). The overall Grading of Recommendations, Assessment, Development, and Evaluation quality of the evidence was low. Conclusions: The findings suggest that the web-based decision aids provide a modern, low-cost, and high dissemination rate effective method to promote the improved quality of decision-making in women undergoing PMBR. Trial Registration: PROSPERO CRD42023450496; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=450496 ", doi="10.2196/53872", url="https://www.jmir.org/2024/1/e53872", url="http://www.ncbi.nlm.nih.gov/pubmed/38801766" } @Article{info:doi/10.2196/47484, author="Benda, Natalie and Woode, Sydney and Ni{\~n}o de Rivera, Stephanie and Kalish, B. Robin and Riley, E. Laura and Hermann, Alison and Masterson Creber, Ruth and Costa Pimentel, Eric and Ancker, S. Jessica", title="Understanding Symptom Self-Monitoring Needs Among Postpartum Black Patients: Qualitative Interview Study", journal="J Med Internet Res", year="2024", month="Apr", day="26", volume="26", pages="e47484", keywords="maternal mortality", keywords="patient-reported outcomes", keywords="patient-reported outcome", keywords="health equity", keywords="qualitative research", keywords="mobile health", keywords="mHealth", keywords="qualitative", keywords="postpartum", keywords="postnatal", keywords="maternity", keywords="maternal", keywords="Black", keywords="women's health", keywords="ethnic", keywords="design need", keywords="mortality", keywords="death", keywords="decision support", keywords="information need", keywords="informational need", keywords="obstetric", keywords="obstetrics", keywords="mental health", keywords="mobile phone", abstract="Background: Pregnancy-related death is on the rise in the United States, and there are significant disparities in outcomes for Black patients. Most solutions that address pregnancy-related death are hospital based, which rely on patients recognizing symptoms and seeking care from a health system, an area where many Black patients have reported experiencing bias. There is a need for patient-centered solutions that support and encourage postpartum people to seek care for severe symptoms. Objective: We aimed to determine the design needs for a mobile health (mHealth) patient-reported outcomes and decision-support system to assist Black patients in assessing when to seek medical care for severe postpartum symptoms. These findings may also support different perinatal populations and minoritized groups in other clinical settings. Methods: We conducted semistructured interviews with 36 participants---15 (42\%) obstetric health professionals, 10 (28\%) mental health professionals, and 11 (31\%) postpartum Black patients. The interview questions included the following: current practices for symptom monitoring, barriers to and facilitators of effective monitoring, and design requirements for an mHealth system that supports monitoring for severe symptoms. Interviews were audio recorded and transcribed. We analyzed transcripts using directed content analysis and the constant comparative process. We adopted a thematic analysis approach, eliciting themes deductively using conceptual frameworks from health behavior and human information processing, while also allowing new themes to inductively arise from the data. Our team involved multiple coders to promote reliability through a consensus process. Results: Our findings revealed considerations related to relevant symptom inputs for postpartum support, the drivers that may affect symptom processing, and the design needs for symptom self-monitoring and patient decision-support interventions. First, participants viewed both somatic and psychological symptom inputs as important to capture. Second, self-perception; previous experience; sociocultural, financial, environmental, and health systems--level factors were all perceived to impact how patients processed, made decisions about, and acted upon their symptoms. Third, participants provided recommendations for system design that involved allowing for user control and freedom. They also stressed the importance of careful wording of decision-support messages, such that messages that recommend them to seek care convey urgency but do not provoke anxiety. Alternatively, messages that recommend they may not need care should make the patient feel heard and reassured. Conclusions: Future solutions for postpartum symptom monitoring should include both somatic and psychological symptoms, which may require combining existing measures to elicit symptoms in a nuanced manner. Solutions should allow for varied, safe interactions to suit individual needs. While mHealth or other apps may not be able to address all the social or financial needs of a person, they may at least provide information, so that patients can easily access other supportive resources. ", doi="10.2196/47484", url="https://www.jmir.org/2024/1/e47484", url="http://www.ncbi.nlm.nih.gov/pubmed/38669066" } @Article{info:doi/10.2196/55847, author="Lv, Xiaolei and Zhang, Xiaomeng and Li, Yuan and Ding, Xinxin and Lai, Hongchang and Shi, Junyu", title="Leveraging Large Language Models for Improved Patient Access and Self-Management: Assessor-Blinded Comparison Between Expert- and AI-Generated Content", journal="J Med Internet Res", year="2024", month="Apr", day="25", volume="26", pages="e55847", keywords="large language model", keywords="artificial intelligence", keywords="public oral health", keywords="health care access", keywords="patient education", abstract="Background: While large language models (LLMs) such as ChatGPT and Google Bard have shown significant promise in various fields, their broader impact on enhancing patient health care access and quality, particularly in specialized domains such as oral health, requires comprehensive evaluation. Objective: This study aims to assess the effectiveness of Google Bard, ChatGPT-3.5, and ChatGPT-4 in offering recommendations for common oral health issues, benchmarked against responses from human dental experts. Methods: This comparative analysis used 40 questions derived from patient surveys on prevalent oral diseases, which were executed in a simulated clinical environment. Responses, obtained from both human experts and LLMs, were subject to a blinded evaluation process by experienced dentists and lay users, focusing on readability, appropriateness, harmlessness, comprehensiveness, intent capture, and helpfulness. Additionally, the stability of artificial intelligence responses was also assessed by submitting each question 3 times under consistent conditions. Results: Google Bard excelled in readability but lagged in appropriateness when compared to human experts (mean 8.51, SD 0.37 vs mean 9.60, SD 0.33; P=.03). ChatGPT-3.5 and ChatGPT-4, however, performed comparably with human experts in terms of appropriateness (mean 8.96, SD 0.35 and mean 9.34, SD 0.47, respectively), with ChatGPT-4 demonstrating the highest stability and reliability. Furthermore, all 3 LLMs received superior harmlessness scores comparable to human experts, with lay users finding minimal differences in helpfulness and intent capture between the artificial intelligence models and human responses. Conclusions: LLMs, particularly ChatGPT-4, show potential in oral health care, providing patient-centric information for enhancing patient education and clinical care. The observed performance variations underscore the need for ongoing refinement and ethical considerations in health care settings. Future research focuses on developing strategies for the safe integration of LLMs in health care settings. ", doi="10.2196/55847", url="https://www.jmir.org/2024/1/e55847", url="http://www.ncbi.nlm.nih.gov/pubmed/38663010" } @Article{info:doi/10.2196/48793, author="Wahl, J. Kate and Brooks, Melissa and Trenaman, Logan and Desjardins-Lorimer, Kirsten and Bell, M. Carolyn and Chokmorova, Nazgul and Segall, Romy and Syring, Janelle and Williams, Aleyah and Li, C. Linda and Norman, V. Wendy and Munro, Sarah", title="User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Apr", day="16", volume="26", pages="e48793", keywords="family planning", keywords="abortion", keywords="shared decision-making", keywords="patient decision aid", keywords="qualitative", keywords="evaluation", keywords="Canada", keywords="health equity", abstract="Background: People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive---there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. Objective: We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. Methods: We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers' decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy (``patient'' participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. Results: A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100\%; health care professionals: n=22, 88\%), was not missing information (patients: n=21, 84\%; health care professionals: n=18, 72\%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92\%; health care professionals: n=23, 92\%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. Conclusions: We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making. ", doi="10.2196/48793", url="https://www.jmir.org/2024/1/e48793", url="http://www.ncbi.nlm.nih.gov/pubmed/38625731" } @Article{info:doi/10.2196/55080, author="Walkner, Tammy and Karr, W. Daniel and Murray, Sarah and Heeren, Amanda and Berry-Stoelzle, Maresi", title="Participation in Advance Care Planning Among Medically At-Risk Rural Veterans: Protocol for a Personalized Engagement Model", journal="JMIR Res Protoc", year="2024", month="Apr", day="12", volume="13", pages="e55080", keywords="advance care planning", keywords="chronic disease", keywords="end-of-life care", keywords="health care decision", keywords="medical decision-making", keywords="recruiting", keywords="shared medical decision-making", abstract="Background: Many of the challenges in advanced care planning (ACP) conversations are linked to the waxing and waning progress of serious illnesses. Conversations with patients about future medical care decisions by a surrogate decision maker have historically been left until late in the patient's disease trajectory. These conversations often happen at a time when the patient is already very ill. The challenge in effective early ACP and serious illness conversations is to create a situation where patients appreciate the link between current and future medical care. Setting the stage to make these conversations more accessible includes using telehealth to have conversations at the patient's place of choice. The personalization used includes addressing the current medical and social needs of the patient and ensuring that expressed needs are addressed as much as possible. Engaging patients in these conversations allows the documentation of patient preferences in the electronic health record (EHR), providing guidelines for future medical care. Objective: The objective of our telehealth serious illness care conversations program was to successfully recruit patients who lacked up-to-date documentation of ACP in their EHR. Once these patients were identified, we engaged in meaningful, structured conversations to address the veterans' current needs and concerns. We developed a recruitment protocol that increased the uptake of rural veterans' participation in serious illness care conversations and subsequent EHR documentation. Methods: The recruitment protocol outlined herein used administrative data to determine those patients who have not completed or updated formal ACP documentation in the EHR and who are at above-average risk for death in the next 3-5 years. The key features of the telehealth serious illness care conversations recruitment protocol involve tailoring the recruitment approach to address current patient concerns while emphasizing future medical decision-making. Results: As of September 2022, 196 veterans had completed this intervention. The recruitment method ensures that the timing of the intervention is patient driven, allowing for veterans to engage in ACP at a time and place convenient for them and their identified support persons. Conclusions: The recruitment protocol has been successful in actively involving patients in ACP conversations, leading to an uptick in completed formal documentation of ACP preferences within the EHR for this specific population. This documentation is then available to the medical team to guide future medical care. International Registered Report Identifier (IRRID): RR1-10.2196/55080 ", doi="10.2196/55080", url="https://www.researchprotocols.org/2024/1/e55080", url="http://www.ncbi.nlm.nih.gov/pubmed/38608267" } @Article{info:doi/10.2196/47017, author="Sun, Wan-Na and Kao, Chi-Yin", title="The Challenges in Using eHealth Decision Resources for Surrogate Decision-Making in the Intensive Care Unit", journal="J Med Internet Res", year="2024", month="Apr", day="1", volume="26", pages="e47017", keywords="decision-making", keywords="eHealth", keywords="intensive care unit", keywords="literacy", keywords="surrogate", keywords="mobile phone", doi="10.2196/47017", url="https://www.jmir.org/2024/1/e47017", url="http://www.ncbi.nlm.nih.gov/pubmed/38557504" } @Article{info:doi/10.2196/45754, author="Slade, Emily and Rennick-Egglestone, Stefan and Ng, Fiona and Kotera, Yasuhiro and Llewellyn-Beardsley, Joy and Newby, Chris and Glover, Tony and Keppens, Jeroen and Slade, Mike", title="The Implementation of Recommender Systems for Mental Health Recovery Narratives: Evaluation of Use and Performance", journal="JMIR Ment Health", year="2024", month="Mar", day="29", volume="11", pages="e45754", keywords="recommender system", keywords="mean absolute error", keywords="precision", keywords="intralist diversity", keywords="item space coverage", keywords="fairness across users", keywords="psychosis", keywords="Narrative Experiences Online trial", keywords="NEON trial", keywords="lived experience narrative", keywords="recovery story", abstract="Background: Recommender systems help narrow down a large range of items to a smaller, personalized set. NarraGive is a first-in-field hybrid recommender system for mental health recovery narratives, recommending narratives based on their content and narrator characteristics (using content-based filtering) and on narratives beneficially impacting other similar users (using collaborative filtering). NarraGive is integrated into the Narrative Experiences Online (NEON) intervention, a web application providing access to the NEON Collection of recovery narratives. Objective: This study aims to analyze the 3 recommender system algorithms used in NarraGive to inform future interventions using recommender systems for lived experience narratives. Methods: Using a recently published framework for evaluating recommender systems to structure the analysis, we compared the content-based filtering algorithm and collaborative filtering algorithms by evaluating the accuracy (how close the predicted ratings are to the true ratings), precision (the proportion of the recommended narratives that are relevant), diversity (how diverse the recommended narratives are), coverage (the proportion of all available narratives that can be recommended), and unfairness (whether the algorithms produce less accurate predictions for disadvantaged participants) across gender and ethnicity. We used data from all participants in 2 parallel-group, waitlist control clinical trials of the NEON intervention (NEON trial: N=739; NEON for other [eg, nonpsychosis] mental health problems [NEON-O] trial: N=1023). Both trials included people with self-reported mental health problems who had and had not used statutory mental health services. In addition, NEON trial participants had experienced self-reported psychosis in the previous 5 years. Our evaluation used a database of Likert-scale narrative ratings provided by trial participants in response to validated narrative feedback questions. Results: Participants from the NEON and NEON-O trials provided 2288 and 1896 narrative ratings, respectively. Each rated narrative had a median of 3 ratings and 2 ratings, respectively. For the NEON trial, the content-based filtering algorithm performed better for coverage; the collaborative filtering algorithms performed better for accuracy, diversity, and unfairness across both gender and ethnicity; and neither algorithm performed better for precision. For the NEON-O trial, the content-based filtering algorithm did not perform better on any metric; the collaborative filtering algorithms performed better on accuracy and unfairness across both gender and ethnicity; and neither algorithm performed better for precision, diversity, or coverage. Conclusions: Clinical population may be associated with recommender system performance. Recommender systems are susceptible to a wide range of undesirable biases. Approaches to mitigating these include providing enough initial data for the recommender system (to prevent overfitting), ensuring that items can be accessed outside the recommender system (to prevent a feedback loop between accessed items and recommended items), and encouraging participants to provide feedback on every narrative they interact with (to prevent participants from only providing feedback when they have strong opinions). ", doi="10.2196/45754", url="https://mental.jmir.org/2024/1/e45754", url="http://www.ncbi.nlm.nih.gov/pubmed/38551630" } @Article{info:doi/10.2196/56892, author="Irvine, Kathryn Mary and Zimba, Rebecca and Avoundjian, Tigran and Peterson, Meghan and Emmert, Connor and Kulkarni, G. Sarah and Philbin, M. Morgan and Kelvin, A. Elizabeth and Nash, Denis", title="Patient Education and Decision Support for Long-Acting Injectable HIV Antiretroviral Therapy: Protocol for Tool Development and Pilot Testing with Ryan White HIV/AIDS Program Medical Case Management Programs in New York", journal="JMIR Res Protoc", year="2024", month="Mar", day="27", volume="13", pages="e56892", keywords="HIV", keywords="implementation science", keywords="long-acting injectables", keywords="LAI", keywords="patient decision aid", keywords="medical case management", keywords="MCM", keywords="antiretroviral therapy", keywords="ART", abstract="Background: Long-acting injectable (LAI) HIV antiretroviral therapy (ART) presents a major opportunity to facilitate and sustain HIV viral suppression, thus improving health and survival among people living with HIV and reducing the risk of onward transmission. However, realizing the public health potential of LAI ART requires reaching patients who face barriers to daily oral ART adherence and thus can clinically benefit from alternative treatment modalities. Ryan White HIV/AIDS Program Part A medical case management (MCM) programs provide an array of services to address barriers to HIV care and treatment among economically and socially marginalized people living with HIV. These programs have demonstrated effectiveness in improving engagement along the continuum of care, but findings of limited program impact on durable viral suppression highlight the need to further innovate and hone strategies to support long-term ART adherence. Objective: This study aims to adapt and expand Ryan White MCM service strategies to integrate LAI ART regimen options, with the larger goal of improving health outcomes in the populations that could most benefit from alternatives to daily oral ART regimens. Methods: In 3 phases of work involving patient and provider participants, this study uses role-specific focus groups to elicit perceptions of LAI versus daily oral ART; discrete choice experiment (DCE) surveys to quantify preferences for different ART delivery options and related supports; and a nonrandomized trial to assess the implementation and utility of newly developed tools at 6 partnering Ryan White HIV/AIDS Program Part A MCM programs based in urban, suburban, and semirural areas of New York. Findings from the focus groups and DCEs, as well as feedback from advisory board meetings, informed the design and selection of the tools: a patient-facing, 2-page fact sheet, including frequently asked questions and a side-by-side comparison of LAI with daily oral ART; a patient-facing informational video available on YouTube (Google Inc); and a patient-provider decision aid. Implementation outcomes, measured through provider interviews, surveys, and service reporting, will guide further specification of strategies to integrate LAI ART options into MCM program workflows. Results: The study was funded in late April 2021 and received approval from the institutional review board in May 2021 under protocol 20-096. Focus groups were conducted in late 2021 (n=21), DCEs ran from June 2022 to January 2023 (n=378), and tools for piloting were developed by May 2023. The trial (May 2023 through January 2024) has enrolled >200 patients. Conclusions: This study is designed to provide evidence regarding the acceptability, feasibility, appropriateness, and utility of a package of patient-oriented tools for comparing and deciding between LAI ART and daily oral ART options. Study strengths include formative work to guide tool development, a mixed methods approach, and the testing of tools in real-world safety-net service settings. Trial Registration: Clinicaltrials.gov NCT05833542; https://clinicaltrials.gov/study/NCT05833542 International Registered Report Identifier (IRRID): DERR1-10.2196/56892 ", doi="10.2196/56892", url="https://www.researchprotocols.org/2024/1/e56892", url="http://www.ncbi.nlm.nih.gov/pubmed/38536227" } @Article{info:doi/10.2196/47944, author="Schilstra, E. Clarissa and Ellis, J. Sarah and Cohen, Jennifer and Gall, Alana and Diaz, Abbey and Clarke, Kristina and Dumlao, Gadiel and Chard, Jennifer and Cumming, M. Therese and Davis, Esther and Dhillon, Haryana and Burns, Anne Mary and Docking, Kimberley and Koh, Eng-Siew and O'Reilly, Josephine and Sansom-Daly, M. Ursula and Shaw, Joanne and Speers, Nicole and Taylor, Natalie and Warne, Anthea and Fardell, E. Joanna", title="Exploring Web-Based Information and Resources That Support Adolescents and Young Adults With Cancer to Resume Study and Work: Environmental Scan Study", journal="JMIR Cancer", year="2024", month="Mar", day="25", volume="10", pages="e47944", keywords="adolescent", keywords="cancer", keywords="education", keywords="employment", keywords="information needs", keywords="oncology", keywords="online information", keywords="quality of life", keywords="resource", keywords="return to work", keywords="school", keywords="study", keywords="supportive resources", keywords="treatment", keywords="young adult", abstract="Background: Adolescents and young adults (AYAs) diagnosed with cancer experience physical, cognitive, and psychosocial effects from cancer treatment that can negatively affect their ability to remain engaged in education or work through cancer treatment and in the long term. Disengagement from education or work can have lasting implications for AYAs' financial independence, psychosocial well-being, and quality of life. Australian AYAs with cancer lack access to adequate specialist support for their education and work needs and report a preference for web-based support that they can access from anywhere, in their own time. However, it remains unclear what web-based resources exist that are tailored to support AYAs with cancer in reaching their educational or work goals. Objective: This study aimed to determine what web-based resources exist for Australian AYAs with cancer to (1) support return to education or work and (2) identify the degree to which existing resources are age-specific, cancer-specific, culturally inclusive, and evidence-based; are co-designed with AYAs; use age-appropriate language; and are easy to find. Methods: We conducted an environmental scan by searching Google with English search terms in August 2022 to identify information resources about employment and education for AYAs ever diagnosed with cancer. Data extraction was conducted in Microsoft Excel, and the following were assessed: understandability and actionability (using the Patient Education and Materials Tool), readability (using the Sydney Health Literacy Laboratory Health Literacy Editor), and whether the resource was easy to locate, evidence-based, co-designed with AYAs, and culturally inclusive of Aboriginal and Torres Strait Islander peoples. The latter was assessed using 7 criteria previously developed by members of the research team. Results: We identified 24 web-based resources, comprising 22 written text resources and 12 video resources. Most resources (21/24, 88\%) were published by nongovernmental organizations in Australia, Canada, the United States, and the United Kingdom. A total of 7 resources focused on education, 8 focused on work, and 9 focused on both education and work. The evaluation of resources demonstrated poor understandability and actionability. Resources were rarely evidence-based or co-designed by AYAs, difficult to locate on the internet, and largely not inclusive of Aboriginal and Torres Strait Islander populations. Conclusions: Although web-based resources for AYAs with cancer are often available through the websites of hospitals or nongovernmental organizations, this environmental scan suggests they would benefit from more evidence-based and actionable resources that are available in multiple formats (eg, text and audio-visual) and tailored to be age-appropriate and culturally inclusive. ", doi="10.2196/47944", url="https://cancer.jmir.org/2024/1/e47944", url="http://www.ncbi.nlm.nih.gov/pubmed/38526527" } @Article{info:doi/10.2196/50421, author="Baines, Rebecca and Stevens, Sebastian and Austin, Daniela and Anil, Krithika and Bradwell, Hannah and Cooper, Leonie and Maramba, Daniel Inocencio and Chatterjee, Arunangsu and Leigh, Simon", title="Patient and Public Willingness to Share Personal Health Data for Third-Party or Secondary Uses: Systematic Review", journal="J Med Internet Res", year="2024", month="Mar", day="5", volume="26", pages="e50421", keywords="data sharing", keywords="personal health data", keywords="patient", keywords="public attitudes", keywords="systematic review", keywords="secondary use", keywords="third party", keywords="willingness to share", keywords="data privacy and security", abstract="Background: International advances in information communication, eHealth, and other digital health technologies have led to significant expansions in the collection and analysis of personal health data. However, following a series of high-profile data sharing scandals and the emergence of COVID-19, critical exploration of public willingness to share personal health data remains limited, particularly for third-party or secondary uses. Objective: This systematic review aims to explore factors that affect public willingness to share personal health data for third-party or secondary uses. Methods: A systematic search of 6 databases (MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and SocINDEX) was conducted with review findings analyzed using inductive-thematic analysis and synthesized using a narrative approach. Results: Of the 13,949 papers identified, 135 were included. Factors most commonly identified as a barrier to data sharing from a public perspective included data privacy, security, and management concerns. Other factors found to influence willingness to share personal health data included the type of data being collected (ie, perceived sensitivity); the type of user requesting their data to be shared, including their perceived motivation, profit prioritization, and ability to directly impact patient care; trust in the data user, as well as in associated processes, often established through individual choice and control over what data are shared with whom, when, and for how long, supported by appropriate models of dynamic consent; the presence of a feedback loop; and clearly articulated benefits or issue relevance including valued incentivization and compensation at both an individual and collective or societal level. Conclusions: There is general, yet conditional public support for sharing personal health data for third-party or secondary use. Clarity, transparency, and individual control over who has access to what data, when, and for how long are widely regarded as essential prerequisites for public data sharing support. Individual levels of control and choice need to operate within the auspices of assured data privacy and security processes, underpinned by dynamic and responsive models of consent that prioritize individual or collective benefits over and above commercial gain. Failure to understand, design, and refine data sharing approaches in response to changeable patient preferences will only jeopardize the tangible benefits of data sharing practices being fully realized. ", doi="10.2196/50421", url="https://www.jmir.org/2024/1/e50421", url="http://www.ncbi.nlm.nih.gov/pubmed/38441944" } @Article{info:doi/10.2196/46625, author="Ow, Tsai-Wing and Sukocheva, Olga and Bampton, Peter and Iyngkaran, Guruparan and Rayner, K. Christopher and Tse, Edmund", title="Improving Concordance Between Clinicians With Australian Guidelines for Bowel Cancer Prevention Using a Digital Application: Randomized Controlled Crossover Study", journal="JMIR Cancer", year="2024", month="Feb", day="22", volume="10", pages="e46625", keywords="colorectal cancer", keywords="guidelines", keywords="colorectal cancer screening", keywords="digital application", keywords="questionnaire", keywords="application", keywords="cancer prevention", keywords="prevention", keywords="cancer", keywords="bowel cancer", keywords="surveillance", keywords="clinical vignette quiz", keywords="usability", keywords="Australia", abstract="Background: Australia's bowel cancer prevention guidelines, following a recent revision, are among the most complex in the world. Detailed decision tables outline screening or surveillance recommendations for 230 case scenarios alongside cessation recommendations for older patients. While these guidelines can help better allocate limited colonoscopy resources, their increasing complexity may limit their adoption and potential benefits. Therefore, tools to support clinicians in navigating these guidelines could be essential for national bowel cancer prevention efforts. Digital applications (DAs) represent a potentially inexpensive and scalable solution but are yet to be tested for this purpose. Objective: This study aims to assess whether a DA could increase clinician adherence to Australia's new colorectal cancer screening and surveillance guidelines and determine whether improved usability correlates with greater conformance to guidelines. Methods: As part of a randomized controlled crossover study, we created a clinical vignette quiz to evaluate the efficacy of a DA in comparison with the standard resource (SR) for making screening and surveillance decisions. Briefings were provided to study participants, which were tailored to their level of familiarity with the guidelines. We measured the adherence of clinicians according to their number of guideline-concordant responses to the scenarios in the quiz using either the DA or the SR. The maximum score was 18, with higher scores indicating improved adherence. We also tested the DA's usability using the System Usability Scale. Results: Of 117 participants, 80 were included in the final analysis. Using the SR, the adherence of participants was rated a median (IQR) score of 10 (7.75-13) out of 18. The participants' adherence improved by 40\% (relative risk 1.4, P<.001) when using the DA, reaching a median (IQR) score of 14 (12-17) out of 18. The DA was rated highly for usability with a median (IQR) score of 90 (72.5-95) and ranked in the 96th percentile of systems. There was a moderate correlation between the usability of the DA and better adherence (rs=0.4; P<.001). No differences between the adherence of specialists and nonspecialists were found, either with the SR (10 vs 9; P=.47) or with the DA (13 vs 15; P=.24). There was no significant association between participants who were less adherent with the DA (n=17) and their age (P=.06), experience with decision support tools (P=.51), or academic involvement with a university (P=.39). Conclusions: DAs can significantly improve the adoption of complex Australian bowel cancer prevention guidelines. As screening and surveillance guidelines become increasingly complex and personalized, these tools will be crucial to help clinicians accurately determine the most appropriate recommendations for their patients. Additional research to understand why some practitioners perform worse with DAs is required. Further improvements in application usability may optimize guideline concordance further. ", doi="10.2196/46625", url="https://cancer.jmir.org/2024/1/e46625", url="http://www.ncbi.nlm.nih.gov/pubmed/38238256" } @Article{info:doi/10.2196/47545, author="Kokorelias, Marie Kristina and Lee, Joan Tin-Suet and Bayley, Mark and Seto, Emily and Toulany, Alene and Nelson, A. Michelle L. and Dimitropoulos, Gina and Penner, Melanie and Simpson, Robert and Munce, P. Sarah E.", title="A Web-Based Peer-Patient Navigation Program (Compassionate Online Navigation to Enhance Care Transitions) for Youth Living With Childhood-Acquired Disabilities Transitioning From Pediatric to Adult Care: Qualitative Descriptive Study", journal="JMIR Pediatr Parent", year="2024", month="Feb", day="7", volume="7", pages="e47545", keywords="youth", keywords="patient navigation", keywords="web-based intervention", keywords="peer support", keywords="transition", keywords="childhood disability", keywords="caregiver", keywords="transitional care intervention", keywords="social support", keywords="usability", keywords="program", keywords="children", keywords="pediatric", keywords="disability", keywords="digital health", keywords="eHealth", keywords="web-based support", keywords="web-based health", abstract="Background: Studies have highlighted significant challenges associated with the transition from pediatric to adult health and social care services for youth living with childhood-acquired disabilities and their caregivers. Patient navigation has been proposed as an effective transitional care intervention. Better understanding of how patient navigation may support youth and their families during pediatric to adult care transitions is warranted. Objective: This study aims to describe the preferred adaptations of an existing web-based platform from the perspectives of youth with childhood-onset disabilities and their family caregivers to develop a web-based peer-patient navigation program, Compassionate Online Navigation to Enhance Care Transitions (CONNECT). Methods: A qualitative descriptive design was used. Participants included youth living with childhood-acquired disabilities (16/23, 70\%) and their caregivers (7/23, 30\%). Semistructured interviews and focus groups were conducted, digitally recorded, and transcribed. Thematic analysis was used to analyze the data and was facilitated through NVivo software (Lumivero). Results: Participants desired a program that incorporated (1) self-directed learning, (2) a library of reliable health and community resources, and (3) emotional and social supports. On the basis of participants' feedback, CONNECT was deemed satisfactory, as it was believed that the program would help support appropriate transition care through the provision of trusted health-related information. Participants highlighted the need for options to optimize confidentiality in their health and social care and the choice to remain anonymous to other participants. Conclusions: Web-based patient navigation programs such as CONNECT may deliver peer support that can improve the quality and experience of care for youth, and their caregivers, transitioning from pediatric to adult care through personalized support, health care monitoring, and health and social care resources. Future studies are needed to test the feasibility, acceptability, usability, use, and effectiveness of CONNECT among youth with childhood-onset disabilities. ", doi="10.2196/47545", url="https://pediatrics.jmir.org/2024/1/e47545", url="http://www.ncbi.nlm.nih.gov/pubmed/38324351" } @Article{info:doi/10.2196/52096, author="Dryden, M. Eileen and Anwar, Chitra and Conti, Jennifer and Boudreau, H. Jacqueline and Kennedy, A. Meaghan and Hung, W. William and Nearing, A. Kathryn and Pimentel, B. Camilla and Moo, Lauren", title="The Development and Use of a New Visual Tool (REVISIT) to Support Participant Recall: Web-Based Interview Study Among Older Adults", journal="JMIR Form Res", year="2024", month="Feb", day="1", volume="8", pages="e52096", keywords="qualitative interviews", keywords="visual recall aid", keywords="older adults", keywords="health services research", keywords="web-based methods", keywords="visual tool", keywords="recall", keywords="qualitative interview", keywords="experience", keywords="perspective", keywords="motivation", keywords="patient", keywords="recall capacity", keywords="medical information", keywords="visual appointment", keywords="geriatric", keywords="older people", keywords="telemedicine", keywords="videoconference", keywords="e-consultation", keywords="e-medicine", keywords="internet medicine", keywords="REVISIT", keywords="Remembering Healthcare Encounters Visually and Interactively", keywords="mobile phone", abstract="Background: Qualitative health services research often relies on semistructured or in-depth interviews to develop a deeper understanding of patient experiences, motivations, and perspectives. The quality of data gathered is contingent upon a patient's recall capacity; yet, studies have shown that recall of medical information is low. Threats to generating rich and detailed interview data may be more prevalent when interviewing older adults. Objective: We developed and studied the feasibility of using a tool, Remembering Healthcare Encounters Visually and Interactively (REVISIT), which has been created to aid the recall of a specific telemedicine encounter to provide health services research teams with a visual tool, to improve qualitative interviews with older adults. Methods: The REVISIT visual appointment summary was developed to facilitate web-based interviews with our participants as part of an evaluation of a geriatric telemedicine program. Our primary aims were to aid participant recall, maintain focus on the index visit, and establish a shared understanding of the visit between participants and interviewers. The authors' experiences and observations developing REVISIT and using it during videoconference interviews (N=16) were systematically documented and synthesized. We discuss these experiences with REVISIT and suggest considerations for broader implementation and future research to expand upon this preliminary work. Results: REVISIT enhanced the interview process by providing a focus and catalyst for discussion and supporting rapport-building with participants.?REVISIT appeared to support older patients' and caregivers' recollection of a clinical visit, helping them to share additional details about their experience. REVISIT was difficult to read for some participants, however, and could not be used for phone interviews. Conclusions: REVISIT is a promising tool to enhance the quality of data collected during interviews with older, rural adults and caregivers about a health care encounter. This novel tool may aid recall of health care experiences for those groups for whom it may be more challenging to collect accurate, rich qualitative data (eg, those with cognitive impairment or complex medical care), allowing health services research to include more diverse patient experiences. ", doi="10.2196/52096", url="https://formative.jmir.org/2024/1/e52096", url="http://www.ncbi.nlm.nih.gov/pubmed/38300691" } @Article{info:doi/10.2196/43943, author="Zhang, Xiaojuan and Wen, Justin Yingkun and Han, Ning and Jiang, Yawen", title="The Effect of a Video-Assisted Health Education Program Followed by Peer Education on the Health Literacy of COVID-19 and Other Infectious Diseases Among School Children: Quasi-Randomized Controlled Trial", journal="JMIR Hum Factors", year="2024", month="Jan", day="29", volume="11", pages="e43943", keywords="infectious diseases", keywords="primary school students", keywords="quasi-randomized controlled trial", keywords="video-assisted health education", keywords="peer education", keywords="item response theory", keywords="IRT", abstract="Background: To improve the engagement and effectiveness of traditional health programs, it is necessary to explore alternative models of health education including video-assisted lectures and peer education. Objective: This study aimed to evaluate the effects of a combination of video-assisted lectures and peer education on health literacy related to infectious diseases among students. Methods: Third-grade classes from 11 pilot schools in Longgang District of Shenzhen, China, were randomized to the intervention and control groups. In the intervention group, a video-assisted interactive health education program was conducted twice over a time span of 5 months. Each of the 2 sessions included a 40-minute lecture on COVID-19 and other common infectious diseases in schools and a 5-minute science video. In addition, 5 ``little health supervisors'' at the end of the first session were elected in each class, who were responsible for helping class members to learn health knowledge and develop good hygiene habits. Students answered the same quiz before the first and after the second session. Models based on item response theory (IRT) were constructed to score the students' knowledge of infectious diseases based on the quiz. Results: In total, 52 classes and 2526 students (intervention group: n=1311; control group: n=1215) were enrolled. Responses of the baseline survey were available for 2177 (86.2\%; intervention group: n=1306; control group: n=871) students and those of the postintervention survey were available for 1862 (73.7\%; intervention group: n=1187; control group: n=675). There were significant cross-group differences in the rates of correctly answering questions about influenza symptoms, transmission, and preventive measures; chicken pox symptoms; norovirus diarrhea symptoms; mumps symptoms; and COVID-19 symptoms. Average IRT scores of questions related to infectious diseases in the intervention and control groups were, respectively, --0.0375 (SD 0.7784) and 0.0477 (SD 0.7481) before the intervention (P=.01), suggesting better baseline knowledge in the control group. After the intervention, the average scores of the intervention and control groups were 0.0543 (SD 0.7569) and --0.1115 (SD 0.7307), respectively (P<.001), suggesting not only significantly better scores but also greater improvement in the intervention group. Conclusions: After the health education project, the correct answer rate of infectious disease questions in the intervention group was higher than that of the control group, which indicates significant effects of the combination of video-assisted lectures and peer education for the promotion of health literacy. In addition, the intervention effect of the first session persisted for at least 4 months up to the second session. As such, the proposed program was effective in improving the health literacy of school children in relation to infectious diseases and should be considered for massive health promotion campaigns during pandemics. Trial Registration: ISRCTN ISRCTN49297995; https://www.isrctn.com/ISRCTN49297995 ", doi="10.2196/43943", url="https://humanfactors.jmir.org/2024/1/e43943", url="http://www.ncbi.nlm.nih.gov/pubmed/38285496" } @Article{info:doi/10.2196/51200, author="Li, Shuning and Felix Gomez, Gomez Grace and Xu, Huiping and Rajapuri, Singh Anushri and Dixon, E. Brian and Thyvalikakath, Thankam", title="Dentists' Information Needs and Opinions on Accessing Patient Information via Health Information Exchange: Survey Study", journal="JMIR Form Res", year="2024", month="Jan", day="11", volume="8", pages="e51200", keywords="dentistry", keywords="medical history", keywords="integrated medical and dental records", keywords="health information exchange", keywords="medical record", keywords="dental record", keywords="dental", keywords="medical information", keywords="dental care", keywords="adverse drug effect", keywords="medication", keywords="allergies", keywords="cost", keywords="data safety", keywords="data accuracy", abstract="Background: The integration of medical and dental records is gaining significance over the past 2 decades. However, few studies have evaluated the opinions of practicing dentists on patient medical histories. Questions remain on dentists' information needs; their perception of the reliability of patient-reported medical history; satisfaction with the available information and the methods to gather this information; and their attitudes to other options, such as a health information exchange (HIE) network, to collect patient medical history. Objective: This study aims to determine Indiana dentists' information needs regarding patients' medical information and their opinions about accessing it via an HIE. Methods: We administered a web-based survey to Indiana Dental Association members to assess their current medical information-retrieval approaches, the information critical for dental care, and their willingness to access or share information via an HIE. We used descriptive statistics to summarize survey results and multivariable regression to examine the associations between survey respondents' characteristics and responses. Results: Of the 161 respondents (161/2148, 7.5\% response rate), 99.5\% (n=160) respondents considered patients' medical histories essential to confirm no contraindications, including allergies or the need for antibiotic prophylaxis during dental care and other adverse drug events. The critical information required were medical conditions or diagnosis, current medications, and allergies, which were gathered from patient reports. Furthermore, 88.2\% (n=142) of respondents considered patient-reported histories reliable; however, they experienced challenges obtaining information from patients and physicians. Additionally, 70.2\% (n=113) of respondents, especially those who currently access an HIE or electronic health record, were willing to use an HIE to access or share their patient's information, and 91.3\% (n=147) shared varying interests in such a service. However, usability, data accuracy, data safety, and cost are the driving factors in adopting an HIE. Conclusions: Patients' medical histories are essential for dentists to optimize dental care, especially for those with chronic conditions. In addition, most dentists are interested in using an HIE to access patient medical histories. The findings from this study can provide an alternative option for improving communications between dental and medical professionals and help the health information technology system or tool developers identify critical requirements for more user-friendly designs. ", doi="10.2196/51200", url="https://formative.jmir.org/2024/1/e51200", url="http://www.ncbi.nlm.nih.gov/pubmed/38206667" } @Article{info:doi/10.2196/50550, author="Fridriksdottir, Nanna and Ingadottir, Brynja and Skuladottir, Kristin and Zo{\"e}ga, Sigridur and Gunnarsdottir, Sigridur", title="Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study", journal="JMIR Form Res", year="2023", month="Dec", day="22", volume="7", pages="e50550", keywords="web portal for patients with cancer", keywords="supportive digital health service", keywords="symptom monitoring", keywords="self-management support", keywords="feasibility", keywords="usability", keywords="acceptability", keywords="patient education", keywords="health engagement", keywords="patient-reported outcomes", keywords="digital health service", keywords="patient portal", keywords="electronic health records", keywords="mobile phone", abstract="Background: Digital supportive cancer care is recommended to improve patient outcomes. A portal was designed and embedded within the electronic medical record and public health portal of Iceland, consisting of symptom and needs monitoring, educational material, and messaging. Objective: This study aims to assess (1) portal feasibility (adoption, engagement, usability, and acceptability), (2) potential predictors of usability and acceptability, and (3) the potential impact of the portal on patient-reported outcomes. Methods: This was a single-arm, before-and-after feasibility study at a university hospital among patients with cancer who were undergoing chemotherapy. Participation included filling out the Edmonton Symptom Assessment System--Revised (ESASr) weekly and the Distress Thermometer and Problem List (DT\&PL) 3 times; reading educational material and messaging; and completing study questionnaires. Clinical and portal engagement data were collected from medical records. Data from patients were collected electronically at baseline and 7 to 10 days after the third chemotherapy round. Usability was assessed using the System Usability Scale (score 0-100), and acceptability was assessed using a 35-item survey (score 1-5). Patient-reported outcome measures included ESASr and DT\&PL; a single-item scale for quality of life, family support, and quality of care; and multi-item scales for health literacy (Brief Health Literacy Screener), health engagement (Patient Health Engagement Scale), self-care self-efficacy (Self-Care Self-Efficacy scale), symptom interference (MD Anderson Symptom Inventory), knowledge expectations (Hospital Patients' Knowledge Expectations), and received knowledge (Hospital Patients' Received Knowledge). Health care professionals were interviewed regarding portal feasibility. Results: The portal adoption rate was 72\% (103/143), and the portal use rate was 76.7\% (79/103) over a mean 8.6 (SD 2.7) weeks. The study completion rate was 67\% (69/103). The combined completion rate of the ESASr and DT\&PL was 78.4\% (685/874). Patients received a mean 41 (SD 13) information leaflets; 33\% (26/79) initiated messaging, 73\% (58/79) received messages, and 85\% (67/79) received follow-up phone calls. The mean System Usability Scale score was 72.3 (SD 14.7), indicating good usability. Usability was predicted by age ($\beta$=?.45), ESASr engagement ($\beta$=.5), symptom interference ($\beta$=.4), and received knowledge ($\beta$=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age ($\beta$=?.31), ESASr engagement ($\beta$=.37), symptom interference ($\beta$=.60), self-care self-efficacy ($\beta$=.37), and received knowledge ($\beta$=.41). ESASr scores improved for total symptom distress (P=.003; Cohen d=0.36), physical symptoms (P=.01; Cohen d=0.31), and emotional symptoms (P=.01; Cohen d=0.31). Daily symptom interference increased (P=.03; Cohen d=0.28), quality of life improved (P=.03; Cohen d=0.27) and health engagement (P=.006; Cohen d=0.35) improved, while knowledge expectations decreased (P?.001; Cohen d=2.57). Health care professionals were positive toward the portal but called for clearer role delineation and follow-up. Conclusions: This study supports the feasibility of a support portal and the results indicate the possibility of improving patient outcomes, but further developments are warranted. ", doi="10.2196/50550", url="https://formative.jmir.org/2023/1/e50550", url="http://www.ncbi.nlm.nih.gov/pubmed/38015268" } @Article{info:doi/10.2196/44382, author="Kast, Kristina and Otten, Sara-Marie and Konopik, Jens and Maier, B. Claudia", title="Web-Based Public Reporting as a Decision-Making Tool for Consumers of Long-Term Care in the United States and the United Kingdom: Systematic Analysis of Report Cards", journal="JMIR Form Res", year="2023", month="Dec", day="14", volume="7", pages="e44382", keywords="long-term care", keywords="medical decision-making", keywords="nursing homes", keywords="public reporting", keywords="quality improvement", keywords="report cards", abstract="Background: Report cards can help consumers make an informed decision when searching for a long-term care facility. Objective: This study aims to examine the current state of web-based public reporting on long-term care facilities in the United States and the United Kingdom. Methods: We conducted an internet search for report cards, which allowed for a nationwide search for long-term care facilities and provided freely accessible quality information. On the included report cards, we drew a sample of 1320 facility profiles by searching for long-term care facilities in 4 US and 2 UK cities. Based on those profiles, we analyzed the information provided by the included report cards descriptively. Results: We found 40 report cards (26 in the United States and 14 in the United Kingdom). In total, 11 of them did not state the source of information. Additionally, 7 report cards had an advanced search field, 24 provided simplification tools, and only 3 had a comparison function. Structural quality information was always provided, followed by consumer feedback on 27 websites, process quality on 15 websites, prices on 12 websites, and outcome quality on 8 websites. Inspection results were always displayed as composite measures. Conclusions: Apparently, the identified report cards have deficits. To make them more helpful for users and to bring public reporting a bit closer to its goal of improving the quality of health care services, both countries are advised to concentrate on optimizing the existing report cards. Those should become more transparent and improve the reporting of prices and consumer feedback. Advanced search, simplification tools, and comparison functions should be integrated more widely. ", doi="10.2196/44382", url="https://formative.jmir.org/2023/1/e44382", url="http://www.ncbi.nlm.nih.gov/pubmed/38096004" } @Article{info:doi/10.2196/46611, author="Tsulukidze, Maka and Grande, W. Stuart and Naslund, A. John", title="An Active Model of Research Translation for the General Public: Content Analysis of a YouTube-Based Health Podcast", journal="JMIR Form Res", year="2023", month="Dec", day="5", volume="7", pages="e46611", keywords="evidence translation", keywords="user engagement", keywords="consumer education", keywords="online health information", keywords="disseminating science", keywords="health education", abstract="Background: Online health information seeking is changing the way people engage with health care and the health system. Recent changes in practices related to seeking, accessing, and disseminating scientific research, and in particular health information, have enabled a high level of user engagement. Objective: This study aims to examine an innovative model of research translation, The Huberman Lab Podcast (HLP), developed by Andrew Huberman, Professor of Neurobiology and Ophthalmology at the Stanford School of Medicine. The HLP leverages social media to deliver health information translated into specific, actionable practices and health strategies directly to the general public. This research characterizes the HLP as an Active Model of Research Translation and assesses its potential as a framework for replicability and wider adoption. Methods: We applied conventional content analysis of the YouTube transcript data and directed content analysis of viewers' YouTube comments to 23 HLP episodes released from January to October 2021, reflecting the time of data analysis. We selected 7 episodes and a welcome video, to describe and identify key characteristics of the HLP model. We analyzed viewer comments for 18 episodes to determine whether viewers found the HLP content valuable, accessible, and easy to implement. Results: The key HLP features are direct-to-the-consumer, zero-cost, bilingual, and actionable content. We identified 3 main organizing categories and 10 subcategories as the key elements of the HLP: (1) Why: Educate and Empower and Bring Zero Cost to Consumer Information to the General Public; (2) What: Tools and Protocols; Underlying Mechanisms; and Grounded in Science; (3) How: Linear and Iterative Knowledge Building Process; Lecture-Style Sessions; Interactive and Consumer Informed; Easily Accessible; and Building the Community. Analysis of viewers' comments found strong consumer support for the key HLP model elements. Conclusions: This Active Model of Research Translation offers a way to synthesize scientific evidence and deliver it directly to end users in the form of actionable tools and education. Timely evidence translation using effective consumer engagement and education techniques appears to improve access and confidence related to health information use and reduces challenges to understanding and applying health information received from health providers. Framing complex content in an approachable manner, engaging the target audience, encouraging participation, and ensuring open access to the content meet current recommendations on innovative practices for leveraging social media or other digital platforms for disseminating science and research findings to the general public, and are likely key contributors to HLP impact and potential for success. The model offers a replicable framework for translating and disseminating scientific evidence. Similar active models of research translation can have implications for accessing health information and implementing health strategies for improved outcomes. Areas for further investigation are specific and measurable impacts on health, usability, and relevance of the model for reaching marginalized and high-risk populations. ", doi="10.2196/46611", url="https://formative.jmir.org/2023/1/e46611", url="http://www.ncbi.nlm.nih.gov/pubmed/38051560" } @Article{info:doi/10.2196/49186, author="Mignanelli, Ga{\"e}tan and Boyer, Richard and Bonifas, Nicolas and Rineau, Emmanuel and Moussali, Yassine and Le Guen, Morgan", title="Survey of the Impact of Decision Support in Preoperative Management of Anemia (i-Anemia): Survey Study", journal="JMIR Perioper Med", year="2023", month="Dec", day="1", volume="6", pages="e49186", keywords="anemia", keywords="transfusion", keywords="patient blood management", keywords="preoperative optimization", keywords="preoperative", keywords="blood", keywords="decision support", keywords="randomized", keywords="case", keywords="survey", keywords="anesthesiologists", keywords="anesthesiologist", keywords="anesthesia", keywords="anesthesiology", keywords="professional development", keywords="digital health", keywords="surgery", keywords="perioperative", abstract="Background: Major surgery on patients with anemia has demonstrated an increased risk of perioperative blood transfusions and postoperative morbidity and mortality. Recent studies have shown that integrating preoperative anemia treatment as a component of perioperative blood management may reduce blood product utilization and improve outcomes in both cardiac and noncardiac surgery. However, outpatient management of anemia falls outside of daily practice for most anesthesiologists and is probably weakly understood. Objective: We conducted a simulated case survey with anesthesiologists to accomplish the following aims: (1) evaluate the baseline knowledge of the preoperative optimization of anemia and (2) determine the impact of real-time clinical decision support on anemia management. Methods: We sent a digital survey (i-Anemia) to members of the French Society of Anaesthesia and Critical Care. The i-Anemia survey contained 7 simulated case vignettes, each describing a patient's brief clinical history and containing up to 3 multiple-choice questions related to preoperative anemia management (12 questions in total). The cases concerned potential situations of preoperative anemia and were created and validated with a committee of patient blood management experts. Correct answers were determined by the current guidelines or by expert consensus. Eligible participants were randomly assigned to control or decision support groups. In the decision support group, the primary outcome measured was the correct response rate. Results: Overall, 1123 participants were enrolled and randomly divided into control (n=568) and decision support (n=555) groups. Among them, 763 participants fully responded to the survey. We obtained a complete response rate of 65.6\% (n=364) in the group receiving cognitive aid and 70.2\% (n=399) in the group without assistance. The mean duration of response was 10.2 (SD 6.8) minutes versus 7.8 (SD 5) minutes for the decision support and control groups, respectively (P<.001). The score significantly improved with cognitive aid (mean 10.3 out of 12, SD 2.1) in comparison to standard care (mean 6.2 out of 12, SD 2.1; P<.001). Conclusions: Management strategies to optimize preoperative anemia are not fully known and applied by anesthesiologists in daily practice despite their clinical importance. However, adding a decision support tool can significantly improve patient care by reminding practitioners of current recommendations. ", doi="10.2196/49186", url="https://periop.jmir.org/2023/1/e49186", url="http://www.ncbi.nlm.nih.gov/pubmed/38039068" } @Article{info:doi/10.2196/47762, author="Tan, Yun Denise Jia and Ko, Ki Tsz and Fan, Siu Ka", title="The Readability and Quality of Web-Based Patient Information on Nasopharyngeal Carcinoma: Quantitative Content Analysis", journal="JMIR Form Res", year="2023", month="Nov", day="27", volume="7", pages="e47762", keywords="nasopharyngeal cancer", keywords="internet information", keywords="readability", keywords="Journal of the American Medical Association", keywords="JAMA", keywords="DISCERN", keywords="artificial intelligence", keywords="AI", abstract="Background: Nasopharyngeal carcinoma (NPC) is a rare disease that is strongly associated with exposure to the Epstein-Barr virus and is characterized by the formation of malignant cells in nasopharynx tissues. Early diagnosis of NPC is often difficult owing to the location of initial tumor sites and the nonspecificity of initial symptoms, resulting in a higher frequency of advanced-stage diagnoses and a poorer prognosis. Access to high-quality, readable information could improve the early detection of the disease and provide support to patients during disease management. Objective: This study aims to assess the quality and readability of publicly available web-based information in the English language about NPC, using the most popular search engines. Methods: Key terms relevant to NPC were searched across 3 of the most popular internet search engines: Google, Yahoo, and Bing. The top 25 results from each search engine were included in the analysis. Websites that contained text written in languages other than English, required paywall access, targeted medical professionals, or included nontext content were excluded. Readability for each website was assessed using the Flesch Reading Ease score and the Flesch-Kincaid grade level. Website quality was assessed using the Journal of the American Medical Association (JAMA) and DISCERN tools as well as the presence of a Health on the Net Foundation seal. Results: Overall, 57 suitable websites were included in this study; 26\% (15/57) of the websites were academic. The mean JAMA and DISCERN scores of all websites were 2.80 (IQR 3) and 57.60 (IQR 19), respectively, with a median of 3 (IQR 2-4) and 61 (IQR 49-68), respectively. Health care industry websites (n=3) had the highest mean JAMA score of 4 (SD 0). Academic websites (15/57, 26\%) had the highest mean DISCERN score of 77.5. The Health on the Net Foundation seal was present on only 1 website, which also achieved a JAMA score of 3 and a DISCERN score of 50. Significant differences were observed between the JAMA score of hospital websites and the scores of industry websites (P=.04), news service websites (P<.048), charity and nongovernmental organization websites (P=.03). Despite being a vital source for patients, general practitioner websites were found to have significantly lower JAMA scores compared with charity websites (P=.05). The overall mean readability scores reflected an average reading age of 14.3 (SD 1.1) years. Conclusions: The results of this study suggest an inconsistent and suboptimal quality of information related to NPC on the internet. On average, websites presented readability challenges, as written information about NPC was above the recommended reading level of sixth grade. As such, web-based information requires improvement in both quality and accessibility, and healthcare providers should be selective about information recommended to patients, ensuring they are reliable and readable. ", doi="10.2196/47762", url="https://formative.jmir.org/2023/1/e47762", url="http://www.ncbi.nlm.nih.gov/pubmed/38010802" } @Article{info:doi/10.2196/46146, author="Dukhanin, Vadim and Wolff, L. Jennifer and Salmi, Liz and Harcourt, Kendall and Wachenheim, Deborah and Byock, Ira and Gonzales, J. Matthew and Niehus, Doug and Parshley, Marianne and Reay, Caroline and Epstein, Sara and Mohile, Supriya and Farrell, W. Timothy and Supiano, A. Mark and Jajodia, Anushka and DesRoches, M. Catherine and ", title="Co-Designing an Initiative to Increase Shared Access to Older Adults' Patient Portals: Stakeholder Engagement", journal="J Med Internet Res", year="2023", month="Nov", day="22", volume="25", pages="e46146", keywords="patient portal", keywords="electronic health record", keywords="care partners", keywords="stakeholder engagement", keywords="patient engagement", keywords="human-centered design", keywords="mobile phone", keywords="design", keywords="older adults", keywords="digital platform", keywords="awareness", keywords="development", keywords="engagement", keywords="stakeholder", keywords="education", abstract="Background: The patient portal is a widely available secure digital platform offered by care delivery organizations that enables patients to communicate electronically with clinicians and manage their care. Many organizations allow patients to authorize family members or friends---``care partners''---to share access to patient portal accounts, thus enabling care partners to receive their own identity credentials. Shared access facilitates trilateral information exchange among patients, clinicians, and care partners; however, uptake and awareness of this functionality are limited. Objective: We partnered with 3 health care organizations to co-design an initiative that aimed to increase shared access registration and use and that can be implemented using existing patient portals. Methods: In 2020, we undertook a rigorous selection process to identify 3 geographically diverse health care organizations that had engaged medical informatics teams and clinical champions within service delivery lines caring for older adults. We prioritized selecting organizations that serve racially and socioeconomically diverse populations and possess sophisticated reporting capabilities, a stable patient portal platform, a sufficient volume of older adult patients, and active patient and family advisory councils. Along with patients and care partners, clinicians, staff, and other stakeholders, the study team co-designed an initiative to increase the uptake of shared access guided by either an iterative, human-centered design process or rapid assessment procedures of stakeholders' inputs. Results: Between February 2020 and April 2022, 73 stakeholder engagements were conducted with patients and care partners, clinicians and clinic staff, medical informatics teams, marketing and communications staff, and administrators, as well as with funders and thought leaders. We collected insights regarding (1) barriers to awareness, registration, and use of shared access; (2) features of consumer-facing educational materials to address identified barriers; (3) features of clinician- and staff-facing materials to address identified barriers; and (4) approaches to fit the initiative into current workflows. Using these inputs iteratively via a human-centered design process, we produced brochures and posters, co-designed organization-specific web pages detailing shared access registration processes, and developed clinician and staff talking points about shared access and staff tip sheets that outline shared access registration steps. Educational materials emphasized the slogan ``People remember less than half of what their doctors say,'' which was selected from 9 candidate alternatives as resonating best with the full range of the initiative's stakeholders. The materials were accompanied by implementation toolkits specifying and reinforcing workflows involving both in-person and telehealth visits. Conclusions: Meaningful and authentic stakeholder engagement allowed our deliberate, iterative, and human-centered co-design aimed at increasing the use of shared access. Our initiative has been launched as a part of a 12-month demonstration that will include quantitative and qualitative analysis of registration and use of shared access. Educational materials are publicly available at Coalition for Care Partners. ", doi="10.2196/46146", url="https://www.jmir.org/2023/1/e46146", url="http://www.ncbi.nlm.nih.gov/pubmed/37991827" } @Article{info:doi/10.2196/47913, author="Beyeler, Marina and L{\'e}geret, Corinne and Kiwitz, Fabian and van der Horst, Klazine", title="Usability and Overall Perception of a Health Bot for Nutrition-Related Questions for Patients Receiving Bariatric Care: Mixed Methods Study", journal="JMIR Hum Factors", year="2023", month="Nov", day="8", volume="10", pages="e47913", keywords="bariatric surgery", keywords="nutrition information", keywords="usability", keywords="satisfaction", keywords="artificial intelligence", keywords="health bot", keywords="mobile phone", abstract="Background: Currently, over 4000 bariatric procedures are performed annually in Switzerland. To improve outcomes, patients need to have good knowledge regarding postoperative nutrition. To potentially provide them with knowledge between dietetic consultations, a health bot (HB) was created. The HB can answer bariatric nutrition questions in writing based on artificial intelligence. Objective: This study aims to evaluate the usability and perception of the HB among patients receiving bariatric care. Methods: Patients before or after bariatric surgery tested the HB. A mixed methods approach was used, which consisted of a questionnaire and qualitative interviews before and after testing the HB. The dimensions usability of, usefulness of, satisfaction with, and ease of use of the HB, among others, were measured. Data were analyzed using R Studio (R Studio Inc) and Excel (Microsoft Corp). The interviews were transcribed and a summary inductive content analysis was performed. Results: A total of 12 patients (female: n=8, 67\%; male: n=4, 33\%) were included. The results showed excellent usability with a mean usability score of 87 (SD 12.5; range 57.5-100) out of 100. Other dimensions of acceptability included usefulness (mean 5.28, SD 2.02 out of 7), satisfaction (mean 5.75, SD 1.68 out of 7), and learnability (mean 6.26, SD 1.5 out of 7). The concept of the HB and availability of reliable nutrition information were perceived as desirable (mean 5.5, SD 1.64 out of 7). Weaknesses were identified in the response accuracy, limited knowledge, and design of the HB. Conclusions: The HB's ease of use and usability were evaluated to be positive; response accuracy, topic selection, and design should be optimized in a next step. The perceptions of nutrition professionals and the impact on patient care and the nutrition knowledge of participants need to be examined in further studies. ", doi="10.2196/47913", url="https://humanfactors.jmir.org/2023/1/e47913", url="http://www.ncbi.nlm.nih.gov/pubmed/37938894" } @Article{info:doi/10.2196/46961, author="Faraldo-Cabana, Araceli and S{\'a}nchez-Fructuoso, Ana and P{\'e}rez-Flores, Isabel and Beneit-Montesinos, Vicente Juan and Mu{\~n}oz-Jim{\'e}nez, Daniel and Peix Jim{\'e}nez, Bel{\'e}n and Asensio Arredondo, Sara and Nu{\~n}o Santana, Isabel Enriqueta and Santana Valeros, Jos{\'e} Mar{\'i}a and Hidalgo Gonz{\'a}lez, Virginia and Gonz{\'a}lez Garc{\'i}a, Fernando and Ortu{\~n}o-Soriano, Ismael", title="Development of an Information Guideline for Kidney Transplant Recipients in a Clinical Trial: Protocol for a Modified Delphi Method", journal="JMIR Res Protoc", year="2023", month="Nov", day="6", volume="12", pages="e46961", keywords="compliance", keywords="Delphi method", keywords="guideline", keywords="kidney transplantation", keywords="patient adherence", keywords="patients", abstract="Background: Renal transplantation is the treatment of choice for most cases of end-stage renal disease. Recipients need to lead a healthy lifestyle to minimize the potential side effects of immunosuppressive drugs and improve transplant outcomes. There is not much evidence about the best way to increase adherence to healthy lifestyles in kidney transplant recipients, so one of the objectives set by the nursing team is to train people to acquire the necessary skills and tools to be able to take care of themselves. In this sense, the consensual development of appropriate materials may be useful and of interest. Objective: The aim of this study was to develop an information guide for adults with kidney transplants to be assessed in a subsequent clinical trial as an intervention to increase adherence to healthy habits. Methods: We used a 3-step, methodological, sequential approach: (1) training from a group of experts and item consensus; (2) review of the medical literature available; and (3) use of the Delphi technique with on-site meetings. A total of 5 nurses from the Community of Madrid Kidney Transplantation Unit in Spain were asked to participate. The patients' lifestyle factors that, according to the medical literature available and experts' opinions, have the greatest impact on the survival of the transplanted organ and the recipients themselves were all described. Results: After using the modified Delphi method to reach a consensus on the items to be included and the information needed in each, an information guide for adult kidney transplant patients was developed. This guide facilitates the structuring of health care, information, and recommendations necessary for effective self-care for each person. The result is considered to be an easy-to-understand tool, useful for transplant doctors and nurses, in simple language, with information based on the latest scientific-medical evidence published to date, aspects of which will be evaluated in a clinical trial designed for this purpose. Conclusions: Currently, this guide is the main intervention variable of a clinical trial (registered on ClinicalTrials.gov; NCT05715580) aimed at improving compliance with healthy habits in kidney transplant recipients in the Community of Madrid, Spain. The method used in its development has been useful and agile, and the result is a guide that can be easily updated periodically following the same procedure. International Registered Report Identifier (IRRID): DERR1-10.2196/46961 ", doi="10.2196/46961", url="https://www.researchprotocols.org/2023/1/e46961", url="http://www.ncbi.nlm.nih.gov/pubmed/37930773" } @Article{info:doi/10.2196/46552, author="Diefenbach, A. Michael and Marziliano, Allison and Tagai, K. Erin and Pfister, Halie and Lapitan, Emmanuel and Hall, J. Simon and Vira, Manish and Ibrahim, Said and Aibel, Kelli and Kutikov, Alexander and Horwitz, M. Eric and Miyamoto, Curtis and Reese, C. Adam and Miller, M. Suzanne", title="Preference Elicitation and Treatment Decision-Making Among Men Diagnosed With Prostate Cancer: Randomized Controlled Trial Results of Healium", journal="J Med Internet Res", year="2023", month="Oct", day="20", volume="25", pages="e46552", keywords="prostate cancer", keywords="decision-making", keywords="decision support", keywords="decision tool", keywords="web-based intervention", keywords="patient preferences", keywords="preference elicitation software", keywords="preference", keywords="RCT", keywords="randomized controlled trial", keywords="oncology", keywords="prostate", keywords="men's health", keywords="emotional", abstract="Background: Elicitation of patients' preferences is an integral part of shared decision-making, the recommended approach for prostate cancer decision-making. Existing decision aids for this population often do not specifically focus on patients' preferences. Healium is a brief interactive web-based decision aid that aims to elicit patients' treatment preferences and is designed for a low health literate population. Objective: This study used a randomized controlled trial to evaluate whether Healium, designed to target preference elicitation, is as efficacious as Healing Choices, a comprehensive education and decision tool, in improving outcomes for decision-making and emotional quality of life. Methods: Patients diagnosed with localized prostate cancer who had not yet made a treatment decision were randomly assigned to the brief Healium intervention or Healing Choices, a decision aid previously developed by our group that serves as a virtual information center on prostate cancer diagnosis and treatment. Assessments were completed at baseline, 6 weeks, and 3 months post baseline, and included decisional outcomes (decisional conflict, satisfaction with decision, and preparation for decision-making), and emotional quality of life (anxiety/tension and depression), along with demographics, comorbidities, and health literacy. Results: A total of 327 individuals consented to participate in the study (171 were randomized to the Healium intervention arm and 156 were randomized to Healing Choices). The majority of the sample was non-Hispanic (272/282, 96\%), White (239/314, 76\%), married (251/320, 78.4\%), and was on average 62.4 (SD 6.9) years old. Within both arms, there was a significant decrease in decisional conflict from baseline to 6 weeks postbaseline (Healium, P?.001; Healing Choices, P?.001), and a significant increase in satisfaction with one's decision from 6 weeks to 3 months (Healium, P=.04; Healing Choices, P=.01). Within both arms, anxiety/tension (Healium, P=.23; Healing Choices, P=.27) and depression (Healium, P=.001; Healing Choices, P?.001) decreased from baseline to 6 weeks, but only in the case of depression was the decrease statistically significant. Conclusions: Healium, our brief decision aid focusing on treatment preference elicitation, is as successful in reducing decisional conflict as our previously tested comprehensive decision aid, Healing Choices, and has the added benefit of brevity, making it the ideal tool for integration into the physician consultation and electronic medical record. Trial Registration: ClinicalTrials.gov NCT05800483; https://clinicaltrials.gov/study/NCT05800483 ", doi="10.2196/46552", url="https://www.jmir.org/2023/1/e46552", url="http://www.ncbi.nlm.nih.gov/pubmed/37862103" } @Article{info:doi/10.2196/46809, author="Sangeorzan, Irina and Antonacci, Grazia and Martin, Anne and Grodzinski, Ben and Zipser, M. Carl and Murphy, J. Rory K. and Andriopoulou, Panoraia and Cook, E. Chad and Anderson, B. David and Guest, James and Furlan, C. Julio and Kotter, N. Mark R. and Boerger, F. Timothy and Sadler, Iwan and Roberts, A. Elizabeth and Wood, Helen and Fraser, Christine and Fehlings, G. Michael and Kumar, Vishal and Jung, Josephine and Milligan, James and Nouri, Aria and Martin, R. Allan and Blizzard, Tammy and Vialle, Roberto Luiz and Tetreault, Lindsay and Kalsi-Ryan, Sukhvinder and MacDowall, Anna and Martin-Moore, Esther and Burwood, Martin and Wood, Lianne and Lalkhen, Abdul and Ito, Manabu and Wilson, Nicky and Treanor, Caroline and Dugan, Sheila and Davies, M. Benjamin", title="Toward Shared Decision-Making in Degenerative Cervical Myelopathy: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2023", month="Oct", day="9", volume="12", pages="e46809", keywords="degenerative cervical myelopathy", keywords="spine", keywords="spinal cord", keywords="chronic", keywords="aging", keywords="geriatric", keywords="patient engagement", keywords="shared decision-making", keywords="process mapping", keywords="core information set", keywords="decision-making", keywords="patient education", keywords="common data element", keywords="Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy", keywords="RECODE-DCM", abstract="Background: Health care decisions are a critical determinant in the evolution of chronic illness. In shared decision-making (SDM), patients and clinicians work collaboratively to reach evidence-based health decisions that align with individual circumstances, values, and preferences. This personalized approach to clinical care likely has substantial benefits in the oversight of degenerative cervical myelopathy (DCM), a type of nontraumatic spinal cord injury. Its chronicity, heterogeneous clinical presentation, complex management, and variable disease course engenders an imperative for a patient-centric approach that accounts for each patient's unique needs and priorities. Inadequate patient knowledge about the condition and an incomplete understanding of the critical decision points that arise during the course of care currently hinder the fruitful participation of health care providers and patients in SDM. This study protocol presents the rationale for deploying SDM for DCM and delineates the groundwork required to achieve this. Objective: The study's primary outcome is the development of a comprehensive checklist to be implemented upon diagnosis that provides patients with essential information necessary to support their informed decision-making. This is known as a core information set (CIS). The secondary outcome is the creation of a detailed process map that provides a diagrammatic representation of the global care workflows and cognitive processes involved in DCM care. Characterizing the critical decision points along a patient's journey will allow for an effective exploration of SDM tools for routine clinical practice to enhance patient-centered care and improve clinical outcomes. Methods: Both CISs and process maps are coproduced iteratively through a collaborative process involving the input and consensus of key stakeholders. This will be facilitated by Myelopathy.org, a global DCM charity, through its Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy community. To develop the CIS, a 3-round, web-based Delphi process will be used, starting with a baseline list of information items derived from a recent scoping review of educational materials in DCM, patient interviews, and a qualitative survey of professionals. A priori criteria for achieving consensus are specified. The process map will be developed iteratively using semistructured interviews with patients and professionals and validated by key stakeholders. Results: Recruitment for the Delphi consensus study began in April 2023. The pilot-testing of process map interview participants started simultaneously, with the formulation of an initial baseline map underway. Conclusions: This protocol marks the first attempt to provide a starting point for investigating SDM in DCM. The primary work centers on developing an educational tool for use in diagnosis to enable enhanced onward decision-making. The wider objective is to aid stakeholders in developing SDM tools by identifying critical decision junctures in DCM care. Through these approaches, we aim to provide an exhaustive launchpad for formulating SDM tools in the wider DCM community. International Registered Report Identifier (IRRID): DERR1-10.2196/46809 ", doi="10.2196/46809", url="https://www.researchprotocols.org/2023/1/e46809", url="http://www.ncbi.nlm.nih.gov/pubmed/37812472" } @Article{info:doi/10.2196/49154, author="Holmqvist, Malin and Johansson, Linda and Lindenfalk, Bertil and Thor, Johan and Ros, Axel", title="Older Persons' and Health Care Professionals' Design Choices When Co-Designing a Medication Plan Aiming to Promote Patient Safety: Case Study", journal="JMIR Aging", year="2023", month="Oct", day="5", volume="6", pages="e49154", keywords="co-design", keywords="engagement", keywords="medications", keywords="medication plan", keywords="older people", keywords="older adults", keywords="participatory", keywords="patient experience", keywords="patient safety", keywords="remote", abstract="Background: Harm from medications is a major patient safety challenge among older persons. Adverse drug events tend to arise when prescribing or evaluating medications; therefore, interventions targeting these may promote patient safety. Guidelines highlight the value of a joint plan for continued treatment. If such a plan includes medications, a medication plan promoting patient safety is advised. There is growing evidence for the benefits of including patients and health care professionals in initiatives for improving health care products and services through co-design. Objective: This study aimed to identify participants' needs and requirements for a medication plan and explore their reasoning for different design choices. Methods: Using a case study design, we collected and analyzed qualitative and quantitative data and compared them side by side. We explored the needs and requirements for a medication plan expressed by 14 participants (older persons, nurses, and physicians) during a co-design initiative in a regional health system in Sweden. We performed a directed content analysis of qualitative data gathered from co-design sessions and interviews. Descriptive statistics were used to analyze the quantitative data from survey answers. Results: A medication plan must provide an added everyday value related to safety, effort, and engagement. The physicians addressed challenges in setting aside time to apply a medication plan, whereas the older persons raised the potential for increased patient involvement. According to the participants, a medication plan needs to support communication, continuity, and interaction. The nurses specifically addressed the need for a plan that was easy to gain an overview of. Important function requirements included providing instant access, automation, and attention. Content requirements included providing detailed information about the medication treatment. Having the plan linked to the medication list and instantly obtainable information was also requested. Conclusions: After discussing the needs and requirements for a medication plan, the participants agreed on an iteratively developed medication plan prototype linked to the medication list within the existing electronic health record. According to the participants, the medication plan prototype may promote patient safety and enable patient engagement, but concerns were raised about its use in daily clinical practice. The last step in the co-design framework is testing the intervention to explore how it works and connects with users. Therefore, testing the medication plan prototype in clinical practice would be a future step. ", doi="10.2196/49154", url="https://aging.jmir.org/2023/1/e49154", url="http://www.ncbi.nlm.nih.gov/pubmed/37796569" } @Article{info:doi/10.2196/50638, author="Mesk{\'o}, Bertalan", title="Prompt Engineering as an Important Emerging Skill for Medical Professionals: Tutorial", journal="J Med Internet Res", year="2023", month="Oct", day="4", volume="25", pages="e50638", keywords="artificial intelligence", keywords="AI", keywords="digital health", keywords="future", keywords="technology", keywords="ChatGPT", keywords="GPT-4", keywords="large language models", keywords="language model", keywords="LLM", keywords="prompt", keywords="prompts", keywords="prompt engineering", keywords="AI tool", keywords="engineering", keywords="healthcare professional", keywords="decision-making", keywords="LLMs", keywords="chatbot", keywords="chatbots", keywords="conversational agent", keywords="conversational agents", keywords="NLP", keywords="natural language processing", doi="10.2196/50638", url="https://www.jmir.org/2023/1/e50638", url="http://www.ncbi.nlm.nih.gov/pubmed/37792434" } @Article{info:doi/10.2196/47109, author="Rennick-Egglestone, Stefan and Subhani, Mohsan and Knight, Holly and Jones, A. Katy and Hutton, Clare and Jackson, Tracey and Hutton, Matthew and Wragg, Andrew and Morling, R. Joanne and Sprange, Kirsty and Ryder, D. Stephen", title="Transient Elastography and Video Recovery Narrative Access to Support Recovery From Alcohol Misuse: Development of a Novel Intervention for Use in Community Alcohol Treatment Services", journal="JMIR Form Res", year="2023", month="Oct", day="4", volume="7", pages="e47109", keywords="recovery narrative", keywords="recovery story", keywords="alcohol misuse", keywords="alcohol use disorder", keywords="feasibility trial", keywords="complex intervention", keywords="KLIFAD intervention", abstract="Background: Mortality from alcohol-related liver disease has risen significantly for 3 decades. Transient elastography (TE) is a noninvasive test providing a numerical marker of liver disease. Preliminary evidence suggests that TE can reduce alcohol consumption. The KLIFAD (does knowledge of liver fibrosis affect high-risk drinking behavior?) study has developed a complex intervention wherein people receiving alcohol treatment are provided with access to TE, accompanied by scripted feedback tailored to their disease state, and access to video narratives describing alcohol misuse recovery after receiving TE. Recovery narratives are included due to preliminary evidence from mental health studies which suggest that access to digital narratives describing recovery from mental health problems can help people affected by mental health problems, including through mechanisms with the potential to be transferable to an alcohol treatment setting, for example, by increasing hope for the future, enabling learning from the experience of others, or promoting help-seeking behaviors. Objective: We aimed to develop the KLIFAD intervention to the point that it could be delivered in a feasibility trial and to produce knowledge relevant to clinicians and researchers developing interventions making use of biomarkers of disease. Methods: In research activity 1, standardized scripted feedback was developed by this study, and then iterated through focus groups with people who had experienced alcohol misuse and TE, and key alcohol workers with experience in delivering TE. We report critical design considerations identified through focus groups, in the form of sensitizing concepts. In research activity 2, a video production guide was coproduced to help produce impactful video-based recovery narratives, and a patient and public involvement (PPI) panel was consulted for recommendations on how best to integrate recovery narratives into an alcohol treatment setting. We report PPI recommendations and an overview of video form and content. Results: Through research activity 1, we learnt that patient feedback has not been standardized in prior use of TE, that receiving a numeric marker can provide an objective target that motivates and rewards recovery, and that key alcohol workers regularly tailor information to their clients. Through research activity 2, we developed a video production guide asking narrators what recovery means to them, what helped their recovery, and what they have learned about recovery. We produced 10 recovery narratives and collected PPI recommendations on maximizing impact and safety. These led to the production of unplanned videos presenting caregiver and clinician perspectives, and a choice to limit narrative availability to alcohol treatment settings, where support is available around distressing content. These choices have been evaluated through a feasibility randomized controlled trial [ISRCTN16922410]. Conclusions: Providing an objective target that motivates and rewards recovery is a candidate change mechanism for complex interventions integrating biomarkers of disease. Recovery narratives can contain distressing content; intervention developers should attend to safe usage. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-054954 ", doi="10.2196/47109", url="https://formative.jmir.org/2023/1/e47109", url="http://www.ncbi.nlm.nih.gov/pubmed/37792440" } @Article{info:doi/10.2196/44170, author="Goueth, Rose and Darney, Blair and Hoffman, Aubri and Eden, B. Karen", title="Evaluating the Acceptability and Feasibility of a Sexual Health--Focused Contraceptive Decision Aid for Diverse Young Adults: User-Centered Usability Study", journal="JMIR Form Res", year="2023", month="Oct", day="3", volume="7", pages="e44170", keywords="decision aid", keywords="contraception", keywords="decision-making", keywords="user-centered design", keywords="young adults", keywords="pilot study", keywords="feasibility", keywords="acceptability", keywords="development", keywords="support", keywords="tool", keywords="survey", keywords="sexual health", abstract="Background: Young adults with low sexual health literacy levels may find it difficult to make informed decisions about contraceptive methods. We developed and pilot-tested a web-based decision aid---Healthy Sex Choices---designed to support diverse young adults with their contraceptive decision-making. Objective: This pilot study aimed to evaluate whether the Healthy Sex Choices decision aid is acceptable and feasible to patients and clinicians. Methods: We used the Ottawa Decision Support Framework and the International Patient Decision Aid Standards to develop and pilot the decision tool. We first conducted a needs assessment with our advisory panel (5 clinicians and 2 patients) that informed decision aid development. All panelists participated in semistructured interviews about their experience with contraceptive counseling. Clinicians also completed a focus group session centered around the development of sex education content for the tool. Before commencing the pilot study, 5 participants from ResearchMatch (Vanderbilt University Medical Center) assessed the tool and suggested improvements. Results: Participants were satisfied with the tool, rating the acceptability as ``good.'' Interviewees revealed that the tool made contraceptive decision-making easier and would recommend the tool to a family member or friend. Participants had a nonsignificant change in knowledge scores (53\% before vs 45\% after; P=.99). Overall, decisional conflict scores significantly decreased (16.1 before vs 2.8 after; P<.001) with the informed subscale (patients feeling more informed) having the greatest decline (23.1 vs 4.7; mean difference 19.0, SD 27.1). Subanalyses of contraceptive knowledge and decisional conflict illustrated that participants of color had lower knowledge scores (48\% vs 55\%) and higher decisional conflict (20.0 vs 14.5) at baseline than their white counterparts. Conclusions: Participants found Healthy Sex Choices to be acceptable and reported reduced decisional conflict after using the tool. The development and pilot phases of this study provided a foundation for creating reproductive health decision aids that acknowledge and provide guidance for diverse patient populations. ", doi="10.2196/44170", url="https://formative.jmir.org/2023/1/e44170", url="http://www.ncbi.nlm.nih.gov/pubmed/37788070" } @Article{info:doi/10.2196/45695, author="Cardwell, Trey Ethan and Ludwick, Teralynn and Fairley, Christopher and Bourne, Christopher and Chang, Shanton and Hocking, S. Jane and Kong, S. Fabian Y.", title="Web-Based STI/HIV Testing Services Available for Access in Australia: Systematic Search and Analysis", journal="J Med Internet Res", year="2023", month="Sep", day="22", volume="25", pages="e45695", keywords="STI/HIV testing", keywords="STI/HIV", keywords="self-testing", keywords="sexual health", keywords="web-based STI testing", keywords="web-based STI/HIV testing", abstract="Background: Sexually transmitted infection (STI) rates continue to rise in Australia, and timely access to testing and treatment is crucial to reduce transmission. Web-based services have been viewed as a way to improve timely access to STI/HIV testing and have proliferated in recent years. However, the regulation of these services in Australia is minimal, leading to concerns about their quality. The purpose of this review was to systematically identify web-based STI/HIV testing services available in Australia and assess them on aspects of quality, reliability, and accessibility. Objective: We aim to systematically identify and assess web-based STI/HIV testing services available in Australia. Methods: A Google search of Australian web-based services was conducted in March 2022 and repeated in September 2022 using Boolean operators and search terms related to test services (eg, on the internet or home), STIs (eg, chlamydia or gonorrhea), and test type (eg, self-test). The first 10 pages were assessed, and services were categorized as self-testing (ST; test at home), self-sampling (SS; sample at home and return to laboratory), or self-navigated pathology (SNP; specimens collected at pathology center). Website reliability was assessed against the Health on the Net Foundation code of conduct, and service quality was assessed using a scorecard that was developed based on similar reviews, Australian guidelines for in-person services, and UK standards. Additionally, we looked at measures of accessibility including cost, rural access, and time to test results. Results: Seventeen services were identified (8 ST, 2 SS, and 7 SNP). Only 4 services offered recommended testing for all 4 infections (chlamydia, gonorrhea, syphilis, and HIV) including genital, anorectal, and oropharyngeal sites, and 5 offered tests other than those recommended by Australian testing guidelines (eg, Ureaplasma). Nine services (1 SNP, 8 self-test) had no minimum age requirements for access. Reliability scores (scale 0-8) were similar between all services (range 4.75-8.0). Quality weighted scores (scale 0-58) were similar between SNP and SS services (average 44.89, SD 5.56 and 44.75, SD 1.77, respectively) but lower for ST services (22.66, SD 8.93; P=.002). Government-funded services were of higher quality than private services (43.54, SD 6.71 vs 29.43, SD 13.55; P=.03). The cost for services varied between SNP (Aus \$0-\$595; ie, US \$0-\$381.96), self-sample (Aus \$0; ie, US \$0), and ST (Aus \$0-\$135; ie, US \$0-\$86.66). The time to test results was much shorter for SNP services ({\textasciitilde}4 days) than for SS ({\textasciitilde}12 days) and ST ({\textasciitilde}14 days). Conclusions: This review identified considerable variability in the quality and reliability of the web-based STI/HIV testing services in Australia. Given the proliferation and use of these services will likely increase, it is imperative that Australia develops national standards to ensure the standard-of-care offered by web-based STI/HIV testing services is appropriate to protect Australian users from the impact of poorly performing and inappropriate tests. ", doi="10.2196/45695", url="https://www.jmir.org/2023/1/e45695", url="http://www.ncbi.nlm.nih.gov/pubmed/37738083" } @Article{info:doi/10.2196/44129, author="Schick, Sofie Teresa and H{\"o}llerl, Lea and Biedermann, Tilo and Zink, Alexander and Ziehfreund, Stefanie", title="Impact of Digital Media on the Patient Journey and Patient-Physician Relationship Among Dermatologists and Adult Patients With Skin Diseases: Qualitative Interview Study", journal="J Med Internet Res", year="2023", month="Sep", day="22", volume="25", pages="e44129", keywords="digital media", keywords="dermatology", keywords="patient journey", keywords="patient-physician relationship", keywords="semistructured interview", keywords="qualitative content analysis", abstract="Background: Digital media are easily accessible without time restrictions and are widely used for health- or disease-related purposes. However, their influence on the patient journey and the patient-physician relationship has not yet been sufficiently investigated. Objective: This qualitative interview study was designed to explore dermatologists' and patients' experiences with digital media for medical purposes in the context of patient journeys and patient-physician relationships. Methods: Twenty-eight semistructured video conference--based interviews were conducted and audiorecorded by experienced interviewers between November 2021 and June 2022 in Germany. Eligible patients were those who were aged ?18 years, were affected by at least one physician-confirmed skin disease, and were fluent in the German language. The eligibility criterion for dermatologists was that they were currently practicing dermatology in an outpatient setting or in a hospital. Randomly selected dermatologists from the listing of the German National Association of Statutory Health Insurance Physicians and dermatologists from personal academic and professional networks were invited for participation via postal mail and asked to identify potential patient volunteers from their patient bases. All recorded data were pseudonymized, fully transcribed verbatim, and subsequently analyzed according to Mayring's qualitative content analysis by 2 researchers, allowing for both a qualitative interview text analysis and a quantitative assessment of category assignments. Results: In total, 28 participants were interviewed: 16 adult patients and 12 dermatologists. Eight main categories emerged as key areas of interest: (1) the search for diagnosis and symptom triggers, (2) preconsultation digital media use, (3) in-depth information and exchange with other patients, (4) self-treatment, (5) patient-physician interaction, (6) roles of dermatologists and patients, (7) patient eHealth literacy, and (8) opportunities and risks. Categories 1 and 2 were only coded for patients; the other categories were coded for both patients and dermatologists. Patients reported searches for diagnosis or treatment options were most frequently (8/16) caused by a mismatch of symptoms and diagnosis or dissatisfaction with current therapies. Concerns regarding a potentially severe diagnosis prompted searches for initial or in-depth information before or after dermatological consultations. However, the large volume of information of varying quality often confused patients, leading dermatologists to assume the role of evaluating information from preinformed patients. Dermatologists generally encouraged the use of digital media, considered teledermatology advantageous, and viewed big data and artificial intelligence as being potentially beneficial, particularly when searching for rare diagnoses. A single, easily accessible, and free-of-charge platform with high quality information in lay language was recommended by the dermatologists and desired by patients. Conclusions: Digital media are widely accepted by both patients and dermatologists and can positively influence both the dermatological patient journey and patient-physician relationship. Digital media may therefore have great potential to improve specialized health care if patients and dermatologists embrace their new roles. ", doi="10.2196/44129", url="https://www.jmir.org/2023/1/e44129", url="http://www.ncbi.nlm.nih.gov/pubmed/37738078" } @Article{info:doi/10.2196/43632, author="Gould, J. Daniel and Dowsey, M. Michelle and Glanville-Hearst, Marion and Spelman, Tim and Bailey, A. James and Choong, M. Peter F. and Bunzli, Samantha", title="Patients' Views on AI for Risk Prediction in Shared Decision-Making for Knee Replacement Surgery: Qualitative Interview Study", journal="J Med Internet Res", year="2023", month="Sep", day="18", volume="25", pages="e43632", keywords="artificial intelligence", keywords="qualitative research", keywords="semistructured interviews", keywords="knee replacement", keywords="risk prediction", keywords="patient perception", keywords="patient understanding", keywords="patient preference", keywords="patient perspective", abstract="Background: The use of artificial intelligence (AI) in decision-making around knee replacement surgery is increasing, and this technology holds promise to improve the prediction of patient outcomes. Ambiguity surrounds the definition of AI, and there are mixed views on its application in clinical settings. Objective: In this study, we aimed to explore the understanding and attitudes of patients who underwent knee replacement surgery regarding AI in the context of risk prediction for shared clinical decision-making. Methods: This qualitative study involved patients who underwent knee replacement surgery at a tertiary referral center for joint replacement surgery. The participants were selected based on their age and sex. Semistructured interviews explored the participants' understanding of AI and their opinions on its use in shared clinical decision-making. Data collection and reflexive thematic analyses were conducted concurrently. Recruitment continued until thematic saturation was achieved. Results: Thematic saturation was achieved with 19 interviews and confirmed with 1 additional interview, resulting in 20 participants being interviewed (female participants: n=11, 55\%; male participants: n=9, 45\%; median age: 66 years). A total of 11 (55\%) participants had a substantial postoperative complication. Three themes captured the participants' understanding of AI and their perceptions of its use in shared clinical decision-making. The theme Expectations captured the participants' views of themselves as individuals with the right to self-determination as they sought therapeutic solutions tailored to their circumstances, needs, and desires, including whether to use AI at all. The theme Empowerment highlighted the potential of AI to enable patients to develop realistic expectations and equip them with personalized risk information to discuss in shared decision-making conversations with the surgeon. The theme Partnership captured the importance of symbiosis between AI and clinicians because AI has varied levels of interpretability and understanding of human emotions and empathy. Conclusions: Patients who underwent knee replacement surgery in this study had varied levels of familiarity with AI and diverse conceptualizations of its definitions and capabilities. Educating patients about AI through nontechnical explanations and illustrative scenarios could help inform their decision to use it for risk prediction in the shared decision-making process with their surgeon. These findings could be used in the process of developing a questionnaire to ascertain the views of patients undergoing knee replacement surgery on the acceptability of AI in shared clinical decision-making. Future work could investigate the accuracy of this patient group's understanding of AI, beyond their familiarity with it, and how this influences their acceptance of its use. Surgeons may play a key role in finding a place for AI in the clinical setting as the uptake of this technology in health care continues to grow. ", doi="10.2196/43632", url="https://www.jmir.org/2023/1/e43632", url="http://www.ncbi.nlm.nih.gov/pubmed/37721797" } @Article{info:doi/10.2196/47409, author="Scholze, A. Danielle and Gosdin, M. Melissa and Perez, L. Susan and Schweitzer, B. Julie", title="Identifying the Information Needs and Format Preferences for Web-Based Content Among Adults With or Parents of Children With Attention-Deficit/Hyperactivity Disorder: Three-Stage Qualitative Analysis", journal="JMIR Form Res", year="2023", month="Sep", day="11", volume="7", pages="e47409", keywords="ADHD", keywords="pediatric", keywords="adult", keywords="mobile phone", keywords="developmental disorder", keywords="neurodevelopmental", keywords="mental disorder", keywords="information-seeking", keywords="information need", keywords="attention deficit disorder", keywords="hyperactive", keywords="hyperactivity", keywords="interview", keywords="focus group", keywords="think-aloud", keywords="web-based", keywords="online content", keywords="user experience", keywords="information behavior", keywords="web design", abstract="Background: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood and adult behavioral disorder. Internet searches for ADHD information are rising, particularly for diagnosis and treatment. Despite effective ADHD treatments, research suggests that there are delays in seeking help for ADHD. Identifying ways to shorten delays is important for minimizing morbidity associated with ADHD. One way to shorten these delays is to improve internet health information resources. Research shows that parents of children with ADHD feel that much of the information available is technical and not tailored for their child's needs and verbal instructions given by health care providers were too pharmacologically focused with limited information about how to manage and support ADHD symptoms in daily living. A majority of parents search the internet for general and pharmacological information for ADHD and prefer web-based resources for learning about ADHD, but web-based resources may be inaccurate and of low quality. Ensuring accurate information through the internet is an important step in assisting parents and adults in making informed decisions about the diagnosis and treatment of ADHD. Objective: Although a great deal of information regarding ADHD is available on the internet, some information is not based on scientific evidence or is difficult for stakeholders to understand. Determining gaps in access to accurate ADHD information and stakeholder interest in the type of information desired is important in improving patient engagement with the health care system, but minimal research addresses these needs. This study aims to determine the information needs and formatting needs of web-based content for adults with ADHD and parents of children with ADHD in order to improve user experience and engagement. Methods: This was a 3-phase study consisting of in-depth phone interviews about experiences with ADHD and barriers searching for ADHD-related information, focus groups where participants were instructed to consider the pathways by which they made decisions using web-based resources, and observing participants interacting with a newly developed website tailored for adults with potential ADHD and caregivers of children who had or might have ADHD. Phase 1 individual interviews and phase 2 focus groups identified the needs of the ADHD stakeholders related to website content and format. Interview and focus group findings were used to develop a website. Phase 3 used think-aloud interviews to evaluate website usability to inform the tailoring of the website based on user feedback. Results: Interviews and focus group findings revealed preferences for ADHD website information and content, website layout, and information sources. Themes included a preference for destigmatizing information about ADHD, information specific to patient demographics, and evidence-based information tailored to lay audiences. Conclusions: ADHD stakeholders are specifically seeking positive information about ADHD presented in a user-friendly format. ", doi="10.2196/47409", url="https://formative.jmir.org/2023/1/e47409", url="http://www.ncbi.nlm.nih.gov/pubmed/37695648" } @Article{info:doi/10.2196/46865, author="Plys, Ekaterina and Bulliard, Jean-Luc and Chaouch, Aziz and Durand, Marie-Anne and van Duuren, A. Luuk and Br{\"a}ndle, Karen and Auer, Reto and Froehlich, Florian and Lansdorp-Vogelaar, Iris and Corley, A. Douglas and Selby, Kevin", title="Colorectal Cancer Screening Decision Based on Predicted Risk: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Sep", day="7", volume="12", pages="e46865", keywords="colorectal cancer screening", keywords="personalized screening", keywords="risk communication", keywords="shared decision-making", keywords="screening behavior", keywords="Switzerland", abstract="Background: Incidence of and mortality from colorectal cancer (CRC) can be effectively reduced by screening with the fecal immunochemical test (FIT) or colonoscopy. Individual risk to develop CRC within 15 years varies from <1\% to >15\% among people aged 50 to 75 years. Communicating personalized CRC risk and appropriate screening recommendations could improve the risk-benefit balance of screening test allocations and optimize the use of limited colonoscopy resources. However, significant uncertainty exists regarding the feasibility and efficacy of risk-based screening. Objective: We aim to study the effect of communicating individual CRC risk and a risk-based recommendation of the FIT or colonoscopy on participants' choice of screening test. We will also assess the feasibility of a larger clinical trial designed to evaluate the impact of personalized screening on clinical outcomes. Methods: We will perform a pilot randomized controlled trial among 880 residents aged 50 to 69 years eligible to participate in the organized screening program of the Vaud canton, Switzerland. Participants will be recruited by mail by the Vaud CRC screening program. Primary and secondary outcomes will be self-assessed through questionnaires. The risk score will be calculated using the open-source QCancer calculator that was validated in the United Kingdom. Participants will be stratified into 3 groups---low (<3\%), moderate (3\% to <6\%), and high (?6\%) risk---according to their 15-year CRC risk and randomized within each risk stratum. The intervention group participants will receive a newly designed brochure with their personalized risk and screening recommendations. The control group will receive the usual brochure of the Vaud CRC screening program. Our primary outcome, measured using a self-administered questionnaire, is appropriate screening uptake 6 months after the intervention. Screening will be defined as appropriate if participants at high risk undertake colonoscopy and participants at low risk undertake the FIT. We will also measure the acceptability of the risk score and screening recommendations and the psychological factors influencing screening behavior. We will also assess the feasibility of a full-scale randomized controlled trial. Results: We expect that a total sample of 880 individuals will allow us to detect a difference of 10\% ($\alpha$=5\%) between groups. The main outcome will be analyzed using a 2-tailed chi-squared test. We expect that appropriate screening uptake will be higher in the intervention group. No difference in overall screening uptake is expected. Conclusions: We will test the impact of personalized risk information and screening recommendations on participants' choice of screening test in an organized screening program. This study should advance our understanding of the feasibility of large-scale risk-based CRC screening. Our results may provide insights into the optimization of CRC screening by offering screening options with a better risk-benefit balance and optimizing the use of resources. Trial Registration: ClinicalTrials.gov NCT05357508; https://www.clinicaltrials.gov/study/NCT05357508 International Registered Report Identifier (IRRID): DERR1-10.2196/46865 ", doi="10.2196/46865", url="https://www.researchprotocols.org/2023/1/e46865", url="http://www.ncbi.nlm.nih.gov/pubmed/37676720" } @Article{info:doi/10.2196/48630, author="Park, Albert and Sayed, Fatima and Robinson, Patrick and Elopre, Latesha and Ge, Yaorong and Li, Shaoyu and Grov, Christian and Sullivan, Sean Patrick", title="Health Information on Pre-Exposure Prophylaxis From Search Engines and Twitter: Readability Analysis", journal="JMIR Public Health Surveill", year="2023", month="Sep", day="4", volume="9", pages="e48630", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="health literacy", keywords="health education materials", keywords="readability", keywords="prophylaxis", keywords="health information", keywords="electronic health education", keywords="HIV", keywords="infection", keywords="Twitter", abstract="Background: Pre-exposure prophylaxis (PrEP) is proven to prevent HIV infection. However, PrEP uptake to date has been limited and inequitable. Analyzing the readability of existing PrEP-related information is important to understand the potential impact of available PrEP information on PrEP uptake and identify opportunities to improve PrEP-related education and communication. Objective: We examined the readability of web-based PrEP information identified using search engines and on Twitter. We investigated the readability of web-based PrEP documents, stratified by how the PrEP document was obtained on the web, information source, document format and communication method, PrEP modality, and intended audience. Methods: Web-based PrEP information in English was systematically identified using search engines and the Twitter API. We manually verified and categorized results and described the method used to obtain information, information source, document format and communication method, PrEP modality, and intended audience. Documents were converted to plain text for the analysis and readability of the collected documents was assessed using 4 readability indices. We conducted pairwise comparisons of readability based on how the PrEP document was obtained on the web, information source, document format, communication method, PrEP modality, and intended audience, then adjusted for multiple comparisons. Results: A total of 463 documents were identified. Overall, the readability of web-based PrEP information was at a higher level (10.2-grade reading level) than what is recommended for health information provided to the general public (ninth-grade reading level, as suggested by the Department of Health and Human Services). Brochures (n=33, 7\% of all identified resources) were the only type of PrEP materials that achieved the target of ninth-grade reading level. Conclusions: Web-based PrEP information is often written at a complex level for potential and current PrEP users to understand. This may hinder PrEP uptake for some people who would benefit from it. The readability of PrEP-related information found on the web should be improved to align more closely with health communication guidelines for reading level to improve access to this important health information, facilitate informed decisions by those with a need for PrEP, and realize national prevention goals for PrEP uptake and reducing new HIV infections in the United States. ", doi="10.2196/48630", url="https://publichealth.jmir.org/2023/1/e48630", url="http://www.ncbi.nlm.nih.gov/pubmed/37665621" } @Article{info:doi/10.2196/46571, author="Siglen, Elen and Vetti, H{\o}berg Hildegunn and Augestad, Mirjam and Steen, M. Vidar and Lunde, {\AA}shild and Bjorvatn, Cathrine", title="Evaluation of the Rosa Chatbot Providing Genetic Information to Patients at Risk of Hereditary Breast and Ovarian Cancer: Qualitative Interview Study", journal="J Med Internet Res", year="2023", month="Sep", day="1", volume="25", pages="e46571", keywords="chatbot", keywords="chatbots", keywords="genetic", keywords="trust", keywords="acceptability", keywords="perception", keywords="perceived", keywords="genetic counseling", keywords="hybrid health care", keywords="digital health tool", keywords="digital information tool", keywords="digital health technology", keywords="virtual assistant", keywords="hereditary breast and ovarian cancer", keywords="hereditary", keywords="genetic testing", keywords="technology", keywords="genetic clinic", keywords="digital tool", keywords="ovarian cancer", keywords="breast cancer", keywords="information retrieval", keywords="women's health", keywords="breast", keywords="ovarian", keywords="cancer", keywords="oncology", keywords="mobile phone", abstract="Background: Genetic testing has become an integrated part of health care for patients with breast or ovarian cancer, and the increasing demand for genetic testing is accompanied by an increasing need for easy access to reliable genetic information for patients. Therefore, we developed a chatbot app (Rosa) that is able to perform humanlike digital conversations about genetic BRCA testing. Objective: Before implementing this new information service in daily clinical practice, we wanted to explore 2 aspects of chatbot use: the perceived utility and trust in chatbot technology among healthy patients at risk of hereditary cancer and how interaction with a chatbot regarding sensitive information about hereditary cancer influences patients. Methods: Overall, 175 healthy individuals at risk of hereditary breast and ovarian cancer were invited to test the chatbot, Rosa, before and after genetic counseling. To secure a varied sample, participants were recruited from all cancer genetic clinics in Norway, and the selection was based on age, gender, and risk of having a BRCA pathogenic variant. Among the 34.9\% (61/175) of participants who consented for individual interview, a selected subgroup (16/61, 26\%) shared their experience through in-depth interviews via video. The semistructured interviews covered the following topics: usability, perceived usefulness, trust in the information received via the chatbot, how Rosa influenced the user, and thoughts about future use of digital tools in health care. The transcripts were analyzed using the stepwise-deductive inductive approach. Results: The overall finding was that the chatbot was very welcomed by the participants. They appreciated the 24/7 availability wherever they were and the possibility to use it to prepare for genetic counseling and to repeat and ask questions about what had been said afterward. As Rosa was created by health care professionals, they also valued the information they received as being medically correct. Rosa was referred to as being better than Google because it provided specific and reliable answers to their questions. The findings were summed up in 3 concepts: ``Anytime, anywhere''; ``In addition, not instead''; and ``Trustworthy and true.'' All participants (16/16) denied increased worry after reading about genetic testing and hereditary breast and ovarian cancer in Rosa. Conclusions: Our results indicate that a genetic information chatbot has the potential to contribute to easy access to uniform information for patients at risk of hereditary breast and ovarian cancer, regardless of geographical location. The 24/7 availability of quality-assured information, tailored to the specific situation, had a reassuring effect on our participants. It was consistent across concepts that Rosa was a tool for preparation and repetition; however, none of the participants (0/16) supported that Rosa could replace genetic counseling if hereditary cancer was confirmed. This indicates that a chatbot can be a well-suited digital companion to genetic counseling. ", doi="10.2196/46571", url="https://www.jmir.org/2023/1/e46571", url="http://www.ncbi.nlm.nih.gov/pubmed/37656502" } @Article{info:doi/10.2196/45287, author="Vanderhout, Shelley and Goldbloom, B. Ellen and Li, Amy and Newhook, Dennis and Garcia, Meghan and Dulude, Catherine", title="Evaluation Strategies for Understanding Experiences With Virtual Care in Canada: Mixed Methods Study", journal="J Med Internet Res", year="2023", month="Aug", day="30", volume="25", pages="e45287", keywords="environmental scan", keywords="experience", keywords="interviews", keywords="pediatrics", keywords="telemedicine", keywords="virtual care", abstract="Background: Virtual care was rapidly integrated into pediatric health services during the COVID-19 pandemic. While virtual care offers many benefits, it is necessary to better understand the experiences of those who receive, deliver, and coordinate virtual care in order to support sustainable, high-quality, and patient-centered health care. To date, methods implemented to evaluate users' experiences of virtual care have been highly variable, making comparison and data synthesis difficult. Objective: This study aims to describe evaluation strategies currently used to understand personal experiences with pediatric virtual care in Canada. Methods: In this mixed methods environmental scan, we first distributed a web-based questionnaire to clinical, research, and operational leaders delivering and evaluating pediatric virtual care in Canada. The questionnaire collected information about how experiences with virtual care have been or are currently being evaluated and whether these evaluations included the perspectives of children or youth, families, providers, or support staff. Second, respondents were asked to share the questions they used in their evaluations, and a content analysis was performed to identify common question categories. Third, we conducted semistructured interviews to further explore our respondents' evaluation experiences across 4 domains---evaluation approaches, distribution methods, response rates, and lessons learned---and interest in a core set of questions for future evaluations. Results: There were 72 respondents to the web-based questionnaire; among those who had conducted an evaluation, we identified 15 unique evaluations, and 14 of those provided a copy of the tools used to evaluate virtual care. These evaluations measured the virtual care experiences of parents or caregivers (n=15, 100\%), children or youth (n=11, 73\%), health care providers (n=11, 73\%), and support staff (n=4, 27\%). The most common data collection method used was electronic questionnaires distributed by email. Two respondents used validated tools; the remainder modified existing tools or developed new tools. Content analysis of the 14 submitted questionnaires revealed that the most common questions were about overall participant satisfaction, the comparison of virtual care to in-person care, and whether participants would choose virtual care options in the future. Interview findings indicate respondents frequently relied on methods used by peers and that a standardized, core set of questions to evaluate experiences with virtual care would be helpful to improve evaluation practices and support pediatric health care delivery. Conclusions: At our institution and elsewhere in Canada, experiences with pediatric virtual care have been evaluated using a variety of methods. A more consistent evaluation approach using standardized tools may enable more regular comparisons of experiences with virtual care and the synthesis of findings across health care settings. In turn, this may better inform our approach to virtual care, improve its integration into health systems, and facilitate sustainable, high-quality, patient-centered care. ", doi="10.2196/45287", url="https://www.jmir.org/2023/1/e45287", url="http://www.ncbi.nlm.nih.gov/pubmed/37647120" } @Article{info:doi/10.2196/45370, author="Han, Noah and Paul, A. Rachel and Bardakjian, Tanya and Kargilis, Daniel and Bradbury, R. Angela and Chen-Plotkin, Alice and Tropea, F. Thomas", title="User and Usability Testing of a Web-Based Genetics Education Tool for Parkinson Disease: Mixed Methods Study", journal="JMIR Bioinform Biotech", year="2023", month="Aug", day="30", volume="4", pages="e45370", keywords="Parkinson disease", keywords="genetic testing", keywords="teleneurology", keywords="patient education", keywords="neurology", keywords="genetic", keywords="usability", keywords="user testing", keywords="web-based", keywords="internet-based", keywords="web-based resource", keywords="mobile phone", abstract="Background: Genetic testing is essential to identify research participants for clinical trials enrolling people with Parkinson disease (PD) carrying a variant in the glucocerebrosidase (GBA) or leucine-rich repeat kinase 2 (LRRK2) genes. The limited availability of professionals trained in neurogenetics or genetic counseling is a major barrier to increased testing. Telehealth solutions to increase access to genetics education can help address issues around counselor availability and offer options to patients and family members. Objective: As an alternative to pretest genetic counseling, we developed a web-based genetics education tool focused on GBA and LRRK2 testing for PD called the Interactive Multimedia Approach to Genetic Counseling to Inform and Educate in Parkinson's Disease (IMAGINE-PD) and conducted user testing and usability testing. The objective was to conduct user and usability testing to obtain stakeholder feedback to improve IMAGINE-PD. Methods: Genetic counselors and PD and neurogenetics subject matter experts developed content for IMAGINE-PD specifically focused on GBA and LRRK2 genetic testing. Structured interviews were conducted with 11 movement disorder specialists and 13 patients with PD to evaluate the content of IMAGINE-PD in user testing and with 12 patients with PD to evaluate the usability of a high-fidelity prototype according to the US Department of Health and Human Services Research-Based Web Design \& Usability Guidelines. Qualitative data analysis informed changes to create a final version of IMAGINE-PD. Results: Qualitative data were reviewed by 3 evaluators. Themes were identified from feedback data of movement disorder specialists and patients with PD in user testing in 3 areas: content such as the topics covered, function such as website navigation, and appearance such as pictures and colors. Similarly, qualitative analysis of usability testing feedback identified additional themes in these 3 areas. Key points of feedback were determined by consensus among reviewers considering the importance of the comment and the frequency of similar comments. Refinements were made to IMAGINE-PD based on consensus recommendations by evaluators within each theme at both user testing and usability testing phases to create a final version of IMAGINE-PD. Conclusions: User testing for content review and usability testing have informed refinements to IMAGINE-PD to develop this focused, genetics education tool for GBA and LRRK2 testing. Comparison of this stakeholder-informed intervention to standard telegenetic counseling approaches is ongoing. ", doi="10.2196/45370", url="https://bioinform.jmir.org/2023/1/e45370" } @Article{info:doi/10.2196/42921, author="Long, D. Millie and van Deen, K. Welmoed and Weisbein, Laura and Khalil, Carine and Appel, L. Keren and Zhang, Xian and Chen, Wenli and Zubrod, Lori and Maris, Robbie and Ghafari, Afsoon and Dupuy, Taylor and Ha, Y. Christina and Spiegel, R. Brennan M. and Almario, V. Christopher and Melmed, Y. Gil", title="Web-Based Video Education to Improve Uptake of Influenza Vaccination and Other Preventive Health Recommendations in Adults With Inflammatory Bowel Disease: Randomized Controlled Trial of Project PREVENT", journal="J Med Internet Res", year="2023", month="Aug", day="23", volume="25", pages="e42921", keywords="preventative", keywords="education", keywords="inflammatory bowel disease (IBD)", keywords="adults", keywords="inflammation", keywords="disease", keywords="risk", keywords="infections", keywords="bone", keywords="cancer", keywords="development", keywords="patient", keywords="interview", keywords="intervention", keywords="prevention", keywords="vaccination", keywords="influenza", abstract="Background: Patients with inflammatory bowel disease (IBD) are at increased risk of infections, bone fractures, and skin cancers. Objective: We developed preventive health videos using a patient-centered approach and tested their impact on preventive health uptake. Methods: Five animated videos explaining preventive health recommendations in IBD were iteratively developed with patient-centered focus groups and interviews. A randomized controlled trial was then conducted in a web-based IBD cohort to test the impact of video- versus text-based educational interventions. The primary outcome was receipt of the influenza vaccine. Secondary outcomes included intention to receive other preventive health services. Results: Five animated videos were developed with patient input. A total of 1056 patients with IBD were then randomized to receive the video (n=511) or text-only (n=545) interventions; 55\% (281/511) of the video group and 57\% (311/545) of the text-only group had received their influenza vaccine in the prior year. Immediately after the intervention, 73\% (502/683) of patients reported their intention to receive the vaccine, with no difference by the type of intervention (75\%, 231/307, for the video group and 72\%, 271/376, for the text-only group). The proportion of patients who actually received the influenza vaccine after the intervention also did not differ by messaging type (P=.07). The strongest predictor of both intention to receive and actual receipt of the influenza vaccine was prior influenza vaccination. Older age was also associated with a higher likelihood of the intention to receive (age 36-75 years relative to 18-35 years; P=.006) and actual receipt (age >75 years relative to 18-35 years; P=.05) of the influenza vaccine. Conclusions: The proportion of patients receiving the influenza vaccine was high in both groups, but there was no difference in receipt of or in the intention to receive preventive health recommendations by type of messaging. Notably, a portion of patients in both groups had intended to be vaccinated but did not ultimately receive the vaccine. Further evaluation of patient-education strategies is warranted to improve preventive health uptake among patients with IBD. Trial Registration: ClinicalTrials.gov NCT05997537; https://clinicaltrials.gov/ct2/show/NCT05997537 ", doi="10.2196/42921", url="https://www.jmir.org/2023/1/e42921", url="http://www.ncbi.nlm.nih.gov/pubmed/37610821" } @Article{info:doi/10.2196/47574, author="Nguyen, Hoang Thinh and Cunha, Pereira Priscila and Rowland, Friedman Annabelle and Orenstein, Evan and Lee, Tricia and Kandaswamy, Swaminathan", title="User-Centered Design and Evaluation of Clinical Decision Support to Improve Early Peanut Introduction: Formative Study", journal="JMIR Form Res", year="2023", month="Aug", day="22", volume="7", pages="e47574", keywords="clinical decision support", keywords="peanut", keywords="peanut introduction", keywords="early peanut introduction", keywords="allergy", keywords="electronic health records", keywords="simulation", keywords="user-centered design", abstract="Background: Peanut allergy has recently become more prevalent. Peanut introduction recommendations have evolved from suggesting peanut avoidance until the age of 3 years to more recent guidelines encouraging early peanut introduction after the Learning Early about Peanut Allergy (LEAP) study in 2015. Guideline adherence is poor, leading to missed care opportunities. Objective: In this study, we aimed to develop a user-centered clinical decision support (CDS) tool to improve implementation of the most recent early peanut introduction guidelines in the primary care clinic setting. Methods: We edited the note template of the well-child check (WCC) visits at ages 4 and 6 months with CDS prompts and point-of-care education. Formative and summative usability testing were completed with pediatric residents in a simulated electronic health record (EHR). We estimated task completion rates and perceived usefulness of the CDS in summative testing, comparing a test EHR with and without the CDS. Results: Formative usability testing with the residents provided qualitative data that led to improvements in the build for both the 4-month and 6-month WCC note templates. During summative usability testing, the CDS tool significantly improved discussion of early peanut introduction at the 4-month WCC visit compared to scenarios without the CDS tool (9/15, 60\% with CDS and 0/15, 0\% without CDS). All providers except one at the 4-month WCC scenario gave at least an adequate score for the ease of use of the CDS tool for the history of present illness and assessment and plan sections. During the summative usability testing with the 6-month WCC new build note template, providers more commonly provided comprehensive care once obtaining a patient history concerning for an immunoglobulin E--mediated peanut reaction by placing a referral to allergy/immunology (P=.48), prescribing an epinephrine auto-injector (P=.07), instructing on how to avoid peanut products (P<.001), and providing an emergency treatment plan (P=.003) with CDS guidance. All providers gave at least an adequate score for ease of use of the CDS tool in the after-visit summary. Conclusions: User-centered CDS improved application of early peanut introduction recommendations and comprehensive care for patients who have symptoms concerning for peanut allergy in a simulation. ", doi="10.2196/47574", url="https://formative.jmir.org/2023/1/e47574", url="http://www.ncbi.nlm.nih.gov/pubmed/37606983" } @Article{info:doi/10.2196/47298, author="Goueth, Rose and Holt, Kelsey and Eden, B. Karen and Hoffman, Aubri", title="Clinicians' Perspectives and Proposed Solutions to Improve Contraceptive Counseling in the United States: Qualitative Semistructured Interview Study With Clinicians From the Society of Family Planning", journal="JMIR Form Res", year="2023", month="Aug", day="21", volume="7", pages="e47298", keywords="contraceptive counseling", keywords="qualitative study", keywords="decision making", keywords="decision aids", keywords="clinician engagement", keywords="user-centered design", keywords="contraceptive", keywords="birth control", keywords="clinicians' perspectives", keywords="patient-centered counseling", keywords="sexual health", keywords="family planning", abstract="Background: Contraceptive care is a key element of reproductive health, yet only 12\%-30\% of women report being able to access and receive the information they need to make these complex, personal health care decisions. Current guidelines recommend implementing shared decision-making approaches; and tools such as patient decision aid (PtDA) applications have been proposed to improve patients' access to information, contraceptive knowledge, decisional conflict, and engagement in decision-making and contraception use. To inform the design of meaningful, effective, elegant, and feasible PtDA applications, studies are needed of all users' current experiences, needs, and barriers. While multiple studies have explored patients' experiences, needs, and barriers, little is known about clinicians' experiences, perspectives, and barriers to delivering contraceptive counseling. Objective: This study focused on assessing clinicians' experiences, including their perspectives of patients' needs and barriers. It also explored clinicians' suggestions for improving contraceptive counseling and the feasibility of a contraceptive PtDA. Methods: Following the decisional needs assessment approach, we conducted semistructured interviews with clinicians recruited from the Society of Family Planning. The Ottawa Decision Support Framework informed the interview guide and initial codebook, with a specific focus on decision support and decisional needs as key elements that should be assessed from the clinicians' perspective. An inductive content approach was used to analyze data and identify primary themes and suggestions for improvement. Results: Fifteen clinicians (12 medical doctors and 3 nurse practitioners) participated, with an average of 19 years of experience in multiple regions of the United States. Analyses identified 3 primary barriers to the provision of quality contraceptive counseling: gaps in patients' underlying sexual health knowledge, biases that impede decision-making, and time constraints. All clinicians supported the development of contraceptive PtDAs as a feasible solution to these main barriers. Multiple suggestions for improvement were provided, including clinician- and system-level training, tools, and changes that could support successful implementation. Conclusions: Clinicians and developers interested in improving contraceptive counseling and decision-making may wish to incorporate approaches that assess and address upstream factors, such as sexual health knowledge and existing heuristics and biases. Clinical leaders and administrators may also wish to prioritize solutions that improve equity and accessibility, including PtDAs designed to provide education and support in advance of the time-constrained consultations, and strategic training opportunities that support cultural awareness and shared decision-making skills. Future studies can then explore whether well-designed, user-centered shared decision-making programs lead to successful and sustainable uptake and improve patients' reproductive health contraceptive decision-making. ", doi="10.2196/47298", url="https://formative.jmir.org/2023/1/e47298", url="http://www.ncbi.nlm.nih.gov/pubmed/37603407" } @Article{info:doi/10.2196/38965, author="Campos-Castillo, Celeste", title="Impact of Beliefs About Local Physician Supply and Self-Rated Health on Willingness to See a Nurse Practitioner During the COVID-19 Pandemic: Web-Based Survey and Experiment", journal="JMIR Form Res", year="2023", month="Aug", day="16", volume="7", pages="e38965", keywords="primary care shortage", keywords="workforce", keywords="health care seeking", keywords="public opinion", keywords="consumers", keywords="online studies", keywords="COVID-19", keywords="pandemic", keywords="primary care", keywords="nurse practitioners", keywords="nurse", keywords="healthcare", keywords="resources", keywords="advocacy", abstract="Background: The COVID-19 pandemic overburdened primary care clinicians. For nurse practitioners (NPs) to alleviate the burden, the public must be willing to see an NP over a physician. Those with poor health tended to continue seeking care during the pandemic, suggesting that they may be willing to see an NP. Objective: The aim of this study is to evaluate the public's willingness to see an NP for primary care and how this may be associated with their beliefs about the local supply of physicians and self-rated health. Two studies were conducted: (1) a survey to identify correlations and (2) an experiment to assess how willingness is dependent on information about the local supply of physicians. Methods: The survey and experiment were conducted digitally in April and December 2020, respectively. Participants were US adults recruited from Amazon's Mechanical Turk platform. The key independent variables were self-rated health, which was a dichotomized 5-point scale (excellent, very good, good vs fair, and poor), and beliefs about local physician supply. The survey measured beliefs about local physician supply, while the experiment manipulated beliefs by altering information the participants read about the local supply of physicians. Willingness to see an NP was assessed in 2 ways. First as an overall preference over a physician and the second as a preference given 2 clinically significant scenarios in which participants imagined they were experiencing either coughing or a headache (presentation order randomized). Multiple regressions and ANOVAs were used to assess how beliefs about the local physician supply and self-rated health were associated with overall willingness to see an NP. Bivariate probits simultaneously estimated willingness to see an NP in the 2 clinically significant scenarios. Results: The survey showed that concerns about physician supply were associated with lower willingness to see an NP among respondents with comparatively better health but a greater willingness among respondents with comparatively worse health. The experiment suggests that only the latter is causal. For the 2 clinically significant scenarios, these patterns appeared for the coughing scenario in the survey and the headache scenario in the experiment. Conclusions: US adults with comparatively worse self-rated health become more willing to see an NP for primary care when they hear information that raises their concerns about the local physician supply. The differences between the survey and experiment results may be useful for interpreting findings from future studies. Findings may aid in managing finite health care resources during public health crises and crafting successful messaging by NP advocacy groups. Efforts to address nursing shortages will also be needed. ", doi="10.2196/38965", url="https://formative.jmir.org/2023/1/e38965", url="http://www.ncbi.nlm.nih.gov/pubmed/37347928" } @Article{info:doi/10.2196/40157, author="Chang, Yen-Jung and Chen, Jhong-Lin", title="Effectiveness of a Web-Based Intervention for Preventing Substance Use in Young Adults in Taiwan: Quasi-Experimental Study", journal="J Med Internet Res", year="2023", month="Aug", day="14", volume="25", pages="e40157", keywords="controlled substances", keywords="health education", keywords="illicit drugs", keywords="prevention", keywords="substance use", keywords="web-based intervention", keywords="young adults", abstract="Background: Substance use has been one of the most alarming public health problems worldwide, particularly among younger generations. Objective: This study evaluated the effectiveness of a web-based substance use prevention intervention targeted at adults aged 20-29 years. Methods: The intervention materials comprised 5 sets of infographics and 1 animation, all of which focused on mixed themes: (1) the concept of substance use and its harmful effects on health; (2) misinformation regarding new psychoactive substances; (3) regulation of illicit drugs, particularly marijuana; (4) the brain disease model of addiction; (5) critical thinking skills that improve health literacy; and (6) decision-making and communication skills that help people refuse illegal drugs. The study assigned eligible participants into experimental and control groups on the basis of the parity of their participant numbers. These participants completed web-based baseline and follow-up questionnaires that assessed their knowledge, behavioral intention, self-efficacy, and life skills related to substance use prevention. Knowledge was assessed using 8 questions concerning understanding of substance use harms and the regulation of illicit drugs. Behavioral intention and self-efficacy were assessed using 5-point Likert-type scales. Participants' ability to apply life skills to avoid substance use was assessed using 3 testing scenarios regarding substance use. The study used generalized estimating equations to examine the intervention's effectiveness. Results: A total of 1065 participants (539 control and 526 experimental) completed the intervention and questionnaires in 2019. The average ages of the experimental and control groups were 25.68 (SD 2.71) and 25.66 (SD 2.69) years, respectively. The study observed no significant differences in the demographic variables between the 2 groups. The results of the generalized estimating equation analyses indicated that the intervention significantly improved participants' knowledge (P<.001), behavioral intention (P<.001), and self-efficacy (P<.001) but not their life skills (P=.61) related to substance use prevention. Participants in the experimental group responded to a satisfaction survey with positive feedback on the intervention. Conclusions: The web-based intervention was effective in improving participants' knowledge, behavioral intention, and self-efficacy concerning substance use prevention. The findings support continued efforts to use web-based interventions to prevent substance use among young adults. ", doi="10.2196/40157", url="https://www.jmir.org/2023/1/e40157", url="http://www.ncbi.nlm.nih.gov/pubmed/37578821" } @Article{info:doi/10.2196/45384, author="Maul, Valeska Lara and Jahn, Sophie Anna and Pamplona, P. Gustavo S. and Streit, Markus and Gantenbein, Lorena and M{\"u}ller, Simon and Nielsen, Mia-Louise and Greis, Christian and Navarini, A. Alexander and Maul, Julia-Tatjana", title="Acceptance of Telemedicine Compared to In-Person Consultation From the Providers' and Users' Perspectives: Multicenter, Cross-Sectional Study in Dermatology", journal="JMIR Dermatol", year="2023", month="Aug", day="11", volume="6", pages="e45384", keywords="acceptance", keywords="patient", keywords="physician", keywords="satisfaction", keywords="teledermatology", abstract="Background: Teledermatology is currently finding its place in modern health care worldwide as a rapidly evolving field. Objective: The aim of this study was to investigate the acceptance of teledermatology compared to in-person consultation from the perspective of patients and professionals. Methods: This multicenter, cross-sectional pilot study was performed at secondary and tertiary referral centers of dermatology in Switzerland from August 2019 to January 2020. A customized questionnaire addressing demographics and educational data, experience with telemedicine, and presumed willingness to replace in-patient consultations with teledermatology was completed by dermatological patients, dermatologists, and health care workers in dermatology. Results: Among a total of 664 participants, the ones with previous telemedicine experience (171/664, 25.8\%) indicated a high level of overall experience with it (patients: 73/106, 68.9\%, dermatologists: 6/8, 75.0\%, and health care workers: 27/34, 79.4\%). Patients, dermatologists, and health care workers were most likely willing to replace in-person consultations with teledermatology for minor health issues (353/512, 68.9\%; 37/45, 82.2\%; and 89/107, 83.2\%, respectively). We observed a higher preference for telemedicine among individuals who have already used telemedicine (patients: P<.001, dermatologists: P=.03, and health care workers, P=.005), as well as among patients with higher educational levels (P=.003). Conclusions: This study indicates that the preference for teledermatology has a high potential to increase over time since previous experience with telemedicine and a higher level of education were associated with a higher willingness to replace in-patient consultations with telemedicine. We assume that minor skin problems are the most promising issue in teledermatology. Our findings emphasize the need for dermatologists to be actively involved in the transition to teledermatology. Trial Registration: ClinicalTrials.gov NCT04495036; https://classic.clinicaltrials.gov/ct2/show/NCT04495036 ", doi="10.2196/45384", url="https://derma.jmir.org/2023/1/e45384", url="http://www.ncbi.nlm.nih.gov/pubmed/37582265" } @Article{info:doi/10.2196/40003, author="Long, Memphis and Forbes, E. Laura and Papagerakis, Petros and Lieffers, L. Jessica R.", title="YouTube Videos on Nutrition and Dental Caries: Content Analysis", journal="JMIR Infodemiology", year="2023", month="Aug", day="10", volume="3", pages="e40003", keywords="dental caries", keywords="diet", keywords="nutrition", keywords="YouTube", keywords="internet", keywords="consumer health information", abstract="Background: Dental caries is the most common health condition worldwide, and nutrition and dental caries have a strong interconnected relationship. Foods and eating behaviors can be both harmful (eg, sugar) and healthful (eg, meal spacing) for dental caries. YouTube is a popular source for the public to access information. To date, there is no information available on the nutrition and dental caries content of easily accessible YouTube videos. Objective: This study aimed to analyze the content of YouTube videos on nutrition and dental caries. Methods: In total, 6 YouTube searches were conducted using keywords related to nutrition and dental caries. The first 20 videos were selected from each search. Video content was scored (17 possible points; higher scores were associated with more topics covered) by 2 individuals based on the inclusion of information regarding various foods and eating behaviors that impact dental caries risk. For each video, information on video characteristics (ie, view count, length, number of likes, number of dislikes, and video age) was captured. Videos were divided into 2 groups by view rate (views/day); differences in scores and types of nutrition messages between groups were determined using nonparametric statistics. Results: In total, 42 videos were included. Most videos were posted by or featured oral health professionals (24/42, 57\%). The mean score was 4.9 (SD 3.4) out of 17 points. Videos with >30 views/day (high view rate; 20/42, 48\% videos) had a trend toward a lower score (mean 4.0, SD 3.7) than videos with ?30 views/day (low view rate; 22/42, 52\%; mean 5.8, SD 3.0; P=.06), but this result was not statistically significant. Sugar was the most consistently mentioned topic in the videos (31/42, 74\%). No other topics were mentioned in more than 50\% of videos. Low--view rate videos were more likely to mention messaging on acidic foods and beverages (P=.04), water (P=.09), and frequency of sugar intake (P=.047) than high--view rate videos. Conclusions: Overall, the analyzed videos had low scores for nutritional and dental caries content. This study provides insights into the messaging available on nutrition and dental caries for the public and guidance on how to make improvements in this area. ", doi="10.2196/40003", url="https://infodemiology.jmir.org/2023/1/e40003", url="http://www.ncbi.nlm.nih.gov/pubmed/37561564" } @Article{info:doi/10.2196/43959, author="Bul, Kim and Holliday, Nikki and Bhuiyan, Alam Mohammad Rashed and Clark, T. Cain C. and Allen, John and Wark, A. Petra", title="Usability and Preliminary Efficacy of an Artificial Intelligence--Driven Platform Supporting Dietary Management in Diabetes: Mixed Methods Study", journal="JMIR Hum Factors", year="2023", month="Aug", day="9", volume="10", pages="e43959", keywords="nutrition and dietetics", keywords="general diabetes", keywords="qualitative research", keywords="preventive medicine", keywords="web technology", keywords="self-management", keywords="diabetes", keywords="nutrition", keywords="deep learning", keywords="artificial", keywords="mobile phone", abstract="Background: Nutrition plays an important role in diabetes self-management. Web-based diabetes care, driven by artificial intelligence (AI), enables more personalized care. Objective: This study aimed to examine the usability and preliminary efficacy of a web-based AI-driven nutrition platform to support people with diabetes and their carers in identifying healthy recipes, meal planning, and web-based shopping. Methods: Diabetes UK signposted people with diabetes and their carers to the platform's study-specific portal through its website, social media, and newsletters. A total of 73 adult participants with prediabetes or diabetes or their carers completed the baseline web-based survey. Of these 73 participants, 23 (32\%) completed a web-based survey after 8 weeks of platform use. Web-based semistructured interviews were conducted with platform users (7/23, 30\%) who agreed to be followed up and diabetes experts (n=3) who had nutrition and platform knowledge. The intervention consists of a web-based platform that incorporates AI to personalize recipes, meal planning, and shopping list experiences and was made available for 8 weeks. Baseline characteristics, satisfaction, system usability, and diabetes-related and general health indicators were assessed before and after using the platform for 8 weeks. Results: Reductions in weight (mean difference 4.5 kg/m2, 95\% CI 1.0-12.0; P=.009; Cliff $\delta$=0.33) and waist size (mean difference 3.9 cm, 95\% CI 2.0-6.5; P=.008; Cliff $\delta$=0.48) were found. Most of the participants (151/217, 69.6\%) did not regularly use the platform and had low or very low engagement scores. However, the platform was perceived as accessible with no need for additional assistance (11/21, 52\%), user-friendly (8/21, 38\%), and easy to use (8/21, 38\%), regardless of some usability issues. Saving recipes was the most popular feature, with 663 saved recipes. Conclusions: This study indicated that the usability of the nutrition platform was well perceived by users and their carers. As participants managed their diabetes well, adding an education component would be specifically relevant for people less familiar with the role of diet in diabetes management. To assess the platform's effectiveness in improving diabetes-related health indicators, controlled studies with a larger and more diverse participant sample are recommended. ", doi="10.2196/43959", url="https://humanfactors.jmir.org/2023/1/e43959", url="http://www.ncbi.nlm.nih.gov/pubmed/37556198" } @Article{info:doi/10.2196/46434, author="Amiri, Maryam and Li, Juan and Hasan, Wordh", title="Personalized Flexible Meal Planning for Individuals With Diet-Related Health Concerns: System Design and Feasibility Validation Study", journal="JMIR Form Res", year="2023", month="Aug", day="3", volume="7", pages="e46434", keywords="diabetes", keywords="fuzzy logic", keywords="meal planning", keywords="multicriteria decision-making", keywords="optimization", abstract="Background: Chronic diseases such as heart disease, stroke, diabetes, and hypertension are major global health challenges. Healthy eating can help people with chronic diseases manage their condition and prevent complications. However, making healthy meal plans is not easy, as it requires the consideration of various factors such as health concerns, nutritional requirements, tastes, economic status, and time limits. Therefore, there is a need for effective, affordable, and personalized meal planning that can assist people in choosing food that suits their individual needs and preferences. Objective: This study aimed to design an artificial intelligence (AI)--powered meal planner that can generate personalized healthy meal plans based on the user's specific health conditions, personal preferences, and status. Methods: We proposed a system that integrates semantic reasoning, fuzzy logic, heuristic search, and multicriteria analysis to produce flexible, optimized meal plans based on the user's health concerns, nutrition needs, as well as food restrictions or constraints, along with other personal preferences. Specifically, we constructed an ontology-based knowledge base to model knowledge about food and nutrition. We defined semantic rules to represent dietary guidelines for different health concerns and built a fuzzy membership of food nutrition based on the experience of experts to handle vague and uncertain nutritional data. We applied a semantic rule-based filtering mechanism to filter out food that violate mandatory health guidelines and constraints, such as allergies and religion. We designed a novel, heuristic search method that identifies the best meals among several candidates and evaluates them based on their fuzzy nutritional score. To select nutritious meals that also satisfy the user's other preferences, we proposed a multicriteria decision-making approach. Results: We implemented a mobile app prototype system and evaluated its effectiveness through a use case study and user study. The results showed that the system generated healthy and personalized meal plans that considered the user's health concerns, optimized nutrition values, respected dietary restrictions and constraints, and met the user's preferences. The users were generally satisfied with the system and its features. Conclusions: We designed an AI-powered meal planner that helps people create healthy and personalized meal plans based on their health conditions, preferences, and status. Our system uses multiple techniques to create optimized meal plans that consider multiple factors that affect food choice. Our evaluation tests confirmed the usability and feasibility of the proposed system. However, some limitations such as the lack of dynamic and real-time updates should be addressed in future studies. This study contributes to the development of AI-powered personalized meal planning systems that can support people's health and nutrition goals. ", doi="10.2196/46434", url="https://formative.jmir.org/2023/1/e46434", url="http://www.ncbi.nlm.nih.gov/pubmed/37535413" } @Article{info:doi/10.2196/44733, author="Pang, Cheong-Iao Patrick and Munsie, Megan and Chang, Shanton and Tanner, Claire and Walker, Christine", title="Participatory Design and Evaluation of the ``Stem Cells Australia'' Website for Delivering Complex Health Knowledge: Mixed Methods Study", journal="J Med Internet Res", year="2023", month="Jul", day="20", volume="25", pages="e44733", keywords="stem cells", keywords="health websites", keywords="health information--seeking behavior", keywords="complex health information", keywords="participatory design", keywords="public health", abstract="Background: The internet has become a commonly used information source for people seeking to understand their health care options. However, inconsistent representation about what stem cell treatments are available and from whom, coupled with the lack of transparency about what has been shown to work or is even safe, can distract and mislead users. Given these challenges, there is a need to develop effective evidence-based tools for delivering information about health care options involving stem cells. Objective: A need to redesign an existing website in Australia was identified to provide trustworthy information about stem cell research and to counter misinformation. Using a participatory design approach to generate an understanding of what information users need for stem cell treatments, the Stem Cells Australia website serves as a case study for the development and evaluation of websites delivering complex messages about science and health. Methods: This study comprised 3 steps. First, a focus group and several one-on-one interviews with a purposive sample of users (n=12) were conducted to identify their needs and requirements. Second, we designed a new version of the website based on findings from the focus group and interviews. Finally, for evaluating the participatory design process, we collected 180 days of Google Analytics data for both the original and redesigned versions (90 days for each) and compared their differences using 2-sample z tests. Results: The feedback from participants was grouped into 3 themes---needed and unwanted information, how and where to obtain information, and their information preferences. These were translated into requirements for rebuilding the website. The redesigned version reached users in other continents, despite the daily numbers of users (?61.2\%; P<.001) and sessions (?61.7\%; P<.001) decreasing. The redesigned version also showed substantial decrease in daily bounce rate (?97.2\%; P<.001), significant increase in the daily average of page reads per session (+110.8\%; P<.001), and long daily average for session duration (+22.9\%; P=.045). Navigation flow analysis showed more traffic toward web pages related to health conditions in the redesigned version. Conclusions: Websites about stem cell research need to provide content for vulnerable global audiences. Participatory design that addresses knowledge gaps and information needs can produce better performance and engagement, which can be evaluated using Google Analytics, a common web analytics tool used by many websites. Learnings for improving the metrics regarding website identity, research updates, and clinical trials are concluded, which can inform the future design of websites seeking to engage users and provide reliable and accessible science and health information including but not limited to stem cell research and therapies. ", doi="10.2196/44733", url="https://www.jmir.org/2023/1/e44733", url="http://www.ncbi.nlm.nih.gov/pubmed/37471121" } @Article{info:doi/10.2196/47934, author="Yune, Jung So and Kim, Youngjon and Lee, Woog Jea", title="Data Analysis of Physician Competence Research Trend: Social Network Analysis and Topic Modeling Approach", journal="JMIR Med Inform", year="2023", month="Jul", day="19", volume="11", pages="e47934", keywords="physician competency", keywords="research trend", keywords="competency-based education", keywords="professionalism", keywords="topic modeling", keywords="latent Dirichlet allocation", keywords="LDA algorithm", keywords="data science", keywords="social network analysis", abstract="Background: Studies on competency in medical education often explore the acquisition, performance, and evaluation of particular skills, knowledge, or behaviors that constitute physician competency. As physician competency reflects social demands according to changes in the medical environment, analyzing the research trends of physician competency by period is necessary to derive major research topics for future studies. Therefore, a more macroscopic method is required to analyze the core competencies of physicians in this era. Objective: This study aimed to analyze research trends related to physicians' competency in reflecting social needs according to changes in the medical environment. Methods: We used topic modeling to identify potential research topics by analyzing data from studies related to physician competency published between 2011 and 2020. We preprocessed 1354 articles and extracted 272 keywords. Results: The terms that appeared most frequently in the research related to physician competency since 2010 were knowledge, hospital, family, job, guidelines, management, and communication. The terms that appeared in most studies were education, model, knowledge, and hospital. Topic modeling revealed that the main topics about physician competency included Evidence-based clinical practice, Community-based healthcare, Patient care, Career and self-management, Continuous professional development, and Communication and cooperation. We divided the studies into 4 periods (2011-2013, 2014-2016, 2017-2019, and 2020-2021) and performed a linear regression analysis. The results showed a change in topics by period. The hot topics that have shown increased interest among scholars over time include Community-based healthcare, Career and self-management, and Continuous professional development. Conclusions: On the basis of the analysis of research trends, it is predicted that physician professionalism and community-based medicine will continue to be studied in future studies on physician competency. ", doi="10.2196/47934", url="https://medinform.jmir.org/2023/1/e47934", url="http://www.ncbi.nlm.nih.gov/pubmed/37467028" } @Article{info:doi/10.2196/45501, author="Andersson, Susanne and Scandurra, Isabella and Nystr{\"o}m, Ulrika and Varemo, Marika and Hellstrand Tang, Ulla", title="Experiences of a Novel Structured Foot Examination Form for Patients With Diabetes From the Perspective of Health Care Professionals: Qualitative Study", journal="JMIR Nursing", year="2023", month="Jul", day="18", volume="6", pages="e45501", keywords="diabetes", keywords="foot ulcer", keywords="prevention", keywords="primary health care", keywords="qualitative research", keywords="structured foot examination", keywords="validation", keywords="user experiences", keywords="participatory design", abstract="Background: Diabetes is a growing threat to public health, and secondary diseases like foot complications are common. Foot ulcers affect the individual's quality of life and are a great cost to society. Regular foot examinations prevent foot ulcers and are a recommended approach both in Sweden and worldwide. Despite existing guidelines, there are differences in the execution of the foot examination, which results in care inequality. A structured foot examination form based on current guidelines was developed in this study as the first step toward digitalized support in the daily routine, and was validated by diabetes health care professionals. Objective: The study aimed to validate a structured foot examination form by assessing health care professionals' experiences of working with it ``foot side'' when examining patients with diabetes. Methods: Semistructured interviews were held in a focus group and individually with 8 informants from different diabetes professions, who were interviewed regarding their experiences of working with the form in clinical practice. The users' data were analyzed inductively using qualitative content analysis. The study is part of a larger project entitled ``Optimised care of persons with diabetes and foot complications,'' with V{\"a}stra G{\"o}taland Region as the responsible health care authority, where the results will be further developed. Results: Experiences of working with the form were that it simplified the foot examination by giving it an overview and a clear structure. Using the form made differences in work routines between individuals apparent. It was believed that implementing the form routinely would contribute to a more uniform execution. When patients had foot ulcers, the risk categories (established in guidelines) were perceived as contradictory. For example, there was uncertainty about the definition of chronic ulcers and callosities. The expectations were that the future digital format would simplify documentation and elucidate the foot examination, as well as contribute to the accessibility of updated and relevant data for all individuals concerned. Conclusions: The foot examination form works well as a support tool during preventive foot examination, creates a basis for decision-making, and could contribute to a uniform and safer foot examination with more care equality in agreement with current guidelines. Trial Registration: ClinicalTrials.gov NCT05692778; https://clinicaltrials.gov/ct2/show/NCT05692778 ", doi="10.2196/45501", url="https://nursing.jmir.org/2023/1/e45501", url="http://www.ncbi.nlm.nih.gov/pubmed/37463012" } @Article{info:doi/10.2196/40616, author="Schulz, Johannes Peter and Crosignani, Francesca and Petrocchi, Serena", title="Critical Test of the Beneficial Consequences of Lifting the Ban on Direct-to-Consumer Advertising for Prescription Drugs in Italy: Experimental Exposure and Questionnaire Study", journal="J Med Internet Res", year="2023", month="Jul", day="17", volume="25", pages="e40616", keywords="eDTCA", keywords="health literacy", keywords="knowledge", keywords="empowerment", keywords="health information", keywords="antidepressant", keywords="depression", keywords="depressive disorder", keywords="pharmaceutical", keywords="advertise", keywords="advertising", keywords="drug", keywords="marketing", keywords="patient education", keywords="consumer", keywords="health education", abstract="Background: There are only two countries in the world (the United States and New Zealand) that allow the pharmaceutical branch to advertise prescription medication directly to consumers. There is pressure on governments to allow direct-to-consumer advertising (DTCA) for prescription drugs elsewhere too. One argument the industry uses frequently is the claim that exposure to DCTA, through various methods and occasions, is supposed to improve customers' knowledge of a disease and treatment. This argument has been part of the health care community's wider discussion of whether DTCA of prescription drugs benefits the population's general interest or is only an attempt to increase the sales of the pharmaceutical branch. Belief in true learning by DTCA is rooted in concepts of empowered consumers and their autonomous and empowered decision-making. Objective: In this study, we tested the hypotheses that contact with DTCA increases recipients' literacy/knowledge, especially regarding the side effects of treatment (hypothesis 1), and empowerment (hypothesis 2). We further hypothesized that DTCA exposure would not increase depression knowledge (ie, about treatments, symptoms, and prevalence) (hypothesis 3). Methods: A snowball sample of 180 participants was randomly split into three experimental groups receiving (1) a traditional information sheet, (2) a DTCA video clip for an antidepressant prescription drug, or (3) both. The video was original material from the United States translated into Italian for the experiment. Dependent variables were measures of depression knowledge (regarding treatments, symptoms and prevalence, and antidepressant side effects), depression literacy, and empowerment. Results: None of the experimental groups differed significantly from the others in the empowerment measure (hypothesis 2 not confirmed). Partial confirmation of hypothesis 1 was obtained. Lower values on the depression literacy scale were obtained when participants had been given the video compared to the sheet condition. However, the general depression knowledge and its subscale on side effects reached higher scores when participants were exposed to the DTCA, alone or in combination with the information sheet. Finally, participants showed lower scores on knowledge about treatment and symptoms or prevalence after watching the video compared to the sheet condition (hypothesis 3 confirmed). Symptoms and prevalence knowledge increased only when the video was presented in combination with the sheet. Conclusions: There is no evidence for an increase in empowerment following DTCA exposure. An increase in knowledge of the side effects of the medication was observed in the group exposed to the DTCA video. This was the only result that confirmed the hypothesis of the beneficial effect of DTCA videos on knowledge. Written information proved to be the most suitable way to convey knowledge on treatments and symptoms prevalence. Our findings support the necessity of studying health literacy and patient empowerment together and the consequences of such an increase in knowledge in terms of help-seeking behavior. ", doi="10.2196/40616", url="https://www.jmir.org/2023/1/e40616", url="http://www.ncbi.nlm.nih.gov/pubmed/37459159" } @Article{info:doi/10.2196/37140, author="Gardiner, Heather and Siminoff, Laura and Gordon, J. Elisa and Alolod, Gerard and Richardson, Briana and Schupler, Melanie and Benitez, Amanda and Hernandez, Ilda and Guinansaca, Nancy and Ramos, Lori and Bergeron, D. Caroline and Pappaterra, Lianette and Norden, Robert and Daly, Theresa", title="Direct and Indirect Effects of a Web-Based Educational and Communication Skills Intervention ``Promotoras de Donaci{\'o}n'' to Increase Donor Designation in Latinx Communities: Evaluation Study", journal="J Med Internet Res", year="2023", month="Jul", day="10", volume="25", pages="e37140", keywords="Latinx", keywords="Latino", keywords="Latina", keywords="Spanish", keywords="Hispanic organ donation", keywords="organ donor", keywords="donor registration", keywords="donor designation", keywords="education", keywords="e-learning", keywords="digital learning", keywords="promotoras", keywords="program evaluation", keywords="community outreach", keywords="community engagement", keywords="awareness", abstract="Background: Latinx populations are severely underrepresented among organ donors compared with the non-Hispanic White population. The Promotoras de Donaci{\'o}n e-learning module was developed to train Latinx lay health educators (ie, promotoras) to discuss deceased organ donation and promote donor designation within their communities. Objective: This paper described the results of 2 studies designed to assess the direct and indirect effects of the module on promotoras' and mature Latinas' organ donation and donor designation knowledge, attitudes, and behaviors. Methods: In partnership with 4 community-based promotoras organizations, we designed 2 nonrandomized, quasiexperimental pragmatic studies to evaluate the Promotoras de Donaci{\'o}n e-learning module, with participating promotoras and mature Latinas serving as their own controls. Brief surveys were administered to participating promotoras before and after module completion to assess changes in organ donation knowledge and support and communication confidence (study 1). Promotoras participating in the first study were asked to hold at least 2 group conversations about organ donation and donor designation with mature Latinas (study 2); paper-pencil surveys were completed by all participants before and after the group conversations. Descriptive statistics, means and SDs, and counts and percentages were used as appropriate to categorize the samples. Paired sample 2-tailed t test was used to assess changes in knowledge of and support for organ donation and confidence in discussing donation and promoting donor designation from pre- to posttest. Results: Overall, 40 promotoras completed this module (study 1). Increases in organ donation knowledge (mean 6.0, SD 1.9 to mean 6.2, SD 2.9) and support (mean 3.4, SD 0.9 to mean 3.6, SD 0.9) were observed from pre- to posttest; however, these changes did not reach statistical significance. A statistically significant increase in communication confidence was found (mean 692.1, SD 232.4 to mean 852.3, SD 139.7; P=.01). The module was well received, with most participants deeming it well organized, presenting new information, and providing realistic and helpful portrayals of donation conversations. A total of 52 group discussions with 375 attendees were led by 25 promotoras (study 2). The trained promotora-led group discussions about organ donation resulted in increased support for organ donation in promotoras and mature Latinas from pre- to posttest. Knowledge of the steps to become an organ donor and belief that the process is easy to perform increased in mature Latinas from pre- to posttest by 30.7\% and 15.2\%, respectively. In total, 5.6\% (21/375) of attendees submitted completed organ donation registration forms. Conclusions: This evaluation provides preliminary support for the module's direct and indirect effects on organ donation knowledge, attitudes, and behaviors. The need for additional modifications to and future evaluations of the module are discussed. ", doi="10.2196/37140", url="https://www.jmir.org/2023/1/e37140", url="http://www.ncbi.nlm.nih.gov/pubmed/37428526" } @Article{info:doi/10.2196/42551, author="Turnbull, Sophie and Walsh, E. Nicola and Moore, J. Andrew", title="Adaptation and Implementation of a Shared Decision-Making Tool From One Health Context to Another: Partnership Approach Using Mixed Methods", journal="J Med Internet Res", year="2023", month="Jul", day="5", volume="25", pages="e42551", keywords="shared decision-making", keywords="implementation", keywords="theoretical domains framework", keywords="qualitative", keywords="osteoarthritis", keywords="digital", keywords="mixed methods study", keywords="decision-making", keywords="disability", keywords="treatment", keywords="tool", keywords="effectiveness", keywords="acceptability", keywords="users", keywords="design", abstract="Background: Osteoarthritis is a leading cause of pain and disability. Knee osteoarthritis accounts for nearly four-fifths of the burden of osteoarthritis internationally, and 10\% of adults in the United Kingdom have the condition. Shared decision-making (SDM) supports patients to make more informed choices about treatment and care while reducing inequities in access to treatment. We evaluated the experience of a team adapting an SDM tool for knee osteoarthritis and the tool's implementation potential within a local clinical commissioning group (CCG) area in southwest England. The tool aims to prepare patients and clinicians for SDM by providing evidence-based information about treatment options relevant to disease stage. Objective: This study aimed to explore the experiences of a team adapting an SDM tool from one health context to another and the implementation potential of the tool in the local CCG area. Methods: A partnership approach using mixed methods was used to respond to recruitment challenges and ensure that study aims could be addressed within time restrictions. A web-based survey was used to obtain clinicians' feedback on experiences of using the SDM tool. Qualitative interviews were conducted by telephone or video call with a sample of stakeholders involved in adapting and implementing the tool in the local CCG area. Survey findings were summarized as frequencies and percentages. Content analysis was conducted on qualitative data using framework analysis, and data were mapped directly to the Theoretical Domains Framework (TDF). Results: Overall, 23 clinicians completed the survey, including first-contact physiotherapists (11/23, 48\%), physiotherapists (7/23, 30\%), specialist physiotherapists (4/23, 17\%), and a general practitioner (1/23, 4\%). Eight stakeholders involved in commissioning, adapting, and implementing the SDM tool were interviewed. Participants described barriers and facilitators to the adaptation, implementation, and use of the tool. Barriers included a lack of organizational culture that supported and resourced SDM, lack of clinician buy-in and awareness of the tool, challenges with accessibility and usability, and lack of adaptation for underserved communities. Facilitators included the influence of clinical leaders' belief that SDM tools can improve patient outcomes and National Health Service resource use, clinicians' positive experiences of using the tool, and improving awareness of the tool. Themes were mapped to 13 of the 14 TDF domains. Usability issues were described, which did not map to the TDF domains. Conclusions: This study highlights barriers and facilitators to adapting and implementing tools from one health context to another. We recommend that tools selected for adaptation should have a strong evidence base, including evidence of effectiveness and acceptability in the original context. Legal advice should be sought regarding intellectual property early in the project. Existing guidance for developing and adapting interventions should be used. Co-design methods should be applied to improve adapted tools' accessibility and acceptability. ", doi="10.2196/42551", url="https://www.jmir.org/2023/1/e42551", url="http://www.ncbi.nlm.nih.gov/pubmed/37405845" } @Article{info:doi/10.2196/40477, author="Yeung, Anna and Lisk, Ryan and Rana, Jayoti and Guiang, B. Charlie and Bacon, Jean and Brunetta, Jason and Gilbert, Mark and Gesink, Dionne and Grewal, Ramandip and Kwag, Michael and Logie, H. Carmen and Mitterni, Leo and Shahin, Rita and Tan, HS Darrell and Burchell, N. Ann", title="Community and Health Care Provider Preferences for Bacterial Sexually Transmitted Infection Testing Interventions for Gay, Bisexual, and Other Men Who Have Sex With Men: e-Delphi Study", journal="J Med Internet Res", year="2023", month="Jun", day="29", volume="25", pages="e40477", keywords="sexual and gender minorities", keywords="sexually transmitted diseases", keywords="community-based research", keywords="mass screening", keywords="patient acceptance of health care", abstract="Background: Canadian clinical guidelines recommend at least annual and up to quarterly bacterial sexually transmitted infection (STI) testing among sexually active gay, bisexual, and other men who have sex with men (GBM). However, testing rates are suboptimal. Innovative solutions are needed to close the gap because there is currently limited knowledge on how best to approach this issue. Objective: Our aim was to build consensus regarding interventions with the greatest potential for improving local STI testing services for GBM communities in Toronto, Ontario, Canada, using a web-based e-Delphi process. Methods: The e-Delphi method involves using a panel format to conduct successive rounds of prioritization, with feedback between rounds, to determine priorities among groups. We recruited experts separately from the community (GBM who sought or underwent STI testing in the preceding 18 months; conducted between October 2019 and November 2019) and health care providers (those who offered STI testing to GBM in the past 12 months; conducted between February 2020 and May 2020). The experts prioritized 6 to 8 potential interventions on a 7-point Likert scale ranging from definitely not a priority to definitely a priority over 3 survey rounds and ranked their top 3 interventions. Consensus was defined as ?60\% within a {\textpm}1 response point. Summaries of responses were provided in successive rounds. We reported the percentage of a priority (encompassing somewhat a priority, a priority, and definitely a priority responses) at the end of the final round of the survey. Results: Of the community experts (CEs), 84\% (43/51) completed all rounds; 19\% (8/43) were living with HIV; 37\% (16/43) were HIV negative and on pre-exposure prophylaxis; and 42\% (18/43) were HIV negative and not on pre-exposure prophylaxis. We reached consensus on 6 interventions: client reminders (41/43, 95\%), express testing (38/43, 88\%), routine testing (36/43, 84\%), an online booking app (36/43, 84\%), online-based testing (33/43, 77\%), and nurse-led testing (31/43, 72\%). The CEs favored convenient interventions that also maintain a relationship with their provider. Of the provider experts (PEs), 77\% (37/48) completed all rounds; 59\% (22/37) were physicians. Consensus was reached on the same 6 interventions (range 25/37, 68\%, to 39/39, 100\%) but not for provider alerts (7/37, 19\%) and provider audit and feedback (6/37, 16\%). Express testing, online-based testing, and nurse-led testing were prioritized by >95\% (>37/39) of the PEs by the end of round 2 because of streamlined processes and decreased need to see a provider. Conclusions: Both panels were enthusiastic about innovations that make STI testing more efficient, with express testing rating highly in both the prioritizations and top 3 rankings. However, CEs preferred convenient interventions that involved their provider, whereas PEs favored interventions that prioritized patient independence and reduced patient-provider time. International Registered Report Identifier (IRRID): RR2-10.2196/13801 ", doi="10.2196/40477", url="https://www.jmir.org/2023/1/e40477", url="http://www.ncbi.nlm.nih.gov/pubmed/37384393" } @Article{info:doi/10.2196/40802, author="Squires, A. Natalie and Soyemi, Elizabeth and Yee, M. Lynn and Birch, M. Eleanor and Badreldin, Nevert", title="Content Quality of YouTube Videos About Pain Management After Cesarean Birth: Content Analysis", journal="JMIR Infodemiology", year="2023", month="Jun", day="23", volume="3", pages="e40802", keywords="health information", keywords="internet", keywords="YouTube", keywords="cesarean section", keywords="cesarean", keywords="C-section", keywords="postpartum", keywords="social media", keywords="web-based video", keywords="maternal", keywords="postnatal", keywords="pain", keywords="systematic search", keywords="patient education", keywords="information quality", keywords="accuracy", keywords="credibility", keywords="health education", keywords="educational video", keywords="education resource", keywords="health video", abstract="Background: YouTube is an increasingly common source of health information; however, the reliability and quality of the information are inadequately understood. Several studies have evaluated YouTube as a resource during pregnancy and found the available information to be of poor quality. Given the increasing attention to postpartum health and the importance of promoting safe opioid use after birth, YouTube may be a source of information for birthing individuals. However, little is known about the available information on YouTube regarding postpartum pain. Objective: The purpose of this study is to systematically evaluate the quality of YouTube videos as an educational resource for postpartum cesarean pain management. Methods: A systematic search of YouTube videos was conducted on June 25, 2021, using 36 postpartum cesarean pain management--related keywords, which were identified by clinical experts. The search replicated a default YouTube search via a public account. The first 60 results from each keyword search were reviewed, and unique videos were analyzed. An overall content score was developed based on prior literature and expert opinion to evaluate the video's relevance and comprehensiveness. The DISCERN instrument, a validated metric to assess consumer health information, was used to evaluate the reliability of video information. Videos with an overall content score of ?5 and a DISCERN score of ?39 were classified as high-quality health education resources. Descriptive analysis and intergroup comparisons by video source and quality were conducted. Results: Of 73 unique videos, video sources included medical videos (n=36, 49\%), followed by personal video blogs (vlogs; n=32, 44\%), advertisements (n=3, 4\%), and media (n=2, 3\%). The average overall content score was 3.6 (SD 2.0) out of 9, and the average DISCERN score was 39.2 (SD 8.1) out of 75, indicating low comprehensiveness and fair information reliability, respectively. High-quality videos (n=22, 30\%) most frequently addressed overall content regarding pain duration (22/22, 100\%), pain types (20/22, 91\%), return-to-activity instructions (19/22, 86\%), and nonpharmacologic methods for pain control (19/22, 86\%). There were differences in the overall content score (P=.02) by video source but not DISCERN score (P=.45). Personal vlogs had the highest overall content score at 4.0 (SD 2.1), followed by medical videos at 3.3 (SD 2.0). Longer video duration and a greater number of comments and likes were significantly correlated with the overall content score, whereas the number of video comments was inversely correlated with the DISCERN score. Conclusions: Individuals seeking information from YouTube regarding postpartum cesarean pain management are likely to encounter videos that lack adequate comprehensiveness and reliability. Clinicians should counsel patients to exercise caution when using YouTube as a health information resource. ", doi="10.2196/40802", url="https://infodemiology.jmir.org/2023/1/e40802", url="http://www.ncbi.nlm.nih.gov/pubmed/37351938" } @Article{info:doi/10.2196/46575, author="Brehon, Katelyn and MacIsaac, Rob and Bhatia, Zahra and Buck, Taryn and Charbonneau, Rebecca and Crochetiere, Steven and Donia, Scott and Daoust, Jason and Ho, Chester and Kainth, Hardeep and Loewen, Janee and Lorch, Brandice and Mastrodimos, Kiesha and Neunzig, Brittney and Papathanassoglou, Elizabeth and Parmar, Rajvir and Pohar Manhas, Kiran and Tenove, Terry and Velji, Elysha and Loyola-Sanchez, Adalberto", title="Outcomes of Implementing a Webinar-Based Strategy to Improve Spinal Cord Injury Knowledge and Community Building: Convergent Mixed Methods Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Jun", day="23", volume="10", pages="e46575", keywords="spinal cord injury", keywords="telehealth", keywords="webinars", keywords="mixed methods", keywords="implementation", abstract="Background: COVID-19 disrupted services received by persons with spinal cord injury (SCI) worldwide. The International Disability Alliance declared the need for a disability-inclusive response to the COVID-19 crisis, as decreased access to health care services for individuals living with varying levels of function was unacceptable. As a result, an SCI community in Canada created a novel webinar-based strategy aimed at improving access to self-management information for people living with SCI and other stakeholders. However, although telehealth practices have previously been used effectively in SCI management and rehabilitation, little to no scholarship has investigated the outcomes of implementing a webinar-based telehealth strategy in this population. Objective: This study aims to understand the outcomes of implementing the webinar series. Specifically, the authors aimed to determine the reach of the series; understand its impact on social connectedness, perceptions of disability, and overall quality of interactions among persons with SCI, their families, service providers, and the public at large; and explore the long-term sustainability of the initiative. Methods: The authors implemented a community-based participatory strategy to define a convergent mixed methods design to triangulate qualitative and quantitative data collected simultaneously. Quantitative methods included pop-up questions administered during the live webinars, surveys administered following webinars, and an analysis of YouTube analytics. Qualitative methods included semistructured interviews with persons with SCI and health care providers who attended at least one webinar. The results were integrated, following methods adapted from Creswell and Clark. Results: A total of 234 individuals attended at least 1 of the 6 webinars that took place during the 6-month study period. In total, 13.2\% (31/234) of the participants completed the postwebinar survey, and 23\% (7/31) participated in the semistructured interviews. The reach of the webinar series was mainly to persons with SCI, followed by health professionals, with most of them living in urban areas. The topics sexuality and research were the most viewed on YouTube. The knowledge disseminated during the webinars was mainly perceived as valid and useful, related to the fact that the presentation format involved people with lived experience and clinical experts. The webinars did not necessarily help build a new extended community of people involved in SCI but helped strengthen the existing community of people with SCI in Alberta. The webinar positively influenced the perceptions of normality and disability regarding people with SCI. The webinar format was perceived as highly usable and accessible. Conclusions: The webinar series was associated with improved participant knowledge of what is possible to achieve after an SCI and their perceptions of disability. The long-term implementation of this initiative is feasible, but further considerations to increase its reach to rural areas and ensure the integration of diverse individuals should be taken. ", doi="10.2196/46575", url="https://rehab.jmir.org/2023/1/e46575", url="http://www.ncbi.nlm.nih.gov/pubmed/37351945" } @Article{info:doi/10.2196/47524, author="Tsimicalis, Argerie and Stinson, Jennifer and Thorstad, Kelly and Rauch, Frank and Hamdy, Reggie and Chougui, Khadidja and Addab, Sofia and Palomo, Telma and Bernstein, Mitchell and Dahan-Oliel, Noemi and Veilleux, Louis-Nicolas and Massochin Nunes Pinto, Laura and Passos dos Santos, Raissa", title="The Design, Development, and Usability Testing of an eHealth Program for Youths With Osteogenesis Imperfecta: Protocol for a 2-Phase User-Centered Mixed Methods Study", journal="JMIR Res Protoc", year="2023", month="Jun", day="23", volume="12", pages="e47524", keywords="eHealth program", keywords="osteogenesis imperfecta", keywords="self-management", keywords="youth", keywords="transition of care", abstract="Background: Innovative approaches are needed to address the self-management needs of youths with osteogenesis imperfecta (OI) transitioning into adult-oriented health care systems. Using a sequentially phased research approach, the goal is to design, develop, and test the usability of an innovative eHealth program called ``Teens Taking Charge: Managing OI Online,'' hereafter named ``Teens OI.'' This program seeks to optimize self-management, facilitate a successful transition to adult care, and address a critical gap in the quality of care for youths with OI. Objective: The study objectives are to (1) design and develop an English and French version of the Teens OI and (2) test the usability of the Teens OI in terms of efficiency, effectiveness, and satisfaction from the perspectives of youths with OI and their parents. Methods: A user-centered design is presently in progress to design and develop Teens OI. A ``Website Design and Development Council'' (ie, Council) has been convened, with 20 youths and parent dyads recruited and global experts surveyed at an international meeting. With unanimous support from the Council, usability testing of the Teens OI will ensue in 4 iterative cycles with 32 youth-parent dyads. All sociodemographic and usability metrics will be descriptively analyzed. All recorded interview and focus group data are analyzed using content analysis techniques involving an iterative process of data reduction, data display, conclusion drawing, and verification. Results: As of December 2022, an 8-person, interdisciplinary Teens OI council, comprising 4 health care professionals, 3 youths and young adults with OI, and 1 parent, has been convened to oversee the design and development of Teens OI. Two cycles of interviews have been conducted with 10 youths with OI with or without their parents (n=6) from December 2021 to September 2022. Data analysis has been in progress since April 2022. Aim 2 is ethically approved and will commence following the completion of content development, expected by late July 2023. Preliminary analysis indicates that the following topics need to be prioritized for the youths: mental health, pain, accessibility, medical care, education, community, and parental care. Conclusions: The proposed study will design and develop a self-management and transitional care program for youths with OI in partnership with patients, caregivers, and health care professionals. This study leverages youths' openness to adopt eHealth technologies to meet their needs and has the potential to actively engage them to autonomously manage their lifelong conditions, and facilitate a successful transition to adult health care. Finally, the proposed study will also address a critical gap in the quality of care and the growing concern that the OI population transitioning from pediatric to adult care is at risk of various adverse events associated with the transition. International Registered Report Identifier (IRRID): DERR1-10.2196/47524 ", doi="10.2196/47524", url="https://www.researchprotocols.org/2023/1/e47524", url="http://www.ncbi.nlm.nih.gov/pubmed/37351933" } @Article{info:doi/10.2196/44252, author="Blake, V. Kathryn and Antal, Holly and Bunnell, Timothy H. and He, Jiaxian and Henderson, Robert and Holbrook, T. Janet and McCahan, M. Suzanne and Pennington, Chris and Rogers, Linda and Shade, David and Sugar, A. Elizabeth and Taylor, Alexandra and Wise, A. Robert and Wysocki, Tim", title="Comprehension by Caregivers and Adolescents of Clinical Trial Information Delivered via Multimedia Video Versus Conventional Practice: Nonrandomized Controlled Trial", journal="JMIR Pediatr Parent", year="2023", month="Jun", day="22", volume="6", pages="e44252", keywords="adolescent", keywords="clinical trial", keywords="comprehension", keywords="informed consent", keywords="internet", keywords="multimedia", abstract="Background: Research participants often misunderstand the required elements of informed consent information, whether provided in written or oral format. Informed consent instruments with embedded evidence-based learning theory principles administered in multimedia electronic formats may improve comprehension and retention. Objective: This study aims to determine whether study information comprehension and retention using an interactive multimedia video consent process was noninferior to comprehension and retention after an in-person face-to-face interaction with a conventional written consent document for caregivers and adolescents enrolled in a clinical trial. Methods: Participants were caregivers and children aged 12 to 17 years who were enrolled in a clinical trial of asthma treatment. Consent information was presented as a multimedia web-based video consent interaction or as a conventional written consent document with in-person interaction between the prospective participants and the study staff. The trial used a parallel nonrandomized noninferiority design that compared the 2 consent methods. Caregivers and adolescents completed a 17-item open-ended comprehension questionnaire (score range 17-51) at enrollment and at the end of the study 20 weeks later. Comprehension and retention were compared between the consent formats. Noninferiority was established if the 95\% CI upper bound of the difference in scores (conventional format minus web-based) was less than the noninferiority margin of 2.4; superiority was established if the upper bound of the CI was <0. Results: In total, 54 caregiver and adolescent dyads completed the interactive multimedia web-based video consent, and 25 dyads completed the conventional consent. Overall, 33\% (26/79) of all adolescents were Black, 57\% (45/79) were male, and 61\% (48/79) had a household income of