@Article{info:doi/10.2196/68091,
author="Goldberg, Nina
and Herrmann, Christin
and Di Gion, Paola
and Hautsch, Volker
and Hefter, Klara
and Langebartels, Georg
and Pfaff, Holger
and Ansmann, Lena
and Karbach, Ute
and Wurster, Florian",
title="Sociodemographic and Socioeconomic Determinants for the Usage of Digital Patient Portals in Hospitals: Systematic Review and Meta-Analysis on the Digital Divide",
journal="J Med Internet Res",
year="2025",
month="Jun",
day="3",
volume="27",
pages="e68091",
keywords="patient portal",
keywords="digital divide",
keywords="hospital",
keywords="meta-analysis",
keywords="socioeconomic",
keywords="sociodemographic",
keywords="e-Health",
abstract="Background: Digital patient portals (PPs) are platforms that enhance patient engagement and promote active involvement in health care by providing remote access to personal health data. Although many hospitals are legally required to offer these portals, adoption varies widely among patients, often influenced by sociodemographic and socioeconomic determinants. Evidence suggests that higher income, education, employment status, and specific age groups correlate with increased portal usage, highlighting a digital divide. This study aims to analyze sociodemographic and socioeconomic determinants affecting digital PP usage, addressing inconsistencies in existing research and contributing to strategies for reducing digital health disparities. Objective: This study aimed to conduct a meta-analysis of the sociodemographic and socioeconomic factors contributing to the digital divide in the usage of digital PPs. Methods: A systematic review with meta-analysis was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in PubMed, Web of Science Core Collection, and EBSCOhost. Screening involved 3 reviewers with consensus meetings to resolve discrepancies. Data on sociodemographic and socioeconomic factors and statistical outcomes were extracted, and study quality was assessed using the Mixed Methods Appraisal tool. Results were visualized using forest and funnel plots to assess heterogeneity and publication bias. Results: A total of 2225 studies were identified through a systematic review, and after title and abstract screening, 17 studies were included in the quantitative and qualitative analysis. The qualitative analysis revealed that younger patients (younger than 65 y) were significantly more likely to use the digital PP, while the meta-analysis revealed that women had a 16\% higher likelihood of using the digital PP than men. The relationship between income and digital PP usage was inconsistent, due to different scaling in different studies. A higher level of education was significantly associated with a 37\% greater likelihood of using the digital PP in the meta-analysis. In addition, employed patients were 23\% more likely to use the digital PP, while married patients had a 13\% higher likelihood of using it than unmarried patients. Marital status and employment can be considered as measurable factors of social relationships. Conclusions: The review confirms that sociodemographic and socioeconomic factors significantly influence the usage of digital PP in hospital care. Marital status shows that social support plays a vital role, with married patients 13\% more likely to engage with digital PPs. It is worth noting that social support through connections to society via work or work colleagues can also play an important role as like as a partner at home, with employed individuals being 22\% more likely to use digital PPs. Overall, sociodemographic factors, like marital status, primarily affect usage patterns, while socioeconomic factors, like employment, enable access, emphasizing the need for comprehensive support systems to bridge the digital divide in health care. Trial Registration: German register of clinical trials DRKS00033125; https://drks.de/search/de/trial/DRKS00033125 and PROSPERO CRD42024567203; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024567203 ",
doi="10.2196/68091",
url="https://www.jmir.org/2025/1/e68091"
}


@Article{info:doi/10.2196/62696,
author="Andreadis, Katerina
and Buderer, Nancy
and Langford, Tene Aisha",
title="Patients' Understanding of Health Information in Online Medical Records and Patient Portals: Analysis of the 2022 Health Information National Trends Survey",
journal="J Med Internet Res",
year="2025",
month="May",
day="30",
volume="27",
pages="e62696",
keywords="patient portals",
keywords="health literacy",
keywords="mobile apps",
keywords="digital health",
keywords="online medical records",
keywords="online health information",
keywords="patient-focused care",
keywords="health technology",
abstract="Background: The 21st Century Cures Act mandated instant digital access for patients to see their test results and clinical notes (eg, via patient portals). Entirely using and understanding such health information requires some degree of personal health literacy. Objective: This study aims to assess the associations between ease of understanding online health information and various factors, including sociodemographics, health-related variables, numeracy, and technology-related factors. Methods: This cross-sectional study used data from the National Cancer Institute's 2022 Health Information National Trends Survey (HINTS), a nationally representative survey of US adults that tracks individuals' access and use of their health information. Data was collected from March to December 2022. The survey was conducted across various US settings using a stratified multistage sampling technique to ensure national representation. Our analysis included 3016 respondents with data for all variables of interest. We conducted bivariate and multivariate analyses to assess the odds of finding health information in online medical records or patient portals as ``very easy'' to understand compared with ``not very easy.'' Results: In the multivariate analysis, age group (with the 35-49 years group being 1.9 times more likely compared to the ?75 years group; P=.03), female birth sex (1.4 times more likely; P=.04), ease of understanding medical statistics (8.5 times more likely for those finding it ``very easy''; P<.001), patient-provider communication score (increase of 1.1 odds per 1 unit increase; P<.001), and mode of accessing online records (1.8 times more likely via an app and 1.4 times more likely via both an app and website, P=.01 and P=.003, respectively, versus using a website alone) were significant predictors for finding health information ``very easy'' to understand. Conclusions: Sociodemographic factors, numeracy, patient-provider communication, and method of accessing online records were associated with ease of understanding health information in online medical records or patient portals. Findings from this study may inform interventions to make patient portals and online medical records more patient-centered and easier to navigate. ",
doi="10.2196/62696",
url="https://www.jmir.org/2025/1/e62696"
}


@Article{info:doi/10.2196/71038,
author="Mathioudakis, Nestoras
and Wolf, Risa
and Choudhary, Abha
and Davis, Georgia
and Gallagher, Pat Mary
and Gupta, Meenal
and Kamboj, Manmohan
and Rioles, Nicole
and Ospelt, Emma
and Thapa, Susan
and Weinstock, S. Ruth
and Wright, Trevon
and Ebekozien, Osagie",
title="Implementation and Evaluation of a Best Practice Advisory to Reduce Inequities in Technology Use for People With Type 1 Diabetes: Protocol for a Mixed Methods, Nonrandomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="May",
day="28",
volume="14",
pages="e71038",
keywords="equity",
keywords="disparities",
keywords="continuous glucose monitor",
keywords="automated insulin delivery system",
keywords="insulin pump",
keywords="type 1 diabetes",
keywords="best practice advisory",
keywords="practice advisory",
keywords="clinical decision support",
abstract="Background: Continuous advancements in diabetes technologies have improved self-management for people with type 1 diabetes. Continuous glucose monitoring and automated insulin delivery systems have enhanced the quality of life and glycemic outcomes while reducing severe hypoglycemia and diabetes ketoacidosis hospitalizations. Despite these benefits, racial inequities in the use of advanced diabetes technology (ADT) persist. Objective: This study aims to develop and evaluate a best practice advisory (BPA) within the electronic medical record (EMR) to reduce racial and ethnic disparities in ADT use. We hypothesize that an EMR-based BPA designed to standardize the prescribing of ADTs will minimize racial and ethnic disparities in ADT adoption or progression in use among pediatric and adult people with type 1 diabetes. Methods: The Best Practice Advisories to Reduce Inequities in Technology Use (BPA-TECH) study will use a nonrandomized matched pair intervention design. Phase 1 will use qualitative methods to develop and refine the BPA, including focus groups and surveys of health care providers and people with type 1 diabetes or their caregivers. Phase 2 will evaluate the effectiveness of the BPA through a controlled before-after study of people with type 1 diabetes seen at 7 T1D Exchange Quality Improvement Collaborative (T1DX-QI) centers, with control people with type 1 diabetes matched from nonintervention T1DX-QI centers. The baseline and postintervention periods will be the 12 months before and 12 months after deployment of the BPA at the intervention centers, respectively. Eligibility criteria include people with type 1 diabetes aged ?2 years with an EMR diagnosis of T1D during the baseline period. The primary outcome is the progression in ADT use from the baseline to postintervention periods. Results: This 3-year study began in July 2024, with data collection from key stakeholders for phase 1 qualitative research beginning in August 2024. For phase 2, we estimate approximately 3000 eligible non-Hispanic Black and Hispanic people with type 1 diabetes at the intervention centers and 15,000 matched controls. Data on ADT use, glycated hemoglobin (HbA1c), severe hypoglycemic events, and diabetes ketoacidosis events will be collected via the T1DX-QI coordinating center. The study is powered to detect a between-group difference of 15\% in the proportion of patients in the intervention and control groups in meeting the primary endpoint. We anticipate the completion of this study by May 2027. Conclusions: The BPA-TECH study aims to leverage health IT to address racial and ethnic disparities in ADT use among people with type 1 diabetes. By standardizing the approach to ADT prescribing for people with type 1 diabetes, the BPA-TECH has the potential to promote equity in diabetes management and improve clinical outcomes. The outcomes of this study will inform future efforts to reduce health care disparities. Trial Registration: ClinicalTrials.gov NCT06931275; https://clinicaltrials.gov/search?term=NCT06931275 International Registered Report Identifier (IRRID): DERR1-10.2196/71038 ",
doi="10.2196/71038",
url="https://www.researchprotocols.org/2025/1/e71038",
url="http://www.ncbi.nlm.nih.gov/pubmed/40434817"
}


@Article{info:doi/10.2196/65489,
author="Zlatar, Z. Zvinka
and Greenwood-Hickman, Anne Mikael
and Lujan, Martinez Lazaro N.
and Cooper, Julie
and Florez-Acevedo, Stefani
and Marquez, X. David
and Aceves, Gutierrez Rosa
and Vargas, Paula Andrea
and Rosenberg, E. Dori",
title="Feasibility and Cultural Adaptation of a Community-Engaged Physical Activity Intervention for Hispanic Older Adults: Pilot Study",
journal="JMIR Form Res",
year="2025",
month="May",
day="27",
volume="9",
pages="e65489",
keywords="lifestyle",
keywords="dementia risk reduction",
keywords="brain health",
keywords="sedentary",
keywords="exercise",
abstract="Background: The adult Hispanic population of the United States faces an increased risk of dementia compared to non-Hispanic White adults. Physical activity (PA) can help reduce dementia risk, but culturally adapted interventions for Hispanic populations are lacking. Culturally adapted interventions are needed to increase uptake and adherence to brain health promotion strategies in the Hispanic community. Objective: The De Pie y a Movernos intervention aims to reduce barriers to participation in clinical research by culturally adapting a remotely based PA intervention for middle-aged and older Hispanic adults and establish its feasibility and acceptability through a pre-post pilot study. Findings from the cultural adaptation process will inform a stage II PA randomized controlled trial. Methods: The adaptation process followed Barrera and Castro's 2006 cultural adaptation framework and included a literature review, translation of intervention materials, review by a Hispanic-comprised community advisory board and bilingual staff, and a pre-post pilot study (N=10) with subsequent focus groups to refine the intervention. The pilot intervention included the use of Fitbit activity trackers and 2 individualized goal-setting calls with a health coach over a period of 3 weeks. Feasibility and acceptability were assessed using both quantitative methods and qualitative focus groups. Primary quantitative outcomes included enrollment, recruitment, and completion rates, as well as acceptability (predetermined satisfaction survey scores ?3). Focus groups were thematically coded to identify themes for participants' opinions about several aspects of the intervention and explore key barriers and facilitators to PA engagement to improve the planned stage II trial. Results: Ten Hispanic adults (age: mean 62.7, SD 5.3 years; education: mean 11.8, SD 3.8 years; n=9, 90\% female; n=9, 90\% Spanish-speaking) participated in the pre-post pilot, with a 100\% completion rate, 50\% enrollment rate, and a recruitment rate of 5 participants per month. Acceptability was high (mean score 4.6, SD 0.3; range 1?5). Qualitative analyses indicated that participants had high satisfaction with the intervention. They expressed a preference for adding group-based activities and increased interaction with study staff. Key barriers to PA included lack of awareness about the benefits of PA, low self-efficacy, time constraints, health conditions, and weather, while facilitators included awareness of PA's cognitive benefits, social support from family or friends, accountability, enjoyable activities, self-efficacy, and Fitbit use. Insights from participants and community advisory board recommendations led to modifications for the larger trial, such as incorporating group-based elements for those who want them and adding an option for teleconference coaching calls. Conclusions: The cultural adaptation process was essential in refining the intervention to align with the preferences of older Hispanic adults, which resulted in a feasible and acceptable intervention. Findings will inform a planned stage II randomized controlled trial aimed at promoting PA and reducing dementia risk in older Hispanic adults. ",
doi="10.2196/65489",
url="https://formative.jmir.org/2025/1/e65489"
}


@Article{info:doi/10.2196/65345,
author="Muellmann, Saskia
and Wiersing, Rebekka
and Zeeb, Hajo
and Brand, Tilman",
title="Digital Health Literacy in Adults With Low Reading and Writing Skills Living in Germany: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2025",
month="May",
day="22",
volume="12",
pages="e65345",
keywords="digital health literacy",
keywords="digital health technologies",
keywords="digital health",
keywords="digital divide",
keywords="mobile phone",
keywords="adults",
keywords="mixed methods study",
abstract="Background: Digital health literacy is a key factor in enabling users to navigate in an increasingly digitalized health care system. Low levels of digital health literacy are associated with higher age, low education, and income, as well as low functional health literacy. Around 6.2 million adults living in Germany have low reading and writing skills. Due to their low literacy, this group is often underrepresented in research studies and therefore little is known about their digital health literacy and use of digital health tools. Objective: The objectives of this study were to assess digital health literacy in adults with low reading and writing skills and to explore which digital health tools they use in daily life. Methods: An interviewer-administered survey and focus groups were conducted with adult residents of Bremen, Germany, who were aged 18?64 years and had low reading and writing skills. In addition, a stakeholder workshop was held to derive recommendations on how digital health literacy could be improved. The survey questionnaire included 21 items addressing the use of digital health technologies and digital health literacy (eHealth Literacy Scale). Focus group participants completed several tasks on web-based health information and then discussed their experiences. Survey data were analyzed using descriptive statistics and linear regression. Qualitative content analysis was applied to analyze the focus group data and the written documentation of the stakeholder workshop. Results: Survey participants (n=96) were on average 43 (SD 10.7) years old, 72\% (69/96) were female, and 92\% (88/96) were not born in Germany. Participants reported mainly using information-related digital health technologies such as health apps (40/96, 42\%), health websites (30/96, 31\%), or activity trackers (27/96, 28\%). The mean digital health literacy score was 22 (SD 8) points, with 35\% (34/96) of participants classified as having a low digital health literacy (score between 8-19/40 points). Digital health technology use was associated with higher digital health literacy. For participants in the 5 focus groups (total n=39; mean age 43, SD 12.6 years; n=34, 87\% female), limited technical skills and language problems were the most important challenges. Furthermore, focus group participants reported that they favor videos when searching for web-based health information and prefer to seek support from family members or local organizations for health issues. Stakeholders (n=15) recommended that health websites should be available in multiple languages, contain simple and easy-to-read language, and use images, symbols, and videos. Conclusions: While adults with low reading and writing skills use digital health technologies, many find it challenging to search for health information on the internet due to lacking technical skills and language problems. To ensure that adults with low reading and writing skills are not further left behind, future research should focus on developing tailored interventions to promote digital health literacy. ",
doi="10.2196/65345",
url="https://humanfactors.jmir.org/2025/1/e65345"
}


@Article{info:doi/10.2196/64499,
author="Bratches, WR Reed
and Puga, Frank
and Barr, J. Paul
and Leggett, N. Amanda
and Masel, Meredith
and Odom, Nicholas James
and Jablonski, Rita",
title="Size and Composition of Caregiver Networks Who Manage Medications for Persons Living With Dementia: Cross-Sectional Analysis of the 2011-2022 National Health and Aging Trends Study",
journal="Interact J Med Res",
year="2025",
month="May",
day="22",
volume="14",
pages="e64499",
keywords="caregiver",
keywords="dementia",
keywords="disparities",
keywords="cross-sectional analysis",
keywords="racial",
keywords="ethnic",
keywords="family caregivers",
keywords="logistic regression",
keywords="secondary analysis",
keywords="manage",
keywords="management",
keywords="medication",
keywords="network",
abstract="Background: Family caregivers commonly help manage medications taken by persons living with dementia. Recent work has highlighted the importance of caregiver networks, which are multiple caregivers managing care for a single person, on managing care for persons living with dementia, especially medication management. However, less is known about the composition of caregiver networks. Objective: The objective of this analysis was to describe the composition of caregiver networks that manage medications, the factors associated with helping with medications within caregiver networks, and whether racial or ethnic differences exist in caregiver network composition. Methods: This cross-sectional secondary analysis used data from the National Health and Aging Trends Study (NHATS) ``other person'' files from 2011 to 2022. Descriptive statistics were calculated for caregivers who were identified as helping manage medications for a person with dementia. Mixed-effect logistic regression was used to determine factors associated with helping with medications among caregiver networks, with odds ratios converted to predicted probabilities using marginal standardization. A P value of .05 or less was considered statistically significant. Secondary analysis was stratified by race and ethnicity due to identified cultural differences in living situation and overall caregiver network composition. Results: A total of 15,809 caregivers were analyzed. Of those, 3048 (19.2\%) managed medications for persons living with dementia. Caregiver networks that manage medications tend to include a spouse or partner and child, at least one of whom has a college degree. Every person with dementia reported at least 1 person who managed their medications. White persons with dementia had an average of 2.4 (range 1?9) people who managed medications, while Black or African American persons with dementia had an average of 2.8 (range 1?9) and Hispanic or Latino persons with dementia had an average of 2.9 (range 1?8) people who managed medications. Spouses were most likely to manage medications across all racial and ethnic groups. In regression modeling, female gender (predicted probability [PP] 15\%, 95\% CI 13\%-17\%; P<.001), Black or African American race (PP 7\%, 95\% CI 4\%-10\%; P<.001), and Hispanic ethnicity (PP 4\%, 95\% CI 1\%-9\%; P=.04) were associated with an increased probability of helping with medications. Conclusions: The size and composition of caregiver networks that manage medications for persons living with dementia differ by race and ethnicity but typically includes at least 2 people, one of whom has a college degree. Helping with medications was more likely among non-White family caregivers, while White patients with dementia were more likely to use paid help to manage medications. ",
doi="10.2196/64499",
url="https://www.i-jmr.org/2025/1/e64499"
}


@Article{info:doi/10.2196/59757,
author="Reinders, Patrick
and Augustin, Matthias
and Otten, Marina",
title="Understanding Dermatologists' Acceptance of Digital Health Interventions: Cross-Sectional Survey and Cluster Analysis",
journal="JMIR Hum Factors",
year="2025",
month="May",
day="21",
volume="12",
pages="e59757",
keywords="dermatology",
keywords="cross-sectional survey",
keywords="cluster analysis",
keywords="acceptability",
keywords="eHealth",
keywords="Germany",
keywords="attitude",
keywords="dermatologist",
keywords="digital health intervention",
keywords="teledermatology",
abstract="Background: Digital health interventions (DHIs) have the potential to enhance dermatological care by improving quality, patient empowerment, and efficiency. However, adoption remains limited, particularly in Germany. Objective: This study explores German dermatologists' attitudes toward DHIs, clustering them by acceptance levels and analyzing differences in sociodemographics and current and future DHI use. Methods: We conducted a cross-sectional survey, randomly inviting 1000 dermatologists in Germany to participate. The questionnaire consisted of Likert scale items rating the acceptability of DHIs from 1 to 5. Items on the current and future use of DHIs were also included. Exploratory factor analysis was used to identify factors and reduce data as input for a 2-step clustering algorithm. Results: The survey with 170 dermatologists (mean age 50.8, SD 10.3 y; 74/167, 55.7\% female) identified four factors through the exploratory factor analysis: (1) ``Positive Expectancies and Acceptability of DHIs,'' (2) ``Dermatologists' Digital Competencies,'' (3) ``Negative Expectancies and Barriers,'' and (4) ``Dermatologists' Perspectives on Patients' Acceptability and Competencies.'' The analysis identified three distinct clusters: (1) Indecisives (n=69)---moderate intentions to use DHIs and moderate negative expectations toward them; (2) Adopters (n=60)---high intentions to use DHIs and high digital competencies; and (3) Rejectors (n=26)---low intentions to use DHIs and low digital competencies. Adopters were significantly younger, more often based in urban centers, and exhibited the highest adoption rates of DHIs compared to the other clusters. Across all clusters, inadequate reimbursement and perceived structural barriers were cited as significant challenges to DHI adoption. Still, only one-third of the Adopters used DHIs including teledermatology or artificial intelligence. Conclusions: Dermatologists in Germany exhibited varied levels of acceptance and readiness for DHIs, with demographic and structural factors influencing adoption. Addressing barriers such as reimbursement and investing in digital literacy could promote wider use, potentially reducing health inequalities by improving access to digital health care. ",
doi="10.2196/59757",
url="https://humanfactors.jmir.org/2025/1/e59757"
}


@Article{info:doi/10.2196/68009,
author="Xiao, Yuyin
and Emmers, Dorien
and Li, Shanshan
and Zhang, Hanwen
and Rule, Andrew
and Rozelle, Scott",
title="Screen Exposure and Early Childhood Development in Resource-Limited Regions: Findings From a Population-Based Survey Study",
journal="J Med Internet Res",
year="2025",
month="May",
day="15",
volume="27",
pages="e68009",
keywords="screen time",
keywords="digital media viewing",
keywords="screen use",
keywords="infancy",
keywords="rural area",
keywords="low- and middle-income countries",
abstract="Background: The content of children's screen exposure and interactive coviewing with caregivers are important determinants of early childhood development (ECD) that have been overlooked in past research in resource-limited rural regions. Given the prevalence of digital devices and diverse digital content today, determining screen use practices that minimize the negative impacts on children's development is crucial for promoting healthy screen use among children. Objective: This study aims to examine screen exposure among children aged <3 years in rural China and investigate its relationship with ECD outcomes, focusing on duration, content, coviewing, and interaction. Methods: The sample includes all children aged between 6 and 26 months and their primary caregivers residing in the study area. A survey of screen exposure and household characteristics was conducted for 1052 eligible households. Caregivers reported the duration of screen exposure, defined as the average daily screen time over the past month; the content of exposure, defined by the time spent on educational and child-friendly content; and the caregiver's presence and interaction with the child during exposure. ECD outcomes were evaluated using the third edition of the Bayley Scales of Infant and Toddler Development assessment scale and the Brief Infant Toddler Social Emotional Assessment. Ordinary least squares regression, logistic regression, and chi-square tests were conducted. Results: In total, 28.23\% (297/1052) of the children in our sample were first exposed to screens before the age of 12 months. Children exposed to screens had an average daily screen time of 27.57 (SD 38.90) minutes. Children who were exposed to screens before the age of 12 months and those who had longer screen time between the ages of 12 and 18 months were more likely to be at risk of motor developmental delays. Children exposed to educational content for >15 minutes on a daily basis had fewer social-emotional or behavioral problems than those with no screen exposure and a lower risk of delay in motor skills development than those exposed to educational content for <15 minutes on a daily basis. Caregiver interaction during screen exposure was associated with a lower risk of cognitive and language delays and better socioemotional skills. Conclusions: The type of content viewed and how caregivers engaged in children's screen time were strongly associated with ECD outcomes. Guiding parents to select educational content for their children and engaging in interactive coviewing may better protect children from the negative effects of screen exposure. The findings complement conclusions regarding the impact of screen exposure on ECD in resource-limited rural areas. ",
doi="10.2196/68009",
url="https://www.jmir.org/2025/1/e68009"
}


@Article{info:doi/10.2196/67242,
author="Balki, Eric
and Hayes, Niall
and Holland, Carol",
title="Factors Influencing Older Adults' Perception of the Age-Friendliness of Their Environment and the Impact of Loneliness, Technology Use, and Mobility: Quantitative Analysis",
journal="JMIR Aging",
year="2025",
month="May",
day="6",
volume="8",
pages="e67242",
keywords="COVID-19",
keywords="age-friendliness of environments",
keywords="physical isolation",
keywords="digital communication technologies",
keywords="loneliness",
keywords="cross-sectional",
keywords="WHO",
keywords="World Health Organization",
keywords="older adults",
keywords="reduced mobility",
keywords="age friendliness of environments",
keywords="adult well-being",
keywords="social connections",
keywords="aging in place",
keywords="life-space mobility",
keywords="LSE",
keywords="functional mobility",
keywords="UCLA loneliness scale",
keywords="age-friendly environment assessment tool",
keywords="AFEAT",
abstract="Background: The World Health Organization's (WHO) publication on age-friendly environments (AFEs) imagines future cities to become more age-friendly to harness the latent potential of older adults, especially those who have restricted mobility. AFE has important implications for older adults in maintaining social connections, independence, and successful aging-in-place. However, technology is notably absent in the 8 intersecting domains of AFEs that the WHO imagines improve older adult well-being, and we investigated whether technology should form a ninth domain. While mobility was severely restricted, the COVID-19 pandemic provided an opportunity to test how older adults' perceptions of their AFE changed and what role technology was playing. Objective: This study examined how life-space mobility (LSM), a concept for assessing patterns of functional mobility over time, and loneliness impacted perceived AFEs and the moderating effect of technology. It also explores whether technology should play a greater role as the ninth domain of the WHO's imagination of the AFE of the future. Methods: In this cross-sectional quantitative observation study, data from 92 older adults aged 65-89 years were collected in England from March 2020 to June 2021 during the COVID-19 pandemic. The Life-space Questionnaire, Technology Experience Questionnaire, UCLA (University of California, Los Angeles) Loneliness Scale, and age-friendly environment assessment tool were used. Correlation and moderation analyses were used to investigate relationships between variables. Results: Most participants (86/92, 93\%) had not left their immediate town in the previous 4 weeks before the interview. Restricted LSM was positively correlated to the age-friendly environment assessment tool, that is, rising physical isolation was linked to a better perception of AFEs; however, we discovered this result was due to the moderating impact of increased use of technology, and that restricted LSM actually had a negative effect on AFEs. Loneliness was correlated negatively with the perception of AFEs, but technology use was found to moderate the impact of loneliness. Conclusions: Pandemic-related LSM restrictions impacted perceived AFEs and loneliness negatively, but technology played a moderating role. The findings demonstrate that technology could be considered as a ninth domain in the WHO's assessment of AFEs for older adults and that there is a need for its explicit acknowledgment. ",
doi="10.2196/67242",
url="https://aging.jmir.org/2025/1/e67242"
}


@Article{info:doi/10.2196/64228,
author="Shepperd, A. James
and McBride, M. Colleen
and An, Weihua
and Zhao, Jingsong
and Pentz, D. Rebecca
and Escoffery, Cam
and Ward, Kevin
and Guan, Yue",
title="Trust and Privacy Concerns Among Cancer Survivors Who Did Not Visit a Research Website Offering Free Genetic Counseling Services for Families: Survey Study",
journal="J Med Internet Res",
year="2025",
month="May",
day="6",
volume="27",
pages="e64228",
keywords="internet trust",
keywords="internet privacy",
keywords="hereditary cancers",
keywords="patients and relatives outreach",
keywords="social marketing",
abstract="Background: Digital health tools, such as websites, now proliferate to assist individuals in managing their health. With user input, we developed the Your Family Connects (YFC) website to promote access to genetic services for survivors of ovarian cancer and their relatives. Although we estimated that half or more would access the website, only 18\% of invited survivors did so. We assessed the extent to which perceived relevance of the information provided, trust, and privacy concerns influenced decisions not to access the website. Objective: We designed a theory-based cross-sectional survey to explore the following questions: (1) To what extent did nonresponders endorse privacy concerns? (2) Were privacy concerns associated with recall of receiving the website invitation, time since diagnosis, age, and race? (3) Could we identify profiles of nonresponders that would guide the development of future interventions to encourage engagement in health websites for families affected by inherited cancers? Methods: A sample of survivors who were eligible to access the website yet did not respond to the study invitation was identified by linking study IDs to the Georgia Cancer Registry information. The survey was brief and contained 27 items, including recall of the invitation, interest in ovarian cancer information, benefits of using health websites, trust in health websites, and trust in university-based health research. We conducted factor analyses, regression analyses, ANOVA, correlation analyses, and logistic regression to address research questions. Results: Of the 650 nonresponders to whom we sent the short survey, 368 (56.3\%) responded and provided sufficient data for analysis. The mean response of 2.57 on the trust scale was significantly below the scale midpoint of 3 (t360=11.78, P<.001), suggesting that survivors who did not log on were on average distrustful of health websites. Belonging to a racial or ethnic minority group was associated with being more trusting and less skeptical about health websites. Just 196 (30.1\%) nonresponders recalled the invitation to visit the website. Logistic regression analysis indicated that age was the only significant predictor of recall. Testing a model with age, racial or ethnic minority status, and the 6 privacy concerns correctly classified 58.8\% of nonresponders, a rate of successful classification that was not appreciably better than a logistic regression analysis that included only age as a predictor. Conclusions: The nonresponders in the present study---particularly the White nonresponders---were skeptical of website platforms regardless of whether they recalled receiving a website invitation or not. Social marketing approaches geared toward building trust in web platforms by building a relationship with an information consumer and in collaboration with trusted organizations warrant further investigation. Trial Registration: ClinicalTrials.gov NCT04927013; https://clinicaltrials.gov/study/NCT04927013 ",
doi="10.2196/64228",
url="https://www.jmir.org/2025/1/e64228"
}


@Article{info:doi/10.2196/70822,
author="Li, Jiaying
and Wu, Xiaobing
and Wu, Yibo
and Fong, Tak Daniel Yee
and Song, Yang
and Xu, Siyi
and Kim, Changhwan
and Lin, Xiaohong
and Pandian, Vinciya",
title="Physical, Mental, and Health Empowerment Disparities Across Chronic Obstructive Pulmonary Disease, Asthma, and Combined Groups and the Moderating Role of eHealth Literacy: Cross-Sectional Study",
journal="J Med Internet Res",
year="2025",
month="May",
day="5",
volume="27",
pages="e70822",
keywords="chronic respiratory diseases",
keywords="chronic obstructive pulmonary disease",
keywords="asthma",
keywords="health outcome",
keywords="eHealth literacy",
abstract="Background: Nonpharmacological management plays a key role in enhancing the quality of life for individuals with chronic obstructive pulmonary disease (COPD), asthma, or both. However, disparities in their physical, mental, and health empowerment outcomes have not been fully explored, particularly in relation to the moderating effect of eHealth literacy. Objective: This study aims to assess these disparities and examine how eHealth literacy moderates them to guide the development of tailored nonpharmacological strategies. Methods: We analyzed data from 2 waves of the nationally representative ``Psychology and Behavior Investigation of Chinese Residents'' surveys to identify participants who self-reported asthma, COPD, or both. We assessed 5 physical outcomes (quality of life, physical activity, sleep quality, appetite, nicotine dependence), 4 mental outcomes (anxiety, depression, perceived stress, resilience), and 3 health empowerment measures (social support, self?efficacy, eHealth literacy). Multiple regression with Holm-Bonferroni corrections revealed health disparities and the moderation effect of eHealth literacy. Results: This unfunded study enrolled 1044 participants between June 2022 and August 2023, with data analysis completed within 7 months following data collection. The sample included 254 (24.3\%) participants with asthma, 696 (66.7\%) participants with COPD, and 95 (9.1\%) participants with both conditions. The mean age of the participants was 48.61 (SD 19.70) years, and 536 (51.3\%) participants were male. Linear regression showed that individuals with both COPD and asthma had lower health-related quality of life and higher anxiety and depression compared with those with either condition alone (b ranges from --0.15 to 3.35). This group also showed higher nicotine dependence than asthma-only (b=0.88) and lower resilience than COPD-only groups (b=--0.76) (all adjusted P<.05). eHealth literacy significantly moderated the effect of the disease group on all outcomes except physical activity (all adjusted P for interaction <.05). Nine disease pairs showed disparities in both eHealth literacy groups, 4 only in high literacy, and 8 only in low literacy (all P<.05). Conclusions: Individuals with both COPD and asthma had poorer quality of life, greater anxiety and depression, higher nicotine dependence, and lower resilience, underscoring the need for integrated psychosocial and behavioral interventions. Although higher eHealth literacy was associated with improved quality of life, sleep quality, and resilience, it also widened disparities in anxiety and depression. Therefore, while enhancing eHealth literacy may help reduce overall health inequities among patients with chronic respiratory diseases, its potential adverse effects on mental well-being warrant careful attention. Moreover, lower eHealth literacy was linked to more pronounced disparities, indicating that outreach efforts and digital resources should be specifically designed to reach and empower vulnerable populations. Overall, our findings advocate for condition-specific, eHealth-enhanced care pathways that not only foster digital literacy but also integrate comprehensive mental health services, thereby mitigating health disparities among individuals with chronic respiratory diseases. ",
doi="10.2196/70822",
url="https://www.jmir.org/2025/1/e70822"
}


@Article{info:doi/10.2196/69170,
author="Stauch, Lisa
and Renninger, Denise
and Rangnow, Pia
and Hartmann, Anja
and Fischer, Lisa
and Dadaczynski, Kevin
and Okan, Orkan",
title="Digital Health Literacy of Children and Adolescents and Its Association With Sociodemographic Factors: Representative Study Findings From Germany",
journal="J Med Internet Res",
year="2025",
month="May",
day="5",
volume="27",
pages="e69170",
keywords="digital health literacy",
keywords="sociodemographic",
keywords="health promotion",
keywords="child and adolescent health",
keywords="cross-sectional",
abstract="Background: Children and adolescents extensively use the internet in their daily lives, often seeking information related to health and well-being. In modern society, the volume of health information available in digital environments is constantly increasing. This includes both reliable and misleading content, making it challenging to assess trustworthiness. Digital health literacy is essential for navigating the digital information ecosystem, protecting oneself from misinformation, and making informed health decisions. Objective: This representative study aims to examine the digital health literacy of children and adolescents in Germany and its association with sociodemographic factors. Methods: A cross-sectional study design with face-to-face interviews was utilized to collect data from 1448 children and adolescents aged 9-18 years in Germany between October and November 2022. Digital health literacy was assessed using an adapted and translated version of the Digital Health Literacy Instrument (DHLI), which comprises 7 subscales: operational skills, navigation skills, information searching, self-generated content, evaluating reliability, protecting privacy, and determining relevance. Bivariate and binary logistic regression analyses were conducted to examine associations between digital health literacy subscales and sociodemographic characteristics (sex, age, migration background, school type, and perceived family affluence). Results: The study found that 419 out of 1362 (30.76\%) children and adolescents had a problematic level of digital health literacy, while 63 out of 1362 (4.63\%) had an inadequate level. Overall, the least difficulties were observed in operational skills and determining relevance, whereas the greatest challenges were related to protecting privacy and navigation skills. Age was significantly associated with 6 of the 7 subscales (excluding protecting privacy), with younger children (9-11 years) facing a higher risk of limited skills (operational skills: odds ratio [OR] 5.42, P=.002; navigation skills: OR 4.76, P<.001; information searching: OR 4.68, P<.001; adding self-generated content: OR 7.03, P<.001; evaluating reliability: OR 3.82, P<.001; and determining relevance: OR 4.76.42, P<.001). Migration background was associated with fewer limited digital health literacy skills, while low perceived family affluence was associated with more limited skills. In the subscales of information searching, self-generated content, and evaluating information reliability, a lower risk of limited skills was observed among those with a 2-sided migration background (information searching: OR 0.62, P=.02; adding self-generated content: OR 0.30, P=.003; and evaluating reliability: OR 0.66, P=.03). By contrast, a higher risk was found among those with low perceived family affluence, including in the subscale of determining relevance (information searching: OR 2.18, P<.001; adding self-generated content: OR 1.77, P=.01; evaluating reliability: OR 1.67, P<.001; and determining relevance: OR 1.58, P<.001). Although school type was not associated with any dimension, sex was linked to operational skills, with females having an increased risk of limited skills (OR 1.58, P=.03). Conclusions: The results highlight a strong need for interventions to improve digital health literacy among children and adolescents, particularly in protecting privacy, navigation skills, and evaluating the reliability of health information. Effective interventions should be tailored to address the varying needs associated with age, migration background, and family affluence. ",
doi="10.2196/69170",
url="https://www.jmir.org/2025/1/e69170"
}


@Article{info:doi/10.2196/67383,
author="Sumner, Jennifer
and Wang, Yuchen
and Tan, Ying Si
and Chew, Hoon Emily Hwee
and Wenjun Yip, Alexander",
title="Perspectives and Experiences With Large Language Models in Health Care: Survey Study",
journal="J Med Internet Res",
year="2025",
month="May",
day="1",
volume="27",
pages="e67383",
keywords="digital health",
keywords="artificial intelligence",
keywords="survey research",
keywords="large language model",
keywords="healthcare",
keywords="survey",
keywords="workforce",
keywords="healthcare worker",
keywords="professional",
abstract="Background: Large language models (LLMs) are transforming how data is used, including within the health care sector. However, frameworks including the Unified Theory of Acceptance and Use of Technology highlight the importance of understanding the factors that influence technology use for successful implementation. Objective: This study aimed to (1) investigate users' uptake, perceptions, and experiences regarding LLMs in health care and (2) contextualize survey responses by demographics and professional profiles. Methods: An electronic survey was administered to elicit stakeholder perspectives of LLMs (health care providers and support functions), their experiences with LLMs, and their potential impact on functional roles. Survey domains included: demographics (6 questions), user experiences of LLMs (8 questions), motivations for using LLMs (6 questions), and perceived impact on functional roles (4 questions). The survey was launched electronically, targeting health care providers or support staff, health care students, and academics in health-related fields. Respondents were adults (>18 years) aware of LLMs. Results: Responses were received from 1083 individuals, of which 845 were analyzable. Of the 845 respondents, 221 had yet to use an LLM. Nonusers were more likely to be health care workers (P<.001), older (P<.001), and female (P<.01). Users primarily adopted LLMs for speed, convenience, and productivity. While 75\% (470/624) agreed that the user experience was positive, 46\% (294/624) found the generated content unhelpful. Regression analysis showed that the experience with LLMs is more likely to be positive if the user is male (odds ratio [OR] 1.62, CI 1.06-2.48), and increasing age was associated with a reduced likelihood of reporting LLM output as useful (OR 0.98, CI 0.96-0.99). Nonusers compared to LLM users were less likely to report LLMs meeting unmet needs (45\%, 99/221 vs 65\%, 407/624; OR 0.48, CI 0.35-0.65), and males were more likely to report that LLMs do address unmet needs (OR 1.64, CI 1.18-2.28). Furthermore, nonusers compared to LLM users were less likely to agree that LLMs will improve functional roles (63\%, 140/221 vs 75\%, 469/624; OR 0.60, CI 0.43-0.85). Free-text opinions highlighted concerns regarding autonomy, outperformance, and reduced demand for care. Respondents also predicted changes to human interactions, including fewer but higher quality interactions and a change in consumer needs as LLMs become more common, which would require provider adaptation. Conclusions: Despite the reported benefits of LLMs, nonusers---primarily health care workers, older individuals, and females---appeared more hesitant to adopt these tools. These findings underscore the need for targeted education and support to address adoption barriers and ensure the successful integration of LLMs in health care. Anticipated role changes, evolving human interactions, and the risk of the digital divide further emphasize the need for careful implementation and ongoing evaluation of LLMs in health care to ensure equity and sustainability. ",
doi="10.2196/67383",
url="https://www.jmir.org/2025/1/e67383",
url="http://www.ncbi.nlm.nih.gov/pubmed/40310666"
}


@Article{info:doi/10.2196/67370,
author="Mancuso, Noah
and Michaels, Jenna
and Browne, N. Erica
and Maragh-Bass, C. Allysha
and Stocks, B. Jacob
and Soberano, R. Zachary
and Bond, Lily C.
and Yigit, Ibrahim
and Comello, G. Maria Leonora
and Larsen, Adams Margo
and Muessig, E. Kathryn
and Pettifor, Audrey
and Hightow-Weidman, B. Lisa
and Budhwani, Henna
and Stoner, D. Marie C.",
title="Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control Trial",
journal="JMIR Public Health Surveill",
year="2025",
month="Apr",
day="16",
volume="11",
pages="e67370",
keywords="COVID-19",
keywords="mHealth",
keywords="African American and Black",
keywords="young adults",
keywords="vaccination",
keywords="mobile health",
abstract="Background: Negative attitudes toward vaccines and suboptimal vaccination rates among African American and Black (Black) Americans have been well documented, due to a history of medical racism and human rights violations in the United States. However, digital health interventions (DHI) have been shown to address racial disparities in several health outcomes, such as cardiovascular disease, HIV, and maternal health. The Tough Talks COVID (TT-C) study was a randomized controlled trial of a DHI designed to empower Black young adults in the United States South to make informed, autonomous decisions about COVID-19 vaccine uptake by addressing structural barriers and misinformation about vaccines. Objective: Our objective was to identify subgroups of Black young adults with various vaccine attitudes at baseline and determine the subgroups for which the TT-C DHI was most impactful. Methods: Black young adults aged 18?29 years in Alabama, Georgia, and North Carolina who were unvaccinated or insufficiently vaccinated against COVID-19 completed three online surveys over three months (N=360). Latent profile analysis was used to identify subgroups based on general vaccine attitudes at baseline, including hesitancy, confidence, knowledge, conspiracy beliefs, and mistrust. Logistic regression was used to examine the associations between latent profiles and vaccine uptake, and linear regression was used to examine changes in vaccine attitudes at three months post-randomization. Modification of the TT-C DHI's effects was assessed by latent profiles. Results: Three latent profiles emerged: vaccine-receptive (n=124), vaccine-neutral (n=155), and vaccine-resistant (n=81). Political affiliation, income, social support, and recent flu vaccination differed significantly between the three subgroups (P<.05). Vaccine uptake was not significantly different by subgroup, and the TTC-DHI did not have differing effects on uptake across subgroups. However, the DHI had the strongest effect---with statistically significant measures of association (P<.05) and interaction P values (P<.10)---among the baseline vaccine-resistant and vaccine-neutral subgroups compared to the vaccine-receptive subgroups at three months in improving vaccine hesitancy, confidence, and conspiracy beliefs at three months: vaccine-resistant difference: ?0.40 (?0.76 to ?0.37), 0.39 (0.02 to 0.75), and ?0.47 (?0.86 to ?0.09); vaccine neutral difference: ?0.36 (?0.52 to ?0.19), 0.35 (0.18 to 0.51), and ?0.24 (?0.44 to ?0.03). The DHI had no effects on these outcomes among the vaccine-receptive subgroup. Conclusions: Our findings revealed subgroups of Black young adults in the United States South with different vaccination attitudes, for which the TT-C intervention had differing effects. Black young adults who are vaccine-resistant or vaccine-neutral may experience larger gains from a digital vaccine intervention. Future work aimed at improving vaccination outcomes could target these populations to maximize resource efficiency and drive the greatest improvements in vaccine outcomes. Trial Registration: ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/study/NCT05490329 ",
doi="10.2196/67370",
url="https://publichealth.jmir.org/2025/1/e67370"
}


@Article{info:doi/10.2196/64208,
author="Liao, Wan-Chuen
and Angus, Fiona
and Conley, Jane
and Chen, Li-Chia",
title="The Efficacy of Digital Interventions on Adherence to Oral Systemic Anticancer Therapy Among Patients With Cancer: Systematic Review and Meta-Analysis",
journal="JMIR Cancer",
year="2025",
month="Apr",
day="16",
volume="11",
pages="e64208",
keywords="efficacy",
keywords="digital interventions",
keywords="oral systemic anticancer therapy",
keywords="medication adherence",
keywords="cancer",
keywords="oral",
keywords="patients with cancer",
keywords="therapy",
keywords="systematic review",
keywords="meta-analysis",
keywords="care plans",
keywords="medication",
keywords="treatments",
keywords="mobile app",
keywords="mobile applications",
keywords="mHealth",
keywords="multimedia platforms",
keywords="digital technology",
keywords="self-reported",
keywords="mobile phone",
abstract="Background: Digital interventions have been increasingly applied in multidisciplinary care plans to improve medication adherence to oral systemic anticancer therapy (SACT), the crucial lifesaving treatments for many cancers. However, there is still a lack of consensus on the efficacy of those digital interventions. Objectives: This systematic review and meta-analysis aimed to investigate the efficacy of digital interventions in improving adherence to oral SACTs in patients with cancer. Methods: This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. The protocol has been registered at PROSPERO (no. CRD42024550203). Fully published, randomized controlled trials (RCTs) in English on adults with cancer assessing digital interventions for improving adherence to oral SACTs were retrieved from MEDLINE, Embase, APA PsycINFO, and CINAHL Plus up to May 31, 2024. Adherence measures compared between digital intervention users and nonusers were extracted. The proportions of poor adherence were synthesized using a random-effects model. The pooled results were reported as the odds ratio and 95\% CI. The heterogeneity was assessed with the I2 test (\%). The mean difference and 95\% CI were calculated from the mean adherence score and SD. A risk of bias assessment was conducted using version 2 of the Cochrane Risk of Bias Assessment Tool (RoB 2) for RCTs, which ensured that a quality assessment of all included studies was conducted as recommended by the Cochrane Collaboration. Results: This study included 13 RCTs on digital interventions for improving adherence to oral SACTs in patients with cancer. The 13 RCTs, published between 2016 and 2024, were conducted in the United States, South Korea, France, Egypt, Finland, Australia, Colombia, Singapore, and Turkey. The technologies used were mobile apps (n=4), reminder systems (n=4), telephone follow-ups (n=3), and interactive multimedia platforms (n=2). Adherence was measured by surveys (n=8), relative dose intensity (n=2), pill count (n=1), self-reported missed doses (n=1), a smart pill bottle (n=1), and urine aromatase inhibitor metabolite assays (n=1). Concerns regarding risk of bias primarily involved randomization, missing outcome data, and outcome measurement, including nonblinded randomization, subjective patient-reported data, and difficulties in distinguishing between missed appointments and actual medication nonadherence. Pooled results from 11 trials showed that digital technology users had significantly lower risk of poor adherence (odds ratio 0.60, 95\% CI 0.47?0.77). Two studies reported positive mean differences in adherence scores comparing digital intervention users and nonusers. However, due to considerable heterogeneity (I{\texttwosuperior}=73.1\%), it is difficult to make a definitive conclusion from the pooled results about the effect of digital interventions upon adherence to oral anticancer therapy. Conclusions: Digital intervention users exhibited significantly lower risk of poor oral SACTs adherence than nonusers. Acknowledging individual variation and tailoring digital technologies to prioritize patient needs is essential. Trial Registration: PROSPERO CRD42024550203; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024550203 ",
doi="10.2196/64208",
url="https://cancer.jmir.org/2025/1/e64208"
}


@Article{info:doi/10.2196/68093,
author="Harry, Christiana
and Goodday, Sarah
and Chapman, Carol
and Karlin, Emma
and Damian, Joy April
and Brooks, Alexa
and Boch, Adrien
and Lugo, Nelly
and McMillan, Rebecca
and Tempero, Jonell
and Swanson, Ella
and Peabody, Shannon
and McKenzie, Diane
and Friend, Stephen",
title="Using Social Media to Engage and Enroll Underrepresented Populations: Longitudinal Digital Health Research",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="15",
volume="9",
pages="e68093",
keywords="digital health research",
keywords="digital health technology",
keywords="recruitment",
keywords="research subject",
keywords="participant",
keywords="pregnancy",
keywords="maternal health",
keywords="underrepresented populations",
keywords="health equity",
keywords="diversity",
keywords="marginalized",
keywords="advertisement",
keywords="social media",
keywords="retention",
keywords="attrition",
keywords="dropout",
abstract="Background: Emerging digital health research poses roadblocks to the inclusion of historically marginalized populations in research. Exclusion of underresourced communities in digital health research is a result of multiple factors (eg, limited technology access, decreased digital literacy, language barriers, and historical mistrust of research and research institutions). Alternative methods of access and engagement may aid in achieving long-term sustainability of diversified participation in digital health research, ensuring that developed technologies and research outcomes are effective and equitable. Objective: This study aims to (1) characterize socioeconomic and demographic differences in individuals who enrolled and engaged with different remote, digital, and traditional recruitment methods in a digital health pregnancy study and (2) determine whether social media outreach is an efficient way of recruiting and retaining specific underrepresented populations (URPs) in digital health research. Methods: The Better Understanding the Metamorphosis of Pregnancy (BUMP) study was used as a case example. This is a prospective, observational, cohort study using digital health technology to increase understanding of pregnancy among 524 women, aged 18-40 years, in the United States. The study used different recruitment strategies: patient portal for genetic testing results, paid/unpaid social media ads, and a community health organization providing care to pregnant women (Moses/Weitzman Health System). Results: Social media as a recruitment tool to engage URPs in a digital health study was overall effective, with a 23.6\% (140/594) enrollment rate of those completing study interest forms across 25 weeks. Community-based partnerships were less successful, however, resulting in 53.3\% (57/107) engagement with recruitment material and only 8.8\% (5/57) ultimately enrolling in the study. Paid social media ads provided access to and enrollment of a diverse potential participant pool of race- or ethnicity-based URPs in comparison to other digital recruitment channels. Of those that engaged with study materials, paid recruitment had the highest percentage of non-White (non-Hispanic) respondents (85/321, 26.5\%), in comparison to unpaid ads (Facebook and Reddit; 37/167, 22.2\%). Of the enrolled participants, paid ads also had the highest percentage of non-White (non-Hispanic) participants (14/70, 20\%), compared to unpaid ads (8/52, 15.4\%) and genetic testing service subscribers (72/384, 18.8\%). Recruitment completed via paid ads (Instagram) had the highest study retention rate (52/70, 74.3\%) across outreach methods, whereas recruitment via community-based partnerships had the lowest (2/5, 40\%). Retention of non-White (non-Hispanic) participants was low across recruitment methods: paid (8/52, 15.4\%), unpaid (3/35, 14.3\%), and genetic testing service subscribers (50/281, 17.8\%). Conclusions: Social media recruitment (paid/unpaid) provides access to URPs and facilitates sustained retention similar to other methods, but with varying strengths and weaknesses. URPs showed lower retention rates than their White counterparts across outreach methods. Community-based recruitment showed lower engagement, enrollment, and retention. These findings highlight social media's potential for URP engagement and enrollment, illuminate potential roadblocks of traditional methods, and underscore the need for tailored research to improve URP enrollment and retention. ",
doi="10.2196/68093",
url="https://formative.jmir.org/2025/1/e68093"
}


@Article{info:doi/10.2196/58916,
author="Francis, M. Jackson
and Neti, S. Sitapriya
and Polavarapu, Dhatri
and Atem, Folefac
and Xie, Luyu
and Kapera, Olivia
and Mathew, S. Matthew
and Marroquin, Elisa
and McAdams, Carrie
and Schellinger, Jeffrey
and Ngenge, Sophia
and Kukreja, Sachin
and Schneider, E. Benjamin
and Almandoz, P. Jaime
and Messiah, E. Sarah",
title="Association of Social Media Recruitment and Depression Among Racially and Ethnically Diverse Metabolic and Bariatric Surgery Candidates: Prospective Cohort Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="10",
volume="9",
pages="e58916",
keywords="social media",
keywords="social media recruitment",
keywords="depression",
keywords="depressed",
keywords="major depressive disorder",
keywords="MDD",
keywords="depressive disorder",
keywords="depressive",
keywords="race",
keywords="racial",
keywords="racial differences",
keywords="ethnic",
keywords="ethnic differences",
keywords="ethnicity",
keywords="metabolic surgery",
keywords="bariatric surgery",
keywords="obesity",
keywords="obese",
keywords="online health",
keywords="ethics",
keywords="mental health",
keywords="eHealth",
keywords="internet",
keywords="digital health",
keywords="digital mental health",
keywords="online interventions",
keywords="public engagement",
keywords="public health",
abstract="Background: Due to the widespread use of social media and the internet in today's connected world, obesity and depression rates are increasing concurrently on a global scale. This study investigated the complex dynamics involving social media recruitment for scientific research, race, ethnicity, and depression among metabolic and bariatric surgery (MBS) candidates. Objective: This study aimed to determine (1) the association between social media recruitment and depression among MBS candidates and (2) racial and ethnic differences in social media recruitment engagement. Methods: The analysis included data from 380 adult MBS candidates enrolled in a prospective cohort study from July 2019 to December 2022. Race and ethnicity, recruitment method (social media: yes or no), and depression status were evaluated using $\chi$2 tests and logistic regression models. Age, sex, and ethnicity were adjusted in multivariable logistic regression models. Results: The mean age of the candidates was 47.35 (SD 11.6) years, ranging from 18 to 78 years. Participants recruited through social media (n=41, 38.32\%) were more likely to report past or current episodes of depression compared to nonsocial media--recruited participants (n=74, 27.11\%; P=.03), with a 67\% increased likelihood of depression (odds ratio [OR] 1.67, 95\% CI 1.04?2.68, P=.03). Further analysis showed that participants with a history of depression who were below the mean sample age were 2.26 times more likely to be recruited via social media (adjusted OR [aOR] 2.26, 95\% CI 1.03?4.95; P=.04) compared to those above the mean age. Hispanic (n=26, 38.81\%) and non-Hispanic White (n=53, 35.10\%) participants were significantly more likely to be recruited via social media than non-Hispanic Black (n=27, 18.37\%) participants (P<.001). After adjusting for covariates, non-Hispanic Black participants were 60\% less likely than non-Hispanic White participants to be recruited via social media (aOR 0.40, 95\% CI 0.22?0.71; P=.002). Conclusions: We found that individuals recruited through social media channels, especially younger participants, were more likely to report past or current episodes of depression compared to those recruited through nonsocial media. The study also showed that non-Hispanic Black individuals are less likely to engage in social media recruitment for scientific research versus other racial and ethnic groups. Future mental health--related studies should consider strategies to mitigate potential biases introduced by recruitment methods to ensure the validity and generalizability of research findings. ",
doi="10.2196/58916",
url="https://formative.jmir.org/2025/1/e58916"
}


@Article{info:doi/10.2196/69952,
author="Holmqvist, Sophia
and Kaplan, Marina
and Chaturvedi, Riya
and Shou, Haochang
and Giovannetti, Tania",
title="Longitudinal and Combined Smartwatch and Ecological Momentary Assessment in Racially Diverse Older Adults: Feasibility, Adherence, and Acceptability Study",
journal="JMIR Hum Factors",
year="2025",
month="Apr",
day="8",
volume="12",
pages="e69952",
keywords="cognitive impairment",
keywords="smartwatch",
keywords="longitudinal monitoring",
keywords="ecological momentary assessment",
keywords="aging",
abstract="Background: Due to the rising prevalence of Alzheimer disease and related dementias, easily deployable tools to quantify risk are needed. Smartphones and smartwatches enable unobtrusive and continuous monitoring, but there is limited information regarding the feasibility, adherence, and acceptability of digital data collection among racially diverse older adults. Objective: This paper examined the feasibility, adherence, and acceptability of a 4-week combined smartwatch monitoring and ecological momentary assessment (EMA) study in a racially diverse sample of older adults. Methods: A total of 44 older adults (aged ?55 y) with either mild cognitive impairment or healthy cognition completed an informed consent comprehension quiz, baseline cognitive testing, training regarding digital data collection, and questionnaires. Participants were instructed to wear a Garmin Vivosmart 4 smartwatch for 23 h/d for 4 weeks, sync 2 smartphone apps (Garmin and Labfront) daily, and complete a daily EMA survey with automated prompts for surveys and charging. Training time, smartwatch adherence (eg, wear time), daily EMA survey response rate, and performance on the consent quiz were quantified. Associations between feasibility and adherence metrics and participant factors were evaluated. Self-reported usability of the apps and smartwatch was collected at study end. Results: Consent comprehension quiz scores were high (mean 97.33\%, SD 6.86\% correct), and training sessions lasted on average 17.93 (SD 6.89) minutes. During the 4-week study, participants wore the smartwatch for an average of 21 h/d (SD 1.53) and showed an average response rate of 94\% (SD 9.58\%) to daily EMA surveys. In unadjusted bivariate analyses, age, race, and cognition were associated with feasibility and adherence measures, but only age and race remained significant in multivariate models. After accounting for all participant factors, older age was a significant predictor of longer training time, and Black race was a significant predictor of lower daily wear time. On the usability survey, all participants (45/45, 100\%) indicated willingness to participate in future smartwatch studies, >80\% (37/45) had a positive experience, and >90\% (41/45) were satisfied with smartphone app syncing. Conclusions: Smartwatch monitoring, requiring daily wear, smartphone syncing, and daily EMA survey completion, is highly feasible in older adults because adherence to daily wear and EMA surveys was high, as was general satisfaction on usability surveys. Although older participants may require more training on smartwatch and smartphone procedures and automated prompting during the study period, longitudinal monitoring with the Garmin Vivosmart 4 smartwatch and Labfront app is acceptable and feasible for collecting nearly continuous data in Black and White older adults, including those with mild cognitive impairment and those without. ",
doi="10.2196/69952",
url="https://humanfactors.jmir.org/2025/1/e69952"
}


@Article{info:doi/10.2196/59807,
author="Thorup, Brun Charlotte
and Uitto, Mika
and Butler-Henderson, Kerryn
and Wamala-Andersson, Sarah
and Hoffr{\'e}n-Mikkola, Merja
and Schack Thoft, Diana
and Korsbakke Emtek{\ae}r H{\ae}sum, Lisa
and Irrazabal, Gabriela
and Pruneda Gonz{\'a}lez, Laura
and Valkama, Katja",
title="Choosing the Best Digital Health Literacy Measure for Research: Mixed Methods Study",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="8",
volume="27",
pages="e59807",
keywords="digital health literacy",
keywords="digital literacy",
keywords="Horizon Europe",
keywords="EU",
keywords="health technology",
keywords="life expectancy",
keywords="health literacy",
keywords="chronic disease",
keywords="digitalization",
keywords="digital health service",
keywords="digital health intervention",
keywords="technology",
keywords="healthcare",
abstract="Background: The global demographic shift towards longer life expectancy and complex health needs is increasing the number of people with chronic diseases, placing pressure on health and care systems. With the digitalization of healthcare, digital Health Literacy (dHL), or the use of digital skills in health, is gaining importance. It involves navigating digital health information, using digital tools effectively, and making informed health decisions. Measuring dHL can help identify gaps and develop strategies to improve dHL and health, ensuring citizens equal opportunity to participate in a digital healthcare system. The European project ``The Improving Digital Empowerment for Active and Healthy Living (IDEAHL)'' with the objective to empower European Union citizens to use digital instruments to take a more active role in managing their health and well-being creates the base for this overview Objective: This paper aims to conduct an overview of existing assessment tools for measuring dHL and recommend strategies for choosing relevant assessment tools. Methods: This study was carried out as a mixed method study initiated by a scoping review (10 scientific databases, 14 databases with grey literature and 14 predefined reports) in addition to three papers published after finalisations the literature search in IDEAHL, followed by a qualitative workshop study and a final analysis combining results. Results: The literature search resulted in 33 papers on dHL instruments, that was analyzed together with three recently published reviews and findings from a workshop with 13 champions (understood as professionals with expertise in HL and dHL) from five countries (Spain, Denmark, Sweden, Australia, and Germany) representing the health sector or health literacy research. Future tools should adapt to the latest trends and technologies, considering attitudes towards digital health and trust in its services. They should identify beneficiaries of digital health services, measure the impact of dHL interventions, and objectively evaluate functional skills. These tools should be evidence-based, validate instruments, interpret dHL results, and capture diverse experiences to reveal health behaviour changes. Conclusions: The eHealth Literacy Scale (eHEALS), despite being the most frequently utilized tool, has limitations in scope and adaptability. Future tools need to reflect digital trends, encompassing individual skills. However, it is important to note that the `adequacy' of dHL is context-specific and relies on healthcare systems and the technology provided, particularly the user interface. The focus should be on health improvement, not just elevating dHL levels. A comprehensive approach to dHL assessments addressing diversity and relevance is crucial. Ethical considerations in dHL, including privacy and data security, are important due to potential feelings of shame among those with low literacy levels. ",
doi="10.2196/59807",
url="https://www.jmir.org/2025/1/e59807"
}


@Article{info:doi/10.2196/60472,
author="Maini, Ishana
and Gilotra, Kevin
and Sadigh, Gelareh",
title="Patient Factors Associated With the Use of Online Portal Health Information in the Postpandemic Era: Cross-Sectional Analysis of a National Survey",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="3",
volume="27",
pages="e60472",
keywords="patient portal",
keywords="utilization",
keywords="health disparity",
keywords="post-pandemic",
keywords="health information",
keywords="prevalence",
keywords="portal use",
keywords="survey",
keywords="health care provider",
keywords="Americans",
keywords="US",
abstract="Background: Patients' electronic access to their health information can improve long-term health outcomes. Few studies have evaluated barriers that may limit access to portal health information before the COVID-19 pandemic such as preference for in-person visits, lack of perceived need to use a patient portal system, and lack of comfort or experience with computers. With the increased use of telehealth during the pandemic, patients' comfort with portal applications and digital health literacy has improved. Objective: The purpose of this study was to assess the prevalence of portal use and factors associated with patients' portal access after the COVID-19 pandemic. Methods: This study used data from the 2022 National Cancer Institute's Health Information National Trends Survey (HINTS 6). Adult patients (aged ?18 years) who responded to the survey question about patient portal access were included. A multivariate logistic regression analysis was performed to determine characteristics associated with portal access. Results: A total number of 5958 patients were included (weighted n=245,721,106), with a mean age of 48.2 (20.1) years and were mostly female (119,538,392/236,138,857, 50.6\%) and white (167,163,482/227,232,636, 73.6\%). Overall, 61.3\% (150,722,178/245,721,106) of all respondents reported accessing portals over the last 12 months and 43.7\% (82,620,907/188,860,031) used multiple portals. Most participants (135,011,661/150,104,795, 89.9\%) reported using portals to access test results, followed by viewing clinical notes (104,541,142/149,867,276, 69.8\%) downloading personal health information (47,801,548/150,017,130, 31.9\%). The likelihood of portal use significantly increased by 24.9\% points (95\% CI 19.4-30.5) when patients were offered access to portals by health care providers or insurers compared with those not offered access or did not know if they were offered access. The likelihood of portal use also increased by 19.5\% points (95\% CI 15.1-23.9) among patients with a health care provider encouraging them to access portals, compared to patients who did not receive encouragement to do so. Having a college education versus education below college level and living in metropolitan areas versus nonmetropolitan regions increased the probability of portal use by 6.9\% points (95\% CI 3.1-10.8) and 6.9\% points (95\% CI 1.3-12.6), respectively. Of note, males (compared with females) and those of Hispanic background (compared with non-Hispanic individuals) were less likely to be offered portal access by 10.8\% points (95\% CI 6.3-15.2) and 6.9\% points (95\% CI 1.7-12.1), respectively. Conclusions: This study demonstrates that most Americans use patient portals, though certain patient populations such as those with less than college degree education or living in nonmetropolitan areas continue to face greater difficulty accessing them. Interventions targeted at equality in offering access to patient portals and encouraging patients to use them could advance equitable and widespread access to patient portals. ",
doi="10.2196/60472",
url="https://www.jmir.org/2025/1/e60472"
}


@Article{info:doi/10.2196/66117,
author="Stephen, Anna Divya
and Nordin, Anna
and Johansson, Unn-Britt
and Nilsson, Jan",
title="eHealth Literacy and Its Association With Demographic Factors, Disease-Specific Factors, and Well-Being Among Adults With Type 1 Diabetes: Cross-Sectional Survey Study",
journal="JMIR Diabetes",
year="2025",
month="Mar",
day="31",
volume="10",
pages="e66117",
keywords="cross-sectional studies",
keywords="diabetes mellitus, type 1",
keywords="digital technology",
keywords="eHealth literacy",
keywords="health literacy",
abstract="Background: The use of digital health technology in diabetes self-care is increasing, making eHealth literacy an important factor to consider among people with type 1 diabetes. There are very few studies investigating eHealth literacy among adults with type 1 diabetes, highlighting the need to explore this area further. Objective: The aim of this study was to explore associations between eHealth literacy and demographic factors, disease-specific factors, and well-being among adults with type 1 diabetes. Methods: The study used data from a larger cross-sectional survey conducted among adults with type 1 diabetes in Sweden (N=301). Participants were recruited using a convenience sampling method primarily through advertisements on social media. Data were collected between September and November 2022 primarily through a web-based survey, although participants could opt to answer a paper-based survey. Screening questions at the beginning of the survey determined eligibility to participate. In this study, eHealth literacy was assessed using the Swedish version of the eHealth Literacy Scale (Sw-eHEALS). The predictor variables, well-being was assessed using the World Health Organization-5 Well-Being Index and psychosocial self-efficacy using the Swedish version of the Diabetes Empowerment Scale. The survey also included research group--developed questions on demographic and disease-specific variables as well as digital health technology use. Data were analyzed using multiple linear regression presented as nested models. A sample size of 270 participants was required in order to detect an association between the dependent and predictor variables using a regression model based on an F test. The final sample size included in the nested regression model was 285. Results: The mean Sw-eHEALS score was 33.42 (SD 5.32; range 8?40). The model involving both demographic and disease-specific variables explained 31.5\% of the total variation in eHealth literacy and was deemed the best-fitting model. Younger age (P=.01; B=--0.07, SE=0.03;95\% CI --0.12 to --0.02), lower self-reported glycated hemoglobin levels (P=.04; B=--0.06, SE=0.03; 95\% CI --0.12 to 0.00), and higher psychosocial self-efficacy (P<.001; B=3.72, SE=0.53; 95\% CI 2.68-4.75) were found associated with higher Sw-eHEALS scores when adjusted for demographic and disease-specific variables in this model. Well-being was not associated with eHealth literacy in this study. Conclusions: The demographic and disease-specific factors explained the variation in eHealth literacy in this sample. Further studies in this area using newer eHealth literacy tools are important to validate our findings. The study highlights the importance of development and testing of interventions to improve eHealth literacy in this population for better glucose control. These eHealth literacy interventions should be tailored to meet the needs of people in varying age groups and with differing levels of psychosocial self-efficacy. ",
doi="10.2196/66117",
url="https://diabetes.jmir.org/2025/1/e66117"
}


@Article{info:doi/10.2196/65269,
author="Yang, Jun Hyo
and Lee, Ji-Hyun
and Lee, Wonjae",
title="Factors Influencing Health Care Technology Acceptance in Older Adults Based on the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology: Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="28",
volume="27",
pages="e65269",
keywords="technology adoption",
keywords="older adults",
keywords="health care technology",
keywords="technology acceptance model",
keywords="unified theory of acceptance and use of technology",
keywords="meta-analysis",
abstract="Background: The technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT) are widely used to examine health care technology acceptance among older adults. However, existing literature exhibits considerable heterogeneity, making it difficult to determine consistent predictors of acceptance and behavior. Objective: We aimed to (1) determine the influence of perceived usefulness (PU), perceived ease of use (PEOU), and social influence (SI) on the behavioral intention (BI) to use health care technology among older adults and (2) assess the moderating effects of age, gender, geographic region, type of health care technology, and presence of visual demonstrations. Methods: A systematic search was conducted across Google Scholar, Web of Science, Scopus, IEEE Xplore, and ProQuest databases on March 15, 2024, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Of the 1167 initially identified studies, 41 studies (11,574 participants; mean age 67.58, SD 4.76 years; and female:male ratio=2.00) met the inclusion criteria. The studies comprised 12 mobile health, 12 online or telemedicine, 9 wearable, and 8 home or institution hardware investigations, with 23 studies from Asia, 7 from Europe, 7 from African-Islamic regions, and 4 from the United States. Studies were eligible if they used the TAM or UTAUT, examined health care technology adoption among older adults, and reported zero-order correlations. Two independent reviewers screened studies, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale, evaluating selection, comparability, and outcome assessment with 34\% (14/41) of studies rated as good quality and 66\% (27/41) as satisfactory. Results: Random-effects meta-analysis revealed significant positive correlations for PU-BI (r=0.607, 95\% CI 0.543-0.665; P<.001), PEOU-BI (r=0.525, 95\% CI 0.462-0.583; P<.001), and SI-BI (r=0.551, 95\% CI 0.468-0.624; P<.001). High heterogeneity was observed across studies (I{\texttwosuperior}=95.9\%, 93.6\%, and 95.3\% for PU-BI, PEOU-BI, and SI-BI, respectively). Moderator analyses revealed significant differences based on geographic region for PEOU-BI (Q=8.27; P=.04), with strongest effects in Europe (r=0.628) and weakest in African-Islamic regions (r=0.480). Technology type significantly moderated PU-BI (Q=8.08; P=.04) and SI-BI (Q=14.75; P=.002), with home or institutional hardware showing the strongest effects (PU-BI: r=0.736; SI-BI: r=0.690). Visual demonstrations significantly enhanced PU-BI (r=0.706 vs r=0.554; Q=4.24; P=.04) and SI-BI relationships (r=0.670 vs r=0.492; Q=4.38; P=.04). Age and gender showed no significant moderating effects. Conclusions: The findings indicate that PU, PEOU, and SI significantly impact the acceptance of health care technology among older adults, with heterogeneity influenced by geographic region, type of technology, and presence of visual demonstrations. This suggests that tailored strategies for different types of technology and the use of visual demonstrations are important for enhancing adoption rates. Limitations include varying definitions of older adults across studies and the use of correlation coefficients rather than controlled effect sizes. Results should therefore be interpreted within specific contexts and populations. ",
doi="10.2196/65269",
url="https://www.jmir.org/2025/1/e65269"
}


@Article{info:doi/10.2196/64707,
author="Pettersson, Linda
and Johansson, Stefan
and Demmelmaier, Ingrid
and von Koch, Lena
and Gulliksen, Jan
and Hedvall, Per-Olof
and Gummesson, Karl
and Gustavsson, Catharina",
title="Accessibility of eHealth Before and During the COVID-19 Pandemic Among People With and People Without Impairment: Repeated Cross-Sectional Survey",
journal="JMIR Public Health Surveill",
year="2025",
month="Mar",
day="28",
volume="11",
pages="e64707",
keywords="eHealth",
keywords="impairment",
keywords="accessibility",
keywords="digital inclusion",
keywords="universal design",
keywords="disability",
keywords="digital divide",
keywords="electronic health",
keywords="COVID-19",
keywords="pandemic",
keywords="cross-sectional study",
keywords="Sweden",
keywords="online booking",
keywords="digital identification",
keywords="web portal",
keywords="health information",
keywords="control group",
keywords="public health",
keywords="digital health",
keywords="digital literacy",
keywords="health informatics",
keywords="mobile phone",
abstract="Background: The adoption of eHealth accelerated during the COVID-19 pandemic. Inequalities in the adoption of eHealth during the COVID-19 pandemic have been reported, but there are few such studies among people with impairment. Objectives: This study aimed to investigate self-reported use and difficulty in the use of eHealth before the COVID-19 pandemic compared to during late social distancing restrictions in Sweden, among people with and without impairment, as well as between different types of impairment. Methods: A cross-sectional survey was distributed twice by snowball sampling to people with self-reported impairment and a general population matched by age, gender, and county. Use and difficulty in the use of six eHealth services were compared between groups using chi-square test and logistic regression with year interaction terms, reported as odds ratio adjusted (aOR) for gender and age with 95\% CI. Results: The surveys included 1631 (in 2019) and 1410 (in 2021) participants with impairment, and 1084 (in 2019) and 1223 (in 2021) participants without. Participants with impairment, compared to those without impairment, reported less use and more difficulty in booking health care appointments online, digital identification, and the Swedish national web portal for health information and eHealth services (1177.se), both before and during the pandemic (P=.003 or lower). Video health care appointments were the exception to this disability digital divide in eHealth as video appointment adoption was the most likely among participants with attention, executive, and memory impairments (interaction term aOR 2.10, 95\% CI 1.30?3.39). Nonuse and difficulty in the use of eHealth were consistently associated with language impairments and intellectual impairments. For example, language impairments were inversely associated with use of the logged-in eHealth services in 1177.se in 2021 (aOR 0.49, 95\% CI 0.36?0.67) and were associated with difficulty in the use of 1177.se in 2019 (aOR 2.24, 95\% CI 1.50?3.36) and the logged-in eHealth services in 1177.se in 2021 (aOR 1.89, 95\% CI 1.32?2.70). Intellectual impairments were inversely associated with the use of the logged-in eHealth services in 1177.se in 2021 (aOR 0.19, 95\% CI 0.13?0.27). Conclusions: This repeated cross-sectional survey study, including participants with diverse types of impairment and a control group without impairment, reveals persisting disability digital divides, despite an accelerated adoption of eHealth across the pandemic. eHealth services were not accessible to some groups of people who were identified as being at risk of severe disease during the COVID-19 pandemic. This implies that all people could not use eHealth as a measure of infection protection. ",
doi="10.2196/64707",
url="https://publichealth.jmir.org/2025/1/e64707"
}


@Article{info:doi/10.2196/55072,
author="Wadman, Ruth
and Walker, Lauren
and Taylor, Olivia
and Heron, Paul
and Newbronner, Elizabeth
and Spanakis, Panagiotis
and Crosland, Suzanne
and Peckham, Jane Emily",
title="Patterns of Internet Use in People Diagnosed With Severe Mental Illness: Qualitative Interview Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="28",
volume="27",
pages="e55072",
keywords="severe mental illness",
keywords="internet use",
keywords="qualitative",
keywords="typology",
keywords="protective strategies",
keywords="digital divide",
abstract="Background: People with severe mental illness (SMI) face profound health inequalities, which may be exacerbated by increased rates of digital exclusion, especially as health services move to online provision. The activities that people carry out online can affect how they feel about the internet and may determine whether a person has a positive or negative experience when using the internet. This, in turn, could affect their mental health. To support people with SMI in using digital technology and the internet safely, it is important to understand the internet and digital technology use of those with SMI and their perceived positive or negative impact on their mental health. Objective: This study aimed to explore the internet and digital technology use of those with SMI, with particular focus on any association between greater use of the internet and poorer self-reported mental health. Methods: We carried out a qualitative interview study with 16 people with SMI. The sample was drawn from a wider investigation of the impact of the pandemic and its restrictions on the health and well-being of 367 people with SMI. We purposively sampled from the wider study based on age, gender, frequency of internet use, and self-reported mental health. The data were analyzed by 2 researchers using framework analysis. Results: Participant experiences fell into 3 broad categories: those who had a positive or neutral internet-based experience, those who had negative or difficult experiences, and low users or those with poor digital literacy. Those who had positive or neutral experiences could be broken down into 2 subcategories: first, those with positive or neutral experiences of the internet who were similar in terms of the activities participated in, feelings reported, and their concerns about the internet, and second, conscious users who were mindful of their interaction with the internet world. Participants with difficult experiences fell into 2 categories: those with worries and fears related to using the internet and those who had difficulty limiting their internet use. Conclusions: People with SMI, similarly the general population, are expected to conduct more of their activities of daily living online in the postpandemic world. This research shows that most internet users with SMI have positive or neutral experiences. However, our typology reveals subgroups of the population with SMI for whom there is a relationship between internet use and difficult feelings. These subgroups can be identified by asking questions about online activities; time spent online; feelings, difficulties, or issues experienced; and use of gambling, dating, adult content, and conspiracy theory websites. Our findings point to further work in collaboration with people with lived experience to modify and test this typology. ",
doi="10.2196/55072",
url="https://www.jmir.org/2025/1/e55072"
}


@Article{info:doi/10.2196/70404,
author="Mackwood, Matthew
and Fisher, Elliott
and Schmidt, O. Rachel
and O'Malley, James A.
and Rodriguez, P. Hector
and Shortell, Stephen
and Akr{\'e}, Ellesse-Roselee
and Berube, Alena
and Schifferdecker, E. Karen",
title="Primary Care Practice Factors Associated With Telehealth Adoption in the United States: Cross-Sectional Survey Analysis",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="28",
volume="27",
pages="e70404",
keywords="telehealth",
keywords="telemedicine",
keywords="remote consultation",
keywords="primary health care",
keywords="general practice",
keywords="internet access",
keywords="health policy",
keywords="health care economics and organizations",
keywords="access to primary care",
keywords="digital divide",
keywords="vulnerable populations",
keywords="medically underserved area",
doi="10.2196/70404",
url="https://www.jmir.org/2025/1/e70404"
}


@Article{info:doi/10.2196/66058,
author="Zhang, Chenglin
and Mohamad, Emma
and Azlan, Anis Arina
and Wu, Anqi
and Ma, Yilian
and Qi, Yihan",
title="Social Media and eHealth Literacy Among Older Adults: Systematic Literature Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="26",
volume="27",
pages="e66058",
keywords="eHealth literacy",
keywords="digital health literacy",
keywords="older adults",
keywords="social media",
keywords="health information",
keywords="systematic review",
abstract="Background: The advent of social media has significantly transformed health communication and the health-related actions of older adults, offering both obstacles and prospects for this generation to embrace eHealth developments. Objective: We aimed to investigate the correlation between social media and eHealth literacy in older individuals and answer four research questions: (1) What are the specific social media behaviors (including general use behaviors and health behaviors) of older adults on social media? (2) How do these behaviors impact their eHealth literacy? (3) How does eHealth literacy influence older adults' social media behaviors? and (4) What factors influence older adults' use of social media for health-related purposes? Methods: Using predetermined keywords and inclusion criteria, we searched Scopus, Web of Science, and PubMed databases for English-language journal articles published from 2000 to 2024, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) principles. The initial search identified 1591 publications, and after removing duplicates, 48.21\% (767/1591) of publications remained. Ultimately, 1\% (16/1591) of studies met the inclusion criteria. A research question--driven manual qualitative thematic analysis was conducted, guided by the categorization of social media use behaviors, the definition of eHealth literacy, and the social-ecological model to provide direction for coding and thematic analysis. In addition, attention was given to identifying unanticipated behaviors or phenomena during the coding process, and these were subsequently incorporated into the analytical framework. Results: The results indicated that older adults' general social media use behaviors are primarily characterized by social media preferences, with 2 subthemes identified. Their social media health behaviors revealed 5 main themes and 14 subthemes. Among the primary themes, health information behavior appeared most frequently (12/16, 75\%), followed by self-management (8/16, 50\%). Other themes included health decision-making (4/16, 25\%), telemedicine (3/16, 19\%), and health interventions (2/16, 13\%). Cross-thematic analysis confirmed that older adults' social media use behaviors and their eHealth literacy had a reciprocal relationship. Finally, the study revealed that the use of social media to improve eHealth literacy among older adults was influenced by individual, interpersonal, institutional or organizational, and social factors. Conclusions: The reciprocal relationship between older adults' social media use and eHealth literacy highlights the importance of establishing a long-term positive mechanism that mutually reinforces social media health practices and eHealth literacy. Based on the findings, this review proposes key directions for efforts to achieve this goal: (1) leveraging postpandemic momentum to enhance eHealth literacy among older adults through social media, (2) reconsidering the dimensions of eHealth literacy among older adults in the context of Web 2.0, (3) actively developing age-friendly integrated social media health service platforms, (4) optimizing social media for engaging and reliable health information for older adults, and (5) integrating social support systems to foster lifelong eHealth learning for older adults. ",
doi="10.2196/66058",
url="https://www.jmir.org/2025/1/e66058"
}


@Article{info:doi/10.2196/63671,
author="Yu, Yao
and Liang, Zhenning
and Zhou, Qingping
and Tuersun, Yusupujiang
and Liu, Siyuan
and Wang, Chenxi
and Xie, Yuying
and Wang, Xinyu
and Wu, Zhuotong
and Qian, Yi",
title="Decomposition and Comparative Analysis of Urban-Rural Disparities in eHealth Literacy Among Chinese University Students: Cross-Sectional Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="26",
volume="27",
pages="e63671",
keywords="university students",
keywords="eHealth literacy",
keywords="urban-rural disparities",
keywords="Fairlie decomposition model",
keywords="health equity",
abstract="Background: Mobile health care is rapidly expanding in China, making the enhancement of eHealth literacy a crucial strategy for improving public health. However, the persistent urban-rural divide may contribute to disparities in eHealth literacy between urban and rural university students, potentially affecting their health-related behaviors and outcomes. Objective: This study aims to examine disparities in eHealth literacy between university students in urban and rural China, identifying key influencing factors and their contributions. The findings will help bridge these gaps, promote social equity, enhance overall health and well-being, and inform future advancements in the digital health era. Methods: The eHealth Literacy Scale (eHEALS) was used to assess eHealth literacy levels among 7230 university students from diverse schools and majors across 10 regions, including Guangdong Province, Shanghai Municipality, and Jiangsu Province. Descriptive statistics summarized demographic, sociological, and lifestyle characteristics. Chi-square tests examined the distribution of eHealth literacy between urban and rural students. A binary logistic regression model identified key influencing factors, while a Fairlie decomposition model quantified their contributions to the observed disparities. Results: The average eHealth literacy score among Chinese university students was 29.22 (SD 6.68), with 4135 out of 7230 (57.19\%) scoring below the passing mark. Rural students had a significantly higher proportion of inadequate eHealth literacy (2837/4510, 62.90\%) compared with urban students (1298/2720, 47.72\%; P<.001). The Fairlie decomposition analysis showed that 71.4\% of the disparity in eHealth literacy was attributable to urban-rural factors and unobserved variables, while 28.6\% resulted from observed factors. The primary contributors were monthly per capita household income (13.4\%), exercise habits (11.7\%), and 9-item Patient Health Questionnaire (PHQ-9) scores (2.1\%). Conclusions: Rural university students exhibit lower eHealth literacy levels than their urban counterparts, a disparity influenced by differences in socioeconomic status, individual lifestyles, and personal health status. These findings highlight the need for targeted intervention strategies, including (1) improving access to eHealth resources in rural and underserved areas; (2) fostering an environment that encourages physical activity to promote healthy behaviors; (3) expanding school-based mental health services to enhance health information processing capacity; and (4) implementing systematic eHealth literacy training with ongoing evaluation. These strategies will support equitable access to and utilization of eHealth resources for all students, regardless of their geographic location. ",
doi="10.2196/63671",
url="https://www.jmir.org/2025/1/e63671"
}


@Article{info:doi/10.2196/70483,
author="Chen, Si
and Ebrahimi, V. Omid
and Cheng, Cecilia",
title="New Perspective on Digital Well-Being by Distinguishing Digital Competency From Dependency: Network Approach",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="25",
volume="27",
pages="e70483",
keywords="digital wellness",
keywords="affective well-being",
keywords="emotional regulation",
keywords="coping",
keywords="digital competence",
keywords="digital autonomy",
keywords="artificial intelligence",
abstract="Background: In the digital age, there is an emerging area of research focusing on digital well-being (DWB), yet conceptual frameworks of this novel construct are lacking. The current conceptualization either approaches the concept as the absence of digital ill-being, running the risk of pathologizing individual digital use, or follows the general subjective well-being framework, failing to highlight the complex digital nature at play. Objective: This preregistered study aimed to address this gap by using a network analysis, which examined the strength of the relationships among affective (digital stress and web-based hedonic well-being), cognitive (online intrinsic needs satisfaction), and social (online social connectedness and state empathy) dimensions of DWB and their associations with some major DWB protective and risk factors (ie, emotional regulation, nomophobia, digital literacy, self-control, problematic internet use, coping styles, and online risk exposure). Methods: The participants were 578 adults (mean age 38.7, SD 13.14 y; 277/578, 47.9\% women) recruited from the United Kingdom and the United States who completed an online survey. Two network models were estimated. The first one assessed the relationships among multiple dimensions of DWB, and the second examined the relationships between DWB dimensions and related protective and risk factors. Results: The 2 resulting network structures demonstrated high stability, with the correlation stability coefficients being 0.67 for the first and 0.75 for the second regularized Gaussian graphical network models. The first network indicated that all DWB variables were positively related, except for digital stress, which was negatively correlated with the most central node---online intrinsic needs satisfaction. The second network revealed 2 distinct communities: digital competency and digital dependency. Emotional regulation emerged as the most central node with the highest bridge expected influence, positively associated with emotion-focused coping in the digital competency cluster and negatively associated with avoidant coping in the digital dependency cluster. In addition, some demographic differences were observed. Women scored higher on nomophobia ($\chi$24=10.7; P=.03) and emotion-focused coping ($\chi$24=14.9; P=.01), while men scored higher on digital literacy ($\chi$24=15.2; P=.01). Compared with their older counterparts, younger individuals scored lower on both emotional regulation (Spearman $\rho$=0.27; P<.001) and digital self-control (Spearman $\rho$=0.35; P<.001) and higher on both digital stress (Spearman $\rho$=?0.14; P<.001) and problematic internet use (Spearman $\rho$=?0.25; P<.001). Conclusions: The network analysis revealed how different aspects of DWB were interconnected, with the cognitive component being the most influential. Emotional regulation and adaptive coping strategies were pivotal in distinguishing digital competency from dependency. ",
doi="10.2196/70483",
url="https://www.jmir.org/2025/1/e70483"
}


@Article{info:doi/10.2196/60547,
author="Salma, Jordana
and Au, Alesia
and Sayadi, Ghada
and Kleib, Manal",
title="Digital Competence of Arabic-Speaking Immigrant and Refugee Older Adults Enacting Agency and Navigating Barriers: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="25",
volume="27",
pages="e60547",
keywords="digital competence",
keywords="Arab",
keywords="older adult",
keywords="co-design",
keywords="migrant",
keywords="information and communications technology",
keywords="ICT",
abstract="Background: Canada's immigrant and refugee older adult population is projected to grow substantially, making equitable access to information and communications technologies (ICTs) vital for enhancing quality of life in older age. Strengthening the digital competence of immigrant and refugee older adults can improve their social connectedness and access to local information. Objective: This study explored the digital competence of Arabic-speaking immigrant and refugee older adults, focusing on how they engage with ICTs to meet their information and communication needs and the strategies they use to navigate digital barriers. Methods: A qualitative descriptive methodology within a social constructivist paradigm was adopted, incorporating triangulated data collection and iterative co-design cycles. The qualitative approach facilitated an in-depth exploration of participants' experiences, skills, and emotions and the contextual factors influencing their digital competence. Data were collected through storytelling approaches, qualitative interviews, and focus group discussions, which were effective in capturing the experiential aspects of aging and technology use. Co-design cycles informed 6 digital learning sessions tailored to participants' immediate learning needs, fostering motivation and engagement and allowing for observation of ICT use. Digital competence was mapped across the learning domains of the Digital Competence Framework for Citizens 2.2. Results: This study engaged 31 Arabic-speaking immigrant and refugee older adults residing in Canada. Most participants had limited formal education (19/31, 61\%), lived with family (22/31, 70\%), and reported a low income (21/31, 68\%). All participants (31/31, 100\%) used smartphones as their primary ICT device, whereas few (3/31, 10\%) had access to a computer. In total, 3 themes were identified from the analysis, grounded in Digital Competence Framework for Citizens 2.2 competencies on information and data literacy, communication and collaboration, and safety and problem-solving. The themes focused on agency, which is enhanced or constrained using ICTs, impacting older adults' desire and ability to use these technologies to independently meet their daily needs. Conclusions: Immigrant and refugee older adults require support to navigate digital barriers and gain digital competence. Smartphones serve as a critical tool for enhancing digital agency, which can lead to greater social connectedness and improved access to local resources in older age. The findings will inform the design of future digital competence programs for older migrants, emphasizing community partnership and reciprocal learning. ",
doi="10.2196/60547",
url="https://www.jmir.org/2025/1/e60547"
}


@Article{info:doi/10.2196/64505,
author="Bober, Timothy
and Garvin, Sophia
and Krall, Jodi
and Zupa, Margaret
and Low, Carissa
and Rosland, Ann-Marie",
title="Examining How Adults With Diabetes Use Technologies to Support Diabetes Self-Management: Mixed Methods Study",
journal="JMIR Diabetes",
year="2025",
month="Mar",
day="25",
volume="10",
pages="e64505",
keywords="diabetes",
keywords="self-management",
keywords="mobile health",
keywords="health technology",
keywords="continuous glucose monitors",
keywords="digital health literacy",
abstract="Background: Technologies such as mobile apps, continuous glucose monitors (CGMs), and activity trackers are available to support adults with diabetes, but it is not clear how they are used together for diabetes self-management. Objective: This study aims to understand how adults with diabetes with differing clinical profiles and digital health literacy levels integrate data from multiple behavior tracking technologies for diabetes self-management. Methods: Adults with type 1 or 2 diabetes who used ?1 diabetes medications responded to a web-based survey about health app and activity tracker use in 6 categories: blood glucose level, diet, exercise and activity, weight, sleep, and stress. Digital health literacy was assessed using the Digital Health Care Literacy Scale, and general health literacy was assessed using the Brief Health Literacy Screen. We analyzed descriptive statistics among respondents and compared health technology use using independent 2-tailed t tests for continuous variables, chi-square for categorical variables, and Fisher exact tests for digital health literacy levels. Semistructured interviews examined how these technologies were and could be used to support daily diabetes self-management. We summarized interview themes using content analysis. Results: Of the 61 survey respondents, 21 (34\%) were Black, 23 (38\%) were female, and 29 (48\%) were aged ?45 years; moreover, 44 (72\%) had type 2 diabetes, 36 (59\%) used insulin, and 34 (56\%) currently or previously used a CGM. Respondents had high levels of digital and general health literacy: 87\% (46/53) used at least 1 health app, 59\% (36/61) had used an activity tracker, and 62\% (33/53) used apps to track ?1 health behaviors. CGM users and nonusers used non-CGM health apps at similar rates (16/28, 57\% vs 12/20, 60\%; P=.84). Activity tracker use was also similar between CGM users and nonusers (20/33, 61\% vs 14/22, 64\%; P=.82). Respondents reported sharing self-monitor data with health care providers at similar rates across age groups (17/32, 53\% for those aged 18-44 y vs 16/29, 55\% for those aged 45-70 y; P=.87). Combined activity tracker and health app use was higher among those with higher Digital Health Care Literacy Scale scores, but this difference was not statistically significant (P=.09). Interviewees (18/61, 30\%) described using blood glucose level tracking apps to personalize dietary choices but less frequently used data from apps or activity trackers to meet other self-management goals. Interviewees desired data that were passively collected, easily integrated across data sources, visually presented, and tailorable to self-management priorities. Conclusions: Adults with diabetes commonly used apps and activity trackers, often alongside CGMs, to track multiple behaviors that impact diabetes self-management but found it challenging to link tracked behaviors to glycemic and diabetes self-management goals. The findings indicate that there are untapped opportunities to integrate data from apps and activity trackers to support patient-centered diabetes self-management. ",
doi="10.2196/64505",
url="https://diabetes.jmir.org/2025/1/e64505",
url="http://www.ncbi.nlm.nih.gov/pubmed/40131316"
}


@Article{info:doi/10.2196/63584,
author="Bataineh, S. Bara
and Marti, Nathan C.
and Murthy, Dhiraj
and Badillo, David
and Chow, Sherman
and Loukas, Alexandra
and Wilkinson, V. Anna",
title="Vaping, Acculturation, and Social Media Use Among Mexican American College Students: Protocol for a Mixed Methods Web-Based Cohort Study",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="24",
volume="14",
pages="e63584",
keywords="vaping",
keywords="social media",
keywords="Mexican American",
keywords="college students",
keywords="marketing",
keywords="acculturation",
keywords="protocol",
keywords="artificial intelligence",
abstract="Background: The tobacco industry has a history of targeting minority communities, including Hispanic individuals, by promoting vaping through social media. This marketing increases the risk of vaping among Hispanic young adults, including college students. In Texas, college enrollment among Mexican Americans has significantly increased over recent years. However, little research exists on the link between social media and vaping and the underlying mechanisms (ie, outcome expectations, attitudes, and beliefs) explaining how vaping-related social media impacts vaping among Mexican American college students. Moreover, there is limited knowledge about how acculturation moderates the association between social media and vaping. Hispanic individuals, particularly Mexican Americans, are the largest ethnic group in Texas colleges; thus, it is crucial to understand the impact of social media and acculturation on their vaping behaviors. Objective: We outline the mixed methods used in Project Vaping, Acculturation, and Media Study (VAMoS). We present descriptive analyses of the participants enrolled in the study, highlight methodological strengths, and discuss lessons learned during the implementation of the study protocol related to recruitment and data collection and management. Methods: Project VAMoS is being conducted with Mexican American students attending 1 of 6 Texas-based colleges: University of Texas (UT) Arlington, UT Dallas, UT El Paso, UT Rio Grande Valley, UT San Antonio, and the University of Houston System. This project has 2 phases. Phase 1 included an ecological momentary assessment (EMA) study and qualitative one-on-one interviews (years 1-2), and phase 2 includes cognitive interviews and a 4-wave web-based survey study (years 2-4) with objective assessments of vaping-related social media content to which participants are exposed. Descriptive statistics summarized participants' characteristics in the EMA and web-based survey. Results: The EMA analytic sample comprised 51 participants who were primarily female (n=37, 73\%), born in the United States (n=48, 94\%), of middle socioeconomic status (n=38, 75\%), and aged 21 years on average (SD 1.7 years). The web-based survey cohort comprised 1492 participants self-identifying as Mexican American; Tejano, Tejana, or Tejanx; or Chicano, Chicana, or Chicanx heritage who were primarily female (n=1042, 69.8\%), born in the United States (n=1366, 91.6\%), of middle socioeconomic status (n=1174, 78.7\%), and aged 20.1 years on average at baseline (SD 2.2 years). Of the baseline cohort, the retention rate in wave 2 was 74.7\% (1114/1492). Conclusions: Project VAMoS is one of the first longitudinal mixed methods studies exploring the impact of social media and acculturation on vaping behaviors specifically targeting Mexican American college students. Its innovative approach to objectively measuring social media exposure and engagement related to vaping enhances the validity of self-reported data beyond what national surveys can achieve. The results can be used to develop evidence-based, culturally relevant interventions to prevent vaping among this rapidly growing minority population. International Registered Report Identifier (IRRID): DERR1-10.2196/63584 ",
doi="10.2196/63584",
url="https://www.researchprotocols.org/2025/1/e63584"
}


@Article{info:doi/10.2196/64635,
author="Shih, J. Jonathan
and Kuznia, Magdalene
and Nouri, Sarah
and Sherwin, B. Elizabeth
and Kemper, E. Kathryn
and Rubinsky, D. Anna
and Lyles, R. Courtney
and Khoong, C. Elaine",
title="Differences in Telemedicine Use for Patients With Diabetes in an Academic Versus Safety Net Health System: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="24",
volume="27",
pages="e64635",
keywords="telehealth",
keywords="telemedicine",
keywords="diabetes",
keywords="delivery of health care",
keywords="primary health care",
keywords="health care utilization",
keywords="health care disparities",
keywords="chronic disease",
keywords="COVID-19",
keywords="safety net providers",
keywords="public health emergency",
keywords="older adults",
abstract="Background: The COVID-19 public health emergency catalyzed widespread adoption of both video- and audio-only telemedicine visits. This proliferation highlighted inequities in use by age, race and ethnicity, and preferred language. Few studies have investigated how differences in health system telemedicine implementation affected these inequities. Objective: This study aims to describe patients who used telemedicine during the public health emergency and identify predictors of telemedicine use across 2 health systems with different telemedicine implementations. Methods: This retrospective cohort study included adults with diabetes receiving primary care between July 2020 and March 2021 at 2 independent health systems in San Francisco, California. Participant sociodemographic characteristics, health information, and telemedicine utilization were acquired from electronic health records. The primary outcome was visit type (any audio or video telemedicine vs in-person only) during the study period. We used multivariable logistic regression to assess the association between visit type and key predictors associated with digital exclusion (age, race and ethnicity, preferred language, and neighborhood socioeconomic status), adjusting for baseline health. We included an interaction term to evaluate health system impact on each predictor and then stratified by health system (academic, which prioritized video-enabled visits, vs safety net, which prioritized audio-only visits). Results: Among 10,201 patients, we found higher odds of telemedicine use in the safety net system compared with the academic system (adjusted odds ratio [aOR] 2.94, 95\% CI 2.48-3.48). Patients with younger age (18-34 years: aOR 2.55, 95\% CI 1.63-3.97; 35-49 years: aOR 1.39, 95\% CI 1.12-1.73 vs 75+ years) and Chinese-language preference (aOR 2.04, 95\% CI 1.66-2.5 vs English) had higher odds of having a telemedicine visit. Non-Hispanic Asian (aOR 0.67, 95\% CI 0.56-0.79), non-Hispanic Black (aOR 0.83, 95\% CI 0.68-1), and Hispanic or Latine (aOR 0.76, 95\% CI 0.61-0.95) patients had lower odds of having a telemedicine visit than non-Hispanic White patients. We found significant interactions between health system and age, race and ethnicity, and preferred language (P<.05). After stratifying by health system, several differences persisted in the academic system: non-Hispanic Asian (aOR 0.57, 95\% CI 0.46-0.70) and Latine (aOR 0.67, 95\% CI 0.50-0.91) patients had lower odds of a telemedicine visit, and younger age groups had higher odds (18-34 years: aOR 3.97, 95\% CI 1.99-7.93; 35-49 years: aOR 1.86, 95\% CI 1.36-2.56). In the safety net system, Chinese-speaking patients had higher odds of having a telemedicine visit (aOR 2.52, 95\% CI 1.85-3.42). Conclusions: We found disparities in telemedicine utilization by age, race and ethnicity, and preferred language, primarily in the health system that used more video visits. While telemedicine expanded rapidly recently, certain populations remain at risk for digital exclusion. These findings suggest that system-level factors influence telemedicine adoption and implementation decisions impact accessibility for populations at risk for digital exclusion. ",
doi="10.2196/64635",
url="https://www.jmir.org/2025/1/e64635",
url="http://www.ncbi.nlm.nih.gov/pubmed/40126552"
}


@Article{info:doi/10.2196/66248,
author="Peng, Yingchun
and Zhang, Zhiying
and Zhang, Ruyi
and Zhang, Yiyao
and Wang, Runying
and Zhang, Jiaying
and Zhai, Shaoqi
and Jin, Qilin
and Zhou, Jiaojiao
and Chen, Jingjing",
title="Multidimensional Evaluation of the Process of Constructing Age-Friendly Communities Among Different Aged Community Residents in Beijing, China: Cross-Sectional Questionnaire Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Mar",
day="21",
volume="11",
pages="e66248",
keywords="age-friendly",
keywords="positive living experience",
keywords="active aging",
keywords="healthy aging",
keywords="community residents",
keywords="older adults",
keywords="age-friendly communities",
keywords="multiple stakeholders",
keywords="evaluating age-friendliness",
keywords="urban and suburban areas",
abstract="Background: The World Health Organization (WHO) has made significant efforts to promote age-friendly community initiatives (AFCI) to address the challenges of population aging. Previous studies have discussed the construction of age-friendly communities (AFC) in urban cities, evaluating AFCs often rooted in the WHO's Checklist and focused on a single group, namely older adults, overlooking the role of other age groups in community development. Objective: This study aims to evaluate AFCs from multidimensional aspects, particularly the positive living experiences of older adults, summarize the deficiencies in both hardware and software aspects in the process of constructing AFCs in China, and provide some recommendations to promote AFCIs worldwide. Methods: Using a multistage sampling strategy, 470 community residents from urban and suburban areas participated in this study. A self-designed questionnaire was designed to use a standardized method to evaluate older adults' living experiences across five dimensions, including the degree of age-friendliness in the community, social support, sense of gain, sense of happiness, and sense of security. Respondents rated each dimension on a 10-point scale. This study defined community residents into 3 groups: residents younger than 45 years(Group 1: youth), those aged 45-59 years (Group 2: middle-aged), and those aged ?60 years (Group 3: old-age). Results: In this study, 382 (81.3\%) community residents were unaware of the relevant concepts of AFCs. Most participants highlighted the importance of community support and health services, followed by respect and social inclusion, and outdoor spaces and buildings. The findings showed that the highest-rated dimension was the sense of security. The mean scores for the degree of the sense of security in urban and suburban areas were 7.88 (SD 1.776) and 7.73 (SD 1.853), respectively. For Group 2, the mean scores were 7.60 (SD 2.070) and 8.03 (SD 1.662), while Group 3 had mean scores of 7.34 (SD 2.004) and 7.91 (SD 1.940). The lowest-rated dimension was social support; the mean scores for Group 1 for the degree of social support in urban and suburban areas were 7.63 (SD 1.835) and 7.48 (SD 1.918), respectively. For Group 2, the mean scores were 6.94 (SD 2.087) and 7.36 (SD 2.228), while those for Group 3 were 6.37 (SD 2.299) and 6.84 (SD 2.062). Further, there were significant differences in the scores of residents among different age groups in urban areas regarding age-friendliness (P<.001), social support, (P<.001), and sense of gain (P=.01). Conclusions: China is in the early stages of developing AFCs. We further highlight the importance of continued research on the collaboration and participation among multiple stakeholders. These outcomes have a direct and positive impact on the well?being of older adults. ",
doi="10.2196/66248",
url="https://publichealth.jmir.org/2025/1/e66248"
}


@Article{info:doi/10.2196/56803,
author="Yadav, Vijay
and Neto, Chaibub Elias
and Doerr, Megan
and Pratap, Abhishek
and Omberg, Larsson",
title="Long-Term Engagement of Diverse Study Cohorts in Decentralized Research: Longitudinal Analysis of ``All of Us'' Research Program Data",
journal="Interact J Med Res",
year="2025",
month="Mar",
day="19",
volume="14",
pages="e56803",
keywords="digital health",
keywords="engagement behavior",
keywords="All of Us Research Program",
keywords="retention",
keywords="decentralized research cohorts",
abstract="Background: The generalizability of clinical research hinges on robust study designs, which include the recruitment and maintenance of a representative study population. This study examines the evolution of the demographic characteristics of 329,038 participants who enrolled and participated in The All of Us Research Program (AoURP), a decentralized study aimed at representing the diversity of the United States. Objective: The primary objectives of this study were to assess alterations in the demographic composition of the cohort at different protocol stages within AoURP, while analyzing completion rates and timeframes for survey and substudy completion. Additionally, we examined how participant interactions with the program impacted engagement and survey responses. Methods: We conducted a longitudinal analysis of the AoURP data, tracking changes in demographic composition, completion rates, and completion times for surveys and substudies. Comparative analyses were performed to assess differences in engagement and survey completion based on sociodemographic characteristics of participants involved in postenrollment study components. Results: The sociodemographic composition of the cohort that participated in the postenrollment study (eg, optional components) differed significantly from that of the recruited population. The proportion of self-identified White participants increased by 21.2\%, whereas the proportion of Black or African American participants decreased by 12.18\% (P=.02). Participants who identified as White (n=93,614, 52.7\%) and NonHispanic (n=109,279, 42.21\%) were more engaged compared to those identifying as Black or African American (n=10,887, 15.76\%), Asian (n=4274, 38.72\%), or Hispanic (n=12,530, 20.7\%; P=.006). Participants' response times to study surveys and completeness varied across all demographic groups (P<.001). Furthermore, those identifying as White skipped fewer survey questions (1.19) compared to those identifying as Black or African American (1.40) or other racial and ethnic identities (P<.001). Conclusions: The AoURP dataset serves as an exceptional resource for investigating diverse public health concerns. However, the longitudinal analysis of participant-level data underscores a significant skew in population diversity, suggesting the need for targeted strategies to enhance engagement and retention across all groups. Ensuring diversity in the cohort is essential for maintaining the study's representativeness and the broad applicability of its findings. ",
doi="10.2196/56803",
url="https://www.i-jmr.org/2025/1/e56803"
}


@Article{info:doi/10.2196/64249,
author="Ghorbanian Zolbin, Maedeh
and Kujala, Sari
and Huvila, Isto",
title="Experiences and Expectations of Immigrant and Nonimmigrant Older Adults Regarding eHealth Services: Qualitative Interview Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="14",
volume="27",
pages="e64249",
keywords="eHealth services",
keywords="older adults",
keywords="immigrant",
keywords="usability",
keywords="user experience",
keywords="emotion",
keywords="self-determination theory",
abstract="Background: The emergence of eHealth services could contribute to improving individuals' quality of life by optimizing effective and efficient care. However, various challenges might limit some older adults' use of eHealth services. Objective: This study aimed to understand the perspectives of older adults (aged ?65 years) of different backgrounds regarding eHealth services. We explored the experiences of Iranian immigrant and nonimmigrant older adults with eHealth services to identify their perceived challenges, emotions, and wishes. Immigrants face more challenges, and there is a need to understand their perspectives in addition to those of nonimmigrants. Iranians are one important immigrant group, as their number is limited and their specific needs are less well understood compared to those of the bigger immigrant groups. Methods: This study used a qualitative explorative research design. Semistructured interviews were conducted between February 2023 and May 2023. The participants were 25 older adults: nonimmigrants residing in cities (n=8, 32\%), nonimmigrants residing in rural areas (n=9, 36\%), and Iranian immigrants residing in cities (n=8, 32\%). Data were analyzed through inductive and deductive content analysis and interpreted through self-determination theory. Results: Interacting with eHealth services was challenging for some older adults. They perceived several difficulties, with the most obvious ones being related to values and preferences, as some older adults did not value eHealth services (16/25, 64\%), had insufficient digital skills (15/25, 60\%), and experienced usability issues (15/25, 60\%). The first two challenges were more pronounced among immigrants. In contrast, nonimmigrants from cities, being more familiar with the services, shared more usability issues. These identified challenges prevented older adults from satisfying their basic psychological needs of being competent and autonomous users and having a sense of belonging (aspects of self-determination theory), which were the main source of negative emotions. A common negative feeling was confusion (16/25, 64\%) among those with limited experience using smart devices and those with poor self-reported digital skills. Conversely, older adults' interaction with eHealth services generated positive emotions that were connected to the satisfaction of their basic psychological needs. Being interested in using eHealth services was a common feeling among most participants regardless of their background and was connected to satisfying their need for being competent and autonomous. The positive emotions could be supported by applying older adults' needs to the design of eHealth services (10/25, 40\%) and by supporting their digital skills (19/25, 76\%). Conclusions: Some older adults value eHealth services and see their added benefits. However, various challenges limit their use of these services. The analysis of older adults' needs yielded several practical ideas that could improve the user-friendliness of the services and highlighted the importance of sufficient support services tailored to the cultural needs of specific groups of older adults. ",
doi="10.2196/64249",
url="https://www.jmir.org/2025/1/e64249"
}


@Article{info:doi/10.2196/60170,
author="H{\"u}er, Theresa
and Walendzik, Anke
and Kleinschmidt, Lara
and H{\"o}fer, Klemens
and Nauendorf, Beatrice
and Malsch, Juliane
and Brittner, Matthias
and Brandenburg, Paul
and Aeustergerling, Andr{\'e}
and Schneider, Udo
and Wadeck, Anja
and Liersch, Sebastian
and Sehlen, Stephanie
and Schwarze, Katharina
and Wasem, J{\"u}rgen",
title="Use of Video Consultation Between 2017 and 2020 in Outpatient Medical Care in Germany and Characteristics of Their User Groups: Analysis of Claims Data",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="14",
volume="9",
pages="e60170",
keywords="video consultation",
keywords="outpatient medical care",
keywords="user groups",
keywords="claims data analysis",
keywords="Germany",
keywords="physician",
keywords="psychotherapist",
keywords="sociodemographic",
keywords="healthcare",
keywords="digital health",
keywords="digital consultation",
keywords="telehealth",
keywords="telemonitoring",
keywords="telemedicine",
abstract="Background: Supplementing outpatient medical care with the use of video consultations could, among other benefits, improve access, especially in structurally disadvantaged areas. Objective: This claims data analysis, carried out as part of the German research project ``Preference-based use of video consultation in urban and rural regions,'' aimed to analyze the use of video consultations and the characteristics of its user groups. Methods: Claims data from 3 Statutory Health Insurance Funds (SHIFs) and 4 Associations of Statutory Health Insurance Physicians (ASHIPs) from the period April 2017 to the end of 2020 were used. Data from a sample of about 6.1 million insured and 33,100 physicians and psychotherapists were analyzed. In addition to data on the use of video consultations, patient data on sociodemographic characteristics, diagnoses, and place of residence were included. To analyze the physicians' perspectives, specialty groups, demographic characteristics, and the type of practice location were also included. In consideration of the principles of data economy and the fact that data analysis represents merely a preliminary phase within the broader project, the SHIFs and ASHIPs transmitted aggregated data (cross-tabulations per subgroup analysis) to the evaluator. For this reason, the analyses were constrained to a comparison of video consultation users versus nonusers, differentiated according to the aforementioned subgroups. Furthermore, the association between place of residence or type of region of the practice location and the use of video consultation was examined. A significance level of P<.05 was set for chi-square tests. Results: From 2017 to 2019, almost no video consultations were used in outpatient care in the German health care system. Although this changed considerably in relative terms with the start of the COVID-19 pandemic (but still at a very low absolute level), there was also a clear decline in the use of video consultations as the number of infections flattened out. Physicians working in psychotherapy and psychological psychotherapists used video consultations with around 16\% (44,808/282,530) of their treatment cases in the second quarter of 2020, followed by psychotherapists using video consultations for children (10,828/113,293, 10\%). Although the absolute number of treatment cases with video consultations among general practitioners was very high compared with other specialist groups, their share of video consultations in all treatment cases was very low at 0.3\% (29,600/9,837,118). Younger age groups and those located in urban areas used video consultations more frequently; this applies to both patients (age groups: $\chi$27=9903.2, P<.001; region types: $\chi$22=3746.2, P<.001) and service providers (age groups: $\chi$23=11,338.2, P<.001; region types: $\chi$22=8474.1, P<.001). Conclusions: The current use of video consultations is below its potential in terms of scope and user groups. The widespread and lasting use of video consultations will only succeed if the potential user groups accept this form of service provision and recognize its advantages. Further analyses (both qualitative, such as focus group discussions, and quantitative, such as preference surveys) should therefore investigate the preferences of user groups for the use of video consultations. International Registered Report Identifier (IRRID): RR2-10.2196/50932 ",
doi="10.2196/60170",
url="https://formative.jmir.org/2025/1/e60170",
url="http://www.ncbi.nlm.nih.gov/pubmed/40085136"
}


@Article{info:doi/10.2196/56720,
author="Varela, Kimahri Luna
and Horton, Stephanie
and Abdelmoity, Ahmed
and Le Pichon, Jean-Baptiste
and Hoffman, A. Mark",
title="YouTube User Traffic to Paired Epilepsy Education Videos in English and Spanish: Comparative Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="13",
volume="9",
pages="e56720",
keywords="epilepsy",
keywords="patient education",
keywords="informatics",
keywords="social media",
keywords="biomedical research",
keywords="social determinants of health",
keywords="accessibility",
keywords="engagement",
keywords="comparative analysis",
keywords="clinical videos",
keywords="English",
keywords="Spanish",
keywords="neurological disorder",
keywords="YouTube",
keywords="bilingual",
keywords="audience engagement",
keywords="clinical knowledge",
abstract="Background: Effectively managing epilepsy in children necessitates the active engagement of parents, a factor that is reliant on their understanding of this neurological disorder. Widely available, high-quality, patient-focused, bilingual videos describing topics important for managing epilepsy are limited. YouTube Analytics is a helpful resource for gaining insights into how users of differing backgrounds consume video content. Objective: This study analyzes traffic to paired educational videos of English and Spanish versions of the same content. By examining the use patterns and preferences of individuals seeking information in different languages, we gained valuable insights into how language influences the use of clinical content. Methods: Physician experts created epilepsy management videos for the REACT (Reaching Out for Epilepsy in Adolescents and Children Through Telemedicine) YouTube channel about 17 subjects, with an English and Spanish version of each. The Children's Mercy Kansas City neurology clinic incorporated these into the department's educational process. YouTube Analytics enabled analysis of traffic patterns and video characteristics between September 2, 2021, and August 31, 2023. Results: The Spanish group had higher engagement and click-through rates. The English versions of all videos had 141,605 total impressions, while impressions for the Spanish versions totaled 156,027. The Spanish videos had 11,339 total views, while the English videos had 3366. The views per month were higher for the Spanish videos (mean 472, SD 292) compared to the English set (mean 140, SD 91; P<.001). The two groups also differed in search behavior and external traffic sources, with WhatsApp driving more traffic to the Spanish videos than the English versions (94 views compared to 1). The frequency of search terms used varied by language. For example, ``tonic clonic'' was the most frequent term (n=372) resulting in views for English videos, while ``tipos de convulsiones'' (types of convulsions) was the most common expression (n=798) resulting in views for Spanish videos. We noted increased monthly views for all videos after adding tags on YouTube. Before tagging, the mean number of views per month for the English-language group was 61 (SD 28), which increased to 220 (SD 53) post tagging. A similar trend can be observed in the Spanish-language group as well. Before tagging, the mean number of monthly views was 201 (SD 71), which increased to 743 (SD 144) after tagging. Conclusions: This study showed high traffic for Spanish video content related to epilepsy in a set of paired English/Spanish videos. This highlights the importance of bilingual health content and optimizing video content based on viewer preferences and search behavior. Understanding audience engagement patterns through YouTube Analytics can further enhance the dissemination of clinical video content to users seeking content in their primary language, and tagging videos can have a substantial impact on views. ",
doi="10.2196/56720",
url="https://formative.jmir.org/2025/1/e56720"
}


@Article{info:doi/10.2196/65776,
author="Wolfe, H. Brooke
and Oh, Jung Yoo
and Choung, Hyesun
and Cui, Xiaoran
and Weinzapfel, Joshua
and Cooper, Amanda R.
and Lee, Hae-Na
and Lehto, Rebecca",
title="Caregiving Artificial Intelligence Chatbot for Older Adults and Their Preferences, Well-Being, and Social Connectivity: Mixed-Method Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="13",
volume="27",
pages="e65776",
keywords="older adults",
keywords="technology use",
keywords="AI chatbots",
keywords="artificial intelligence",
keywords="well-being",
keywords="social connectedness",
keywords="mobile phone",
abstract="Background: The increasing number of older adults who are living alone poses challenges for maintaining their well-being, as they often need support with daily tasks, health care services, and social connections. However, advancements in artificial intelligence (AI) technologies have revolutionized health care and caregiving through their capacity to monitor health, provide medication and appointment reminders, and provide companionship to older adults. Nevertheless, the adaptability of these technologies for older adults is stymied by usability issues. This study explores how older adults use and adapt to AI technologies, highlighting both the persistent barriers and opportunities for potential enhancements. Objective: This study aimed to provide deeper insights into older adults' engagement with technology and AI. The technologies currently used, potential technologies desired for daily life integration, personal technology concerns faced, and overall attitudes toward technology and AI are explored. Methods: Using mixed methods, participants (N=28) completed both a semistructured interview and surveys consisting of health and well-being measures. Participants then participated in a research team--facilitated interaction with an AI chatbot, Amazon Alexa. Interview transcripts were analyzed using thematic analysis, and surveys were evaluated using descriptive statistics. Results: Participants' average age was 71 years (ranged from 65 years to 84 years). Most participants were familiar with technology use, especially using smartphones  (26/28, 93\%) and desktops and laptops (21/28, 75\%). Participants rated appointment reminders (25/28, 89\%), emergency assistance (22/28, 79\%), and health monitoring (21/28, 75\%). Participants rated appointment reminders (25/28, 89.3\%), emergency assistance (22/28, 78.6\%), and health monitoring (21/28, 75\%) as the most desirable features of AI chatbots for adoption. Digital devices were commonly used for entertainment, health management, professional productivity, and social connectivity. Participants were most interested in integrating technology into their personal lives for scheduling reminders, chore assistance, and providing care to others. Challenges in using new technology included a commitment to learning new technologies, concerns about lack of privacy, and worries about future technology dependence. Overall, older adults' attitudes coalesced into 3 orientations, which we label as technology adapters, technologically wary, and technology resisters. These results illustrate that not all older adults were resistant to technology and AI. Instead, older adults are aligned with categories on a spectrum between willing, hesitant but willing, and unwilling to use technology and AI. Researchers can use these findings by asking older adults about their orientation toward technology to facilitate the integration of new technologies with each person's comfortability and preferences. Conclusions: To ensure that AI technologies effectively support older adults, it is essential to foster an ongoing dialogue among developers, older adults, families, and their caregivers, focusing on inclusive designs to meet older adults' needs. ",
doi="10.2196/65776",
url="https://www.jmir.org/2025/1/e65776"
}


@Article{info:doi/10.2196/66054,
author="Tieu, Vivian
and Kim, Sungjin
and Seok, Minji
and Ballas, Leslie
and Kamrava, Mitchell
and Atkins, M. Katelyn",
title="Gender Differences in X (Formerly Twitter) Use Among Oncology Physicians at National Cancer Institute--Designated Cancer Centers: Cross-Sectional Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="11",
volume="27",
pages="e66054",
keywords="social media",
keywords="gender disparities",
keywords="gender differences",
keywords="cross-sectional study",
keywords="twitter",
keywords="oncology",
doi="10.2196/66054",
url="https://www.jmir.org/2025/1/e66054"
}


@Article{info:doi/10.2196/51804,
author="Portela, Diana
and Freitas, Alberto
and Costa, El{\'i}sio
and Giovannini, Mattia
and Bousquet, Jean
and Almeida Fonseca, Jo{\~a}o
and Sousa-Pinto, Bernardo",
title="Impact of Demographic and Clinical Subgroups in Google Trends Data: Infodemiology Case Study on Asthma Hospitalizations",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="10",
volume="27",
pages="e51804",
keywords="infodemiology",
keywords="asthma",
keywords="administrative databases",
keywords="multimorbidity",
keywords="co-morbidity",
keywords="respiratory",
keywords="pulmonary",
keywords="Google Trends",
keywords="correlation",
keywords="hospitalization",
keywords="admissions",
keywords="autoregressive",
keywords="information seeking",
keywords="searching",
keywords="searches",
keywords="forecasting",
abstract="Background: Google Trends (GT) data have shown promising results as a complementary tool to classical surveillance approaches. However, GT data are not necessarily provided by a representative sample of patients and may be skewed toward demographic and clinical groups that are more likely to use the internet to search for their health. Objective: In this study, we aimed to assess whether GT-based models perform differently in distinct population subgroups. To assess that, we analyzed a case study on asthma hospitalizations. Methods: We analyzed all hospitalizations with a main diagnosis of asthma occurring in 3 different countries (Portugal, Spain, and Brazil) for a period of approximately 5 years (January 1, 2012-December 17, 2016). Data on web-based searches on common cold for the same countries and time period were retrieved from GT. We estimated the correlation between GT data and the weekly occurrence of asthma hospitalizations (considering separate asthma admissions data according to patients' age, sex, ethnicity, and presence of comorbidities). In addition, we built autoregressive models to forecast the weekly number of asthma hospitalizations (for the different aforementioned subgroups) for a period of 1 year (June 2015-June 2016) based on admissions and GT data from the 3 previous years. Results: Overall, correlation coefficients between GT on the pseudo-influenza syndrome topic and asthma hospitalizations ranged between 0.33 (in Portugal for admissions with at least one Charlson comorbidity group) and 0.86 (for admissions in women and in White people in Brazil). In the 3 assessed countries, forecasted hospitalizations for 2015-2016 correlated more strongly with observed admissions of older versus younger individuals (Portugal: Spearman $\rho$=0.70 vs $\rho$=0.56; Spain: $\rho$=0.88 vs $\rho$=0.76; Brazil: $\rho$=0.83 vs $\rho$=0.82). In Portugal and Spain, forecasted hospitalizations had a stronger correlation with admissions occurring for women than men (Portugal: $\rho$=0.75 vs $\rho$=0.52; Spain: $\rho$=0.83 vs $\rho$=0.51). In Brazil, stronger correlations were observed for admissions of White than of Black or Brown individuals ($\rho$=0.92 vs $\rho$=0.87). In Portugal, stronger correlations were observed for admissions of individuals without any comorbidity compared with admissions of individuals with comorbidities ($\rho$=0.68 vs $\rho$=0.66). Conclusions: We observed that the models based on GT data may perform differently in demographic and clinical subgroups of participants, possibly reflecting differences in the composition of internet users' health-seeking behaviors. ",
doi="10.2196/51804",
url="https://www.jmir.org/2025/1/e51804"
}


@Article{info:doi/10.2196/50313,
author="Hua, Zhong
and Yuqing, Song
and Qianwen, Liu
and Hong, Chen",
title="Factors Influencing eHealth Literacy Worldwide: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="10",
volume="27",
pages="e50313",
keywords="meta-analysis",
keywords="eHealth literacy",
keywords="eHealth",
keywords="Technology Acceptance Model",
keywords="Literacy and Health Conceptual Framework",
keywords="social determinants of health",
keywords="digital health",
keywords="consumer",
abstract="Background: eHealth literacy has increasingly emerged as a critical determinant of health, highlighting the importance of identifying its influencing factors; however, these factors remain unclear. Numerous studies have explored this concept across various populations, presenting an opportunity for a systematic review and synthesis of the existing evidence to better understand eHealth literacy and its key determinants. Objective: This study aimed to provide a systematic review of factors influencing eHealth literacy and to examine their impact across different populations. Methods: We conducted a comprehensive search of papers from PubMed, CNKI, Embase, Web of Science, Cochrane Library, CINAHL, and MEDLINE databases from inception to April 11, 2023. We included all those studies that reported the eHealth literacy status measured with the eHealth Literacy Scale (eHEALS). Methodological validity was assessed with the standardized Joanna Briggs Institute (JBI) critical appraisal tool prepared for cross-sectional studies. Meta-analytic techniques were used to calculate the pooled standardized $\beta$ coefficient with 95\% CIs, while heterogeneity was assessed using I2, the Q test, and $\tau$2. Meta-regressions were used to explore the effect of potential moderators, including participants' characteristics, internet use measured by time or frequency, and country development status. Predictors of eHealth literacy were integrated according to the Literacy and Health Conceptual Framework and the Technology Acceptance Model (TAM). Results: In total, 17 studies met the inclusion criteria for the meta-analysis. Key factors influencing higher eHealth literacy were identified and classified into 3 themes: (1) actions (internet usage: $\beta$=0.14, 95\% CI 0.102-0.182, I2=80.4\%), (2) determinants (age: $\beta$=--0.042, 95\% CI --0.071 to --0.020, I2=80.3\%; ethnicity: $\beta$=--2.613, 95\% CI --4.114 to --1.112, I2=80.2\%; income: $\beta$=0.206, 95\% CI 0.059-0.354, I2=64.6\%; employment status: $\beta$=--1.629, 95\% CI --2.323 to --0.953, I2=99.7\%; education: $\beta$=0.154, 95\% CI 0.101-0.208, I2=58.2\%; perceived usefulness: $\beta$=0.832, 95\% CI 0.131-1.522, I2=68.3\%; and self-efficacy: $\beta$=0.239, 95\% CI 0.129-0.349, I2=0.0\%), and (3) health status factor (disease: $\beta$=--0.177, 95\% CI --0.298 to --0.055, I2=26.9\%). Conclusions: This systematic review, guided by the Literacy and Health Conceptual Framework model, identified key factors influencing eHealth literacy across 3 dimensions: actions (internet usage), determinants (age, ethnicity, income, employment status, education, perceived usefulness, and self-efficacy), and health status (disease). These findings provide valuable guidance for designing interventions to enhance eHealth literacy. Trial Registration: PROSPERO CRD42022383384; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022383384 ",
doi="10.2196/50313",
url="https://www.jmir.org/2025/1/e50313"
}


@Article{info:doi/10.2196/63482,
author="Yew, Qian Sheng
and Trivedi, Daksha
and Adanan, Hafizah Nurul Iman
and Chew, How Boon",
title="Facilitators and Barriers to the Implementation of Digital Health Technologies in Hospital Settings in Lower- and Middle-Income Countries Since the Onset of the COVID-19 Pandemic: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="6",
volume="27",
pages="e63482",
keywords="digital health implementation",
keywords="facilitators",
keywords="barriers",
keywords="digital health classification framework",
keywords="lower- and middle-income countries",
abstract="Background: Although the implementation process of digital health technologies (DHTs) has been extensively documented in high-income countries, the factors that facilitate and prevent their implementation in lower- and middle-income countries (LMICs) may differ for various reasons. Objective: To address this gap in research, this scoping review aims to determine the facilitators and barriers to implementing DHTs in LMIC hospital settings following the onset of the COVID-19 pandemic. Additionally, the review outlined the types of DHTs that have been implemented in LMICs' hospitals during this pandemic and finally developed a classification framework to categorize the landscape of DHTs. Methods: Systematic searches were conducted on PubMed, Scopus, Web of Science, and Google Scholar for studies published from March 2020 to December 2023. We extracted data on authors, publication years, study objectives, study countries, disease conditions, types of DHTs, fields of clinical medicine where the DHTs are applied, study designs, sample sizes, characteristics of the study population, study location, and data collection methods of the included studies. Both quantitative and qualitative data were utilized to conduct a thematic analysis, using a deductive method based on the Practical, Robust Implementation and Sustainability Model (PRISM), to identify facilitators and barriers to DHT implementation. Finally, all accessible DHTs were identified and organized to create a novel classification framework. Results: Twelve studies were included from 292 retrieved articles. Telemedicine (n=5) was the most commonly used DHT in LMICs' hospitals, followed by hospital information systems (n=4), electronic medical records (n=2), and mobile health (n=1). These 4 DHTs, among the other existing DHTs, allowed us to develop a novel classification framework for DHTs. The included studies used qualitative methods (n=4), which included interviews and focus groups, quantitative methods (n=5), or a combination of both (n=2). Among the 64 facilitators of DHT implementation, the availability of continuous on-the-job training (n=3), the ability of DHTs to prevent cross-infection (n=2), and positive previous experiences using DHTs (n=2) were the top 3 reported facilitators. However, of the 44 barriers to DHT implementation, patients with poor digital literacy and skills in DHTs (n=3), inadequate awareness regarding DHTs among health care professionals and stakeholders (n=2), and concerns regarding the accuracy of disease diagnosis and treatment through DHTs (n=2) were commonly reported. Conclusions: In the postpandemic era, telemedicine, along with other DHTs, has seen increased implementation in hospitals within LMICs. All facilitators and barriers can be categorized into 6 themes, namely, (1) Aspects of the Health Care System; (2) Perspectives of Patients; (3) External Environment; (4) Implementation of Sustainable Infrastructure; (5) Characteristics of Health Care Organization; and (6) Characteristics of Patients. ",
doi="10.2196/63482",
url="https://www.jmir.org/2025/1/e63482",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053793"
}


@Article{info:doi/10.2196/52244,
author="Davis, H. Victoria
and Qiang, Rose Jinfan
and Adekoya MacCarthy, Itunuoluwa
and Howse, Dana
and Seshie, Zita Abigail
and Kosowan, Leanne
and Delahunty-Pike, Alannah
and Abaga, Eunice
and Cooney, Jane
and Robinson, Marjeiry
and Senior, Dorothy
and Zsager, Alexander
and Aubrey-Bassler, Kris
and Irwin, Mandi
and Jackson, A. Lois
and Katz, Alan
and Marshall, Gard Emily
and Muhajarine, Nazeem
and Neudorf, Cory
and Garies, Stephanie
and Pinto, D. Andrew",
title="Perspectives on Using Artificial Intelligence to Derive Social Determinants of Health Data From Medical Records in Canada: Large Multijurisdictional Qualitative Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="6",
volume="27",
pages="e52244",
keywords="artificial intelligence",
keywords="social determinants of health",
keywords="sociodemographic data",
keywords="social needs",
keywords="social care",
keywords="primary care",
keywords="machine learning",
keywords="qualitative study",
abstract="Background: Data on the social determinants of health could be used to improve care, support quality improvement initiatives, and track progress toward health equity. However, this data collection is not widespread. Artificial intelligence (AI), specifically natural language processing and machine learning, could be used to derive social determinants of health data from electronic medical records. This could reduce the time and resources required to obtain social determinants of health data. Objective: This study aimed to understand perspectives of a diverse sample of Canadians on the use of AI to derive social determinants of health information from electronic medical record data, including benefits and concerns. Methods: Using a qualitative description approach, in-depth interviews were conducted with 195 participants purposefully recruited from Ontario, Newfoundland and Labrador, Manitoba, and Saskatchewan. Transcripts were analyzed using an inductive and deductive content analysis. Results: A total of 4 themes were identified. First, AI was described as the inevitable future, facilitating more efficient, accessible social determinants of health information and use in primary care. Second, participants expressed concerns about potential health care harms and a distrust in AI and public systems. Third, some participants indicated that AI could lead to a loss of the human touch in health care, emphasizing a preference for strong relationships with providers and individualized care. Fourth, participants described the critical importance of consent and the need for strong safeguards to protect patient data and trust. Conclusions: These findings provide important considerations for the use of AI in health care, and particularly when health care administrators and decision makers seek to derive social determinants of health data. ",
doi="10.2196/52244",
url="https://www.jmir.org/2025/1/e52244",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053728"
}


@Article{info:doi/10.2196/66032,
author="Uddin, Jamal
and Feng, Cheng
and Xu, Junfang",
title="Health Communication on the Internet: Promoting Public Health and Exploring Disparities in the Generative AI Era",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="6",
volume="27",
pages="e66032",
keywords="internet",
keywords="generative AI",
keywords="artificial intelligence",
keywords="ChatGPT",
keywords="health communication",
keywords="health promotion",
keywords="health disparity",
keywords="health",
keywords="communication",
keywords="AI",
keywords="generative",
keywords="tool",
keywords="genAI",
keywords="gratification theory",
keywords="gratification",
keywords="public health",
keywords="inequity",
keywords="disparity",
doi="10.2196/66032",
url="https://www.jmir.org/2025/1/e66032",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053755"
}


@Article{info:doi/10.2196/64672,
author="DuPont-Reyes, J. Melissa
and Villatoro, P. Alice
and Tang, Lu",
title="Health Information Scanning and Seeking in Diverse Language, Cultural and Technological Media Among Latinx Adolescents: Cross-Sectional Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="5",
volume="27",
pages="e64672",
keywords="adolescent behaviors",
keywords="mental health",
keywords="Latino",
keywords="social media",
keywords="adolescent",
keywords="media use",
keywords="internet use",
keywords="health information seeking",
keywords="health information scanning",
keywords="mobile phone",
abstract="Background: Continuous scientific and policy debate regarding the potential harm and/or benefit of media and social media on adolescent health has resulted, in part, from a deficiency in robust scientific evidence. Even with a lack of scientific consensus, public attitudes, and sweeping social media prohibitions have swiftly ensued. A focus on the diversity of adolescents around the world and their diverse use of language, culture, and social media is absent from these discussions. Objective: This study aims to guide communication policy and practice, including those addressing access to social media by adolescent populations. This study assesses physical and mental health information scanning and seeking behaviors across diverse language, cultural, and technological media and social media among Latinx adolescent residents in the United States. This study also explores how Latinx adolescents with mental health concerns use media and social media for support. Methods: In 2021, a cross-sectional survey was conducted among 701 US-based Latinx adolescents aged 13-20 years to assess their health-related media use. Assessments ascertained the frequency of media use and mental and physical health information scanning and seeking across various media technologies (eg, TV, podcasts, and social media) and language and cultural types (ie, Spanish, Latinx-tailored English, and general English). Linear regression models were used to estimate adjusted predicted means of mental and physical health information scanning and seeking across diverse language and cultural media types, net personal and family factors, in the full sample and by subsamples of mental health symptoms (moderate-high vs none-mild). Results: Among Latinx adolescents, media and social media use was similar across mental health symptoms. However, Latinx adolescents with moderate-high versus none-mild symptoms more often scanned general English media and social media for mental health information (P<.05), although not for physical health information. Also, Latinx adolescents with moderate-high versus none-mild symptoms more often sought mental health information on Latinx-tailored and general English media, and social media (P<.05); a similar pattern was found for physical health information seeking. In addition, Latinx adolescents with moderate-high versus none-mild symptoms often sought help from family and friends for mental and physical health problems and health care providers for mental health only (P<.05). Conclusions: While media and social media usage was similar across mental health, Latinx adolescents with moderate-high symptoms more often encountered mental health content in general English media and social media and turned to general English- and Latinx-tailored media and social media more often for their health concerns. Together these study findings suggest more prevalent and available mental health content in general English versus Spanish language and Latinx-tailored media and underscore the importance of providing accessible, quality health information across diverse language, cultural, and technological media and social networks as a viable opportunity to help improve adolescent health. ",
doi="10.2196/64672",
url="https://www.jmir.org/2025/1/e64672",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053766"
}


@Article{info:doi/10.2196/58867,
author="Beerbaum, Julian
and Robens, Sibylle
and Fehring, Leonard
and Mortsiefer, Achim
and Meister, Sven",
title="Patient Adoption of Digital Use Cases in Family Medicine and a Nuanced Implementation Approach for Family Doctors: Quantitative Web-Based Survey Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="5",
volume="9",
pages="e58867",
keywords="technology acceptance",
keywords="UTAUT",
keywords="family doctor",
keywords="digital health",
keywords="eHealth",
keywords="video consultation",
keywords="electronic health records",
keywords="digital anamnesis",
keywords="online appointment scheduling",
abstract="Background: Digital use cases describe the application of technology to achieve specific outcomes. Several studies in health care have examined patients' overall attitudes toward digitalization and specific use cases. However, these studies have failed to provide a comparison of patient acceptance criteria between inherently different digital use cases in family medicine. Objective: To address this research gap, this paper aimed to assist family doctors in selecting digital use cases by comparing the underlying patient adoption factors and in driving usage of these use cases by presenting a differentiated implementation approach. Methods: Adapting an established Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire to 4 digital use cases in family medicine, we surveyed a large cross-sectional sample of adults living in Germany. The results of the web-based survey were then analyzed via descriptive statistics, ANOVA, and hierarchical regression models to compare the effects of sociodemographic and technology acceptance factors on the intention to use a specific use case. Results: Our web-based survey included 1880 participants. Of these 1880 participants, only 304 (16.2\%) agreed that the degree of digitalization is important when selecting a family practice. However, more digitally literate participants attributed greater importance to this criterion (B=0.226, SE 0.023; $\beta$=.223; P<.001), and digital literacy was found to be dependent on age (Welch F3,968.29=53.441; P<.001). Regarding sociodemographic characteristics, only digital literacy demonstrated a significant effect on the intention to use for all use cases, particularly scheduling doctor appointments online (B=0.322, SE 0.033; $\beta$=.408; P<.001). Furthermore, performance expectancy was the strongest predictor of the intention to use for all use cases, while further effects of technology acceptance factors depended on the use case (receiving medical consultations via video: B=0.603, SE 0.049; $\beta$=.527; P<.001; scheduling doctor appointments online: B=0.566, SE 0.043; $\beta$=.513; P<.001; storing personal medical information via electronic health records: B=0.405, SE 0.047; $\beta$=.348; P<.001; and providing personal information before consultation digitally [digital anamnesis]: B=0.434, SE 0.048; $\beta$=.410; P<.001). To illustrate, perceived privacy and security had an effect on the intention to use electronic health records (B=0.284, SE 0.040; $\beta$=.243; P<.001) but no effect on the intention to use video consultations (B=0.068, SE 0.042; $\beta$=.053; P=.10). Conclusions: In the selection and implementation of digital use cases, family doctors should always prioritize the perceived value of the digital use case for the patient, and further criteria might depend on the digital use case. Practice owners should therefore always harmonize the introduction of digital use cases with their own patient care strategies. Not every digital innovation fits every strategy and therefore every practice. ",
doi="10.2196/58867",
url="https://formative.jmir.org/2025/1/e58867",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053731"
}


@Article{info:doi/10.2196/60369,
author="Tan, Jin Rayner Kay
and Hensel, Devon
and Ivanova, Olena
and Bravo, Gomez Raquel
and Olumide, Adesola
and Adebayo, Emmanuel
and Cleeve, Amanda
and Gesselman, Amanda
and Shah, Jyoti Sonam
and Adesoba, Helen
and Marley, Gifty
and Tang, Weiming",
title="Telemedicine Use During the COVID-19 Pandemic in 8 Countries From the International Sexual Health and Reproductive Health Consortium: Web-Based Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="4",
volume="27",
pages="e60369",
keywords="COVID-19",
keywords="telemedicine",
keywords="sexual and reproductive health",
keywords="pandemic",
keywords="web-based survey",
keywords="sexual health",
keywords="reproductive health",
keywords="communication technology",
keywords="medical education",
keywords="contraception",
keywords="abortion",
keywords="health care delivery",
keywords="care",
keywords="chronic condition",
abstract="Background: Telemedicine is an important way to fill in the access gap to in-person health care services during challenging times like pandemics. Objective: This study aimed to investigate the role that telemedicine played during the COVID-19 pandemic by multicountry comparison of the use of telemedicine prior to and during the pandemic. Methods: This study analyzes data from the second wave of the International Sexual Health and Reproductive Health study. This included data collected between April 2021 and July 2022 in 8 countries, including Armenia (n=296), Egypt (n=889), Germany (n=138), Moldova (n=311), Nigeria (n=205), Portugal (n=951), Singapore (n=13), and Spain (n=54). This study covered sociodemographics, sexual and reproductive health (SRH), and telemedicine use. Descriptive statistics and multilevel modeling were used to assess the factors influencing the use of telemedicine. Results: Overall, 2857 participants were recruited. Approximately 57.6\% (n=1646) of participants had never used telemedicine prior to COVID-19 measures, while 45.9\% (n=1311) of participants required health care but reported not using telemedicine services following the introduction of COVID-19 measures. In high-income countries, the most common mode reported was audio-based telemedicine services, with 283 (71.8\%) and 417 (73.5\%) participants doing so before and during COVID-19, respectively. This was followed by text-based telemedicine services, with 152 (38.6\%) and 173 (30.5\%) participants doing so before and during COVID-19, respectively. In low- to middle-income countries, many participants also reported using audio-based telemedicine services, with 288 (35.3\%) and 237 (40.8\%) participants doing so before and during COVID-19, respectively. This was followed by chat-based telemedicine services, with 265 (32.4\%) and 217 (37.3\%) participants doing so before and during COVID-19, respectively. Multilevel modeling revealed that those who were older (adjusted odds ratio [aOR] 0.99, 95\% CI 0.99-1.00) and were in countries with a higher gross domestic product per capita (aOR 0.99, 95\% CI 0.98-1.00) were less likely to have ever used telemedicine. Participants who were of male sex assigned at birth (aOR 0.79, 95\% CI 0.65-0.96) were less likely to use telemedicine during the pandemic. Participants who perceived that they were worse off financially were more likely to have switched to telemedicine during COVID-19 (aOR 1.39, 95\% CI 1.02-1.89) and were more likely to report having a poor or fair experience of telemedicine services (aOR 1.75, 95\% CI 1.34-2.29). When sexual orientation was included in the model, nonheterosexual individuals were more likely to ever use telemedicine prior to COVID-19 (aOR 1.35, 95\% CI 1.08-1.69), more likely to have used telemedicine during COVID-19 (aOR 1.58, 95\% CI 1.24-2.02), and more likely to have switched to telemedicine during COVID-19 (aOR 1.55, 95\% CI 1.09-2.21). Conclusions: Telemedicine played a key role in addressing health care needs during the COVID-19 pandemic. Age, sex, economic status, and sexual orientation influenced its use. ",
doi="10.2196/60369",
url="https://www.jmir.org/2025/1/e60369",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053813"
}


@Article{info:doi/10.2196/66636,
author="Werts-Pelter, J. Samantha
and Chen, Zhao
and Bea, W. Jennifer
and Sokan, E. Amanda
and Thomson, A. Cynthia",
title="Analysis of the Relationship Between Rural-Urban Status and Use of Digital Health Technology Among Older Cancer Survivors Based on the Health Information National Trends Survey: Cross-Sectional Analysis",
journal="JMIR Cancer",
year="2025",
month="Mar",
day="4",
volume="11",
pages="e66636",
keywords="cancer",
keywords="non-metropolitan",
keywords="disparities",
keywords="digital divide",
keywords="health research",
keywords="aging",
keywords="rural-urban",
keywords="digital health technology",
keywords="cross-sectional",
keywords="health behaviors",
keywords="mobile phone",
abstract="Background: Though telehealth has been a promising avenue for engaging cancer survivors with health care and lifestyle programming, older and rural-dwelling cancer survivors may have additional challenges in accessing digital devices and tools that have not yet been described. This study aimed to use a robust, nationally representative sample collected in 2022 to provide an updated view of digital technology use and the use of technology for health in this population. Objective: This study aimed to examine the prevalence of digital technology use for health-related activities among older cancer survivors in both rural and urban settings. The primary outcomes of interest included (1) internet access and use for health-related activities, (2) digital device ownership and use as a tool for health behaviors, (3) use of social media for health, and (4) use of telehealth. Methods: A cross-sectional analysis of the National Cancer Institute's Health Information National Trends Survey Cycle 6 (HINTS 6) was completed to examine the prevalence of digital technology use among older cancer survivors. For analysis, the sample was restricted to cancer survivors over the age of 60 years (n=710). Unadjusted and adjusted logistic regression models were used to test the association between rurality and digital health tool use. Results: Overall, 17\% (125/710) of the sample lived in a rural area of the United States and the mean sample age was 73 (SD 8.2) years. Older cancer survivors, regardless of rural-urban status, reported a high prevalence of internet usage (n=553, 79.9\%), digital device ownership (n=676, 94.9\%), and social media use (n=448, 66.6\%). In unadjusted models, rural survivors were less likely than urban survivors to report that they had used a health or wellness application in the previous year (odds ratio [OR] 0.56, 95\% CI 0.32-0.97; P=.04). In adjusted models, rural survivors were more likely to report that they had shared personal health information on social media (OR 2.64, 95\% CI 1.13-6.19; P=.03). There were no differences in the proportion of rural and urban respondents who reported receiving health services through telehealth in the previous year. Conclusions: Regardless of the residential status, older cancer survivors report high internet and technology use for health-related activities. These results show promise for the feasibility of using digital technologies to implement supportive care and wellness programming with older cancer survivors. ",
doi="10.2196/66636",
url="https://cancer.jmir.org/2025/1/e66636"
}


@Article{info:doi/10.2196/48370,
author="Francis, Karlee
and Francis, Julie
and Latimer, Margot
and Gould, Hayley
and Blackmore, Shante
and MacLeod, Emily",
title="Development and Testing of the Kids Hurt App, a Web-Based, Pain Self-Report App for First Nations Youths: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="3",
volume="12",
pages="e48370",
keywords="app",
keywords="eHealth",
keywords="pain",
keywords="Indigenous",
keywords="First Nations",
keywords="children",
keywords="youths",
keywords="mobile phone",
abstract="Background: First Nations children and youths may have unique ways to convey their health needs that have not been recognized by health providers. This may contribute to the disparity between high rates of mental health and physical pain and low rates of treatment for the conditions they experience. Evidence suggests that a colonial history has resulted in poor experiences with the health care system, lack of trust with health providers, and miscommunication between clinicians and patients. Contemporary ways, using both Indigenous and Western knowledge, are needed to bridge the gap in communicating pain. Objective: The aim of this qualitative study was to test the usability and clinical feasibility of the Kids Hurt App with First Nations youths and clinicians working with youths. Methods: Using a Two-Eyed Seeing approach, the Kids Hurt App was developed using concepts from validated mood and pain assessment apps combined with community-based research that gathered First Nations youths and clinicians perspectives on quality, intensity, and location of pain and hurt. The Kids Hurt App contains 16 screens accessible on any web-based device. Results: In total, 3 rounds of low-fidelity testing (n=19), 2 rounds of high-fidelity testing (n=20), and 2 rounds of clinical feasibility testing (n=10) were conducted with First Nations youths (10?19 years) to determine the relevance, validity, and usability of the Kids Hurt App. High-fidelity testing was also conducted with 15 clinicians after completing the high-fidelity youth sessions. Youths had constructive suggestions that were used to improve the app in subsequent rounds of version testing. There was one main discrepancy between youths and clinicians related to preference for how best to visually convey pain. The youth's preference was maintained in the app. Conclusions: All youths in all rounds of testing indicated that they would use the Kids Hurt App if it was available to them in a health care setting, with most clinicians noting that the app would be useful in practice. ",
doi="10.2196/48370",
url="https://humanfactors.jmir.org/2025/1/e48370"
}


@Article{info:doi/10.2196/58362,
author="Junkins, Zachary
and Zahan, Nusrath
and Neyens, David",
title="Examining Individuals' Use of the Internet for Health Care Activities Over Time: Results from the US National Health Interview Survey",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="26",
volume="12",
pages="e58362",
keywords="internet",
keywords="web search",
keywords="internet search",
keywords="internet use",
keywords="searching behavior",
keywords="access to health information",
keywords="telemedicine",
keywords="telehealth",
keywords="virtual care",
keywords="virtual health",
keywords="virtual medicine",
keywords="logistic regression model",
keywords="regression model",
keywords="National Health Interview Survey",
keywords="NHIS",
abstract="Background: Telehealth is an increasingly important component of health care services. Telehealth services may present an opportunity to increase the equity, accessibility, and effectiveness of health care. As such, it is critical that telehealth design focuses on reducing the barriers to access and usability that may impair some telehealth users. Objective: Our goal was to identify different demographic characteristics, behaviors, or opinions that may predict groups who are likely to face a barrier to using telehealth services. Methods: We used data from the National Health Interview Survey and multiple logit regression models focused on different aspects of telehealth to examine three different avenues of telehealth service: looking up health information using the internet, scheduling an appointment using the internet, and communicating with a care provider through email using the internet in order to consider the ways in which different telehealth services may face different barriers. Results: Our results suggest that middle-aged (36-55 years old) and older adult (56-85 years old) respondents were significantly less likely to look up health information using the internet or schedule an appointment using the internet versus younger individuals (18-35 years old). Specifically, our analysis found that middle-aged adults were found to have a higher odds ratio than older adults (0.83 vs 0.65) for looking up health information using the internet. We also found that there were differences in age groups for using technology to perform health care--related tasks. In terms of searching for health information using the internet and scheduling appointments using the internet, we found differences between men and women, with women being significantly more likely than men to look up health information using the internet, schedule an appointment using the internet, and communicate with a care provider through email using the internet. Across all the investigated variables, we found that the rates of using the internet for looking up health information, scheduling an appointment, and communicating with a care provider over email increased substantially across the study period. The impact of costs was inconsistent across the different models in our analysis. We also found that there is a strong correlation between respondents' collaboration in their personal health and the likelihood that they would use telehealth services to meet these needs. Conclusions: This analysis provides an exploratory look at the data to highlight barriers that may impact a user's ability to access telehealth services in the context of other potential predictor variables to account for the real-world variability that these may present. Future work should examine the complex relationships of those variables and understand how these interactions are correlated with the respondents' use of telehealth. ",
doi="10.2196/58362",
url="https://humanfactors.jmir.org/2025/1/e58362"
}


@Article{info:doi/10.2196/60699,
author="Han, Hae-Ra
and Chepkorir, Joyline
and Kim, Tina
and Zamora, Martha
and Huang, Emma",
title="Perceptions, Experiences, and Beliefs About Patient Portals Among Women With Limited English Proficiency: Multicultural Qualitative Interview Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="26",
volume="27",
pages="e60699",
keywords="patient portal",
keywords="limited English proficiency",
keywords="immigrant",
keywords="women",
keywords="mobile phone",
abstract="Background: Individuals in the United States with limited English proficiency (LEP) experience a disproportionate disease burden. Patient portals provide patient education, outreach, and linkage to preventive health services. While patient portals have been found to be effective in facilitating the use of preventive services, they have predominantly engaged well-educated, English-speaking, White populations. There is limited research investigating experiences and beliefs about patient portals among populations with LEP. Objective: This study aims to explore perceptions, experiences, and beliefs about patient portals among women with LEP. Methods: We used a qualitative semistructured interview design and recruited a purposive sample of women through diverse methods. The interview guide covered topics including experiences with patient portals, the perceived feasibility and relevance of patient portals, and perceptions of patient portals targeted toward women with LEP for health promotion. The interviews were audio recorded for verbatim transcription and analysis. Each bilingual interviewer reached data saturation after interviewing 12 (43\%), 9 (32\%), and 7 (25\%) Korean-, Spanish-, and Swahili-speaking women, respectively, yielding a total of 28 women in the study. Results: We identified 4 main themes that were common across all linguistic groups: perceived benefits of patient portals, perceived facilitators of patient portal use, perceived barriers to patient portal use, and preferred features and suggested improvements. Perceived benefits of patient portals had 5 subthemes: easier communication with health care providers and health systems, getting connected and staying connected with health systems, easier and efficient access to one's health records over time, staying informed of and engaged with one's health and health management, and better patient engagement in medical visits. Subthemes for perceived facilitators of patient portal use were availability of time, widespread use and availability of smartphones and the internet in the United States, family support, and parenthood. Subthemes for perceived barriers to patient portal use were limited digital literacy and limited access to technology, LEP, lack of awareness and knowledge about patient portals, and illiteracy. Finally, subthemes for preferred features and suggested improvements were expanded language access to accommodate non-English speakers, improved accessibility to health information using graphics and patient education materials, and user onboarding education and technical support. Of note, while most subthemes were shared across all 3 groups, the widespread use and availability of smartphones and the internet in the United States and illiteracy subthemes were unique to Swahili-speaking women. Conclusions: Women with LEP recognized multiple benefits of patient portals; however, several barriers were also identified. These included limited digital literacy, restricted access to technology, LEP, and illiteracy. Barriers to patient portal use were closely tied to social determinants of health, which are commonly experienced by women with LEP. To expedite the attainment of health equity, it is important to promote access to health resources such as patient portals. ",
doi="10.2196/60699",
url="https://www.jmir.org/2025/1/e60699"
}


@Article{info:doi/10.2196/50708,
author="Rinderknecht, Fatuma-Ayaan
and Yang, B. Vivian
and Tilahun, Mekaleya
and Lester, C. Jenna",
title="Perspectives of Black, Latinx, Indigenous, and Asian Communities on Health Data Use and AI: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="21",
volume="27",
pages="e50708",
keywords="augmented intelligence",
keywords="artificial intelligence",
keywords="health equity",
keywords="dermatology",
keywords="Black",
keywords="Latinx",
keywords="Indigenous",
keywords="Asian",
keywords="racial and ethnic minority communities",
keywords="AI",
keywords="health care",
keywords="health data",
keywords="survey",
keywords="racism",
keywords="large language model",
keywords="LLM",
keywords="diversity",
doi="10.2196/50708",
url="https://www.jmir.org/2025/1/e50708"
}


@Article{info:doi/10.2196/63324,
author="Wankah, Paul
and Chandra, Shivani
and Lofters, Aisha
and Mohamednur, Nebila
and Osei, Beverley
and Makuwaza, Tutsirai
and Sayani, Ambreen",
title="Improving Digital Cancer Care for Older Black Adults: Qualitative Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="19",
volume="27",
pages="e63324",
keywords="digital care",
keywords="cancer care",
keywords="older Black adults",
keywords="health equity",
keywords="social determinants of health",
keywords="access to care",
keywords="health quality",
abstract="Background: Health systems are rapidly promoting digital cancer care models to improve cancer care of their populations. However, there is growing evidence that digital cancer care can exacerbate inequities in cancer care for communities experiencing social disadvantage, such as Black communities. Despite the increasing recognition that older Black adults face significant challenges in accessing and using health care services due to multiple socioeconomic and systemic factors, there is still limited evidence regarding how older Black adults' access and use digital cancer care. Objective: This study aims to better understand the digital cancer care experience of older Black adults, their caregivers, and health care providers to identify strategies that can better support patient-centered digital cancer care. Methods: A total of 6 focus group interviews were conducted with older Black adults living with cancer, caregivers, and health care providers (N=55 participants) across 10 Canadian provinces. Focus group interviews were recorded and transcribed. Through a theory-informed thematic analysis approach, experienced qualitative researchers used the Patient Centered Care model and the synergies of oppression conceptual lens to inductively and deductively code interview transcripts in order to develop key themes that captured the digital cancer care experiences of older Black adults. Results: In total, 5 overarching themes describe the experience of older Black adults, caregivers, and health care providers in accessing and using digital cancer care: (1) barriers to access and participation in digital care services, (2) shifting caregivers' dynamics, (3) autonomy of choice and choosing based on the purpose of care, (4) digital accessibility, and (5) effective digital communication. We identify 8 barriers and 6 facilitators to optimal digital cancer for older Black adults. Barriers include limited digital literacy, linguistic barriers in traditional African or Caribbean languages, and patient concerns of shifting power dynamics when supported by their children for digital cancer care; and facilitators include community-based cancer support groups, caregiver support, and key features of digital technologies. Conclusions: These findings revealed a multifaceted range of barriers and facilitators to digital cancer care for older Black adults. This means that a multipronged approach that simultaneously focuses on addressing barriers and leveraging community strengths can improve access and usage of digital cancer care. A redesign of digital cancer care programs, tailored to the needs of most structurally marginalized groups like older Black adults, can enhance the digital care experience for all population groups. Public policies and organizational practices that address issues like availability of internet in remote areas, resources to support linguistic barriers, or culturally sensitive training are important in responding to the complexity of access to digital l cancer care. These findings have implications for other structurally marginalized and underresourced communities that have suboptimal access and usage of digital care. ",
doi="10.2196/63324",
url="https://www.jmir.org/2025/1/e63324"
}


@Article{info:doi/10.2196/57122,
author="Shin, Jiyoung
and Kang, Hun
and Choi, Seongmi
and Chu, Hui Sang
and Choi, JiYeon",
title="Identifying Profiles of Digital Literacy Among Community-Dwelling Korean Older Adults: Latent Profile Analysis",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="19",
volume="27",
pages="e57122",
keywords="digital literacy",
keywords="digital divide",
keywords="older adults",
keywords="South Korea",
keywords="latent profile analysis",
abstract="Background: The digital divide is apparent not only between older and younger generations but also within the older adult population itself. Identifying digital literacy profiles among older adults is crucial for developing targeted strategies to narrow this divide. Objective: This study aimed to identify profiles of digital literacy among community-dwelling older adults and to examine factors associated with these profiles. Methods: Data were collected from community-dwelling older adults in South Korea through a nationwide cross-sectional survey that assessed digital literacy and related factors. Digital literacy was evaluated across 3 domains: information and communication (9 items), content creation and management (4 items), and safety and security (9 items). Latent profile analysis was used to identify profiles of digital literacy among community-dwelling older adults, and multinomial logistic regression was used to identify predictors of profile membership. Results: A total of 1016 older adults completed structured questionnaires (average age 68, SD 6.5 years; 486/1016, 47.8\% men). Three digital literacy profiles were identified (P<.001): ``low level'' (346/1016, 34.1\%), ``middle level'' (374/1016, 36.8\%), and ``high level'' (296/1016, 29.1\%). With the ``middle-level'' digital literacy group as the reference group, older adult participants (odds ratio [OR] 1.11, 95\% CI 1.07-1.15) with less than a middle school education (vs with a college degree or higher; OR 7.22, 95\% CI 2.31-22.54), who needed help with one of the 10 instrumental daily activities (vs ?2 activities; OR 3.06, 95\% CI 1.11-8.40) and who did not engage in in-person social activities (OR 1.81, 95\% CI 1.07-3.07), were more likely to be in the ``low-level'' group. Women were less likely to be in the ``high-level'' digital literacy group than men (OR 0.45, 95\% CI 0.25-0.80). Participants with less than a college education were also less likely to be in the ``high-level'' group, with those having less than a middle school education showing the lowest OR (OR 0.17, 95\% CI 0.07-0.41). Those who had never worked (OR 0.23, 95\% CI 0.06-0.90) and those not engaging in regular physical exercise (OR 0.58, 95\% CI 0.40-0.84) were also less likely to be in the ``high-level'' digital literacy group. Participants with greater social support were more likely to be in the ``high-level'' digital literacy group (OR 1.70, 95\% CI 1.22-2.37). Conclusions: These findings underscore the characteristics linked to lower digital literacy and suggest a tailored approach to meet the needs of diverse groups of older adults in a digitalizing society. To promote digital literacy among older adults, potential strategies include improving access to and guidance for using digital devices, specifically designed for this demographic, as well as promoting social support and encouraging participation in social activities. ",
doi="10.2196/57122",
url="https://www.jmir.org/2025/1/e57122",
url="http://www.ncbi.nlm.nih.gov/pubmed/39969960"
}


@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/10.2196/64290,
author="Mendel, Tamir
and Singh, Nina
and Mann, M. Devin
and Wiesenfeld, Batia
and Nov, Oded",
title="Laypeople's Use of and Attitudes Toward Large Language Models and Search Engines for Health Queries: Survey Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="13",
volume="27",
pages="e64290",
keywords="large language model",
keywords="artificial intelligence",
keywords="LLMs",
keywords="search engine",
keywords="Google",
keywords="internet",
keywords="online health information",
keywords="United States",
keywords="survey",
keywords="mobile phone",
abstract="Background: Laypeople have easy access to health information through large language models (LLMs), such as ChatGPT, and search engines, such as Google. Search engines transformed health information access, and LLMs offer a new avenue for answering laypeople's questions. Objective: We aimed to compare the frequency of use and attitudes toward LLMs and search engines as well as their comparative relevance, usefulness, ease of use, and trustworthiness in responding to health queries. Methods: We conducted a screening survey to compare the demographics of LLM users and nonusers seeking health information, analyzing results with logistic regression. LLM users from the screening survey were invited to a follow-up survey to report the types of health information they sought. We compared the frequency of use of LLMs and search engines using ANOVA and Tukey post hoc tests. Lastly, paired-sample Wilcoxon tests compared LLMs and search engines on perceived usefulness, ease of use, trustworthiness, feelings, bias, and anthropomorphism. Results: In total, 2002 US participants recruited on Prolific participated in the screening survey about the use of LLMs and search engines. Of them, 52\% (n=1045) of the participants were female, with a mean age of 39 (SD 13) years. Participants were 9.7\% (n=194) Asian, 12.1\% (n=242) Black, 73.3\% (n=1467) White, 1.1\% (n=22) Hispanic, and 3.8\% (n=77) were of other races and ethnicities. Further, 1913 (95.6\%) used search engines to look up health queries versus 642 (32.6\%) for LLMs. Men had higher odds (odds ratio [OR] 1.63, 95\% CI 1.34-1.99; P<.001) of using LLMs for health questions than women. Black (OR 1.90, 95\% CI 1.42-2.54; P<.001) and Asian (OR 1.66, 95\% CI 1.19-2.30; P<.01) individuals had higher odds than White individuals. Those with excellent perceived health (OR 1.46, 95\% CI 1.1-1.93; P=.01) were more likely to use LLMs than those with good health. Higher technical proficiency increased the likelihood of LLM use (OR 1.26, 95\% CI 1.14-1.39; P<.001). In a follow-up survey of 281 LLM users for health, most participants used search engines first (n=174, 62\%) to answer health questions, but the second most common first source consulted was LLMs (n=39, 14\%). LLMs were perceived as less useful (P<.01) and less relevant (P=.07), but elicited fewer negative feelings (P<.001), appeared more human (LLM: n=160, vs search: n=32), and were seen as less biased (P<.001). Trust (P=.56) and ease of use (P=.27) showed no differences. Conclusions: Search engines are the primary source of health information; yet, positive perceptions of LLMs suggest growing use. Future work could explore whether LLM trust and usefulness are enhanced by supplementing answers with external references and limiting persuasive language to curb overreliance. Collaboration with health organizations can help improve the quality of LLMs' health output. ",
doi="10.2196/64290",
url="https://www.jmir.org/2025/1/e64290",
url="http://www.ncbi.nlm.nih.gov/pubmed/39946180"
}


@Article{info:doi/10.2196/59841,
author="Clifford, Namuun
and Tunis, Rachel
and Ariyo, Adetimilehin
and Yu, Haoxiang
and Rhee, Hyekyun
and Radhakrishnan, Kavita",
title="Trends and Gaps in Digital Precision Hypertension Management: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="10",
volume="27",
pages="e59841",
keywords="precision health",
keywords="hypertension",
keywords="digital health",
keywords="prediction models",
keywords="personalization",
keywords="phenotyping",
keywords="machine learning",
keywords="algorithms",
keywords="mobile apps",
keywords="mobile health",
abstract="Background: Hypertension (HTN) is the leading cause of cardiovascular disease morbidity and mortality worldwide. Despite effective treatments, most people with HTN do not have their blood pressure under control. Precision health strategies emphasizing predictive, preventive, and personalized care through digital tools offer notable opportunities to optimize the management of HTN. Objective: This scoping review aimed to fill a research gap in understanding the current state of precision health research using digital tools for the management of HTN in adults. Methods: This study used a scoping review framework to systematically search for articles in 5 databases published between 2013 and 2023. The included articles were thematically analyzed based on their precision health focus: personalized interventions, prediction models, and phenotyping. Data were extracted and summarized for study and sample characteristics, precision health focus, digital health technology, disciplines involved, and characteristics of personalized interventions. Results: After screening 883 articles, 46 were included; most studies had a precision health focus on personalized digital interventions (34/46, 74\%), followed by prediction models (8/46, 17\%) and phenotyping (4/46, 9\%). Most studies (38/46, 82\%) were conducted in or used data from North America or Europe, and 63\% (29/46) of the studies came exclusively from the medical and health sciences, with 33\% (15/46) of studies involving 2 or more disciplines. The most commonly used digital technologies were mobile phones (33/46, 72\%), blood pressure monitors (18/46, 39\%), and machine learning algorithms (11/46, 24\%). In total, 45\% (21/46) of the studies either did not report race or ethnicity data (14/46, 30\%) or partially reported this information (7/46, 15\%). For personalized intervention studies, nearly half (14/30, 47\%) used 2 or less types of data for personalization, with only 7\% (2/30) of the studies using social determinants of health data and no studies using physical environment or digital literacy data. Personalization characteristics of studies varied, with 43\% (13/30) of studies using fully automated personalization approaches, 33\% (10/30) using human-driven personalization, and 23\% (7/30) using a hybrid approach. Conclusions: This scoping review provides a comprehensive mapping of the literature on the current trends and gaps in digital precision health research for the management of HTN in adults. Personalized digital interventions were the primary focus of most studies; however, the review highlighted the need for more precise definitions of personalization and the integration of more diverse data sources to improve the tailoring of interventions and promotion of health equity. In addition, there were significant gaps in the reporting of race and ethnicity data of participants, underuse of wearable devices for passive data collection, and the need for greater interdisciplinary collaboration to advance precision health research in digital HTN management. Trial Registration: OSF Registries osf.io/yuzf8; https://osf.io/yuzf8 ",
doi="10.2196/59841",
url="https://www.jmir.org/2025/1/e59841"
}


@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/10.2196/59023,
author="Yang, Lu
and Lynch, Chris
and Lee, Tayu John
and Oldenburg, Brian
and Haregu, Tilahun",
title="Understanding the Association Between Home Broadband Connection and Well-Being Among Middle-Aged and Older Adults in China: Nationally Representative Panel Data Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="10",
volume="27",
pages="e59023",
keywords="digital divide",
keywords="health inequity",
keywords="China",
keywords="longitudinal study",
keywords="broadband",
keywords="internet connection",
keywords="internet",
keywords="well-being",
keywords="psychosocial",
keywords="middle age",
keywords="older adult",
keywords="inequality",
keywords="digital connectivity",
keywords="logistic regression",
keywords="questionnaire",
keywords="survey",
keywords="panel data approach",
abstract="Background: Access to digital technology is among the major social determinants of health, and digital divide impacts health inequality. Yet, the impact of digital connectivity on the well-being and psychosocial outcomes in adults has not been fully studied. Objective: The aim of this study was to investigate the association of home broadband connection with health and well-being of middle-aged adults and adults older than 45 years in China. Methods: A panel data study design of the national sample of China Health and Retirement Longitudinal Study (CHARLS) was conducted in 2015, 2018, and 2020. This study included 16,185 participants older than 45 years. The associations between digital connectivity (home broadband connection), loneliness, social participation, and life satisfaction were assessed using mixed effects logistic regression models, adjusting for socioeconomic factors, behavioral factors, and locality. Broadband internet connectivity, feelings of loneliness, social participation, and satisfaction with life were measured using the self-reported CHARLS questionnaire. Results: We observed a substantial increase in digital connectivity from 29.5\% in 2015 to 59.8\% in 2020. Broadband internet connection at home was positively correlated with social participation (adjusted odds ratio [AOR] 1.34, 95\% CI 1.28-1.41) and life satisfaction (AOR 1.30, 95\% CI 1.20-1.40), after adjusting for confounding factors, while the absence of broadband internet connection was associated with increased loneliness (AOR 0.81, 95\% CI 0.77-0.86). These associations were consistent across age, gender, socioeconomic groups, and geographic areas. Conclusions: This study highlights the potential additional health benefits of digital connectivity beyond the known advantages. Our results suggest the importance of expanding broadband access to enhance social inclusion and life satisfaction. Further research is needed to understand the broader implications and digital determinants of health associated with digital connectivity. ",
doi="10.2196/59023",
url="https://www.jmir.org/2025/1/e59023"
}


@Article{info:doi/10.2196/63799,
author="Liu, Yujie
and Ge, Xin
and Wang, Ying
and Yang, Xue
and Liu, Shangbin
and Xu, Chen
and Xiang, Mi
and Hu, Fan
and Cai, Yong",
title="Urban-Rural Differences in the Association Between Internet Use Trajectories and Depressive Symptoms in Chinese Adolescents: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="7",
volume="27",
pages="e63799",
keywords="internet use",
keywords="trajectory",
keywords="depressive symptoms",
keywords="adolescent",
keywords="urban",
keywords="rural",
abstract="Background: Internet use exhibits diverse trajectories during adolescence, which may contribute to depressive symptoms. Currently, it remains unclear whether the association between internet use trajectories and depressive symptoms varies between urban and rural areas. Objective: This study aimed to investigate the association between internet use trajectories and adolescent depressive symptoms and to explore variation in this association between urban and rural areas. Methods: This longitudinal study used 3-wave data from the 2014-2018 China Family Panel Study. Weekly hours of internet use and depressive symptoms were measured using self-reported questionnaires. Latent class growth modeling was performed to identify the trajectories of internet use. Multivariable logistic regressions were used to examine the association between internet use trajectories and depressive symptoms, stratified by rural and urban residence. Results: Participants were 2237 adolescents aged 10 to 15 years at baseline (mean age 12.46, SD 1.73 years). Two latent trajectory classes of internet use were identified: the low-growth group (n=2008, 89.8\%) and the high-growth group (n=229, 10.2\%). The high-growth group was associated with higher odds of depressive symptoms (OR 1.486, 95\% CI 1.065-2.076) compared to the low-growth group. In the stratified analysis, the association between internet use trajectories and depressive symptoms was significant solely among rural adolescents (OR 1.856, 95\% CI 1.164-2.959). Conclusions: This study elucidates urban-rural differences in the associations between trajectories of internet use and adolescent depressive symptoms. Our findings underscore the importance of prioritizing interventions for rural adolescents' internet use behaviors to mitigate negative effects on their mental health. ",
doi="10.2196/63799",
url="https://www.jmir.org/2025/1/e63799"
}


@Article{info:doi/10.2196/59817,
author="Kraft, A. Stephanie
and Chopra, Shaan
and Duran, C. Miriana
and Rojina, A. Janet
and Beretta, Abril
and L{\'o}pez, I. Katherine
and Javan, Russell
and Wilfond, S. Benjamin
and Rosenfeld, Margaret
and Fogarty, James
and Ko, K. Linda",
title="Perspectives of Hispanic and Latinx Community Members on AI-Enabled mHealth Tools: Qualitative Focus Group Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="6",
volume="27",
pages="e59817",
keywords="wearable electronic devices",
keywords="qualitative research",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="privacy",
keywords="data sharing",
keywords="artificial intelligence",
keywords="AI",
keywords="community",
keywords="chronic conditions",
keywords="chronic disease",
abstract="Background: Mobile health (mHealth) tools have the potential to reduce the burden of chronic conditions that disproportionately affect Hispanic and Latinx communities; however, digital divides in the access to and use of health technology suggest that mHealth has the potential to exacerbate, rather than reduce, these disparities. Objective: A key step toward developing health technology that is accessible and usable is to understand community member perspectives and needs so that technology is culturally relevant and appropriately contextualized. In this study, we aimed to examine the perspectives of Hispanic and Latinx community members in Washington State about mHealth. Methods: We recruited English- and Spanish-speaking Hispanic or Latinx adults to participate in web-based focus groups through existing community-based networks across rural and urban regions of Washington State. Focus groups included a presentation of narrative slideshow materials developed by the research team depicting mHealth use case examples of asthma in children and fall risk in older adults. Focus group questions asked participants to respond to the case examples and to further explore mHealth use preferences, benefits, barriers, and concerns. Focus group recordings were professionally transcribed, and Spanish transcripts were translated into English. We developed a qualitative codebook using deductive and inductive methods and then coded deidentified transcripts using the constant comparison method. The analysis team proposed themes based on review of coded data, which were validated through member checking with a community advisory board serving Latino individuals in the region and finalized through discussion with the entire research team. Results: Between May and September 2023, we conducted 8 focus groups in English or Spanish with 48 participants. Focus groups were stratified by language and region and included the following: 3 (n=18, 38\% participants) Spanish urban groups, 2 (n=14, 29\% participants) Spanish rural groups, 1 (n=6, 13\% participants) English urban group, and 2 (n=10, 21\% participants) English rural groups. We identified the following seven themes: (1) mHealth is seen as beneficial for promoting health and peace of mind; (2) some are unaware of, unfamiliar with, or uncomfortable with technology and may benefit from individualized support; (3) financial barriers limit access to mHealth; (4) practical considerations create barriers to using mHealth in daily life; (5) mHealth raises concern for overreliance on technology; (6) automated mHealth features are perceived as valuable but fallible, requiring human input to ensure accuracy; and (7) data sharing is seen as valuable for limited uses but raises privacy concerns. These themes illustrate key barriers to the benefits of mHealth that communities may face, provide insights into the role of mHealth within families, and examine the appropriate balance of data sharing and privacy protections. Conclusions: These findings offer important insights that can help advance the development of mHealth that responds to community values and priorities. ",
doi="10.2196/59817",
url="https://www.jmir.org/2025/1/e59817"
}


@Article{info:doi/10.2196/63403,
author="Ezeigwe, Juliet Ogochukwu
and Nwosu, Samuel Kenechukwu Obumneme
and Afolayan, Kunle Oladipo
and Ojaruega, Amanda Akpevwe
and Echere, Jovita
and Desai, Manali
and Onigbogi, Olajumoke Modupe
and Oladoyin, Ope Olajumoke
and Okoye, Chioma Nnenna
and Fwelo, Pierre",
title="Technological-Based Interventions in Cancer and Factors Associated With the Use of Mobile Digital Wellness and Health Apps Among Cancer Information Seekers: Cross-Sectional Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="5",
volume="27",
pages="e63403",
keywords="cancer intervention",
keywords="digital health and wellness apps",
keywords="cancer management",
keywords="telehealth",
keywords="mobile health",
keywords="mhealth",
keywords="decision-making",
keywords="United States",
keywords="cross-sectional study",
keywords="adult",
keywords="logistic regression",
keywords="regression analysis",
keywords="digital health",
keywords="young adult",
keywords="cancer screening",
keywords="knowledge seeking",
keywords="barrier",
keywords="utilization",
keywords="engagement",
keywords="digital health engagement",
keywords="diversity",
keywords="cancer information",
keywords="health seeking behavior",
keywords="mobile phone",
abstract="Background: Mobile digital wellness and health apps play a significant role in optimizing health and aiding in cancer management and decision-making. Objective: This study aims to identify the factors influencing the use of mobile health and wellness apps among cancer information seekers in the United States. Methods: We conducted a cross-sectional study using data from the Health Information National Trends Survey. Our analysis focused on 4770 participants who sought cancer information. We performed weighted univariate and multivariable logistic regression to determine the association between the use of health and wellness apps and socioeconomic factors, medical history and conditions, and lifestyle and behavioral factors. Results: A total of 4770 participants who sought cancer information were included in the final analysis. Of these, 80.9\% (n=2705) were health and wellness app users, while 19.1\% (n=793) were nonusers. In the final adjusted model, participants with household incomes ?US \$50,000 had 49\% higher adjusted odds of using these apps than those with incomes <US \$50,000 (adjusted odds ratio [aOR]=1.49, 95\% CI 1.02-2.14). College graduates and those with higher educational levels were avid users compared to those with a high school diploma or less (aOR=1.87, 95\% CI 1.30-2.67). Internet users had over 3 times the odds of using these apps compared to nonusers (aOR=3.28, 95\% CI 1.70-6.33). Participants within the age group 18-34 years were 3.70 times more likely (aOR=3.70, 95\% CI 1.90-7.23) to use a health and wellness app compared to participants within the age group of 75 years and older. Conclusions: Age, education, household income, and use of the internet are the major determinants of the adoption of digital health and wellness apps among seekers of cancer information. Hence, public health programs could be directed toward addressing these factors to improve cancer diagnosis, treatment, and management using these apps. ",
doi="10.2196/63403",
url="https://www.jmir.org/2025/1/e63403"
}


@Article{info:doi/10.2196/63864,
author="Tong, Chau
and Margolin, Drew
and Niederdeppe, Jeff
and Chunara, Rumi
and Liu, Jiawei
and Jih-Vieira, Lea
and King, J. Andy",
title="Colorectal Cancer Racial Equity Post Volume, Content, and Exposure: Observational Study Using Twitter Data",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="3",
volume="27",
pages="e63864",
keywords="racial equity information",
keywords="information exposure",
keywords="health disparities",
keywords="colorectal cancer",
keywords="cancer communication",
keywords="Twitter",
keywords="X",
abstract="Background: Racial inequity in health outcomes, particularly in colorectal cancer (CRC), remains one of the most pressing issues in cancer communication and public health. Social media platforms like Twitter (now X) provide opportunities to disseminate health equity information widely, yet little is known about the availability, content, and reach of racial health equity information related to CRC on these platforms. Addressing this gap is essential to leveraging social media for equitable health communication. Objective: This study aims to analyze the volume, content, and exposure of CRC racial health equity tweets from identified CRC equity disseminator accounts on Twitter. These accounts were defined as those actively sharing information related to racial equity in CRC outcomes. By examining the behavior and impact of these disseminators, this study provides insights into how health equity content is shared and received on social media. Methods: We identified accounts that posted CRC-related content on Twitter between 2019 and 2021. Accounts were classified as CRC equity disseminators (n=798) if they followed at least 2 CRC racial equity organization accounts. We analyzed the volume and content of racial equity--related CRC tweets (n=1134) from these accounts and categorized them by account type (experts vs nonexperts). Additionally, we evaluated exposure by analyzing follower reach (n=6,266,269) and the role of broker accounts---accounts serving as unique sources of CRC racial equity information to their followers. Results: Among 19,559 tweets posted by 798 CRC equity disseminators, only 5.8\% (n=1134) mentioned racially and ethnically minoritized groups. Most of these tweets (641/1134, 57\%) addressed disparities in outcomes, while fewer emphasized actionable content, such as symptoms (11/1134, 1\%) or screening procedures (159/1134, 14\%). Expert accounts (n=479; 716 tweets) were more likely to post CRC equity tweets compared with nonexpert accounts (n=319; 418 tweets). Broker accounts (n=500), or those with a substantial portion of followers relying on them for equity-related information, demonstrated the highest capacity for exposing followers to CRC equity content, thereby extending the reach of these critical messages to underserved communities. Conclusions: This study emphasizes the critical roles played by expert and broker accounts in disseminating CRC racial equity information on social media. Despite the limited volume of equity-focused content, broker accounts were crucial in reaching otherwise unexposed audiences. Public health practitioners should focus on encouraging equity disseminators to share more actionable information, such as symptoms and screening benefits, and implement measures to amplify the reach of such content on social media. Strengthening these efforts could help bridge disparities in cancer outcomes among racially minoritized groups. ",
doi="10.2196/63864",
url="https://www.jmir.org/2025/1/e63864"
}


@Article{info:doi/10.2196/65399,
author="Guo, Lin
and Li, Yunwei
and Cheng, Kai
and Zhao, Ying
and Yin, Wenqiang
and Liu, Ying",
title="Impact of Internet Usage on Depression Among Older Adults: Comprehensive Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="31",
volume="27",
pages="e65399",
keywords="internet usage",
keywords="depression",
keywords="older people",
keywords="mechanism",
keywords="heterogeneity",
keywords="mobile phone",
abstract="Background: Depression is a widespread mental health issue affecting older adults globally, with substantial implications for their well-being. Although digital interventions have proven effective in high-income countries, research on the potential of internet usage to alleviate depression among older adults in high-income countries remains limited. Objective: This study aimed to examine the impact of internet usage on depression among older adults in high-income countries by developing a comprehensive theoretical framework and testing key hypotheses. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), a 2-stage instrumental variable approach was applied to address endogeneity and estimate causal relationships between internet usage and depression. Results: The findings indicate that internet usage results in a 1.41\% reduction in depression levels among older adults. This effect is mediated by four primary mechanisms: (1) enhanced social interaction, (2) increased physical activity, (3) improved intergenerational contact, and (4) expanded access to educational opportunities. A heterogeneity analysis revealed that these effects are more pronounced in urban areas, eastern regions, and regions with superior internet infrastructure. Conclusions: Internet usage plays a crucial role in alleviating depression among older adults in high-income countries, with regional variations. The findings highlight the need for targeted policy interventions to improve internet access and digital literacy, which can mitigate depression and enhance the mental health of older adults. ",
doi="10.2196/65399",
url="https://www.jmir.org/2025/1/e65399"
}


@Article{info:doi/10.2196/53188,
author="Bragg, A. Marie
and Lutfeali, Samina
and Gabler, Godoy Daniela
and Quintana Licona, A. Diego
and Harris, L. Jennifer",
title="Latinx and White Adolescents' Preferences for Latinx-Targeted Celebrity and Noncelebrity Food Advertisements: Experimental Survey Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="31",
volume="27",
pages="e53188",
keywords="Latinx",
keywords="Hispanic",
keywords="adolescents",
keywords="marketing",
keywords="celebrities",
keywords="Spanish",
keywords="advertisements",
keywords="products",
keywords="brands",
keywords="food",
keywords="unhealthy",
keywords="beverages",
keywords="diet",
keywords="nutrition",
keywords="consumers",
keywords="intention",
keywords="purchasing",
keywords="attitudes",
keywords="perceptions",
keywords="preferences",
keywords="youth",
abstract="Background: Exposure to food advertisements is a major driver of childhood obesity, and food companies disproportionately target Latinx youth with their least healthy products. This study assessed the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents. Objective: This web-based within-subjects study aims to assess the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents' preferences for the advertisements and featured products. Methods: Participants (N=903) were selected from a volunteer sample of adolescents, aged 13-17 years, who self-identified as Latinx or White, had daily internet access, and could read and write in English. They participated in a web-based Qualtrics study where each participant viewed 8 advertisements for novel foods and beverages, including 4 advertisements that featured Latinx celebrities and the same 4 advertisements that featured Latinx noncelebrities (matched on all other attributes), in addition to 2 neutral advertisements (featuring bland, nontargeted products and did not feature people). Primary outcomes were participants' ratings of 4 advertisements for food and beverage brands featuring a Latinx celebrity and the same 4 advertisements featuring a Latinx noncelebrity. Multilevel linear regression models compared the effects of celebrities and differences between Latinx and White participants on attitudes (advertisement likeability; positive affect; and brand perceptions) and behavioral intentions (consumption; social media engagement---``liking;'' following; commenting; tagging a friend). Results: Latinx (n=436; 48.3\%) and White (n=467; 51.7\%) participants rated advertisements featuring Latinx celebrities more positively than advertisements featuring noncelebrities on attitude measures except negative affect (Ps?.002), whereas only negative affect differed between Latinx and White participants. Two of the 5 behavioral intention measures differed by celebrity advertisement status (P=.02; P<.001). Additionally, the interaction between celebrity and participant ethnicity was significant for 4 behavioral intentions; Latinx, but not White, participants reported higher willingness to consume the product (P<.001), follow brands (P<.001), and tag friends (P<.001). While White and Latinx adolescents both reported higher likelihoods of ``liking'' advertisements on social media endorsed by Latinx celebrities versus noncelebrities, the effect was significantly larger among Latinx adolescents (P<.01). Conclusions: This study demonstrates the power of Latinx celebrities in appealing to both Latinx and White adolescents but may be particularly persuasive in shaping behavioral intentions among Latinx adolescents. These findings suggest an urgent need to reduce celebrity endorsements in ethnically targeted advertisements that promote unhealthy food products to communities disproportionately affected by obesity and diabetes. The food industry limits food advertising to children ages 12 years and younger, but industry self-regulatory efforts and policies should expand to include adolescents and address disproportionate marketing of unhealthy food to Latinx youth and celebrity endorsements of unhealthy products. ",
doi="10.2196/53188",
url="https://www.jmir.org/2025/1/e53188"
}


@Article{info:doi/10.2196/54460,
author="Weidinger, Florian
and Dietzel, Nikolas
and Graessel, Elmar
and Prokosch, Hans-Ulrich
and Kolominsky-Rabas, Peter",
title="Using Health Information Resources for People With Cognitive Impairment (digiDEM Bayern): Registry-Based Cohort Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="15",
volume="9",
pages="e54460",
keywords="dementia",
keywords="mild cognitive impairment",
keywords="cognitive impairment",
keywords="information sources",
keywords="health information",
keywords="health information--seeking behavior",
keywords="Digital Dementia Registry Bavaria",
keywords="digiDEM",
abstract="Background: Dementia is a growing global health challenge with significant economic and social implications. Underdiagnosis of dementia is prevalent due to a lack of knowledge and understanding among the general population. Enhancing dementia literacy through improved health information--seeking behavior is crucial for the self-determined management of the disease by those affected. Understanding the relationship between dementia literacy, health information--seeking behavior, and the use of various information sources among individuals with cognitive impairment is of high importance in this context. Objective: The aim of this study was to analyze the relevance of different sources of health information from the perspective of people with cognitive impairment, while also evaluating differences based on age, gender, and disease progression. Methods: This study is part of the ongoing project ``Digital Dementia Registry Bavaria -- digiDEM Bayern.'' The Digital Dementia Registry Bavaria is a multicenter, prospective, longitudinal register study in Bavaria, Germany. People with cognitive impairment rated several information sources by using Likert scales with the values unimportant (1) to very important (5). Data were analyzed descriptively, and multiple 2-sample, 2-tailed t tests were used to evaluate differences by cognitive status and gender and using multiple one-way ANOVA to evaluate differences by age group. Results: Data of 924 people with cognitive impairment (531 with dementia, 393 with mild cognitive impairment) were evaluated. The most relevant health information sources were ``Personal visit to a medical professional'' (mean 3.9, SD 1.1) and ``Family / Friends'' (mean 3.9, SD 1.2). ``Internet'' was 1 of the 2 lowest-rated information sources by people with cognitive impairment (mean 1.6, SD 1.1), with nearly three-quarters (684/924, 74\%) of the participants rating the source as unimportant. The age-specific analyses showed significant differences for the sources ``Internet'' (F2,921=61.23; P<.001), ``Courses / Lectures'' (F2,921=18.88; P<.001), and ``Family / Friends'' (F2,921=6.27; P=.002) for the 3 defined age groups. There were several significant differences between people with mild cognitive impairment and dementia whereby the first group evaluated most sources higher, such as ``Internet'' (mean difference=0.6; t640=7.52; P<.001). The only sources rated higher by the dementia group were ``TV / Radio'' and ``Family / Friends,'' with none of them showing significant differences. Gender-specific analyses showed women with cognitive impairment valuing every evaluated source higher than men apart from ``Internet'' (mean difference=0.4; t685=4.97; P<.001). Conclusions: To enhance health and dementia literacy, the best way to communicate health information to people with cognitive impairment is through interpersonal contact with medical professionals and their friends and family. Slight changes in valuation should be considered as the medical condition progresses, along with variations by age and gender. In particular, the evaluation and use of the internet are dependent on these factors. Further research is needed to capture potential changes in the valuation of the internet as a health information source. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-043473 ",
doi="10.2196/54460",
url="https://formative.jmir.org/2025/1/e54460"
}


@Article{info:doi/10.2196/62645,
author="Wu, Mengqiu
and Xue, Yongxi
and Ma, Chengyu",
title="The Association Between the Digital Divide and Health Inequalities Among Older Adults in China: Nationally Representative Cross-Sectional Survey",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="15",
volume="27",
pages="e62645",
keywords="older adults",
keywords="digital divide",
keywords="internet use",
keywords="internet access",
keywords="health inequalities",
abstract="Background: Health inequalities among older adults become increasingly pronounced as aging progresses. In the digital era, some researchers argue that access to and use of digital technologies may contribute to or exacerbate these existing health inequalities. Conversely, other researchers believe that digital technologies can help mitigate these disparities. Objective: This study aimed to investigate the relationship between the digital divide and health inequality among older adults and to offer recommendations for promoting health equity. Methods: Data were obtained from the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) scale, the Instrumental Activities of Daily Living scale, the Mini-Mental State Examination scale, and a 5-point self-rated health scale, respectively. The chi-square and rank sum tests were used to explore whether internet use and access were associated with health inequality status. After controlling for confounders, multiple linear regression models were used to further determine this association. Sensitivity analysis was conducted using propensity score matching, and heterogeneity was analyzed for different influencing factors. Results: The 2018 analysis highlighted widening health disparities among older adults due to internet access and use, with statistically significant increases in inequalities in self-rated health (3.9\%), ADL score (5.8\%), and cognition (7.5\%). Similarly, internet use widened gaps in self-rated health (7.5\%) and cognition (7.6\%). Conversely, the 2020 analysis demonstrated that internet access improved health disparities among older adults, reducing gaps in self-rated health (3.8\%), ADL score (2.1\%), instrumental ADL score (3.5\%), and cognition (7.5\%), with significant results, except for ADL. Internet use also narrowed disparities, with significant effects on self-rated health (4.8\%) and cognition (12.8\%). The robustness of the results was confirmed through propensity score--matching paired tests. In addition, the study found heterogeneity in the effects of internet access and use on health inequalities among older adults, depending on sex, age, education, and region. Conclusions: The impact of internet access and use on health inequalities among older adults showed different trends in 2018 and 2020. These findings underscore the importance of addressing the challenges and barriers to internet use among older adults, particularly during the early stages of digital adoption. It is recommended to promote equitable access to the health benefits of the internet through policy interventions, social support, and technological advancements. ",
doi="10.2196/62645",
url="https://www.jmir.org/2025/1/e62645"
}


@Article{info:doi/10.2196/59027,
author="Liu, Shiyu
and Ma, Jingru
and Sun, Meichen
and Zhang, Chao
and Gao, Yujing
and Xu, Jinghong",
title="Mapping the Landscape of Digital Health Intervention Strategies: 25-Year Synthesis",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="13",
volume="27",
pages="e59027",
keywords="digital health interventions",
keywords="intervention strategies",
keywords="behavior change",
keywords="mHealth",
keywords="eHealth",
keywords="randomized controlled trial",
abstract="Background: Digital health interventions have emerged as promising tools to promote health behavior change and improve health outcomes. However, a comprehensive synthesis of strategies contributing to these interventions is lacking. Objective: This study aims to (1) identify and categorize the strategies used in digital health interventions over the past 25 years; (2) explore the differences and changes in these strategies across time periods, countries, populations, delivery methods, and senders; and (3) serve as a valuable reference for future researchers and practitioners to improve the effectiveness of digital health interventions. Methods: This study followed a systematic review approach, complemented by close reading and text coding. A comprehensive search for published English academic papers from PubMed, Web of Science, and Scopus was conducted. The search employed a combination of digital health and intervention-related terms, along with database-specific subject headings and filters. The time span covered 25 years, from January 1, 1999, to March 10, 2024. Sample papers were selected based on study design, intervention details, and strategies. The strategies were identified and categorized based on the principles of Behavior Change Techniques and Behavior Strategies. Results: A total of 885 papers involving 954,847 participants met the eligibility criteria. We identified 173 unique strategies used in digital health interventions, categorized into 19 themes. The 3 most frequently used strategies in the sample papers were ``guide'' (n=492, 55.6\%), ``monitor'' (n=490, 55.4\%), and ``communication'' (n=392, 44.3\%). The number of strategies employed in each paper ranged from 1 to 32. Most interventions targeted clients (n=844, 95.4\%) and were carried out in hospitals (n=268, 30.3\%). High-income countries demonstrated a substantially higher number and diversity of identified strategies than low- and middle-income countries, and the number of studies targeting the public (n=647, 73.1\%) far exceeded those focusing on vulnerable groups (n=238, 26.9\%). Conclusions: Digital health interventions and strategies have undergone considerable development over the past 25 years. They have evolved from simple approaches to sophisticated, personalized techniques and are trending toward multifaceted interventions, leveraging advanced technologies for real-time monitoring and feedback. Future studies should focus on rigorous evaluations, long-term effectiveness, and tailored approaches for diverse populations, and more attention should be given to vulnerable groups. ",
doi="10.2196/59027",
url="https://www.jmir.org/2025/1/e59027",
url="http://www.ncbi.nlm.nih.gov/pubmed/39804697"
}


@Article{info:doi/10.2196/55828,
author="Park, In Hae
and Jeon, Minjeong
and Ahn, Seon Ji
and Chung, Kyungmi
and Park, Young Jin",
title="Development and Validation of the Digital Sensitivity Scale for Adults: Cross-Sectional Observational Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="10",
volume="27",
pages="e55828",
keywords="information literacy",
keywords="health literacy",
keywords="computer literacy",
keywords="self-efficacy",
keywords="attitude",
keywords="digital divide",
abstract="Background: The COVID-19 pandemic has accelerated the digitalization of modern society, extending digital transformation to daily life and psychological evaluation and treatment. However, the development of competencies and literacy in handling digital technology has not kept pace, resulting in a significant disparity among individuals. Existing measurements of digital literacy were developed before widespread information and communications technology device adoption, mainly focusing on one's perceptions of their proficiency and the utility of device operation. In the contemporary landscape, digital transformation is evolving within specialized domains, necessitating a comprehensive evaluation of digital competencies, attitudes, and proficiency in technology application to bridge the digital divide and ensure digital compliance. Objective: This study was designed to address the shortcomings of existing scales and formulate a digital sensitivity scale tailored to the requirements of today's society. Methods: Initial items of the Yongin Severance Digital Sensitivity Scale (YI-DSS) were collected through a literature review, and expert opinions were gathered to ensure content validity. An exploratory and confirmatory factor analysis included 986 adult participants evaluating 14 digital literacy items and 6 digital efficacy items. The Cronbach $\alpha$ confirmed internal consistency reliability, and 2-tailed t tests, ANOVAs, and post hoc tests analyzed demographic differences in digital literacy and efficacy. Results: A robust 4-factor digital literacy solution was identified: digital application, digital communication, critical thinking, and digital ethics (Kaiser-Meyer-Olkin=0.891; Bartlett {\texttimes} 2=9829.713; P<.001; Cronbach $\alpha$=0.782-0.947). A 2-factor solution defined digital efficacy: digital confidence and digital anxiety (Kaiser-Meyer-Olkin=0.735; Bartlett {\texttimes} 2=3282.217; P<.001; Cronbach $\alpha$=0.787-0.912). Confirmatory factor analysis was conducted for each model (digital literacy model: $\chi$271=676.0, comparative fit index=0.938, Tucker-Lewis index=0.921, standardized root mean square residual=0.73, and root mean square error of approximation=0.093; digital efficacy model: $\chi$28=81.9, comparative fit index=0.977, Tucker-Lewis index=0.958, standardized root mean square residual=0.73, and root mean square error of approximation=0.097), which indicated a good fit. The YI-DSS also showed high correlation with the previously developed Digital Literacy Scale (r=0.809; P<.001). Conclusions: The YI-DSS, as a self-assessment tool, has the potential to bridge the generational information gap by promoting acceptance, motivation, and adaptation to digital technology. Furthermore, given the remote nature of digital therapeutics, an individual's familiarity with required technologies and digital communication strongly influences their acceptance of digital treatments and the efficacy thereof. This scale can play a pivotal role in enhancing compliance with digital therapeutics by preemptively assessing individuals' technological literacy and competency. ",
doi="10.2196/55828",
url="https://www.jmir.org/2025/1/e55828"
}


@Article{info:doi/10.2196/62824,
author="Valla, Guido Luca
and Rossi, Michele
and Gaia, Alessandra
and Guaita, Antonio
and Rolandi, Elena",
title="The Impact of the COVID-19 Pandemic on Oldest-Old Social Capital and Health and the Role of Digital Inequalities: Longitudinal Cohort Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="9",
volume="27",
pages="e62824",
keywords="older adults",
keywords="information and communication technology",
keywords="ICT",
keywords="ICT use",
keywords="COVID-19",
keywords="social capital",
keywords="health",
keywords="mental health",
keywords="digital divide",
abstract="Background: During the COVID-19 pandemic, information and communication technology (ICT) became crucial for staying connected with loved ones and accessing health services. In this scenario, disparities in ICT use may have exacerbated other forms of inequality, especially among older adults who were less familiar with technology and more vulnerable to severe COVID-19 health consequences. Objective: This study investigated changes in ICT use, psychological and physical health, and social capital before and after the pandemic among the oldest old population (aged 80 years or older after the pandemic) and explored how internet use influenced these changes. Methods: We leveraged data from the InveCe.Ab study, a population-based longitudinal cohort of people born between 1935 and 1939 and living in Abbiategrasso, a municipality on the outskirts of Milan, Italy. Participants underwent multidimensional assessment at baseline (2010) and after 2, 4, 8, and 12 years. We restricted our analysis to cohort members who participated in the last wave (ie, 2022) and who did not have a diagnosis of dementia (n=391). We used linear mixed models to assess the impact of COVID-19 and time on changes in social capital, physical and psychological health, and ICT use in a discontinuity regression design while controlling for age, sex, education, and income satisfaction. Then, we assessed the influence of internet use and its interaction with COVID-19 on these changes. Results: COVID-19 had a significant impact on social relationships ($\beta$=--4.35, 95\% CI 6.38 to --2.32; P<.001), cultural activities ($\beta$=--.55, 95\% CI --0.75 to --0.35; P<.001), cognitive functioning ($\beta$=--1.00, 95\% CI --1.28 to --0.72; P<.001), depressive symptoms ($\beta$=.42, 95\% CI 0.10-0.74; P=.009), physical health ($\beta$=.07, 95\% CI 0.04-0.10; P<.001), and ICT use ($\beta$=--.11, 95\% CI --0.18 to --0.03; P=.008). Internet use predicts reduced depressive symptoms ($\beta$=--.56, 95\% CI --1.07 to --0.06; P=.03) over time. The interaction between internet use and COVID-19 was significant for cultural activities ($\beta$=--.73, 95\% CI --1.22 to --0.24; P=.003) and cognitive functioning ($\beta$=1.36, 95\% CI 0.67-2.05; P<.001). Conclusions: The pandemic had adverse effects on older adults' health and social capital. Contrary to expectations, even ICT use dropped significantly after the pandemic. Internet users maintained higher psychological health regardless of time and COVID-19 status. However, COVID-19 was associated with a steeper decline in cognitive functioning among internet nonusers. Policy makers may develop initiatives to encourage ICT adoption among older adults or strengthen their digital skills. Trial Registration: ClinicalTrials.gov NCT01345110; https://clinicaltrials.gov/study/NCT01345110 ",
doi="10.2196/62824",
url="https://www.jmir.org/2025/1/e62824"
}


@Article{info:doi/10.2196/63856,
author="DeLange Martinez, Pauline
and Tancredi, Daniel
and Pavel, Misha
and Garcia, Lorena
and Young, M. Heather",
title="Adapting the Technology Acceptance Model to Examine the Use of Information Communication Technologies and Loneliness Among Low-Income, Older Asian Americans: Cross-Sectional Survey Analysis",
journal="JMIR Aging",
year="2025",
month="Jan",
day="8",
volume="8",
pages="e63856",
keywords="social isolation",
keywords="loneliness",
keywords="aged",
keywords="older adults",
keywords="Asian American",
keywords="immigrant",
keywords="vulnerable populations",
keywords="internet",
keywords="information and communication technologies",
keywords="ICTs",
keywords="digital divide",
keywords="technology acceptance model",
keywords="mobile phone",
abstract="Background: Loneliness is a significant issue among older Asian Americans, exacerbated by the COVID-19 pandemic. Older age, lower income, limited education, and immigrant status heighten loneliness risk. Information communication technologies (ICTs) have been associated with decreased loneliness among older adults. However, older Asian Americans are less likely to use ICTs, particularly if they are immigrants, have limited English proficiency, or are low income. The Technology Acceptance Model posits that perceived usefulness (PU), and perceived ease of use (PEOU) are key factors in predicting technology use. Objective: This study aimed to examine associations between PU, PEOU, ICT use, and loneliness among low-income, older Asian Americans. Methods: Cross-sectional survey data were gathered from predominately older Asian Americans in affordable senior housing (N=401). Using exploratory factor analysis and Horn parallel analysis, we examined 12 survey items to identify factors accounting for variance in ICT use. We deployed structural equation modeling to explore relationships among the latent factors and loneliness, adjusting for demographic and cognitive factors. Results: Exploratory factor analysis and Horn parallel analysis revealed 3 factors that accounted for 56.48\% (6.78/12) total variance. PEOU combined items from validated subscales of tech anxiety and comfort, accounting for a 28.44\% (3.41/12) variance. ICT use combined years of technological experience, computer, tablet, and smartphone use frequency, accounting for 15.59\% (1.87/12) variance. PU combined 2 items assessing the usefulness of technology for social connection and learning and accounted for a 12.44\% (1.49/12) variance. The 3-factor structural equation modeling revealed reasonable fit indexes ($\chi$2133=345.132; P<.001, chi-square minimum (CMIN)/df = 2595, comparative fit index (CFI)=0.93, Tucker-Lewis Index (TLI)=0.88). PEOU was positively associated with PU ($\beta$=.15; P=.01); PEOU and PU were positive predictors of ICT use (PEOU $\beta$=.26, P<.001; PU $\beta$=.18, P=.01); and ICT use was negatively associated with loneliness ($\beta$=--.28, P<.001). Demographic and health covariates also significantly influenced PU, PEOU, ICT use, and loneliness.  English proficiency and education positively predicted PEOU (r=0.25, P<.001; r=0.26, P<.001) and ICT use ($\beta$=1.66, P=.03; $\beta$=.21, P<.001), while subjective cognitive decline and Asian ethnicity were positively associated with loneliness ($\beta$=.31, P<.001; $\beta$=.25, P<.001). Conclusions: This study suggests that targeted interventions enhancing PU or PEOU could increase ICT acceptance and reduce loneliness among low-income Asian Americans. Findings also underscore the importance of considering limited English proficiency and subjective cognitive decline when designing interventions and in future research. ",
doi="10.2196/63856",
url="https://aging.jmir.org/2025/1/e63856"
}


@Article{info:doi/10.2196/53957,
author="Scharf, Tamara
and Huber, A. Carola
and N{\"a}pflin, Markus
and Zhang, Zhongxing
and Khatami, Ramin",
title="Trends in Prescription of Stimulants and Narcoleptic Drugs in Switzerland: Longitudinal Health Insurance Claims Analysis for the Years 2014-2021",
journal="JMIR Public Health Surveill",
year="2025",
month="Jan",
day="7",
volume="11",
pages="e53957",
keywords="prescription trends",
keywords="claims data",
keywords="cross-sectional data",
keywords="narcolepsy",
keywords="prescribers",
keywords="prescribing practices",
keywords="medical care",
keywords="stimulants",
keywords="stimulant medication",
abstract="Background: Stimulants are potent treatments for central hypersomnolence disorders or attention-deficit/hyperactivity disorders/attention deficit disorders but concerns have been raised about their potential negative consequences and their increasing prescription rates. Objective: We aimed to describe stimulant prescription trends in Switzerland from 2014 to 2021. Second, we aimed to analyze the characteristics of individuals who received stimulant prescriptions in 2021 and investigate the link between stimulant prescriptions and hospitalization rates in 2021, using hospitalization as a potential indicator of adverse health outcomes. Methods: Longitudinal and cross-sectional data from a large Swiss health care insurance were analyzed from all insureds older than 6 years. The results were extrapolated to the Swiss general population. We identified prescriptions for methylphenidate, lisdexamfetamine, modafinil, and sodium oxybate and calculated prevalences of each drug prescription over the period from 2014 to 2021. For 2021 we provide detailed information on the prescribers and evaluate the association of stimulant prescription and the number and duration of hospitalization using logistic regression models. Results: We observed increasing prescription rates of all stimulants in all age groups from 2014 to 2021 (0.55\% to 0.81\%, 43,848 to 66,113 insureds with a prescription). In 2021, 37.1\% (28,057 prescriptions) of the medications were prescribed by psychiatrists, followed by 36.1\% (n=27,323) prescribed by general practitioners and 1\% (n=748) by neurologists. Only sodium oxybate, which is highly specific for narcolepsy treatment, was most frequently prescribed by neurologists (27.8\%, 37 prescriptions). Comorbid psychiatric disorders were common in patients receiving stimulants. Patients hospitalized in a psychiatric institution were 5.3 times (odds ratio 5.3, 95\% CI 4.63?6.08, P<.001) more likely to have a stimulant prescription than those without hospitalization. There were no significant associations between stimulant prescription and the total length of inpatient stay (odds ratio 1, 95\% CI 1?1, P=.13). Conclusions: The prescription of stimulant medication in Switzerland increased slightly but continuously over years, but at lower rates compared to the estimated prevalence of central hypersomnolence disorders and attention-deficit/hyperactivity disorders/attention deficit disorders. Most stimulants are prescribed by psychiatrists, closely followed by general practitioners. The increased odds for hospitalization to psychiatric institutions for stimulant receivers reflects the severity of disease and the higher psychiatric comorbidities in these patients. ",
doi="10.2196/53957",
url="https://publichealth.jmir.org/2025/1/e53957"
}


@Article{info:doi/10.2196/49585,
author="Standaar, Lucille
and van Tuyl, Lilian
and Suijkerbuijk, Anita
and Brabers, Anne
and Friele, Roland",
title="Differences in eHealth Access, Use, and Perceived Benefit Between Different Socioeconomic Groups in the Dutch Context: Secondary Cross-Sectional Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="7",
volume="9",
pages="e49585",
keywords="eHealth",
keywords="digital divide",
keywords="socioeconomic factors",
keywords="education",
keywords="income",
keywords="neighborhood",
keywords="health disparities",
keywords="cross-sectional studies",
keywords="digital health care",
keywords="health equity",
keywords="Netherlands",
abstract="Background: There is a growing concern that digital health care may exacerbate existing health disparities. Digital health care or eHealth encompasses the digital apps that are used in health care. Differences in access, use, and perceived benefits of digital technology among socioeconomic groups are commonly referred to as the digital divide. Current research shows that people in lower socioeconomic positions (SEPs) use eHealth less frequently. Objective: This study aims to (1) investigate the association between SEP and eHealth access to, use of, and perceived benefit within the adult Dutch population and (2) evaluate disparities in eHealth access, use, and perceived benefit through three socioeconomic variables---education, standardized income, and the socioeconomic status of the neighborhood. Methods: A secondary analysis was conducted on data from the Nivel Dutch Health Care Consumer Panel (response rate 57\%, 849/1500), to assess access to, use of, and perceived benefits from eHealth. These data were collected to monitor eHealth developments in the Netherlands. eHealth was examined through two concepts: (1) eHealth in general and (2) websites, apps, and wearables. Results were stratified into 9 SEP populations based on 3 indicators---education, standardized income, and socioeconomic status level of the neighborhood. Logistic regression analyses were performed to evaluate whether the outcomes varied significantly across different SEP groups. Age was included as a covariate to control for confounding. Results: This study confirms the association between eHealth and SEP and shows that low SEP respondents have less access (odds ratio [OR] 5.72, 95\% CI 3.06-10.72) and use (OR 4.96, 95\% CI 2.66-9.24) of eHealth compared to medium or high SEP respondents. Differences were most profound when stratifying for levels of education. Conclusions: The access to and use of eHealth has a socioeconomic gradient and emphasizes that SEP indicators cannot be used interchangeably to assess eHealth access and use. The results underline the importance of activities and policies aimed at improving eHealth accessibility and usage among low SEP groups to mitigate disparities in health between different socioeconomic groups. ",
doi="10.2196/49585",
url="https://formative.jmir.org/2025/1/e49585"
}


@Article{info:doi/10.2196/65065,
author="Jin, Hengjiang
and Qu, Ying",
title="Association Between Intergenerational Support, Technology Perception and Trust, and Intention to Seek Medical Care on the Internet Among Chinese Older Adults: Cross-Sectional Questionnaire Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="6",
volume="27",
pages="e65065",
keywords="intergenerational support",
keywords="older adults",
keywords="internet medical intentions",
keywords="perceived technology",
keywords="trust",
abstract="Background: Avoiding technological innovation does not simplify life. In fact, using internet-based medical services can enhance the quality of life for older adults. In the context of an aging population and the growing integration of information technology, the demand for internet-based medical services among older adults is gaining increased attention. While scholars have highlighted the important role of intergenerational support in promoting digital inclusion for older adults, research on the relationship between intergenerational support and older adults' intentions to seek online care remains limited. Objective: This study aims (1) to explore the association between intergenerational support, online medical information, and older adults' intention to seek medical care online, and (2) to examine the mediating role of technology perception and trust, as well as the moderating role of eHealth literacy. Methods: A cross-sectional survey was conducted in China, collecting 958 valid responses from older adults aged 60 years and above. A vast majority of participants were between the ages of 60 and 75 years (771/958, 80.5\%). Of the 958 participants, 559 (58.4\%) resided in rural areas, while 399 (41.6\%) lived in urban areas. The survey included questions on intergenerational support, perceived usefulness, perceived ease of use, trust, online medical information, eHealth literacy, and the intention to seek medical care online. Structural equation modeling and linear regression analysis were applied to explore the relationship between intergenerational support and the intention to seek medical care on the internet. Results: Intergenerational support was positively associated with perceived ease of use ($\beta$=.292, P<.001), perceived usefulness ($\beta$=.437, P<.001), trust ($\beta$=.322, P<.001), and the intention to seek medical care online ($\beta$=.354, P<.001). Online medical information also positively affected the intention to seek medical care online among older adults ($\beta$=.109, P<.001). Perceived ease of use ($\beta$=.029, 95\% CI 0.009-0.054), perceived usefulness ($\beta$=.089, 95\% CI 0.050-0.130), and trust ($\beta$=.063, 95\% CI 0.036-0.099) partially mediated the association between intergenerational support and the intention to seek medical care online. Further analysis found that perceived ease of use, perceived usefulness, and trust played a chain mediating role between intergenerational support and the intention to seek medical care online ($\beta$=.015, 95\% CI 0.008-0.027; $\beta$=.022, 95\% CI 0.012-0.036). Additionally, eHealth literacy played a moderating role in the relationship between intergenerational support and perceived ease of use ($\beta$=.177, P<.001), perceived usefulness ($\beta$=.073, P<.05), trust ($\beta$=.090, P<.01), and the intention to seek medical care online ($\beta$=.124, P<.001). Conclusions: An integrated model of health communication effects was constructed and validated, providing empirical support for the intention to seek medical care online and for the impact of health communication. This model also helps promote the role of technology in empowering the lives of seniors. ",
doi="10.2196/65065",
url="https://www.jmir.org/2025/1/e65065"
}


@Article{info:doi/10.2196/65690,
author="Husain, Laiba
and Greenhalgh, Trisha",
title="Examining Intersectionality and Barriers to the Uptake of Video Consultations Among Older Adults From Disadvantaged Backgrounds With Limited English Proficiency: Qualitative Narrative Interview Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="6",
volume="27",
pages="e65690",
keywords="digital health disparities",
keywords="video consultations",
keywords="intersectionality",
keywords="health inequity",
keywords="digital capital",
keywords="mobile phone",
abstract="Background: The rapid shift to video consultation services during the COVID-19 pandemic has raised concerns about exacerbating existing health inequities, particularly for disadvantaged populations. Intersectionality theory provides a valuable framework for understanding how multiple dimensions of disadvantage interact to shape health experiences and outcomes. Objective: This study aims to explore how multiple dimensions of disadvantage---specifically older age, limited English proficiency, and low socioeconomic status---intersect to shape experiences with digital health services, focusing on video consultations. Methods: Following familiarization visits and interviews with service providers, 17 older people with multiple markers of disadvantage (older age, low socioeconomic status, and limited English proficiency) were recruited in the Redbridge borough of London. Data collection included narrative interviews and ethnographic observations during home visits. Field notes captured participants' living conditions, family dynamics, and technological arrangements. Guided by intersectionality theory and digital capital concepts, interviews explored participants' experiences accessing health care remotely. Intersectional narrative analysis was used to identify key themes and examine how different forms of disadvantage interact. We developed theoretically informed narrative portraits and user personas to synthesize findings. Results: Analysis revealed that the digitalization of health care can exacerbate existing inequities, erode trust, compound oppression, and reduce patient agency for multiply disadvantaged patient populations. Examining intersectionality illuminated how age, language proficiency, and socioeconomic status interact to create unique barriers and experiences. Key themes included the following: weakened presence in digital interactions, erosion of therapeutic relationships, shift from relational to distributed continuity, increased complexity leading to disorientation, engagement shaped by previous experiences of discrimination, and reduced patient agency. Conclusions: This study provides critical insights into how the digitalization of health care can deepen disparities for older patients with low income and limited English proficiency. By applying intersectionality theory to digital health disparities, our findings underscore the need for multifaceted approaches to digital health equity that address the complex interplay of disadvantage. Recommendations include co-designing inclusive digital services, strengthening relational continuity, and developing targeted support to preserve agency and trust for marginalized groups in an increasingly digital health care landscape. ",
doi="10.2196/65690",
url="https://www.jmir.org/2025/1/e65690"
}


@Article{info:doi/10.2196/68243,
author="Tang, Shuhan",
title="Enhancing Methodological Rigor in Mobile Health Care Research",
journal="JMIR Hum Factors",
year="2025",
month="Jan",
day="3",
volume="12",
pages="e68243",
keywords="letter to the editor",
keywords="health care professionals",
keywords="mobile health care",
keywords="technical training",
keywords="cross-sectional survey",
keywords="mobile",
keywords="China",
keywords="web-based questionnaire",
keywords="logistic regression",
keywords="mhealth",
keywords="mobile health",
doi="10.2196/68243",
url="https://humanfactors.jmir.org/2025/1/e68243"
}


@Article{info:doi/10.2196/63034,
author="Tartaglia, Julia
and Jaghab, Brendan
and Ismail, Mohamed
and H{\"a}nsel, Katrin
and Meter, Van Anna
and Kirschenbaum, Michael
and Sobolev, Michael
and Kane, M. John
and Tang, X. Sunny",
title="Assessing Health Technology Literacy and Attitudes of Patients in an Urban Outpatient Psychiatry Clinic: Cross-Sectional Survey Study",
journal="JMIR Ment Health",
year="2024",
month="Dec",
day="30",
volume="11",
pages="e63034",
keywords="digital literacy",
keywords="attitudes",
keywords="mental health",
keywords="digital health technology",
keywords="cluster analysis",
keywords="psychiatry",
keywords="mobile phone",
abstract="Background: Digital health technologies are increasingly being integrated into mental health care. However, the adoption of these technologies can be influenced by patients' digital literacy and attitudes, which may vary based on sociodemographic factors. This variability necessitates a better understanding of patient digital literacy and attitudes to prevent a digital divide, which can worsen existing health care disparities. Objective: This study aimed to assess digital literacy and attitudes toward digital health technologies among a diverse psychiatric outpatient population. In addition, the study sought to identify clusters of patients based on their digital literacy and attitudes, and to compare sociodemographic characteristics among these clusters. Methods: A survey was distributed to adult psychiatric patients with various diagnoses in an urban outpatient psychiatry program. The survey included a demographic questionnaire, a digital literacy questionnaire, and a digital health attitudes questionnaire. Multiple linear regression analyses were used to identify predictors of digital literacy and attitudes. Cluster analysis was performed to categorize patients based on their responses. Pairwise comparisons and one-way ANOVA were conducted to analyze differences between clusters. Results: A total of 256 patients were included in the analysis. The mean age of participants was 32 (SD 12.6, range 16-70) years. The sample was racially and ethnically diverse: White (100/256, 38.9\%), Black (39/256, 15.2\%), Latinx (44/256, 17.2\%), Asian (59/256, 23\%), and other races and ethnicities (15/256, 5.7\%). Digital literacy was high for technologies such as smartphones, videoconferencing, and social media (items with >75\%, 193/256 of participants reporting at least some use) but lower for health apps, mental health apps, wearables, and virtual reality (items with <42\%, 108/256 reporting at least some use). Attitudes toward using technology in clinical care were generally positive (9 out of 10 items received >75\% positive score), particularly for communication with providers and health data sharing. Older age (P<.001) and lower educational attainment (P<.001) negatively predicted digital literacy scores, but no demographic variables predicted attitude scores. Cluster analysis identified 3 patient groups. Relative to the other clusters, cluster 1 (n=30) had lower digital literacy and intermediate acceptance of digital technology. Cluster 2 (n=50) had higher literacy and lower acceptance. Cluster 3 (n=176) displayed both higher literacy and acceptance. Significant between-cluster differences were observed in mean age and education level between clusters (P<.001), with cluster 1 participants being older and having lower levels of formal education. Conclusions: High digital literacy and acceptance of digital technologies were observed among our patients, indicating a generally positive outlook for digital health clinics. Our results also found that patients of older age and lower formal levels of educational attainment had lower digital literacy, highlighting the need for targeted interventions to support those who may struggle with adopting digital health tools. ",
doi="10.2196/63034",
url="https://mental.jmir.org/2024/1/e63034"
}


@Article{info:doi/10.2196/58828,
author="O'Mara, Ben
and Harrison, Matthew
and Harley, Kirsten
and Dwyer, Natasha",
title="Making Video Games More Inclusive for People Living With Motor Neuron Disease: Scoping Review",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Dec",
day="23",
volume="11",
pages="e58828",
keywords="motor neuron disease",
keywords="video games",
keywords="inclusion",
keywords="information technology",
keywords="well-being",
keywords="disability",
keywords="mobile phone",
abstract="Background: Evidence suggests that individuals with motor neuron disease (MND), a terminal illness, find enjoyment and social connection through video games. However, MND-related barriers can make gaming challenging, exacerbating feelings of boredom, stress, isolation, and loss of control over daily life. Objective: We scoped the evidence to describe relevant research and practice regarding what may help reduce difficulties for people with MND when playing video games. Methods: A scoping review was conducted using the Arksey and O'Malley framework, recent scoping review guidance, and engaging with people with lived experience of MND. Peer-reviewed studies were sourced from PubMed and the Swinburne University of Technology Library. Gray literature was identified from government, not-for-profit, commercial, and community websites. Data were extracted and summarized from the collected literature. Results: The evidence base, consisting of quantitative and qualitative research, lived experience stories, information resources, reviews, and guidelines, included 85 documents. Only 8 (9\%) directly addressed video games and people with MND; however, these studies were limited in depth and quality. The primary technologies examined included customized information and communications technology for communication and control of computing systems (including desktop, laptop, smartphone, tablet, and console systems) and video game software and hardware (including hand controllers and accessibility features, such as difficulty level, speed, and remappable buttons and controls). Common factors in the evidence base highlight barriers and enablers to enjoying video games for people with MND. These include technological, physical, social, and economic challenges. Addressing these requires greater involvement of people with MND in game and technology research and development. Changes to information and communications technology, game software and hardware, policies, and guidelines are needed to better meet their needs. Conclusions: There is a significant gap in understanding the lived experience of people with MND with video games and what makes playing them easier, including appropriate customization of technology and the social experience of games. This gap perpetuates exclusion from gaming communities and recreation, potentially worsening social isolation. Existing evidence suggesting viable options for future research and practice. Video game and information and communications technology research and development must prioritize qualitative and quantitative research with people with MND at an appropriate scale, with a focus on lived experience, use of improved participant engagement techniques, and user-focused design for more inclusive games. Practical work needs to increase awareness of what can help make games more inclusive, including incorporation of accessibility early in the game production process, early incorporation of accessibility in game production, and affordable options for customized interfaces and other devices to play games. ",
doi="10.2196/58828",
url="https://rehab.jmir.org/2024/1/e58828",
url="http://www.ncbi.nlm.nih.gov/pubmed/39714921"
}


@Article{info:doi/10.2196/63054,
author="Wang, Yining
and Ren, Hui
and Xiao, Shaotan
and Meng, Tian
and Sun, Shuyue
and Yu, Siyu
and Liu, Qing
and Wang, Fan",
title="Factors Associated With Digital Capacity for Health Promotion Among Primary Care Workers: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="20",
volume="26",
pages="e63054",
keywords="health promotion",
keywords="digital capacity",
keywords="primary care workers",
keywords="Digital Capabilities Framework",
keywords="online survey",
abstract="Background: Health education and promotion are recognized as effective strategies for fostering healthy ageing, reducing the disease burden, and addressing health inequalities, particularly when delivered through digital media. Primary care workers are often regarded as the key providers of these interventions. Despite the strong practical significance and substantial individual demand, the use of digital media for delivering health promotion practices was not widespread in China. One of the main challenges identified is the providers' inadequate capacities. However, little is known about the digital capacity for health promotion among primary care workers. Objective: This study aimed to investigate the levels of digital capacity for health promotion and its associated factors among community health workers. Methods: A total of 1346 community health workers were recruited from across 47 communities in Shanghai, China, through cluster-stratified random sampling. The digital capacity for health promotion was measured using the revised version of the Digital Capabilities Framework. Web-based questionnaires were distributed to collect data from March 20 to March 29, 2024. Data were analyzed using descriptive statistics, independent t tests, one-way ANOVA, and linear hierarchical regression using Stata MP (version 17.0; StataCorp). Results: We included 1199 participants. Among them, 47.5\% (570/1199) had high digital media use for more than 19.6 hours per week, whereas 31.8\% (381/1199) demonstrated high digital media trust. The average level of digital capacity for health promotion was 16.71 (SD 2.94) out of 25 points. Demographics, digital media usage--related characteristics, perceived usefulness and usability, attitudes, and behaviors were significant predictors of the capacities, explaining 44.4\% of the total variance. Master's degree or above ($\beta$=.077; P=.013), perceived usability ($\beta$=.235; P<.001), attitudes toward digital media health promotion ($\beta$=.095; P=.002), and past digital media health promotion practices ($\beta$=.377; P<.001) had significantly positive associations with digital capacities for health promotion. However, senior ($\beta$=--.076; P=.008) or median ($\beta$=--.074; P=.01) titles had a significant negative association with capacity levels. Conclusions: A digitally capable workforce is required for primary health care systems to take full advantage of digital media health promotion. Therefore, solutions are necessary to achieve enhanced capacities among health professionals, including public health policy making, community empowerment, and individual practices. ",
doi="10.2196/63054",
url="https://www.jmir.org/2024/1/e63054"
}


@Article{info:doi/10.2196/57580,
author="Ahmed, Nisar
and Hall, Alex
and Poku, Brenda
and McDermott, Jane
and Astbury, Jayne
and Todd, Chris",
title="Experiences and Views of Older Adults of South Asian, Black African, and Caribbean Backgrounds About the Digitalization of Primary Care Services Since the COVID-19 Pandemic: Qualitative Focus Group Study",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="18",
volume="8",
pages="e57580",
keywords="digital health and primary care services",
keywords="digital exclusion",
keywords="digital divide",
keywords="health inequalities",
keywords="older adults",
keywords="South Asian",
keywords="Black African",
keywords="Caribbean",
keywords="COVID-19 pandemic",
keywords="qualitative focus group study",
abstract="Background: The COVID-19 pandemic from 2020 to 2022 prompted governments worldwide to enforce lockdowns and social restrictions, alongside the rapid adoption of digital health and care services. However, there are concerns about the potential exclusion of older adults, who face barriers to digital inclusion, such as age, socioeconomic status, literacy level, and ethnicity. Objective: This study aims to explore the experiences of older adults from the 3 largest minoritized ethnic groups in England and Wales---people of South Asian, Black African, and Caribbean backgrounds---in the use of digitalized primary care services since the beginning of the COVID-19 pandemic. Methods: In total, 27 individuals participated in 4 focus groups (April and May 2023) either in person or via online videoconferencing. Patient and public involvement and engagement were sought through collaboration with community organizations for focus group recruitment and feedback on the topic guide. Data were analyzed using framework analysis. Results: This paper summarizes the perspectives of 27 older adults from these 3 minoritized ethnic groups and identifies four key themes: (1) service accessibility through digital health (participants faced difficulties accessing digital health care services through online platforms, primarily due to language barriers and limited digital skills, with reliance on younger family members or community organizations for assistance; the lack of digital literacy among older community members was a prominent concern, and digital health care services were felt to be tailored for English speakers, with minimal consultation during the development phase), (2) importance of face-to-face (in-person) appointments for patient-clinician interactions (in-person appointments were strongly preferred, emphasizing the value of physical interaction and connection with health care professionals; video consultations were seen as an acceptable alternative), (3) stressors caused by the shift to remote access (the transition to remote digital access caused stress, fear, and anxiety; participants felt that digital health solutions were imposed without sufficient explanation or consent; and Black African and Caribbean participants reported experiences of racial discrimination within the health care system), and (4) digital solutions (evaluating technology acceptance; participants acknowledged the importance of digitalization but cautioned against viewing it as a one-size-fits-all solution; they advocated for offline alternatives and a hybrid approach, emphasizing the need for choice and a well-staffed clinical workforce). Conclusions: Digital health initiatives should address the digital divide, health inequalities, and the specific challenges faced by older adults, particularly those from minoritized ethnic backgrounds, ensuring accessibility, choice, and privacy. Overcoming language barriers involves more than mere translation. Maintaining in-person options for consultations, addressing sensitive issues, and implementing support systems at the practice level to support those struggling to access services are vital. This study recommends that policy makers ensure the inclusivity of older adults from diverse backgrounds in the design and implementation of digital health and social care services. ",
doi="10.2196/57580",
url="https://formative.jmir.org/2024/1/e57580",
url="http://www.ncbi.nlm.nih.gov/pubmed/39693146"
}


@Article{info:doi/10.2196/57702,
author="Pathak, R. Priya
and Stockwell, S. Melissa
and Lane, M. Mariellen
and Robbins-Milne, Laura
and Friedman, Suzanne
and Pethe, Kalpana
and Krause, C. Margaret
and Soren, Karen
and Matiz, Adriana Luz
and Solomon, B. Lauren
and Burke, E. Maria
and Bracho-Sanchez, Edith",
title="Access to Primary Care Telemedicine and Visit Characterization in a Pediatric, Low-Income, Primarily Latino Population: Retrospective Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Dec",
day="17",
volume="7",
pages="e57702",
keywords="telemedicine",
keywords="telehealth",
keywords="pediatric primary care",
keywords="COVID-19 pandemic",
keywords="disparities",
keywords="primary care",
keywords="pediatrics",
keywords="portals",
keywords="access",
keywords="accessibility",
keywords="accessible",
keywords="use",
keywords="demographics",
keywords="low income",
keywords="Latino",
keywords="Hispanic",
keywords="Spanish",
keywords="mobile phone",
abstract="Background: Since the COVID-19 pandemic, telemedicine has been widely integrated into primary care pediatrics. While initial studies showed some concern for disparities in telemedicine use, telemedicine uptake for pediatric patients in a low-income, primarily Latino community over a sustained period has yet to be described. Objective: We aimed to assess the relationship between demographics, patient portal activation, and telemedicine visits, as well as characterize diagnoses addressed in telemedicine, in a low-income, primarily Latino population over time. Methods: A multidisciplinary team conducted outreach for telemedicine and patient portal activation with the adoption of a new electronic health record. Data were collected on all in-person and telemedicine visits from February 2020 through April 2021 for 4 community-based pediatric practices. The outcomes included patient portal activation, telemedicine use, and reason for telemedicine visits. Bivariate tests and multivariate regression analyses were conducted to assess the independent effects of demographics on the likelihood of portal activation and having a telemedicine visit. Telemedicine diagnoses were categorized, and subanalyses were conducted to explore variations by age and month. Results: There were 12,377 unique patients and 7127 telemedicine visits. Latino patients made up 83.4\% (n=8959) of the population. Nearly all patients (n=10,830, 87.5\%) had an activated portal, and 33.8\% (n=4169) had at least 1 telemedicine visit. Portal activation decreased with age >2 years (2-4 years: adjusted odds ratio [aOR] 0.62, 95\% CI 0.51-0.76; 5-11 years: aOR 0.28, 95\% CI 0.23-0.32; 12-14 years: aOR 0.29, 95\% CI 0.23-0.35; and 15-17 years: aOR 0.46, 95\% CI 0.36-0.58). Spanish-speaking (aOR 0.52, 95\% CI 0.45-0.59) and non-Latino patients (aOR 0.64, 95\% CI 0.54-0.76) had decreased odds of activation and having a telemedicine visit (aOR 0.81, 95\% CI 0.74-0.89 and aOR 0.71, 95\% CI 0.62-0.81, respectively). The top 5 diagnostic categories for telemedicine were infectious disease (n=1749, 26.1\%), dermatology (n=1287, 19.5\%), gastrointestinal (n=771, 11.7\%), well and follow-up care (n=459, 7\%), and other specialty-related care (n=415, 6.3\%). Infectious disease showed the most variation over time. Age-based patterns included a decrease in the proportion of infectious disease diagnoses by increasing age group and a higher proportion of well and follow-up care in older ages. Additional telemedicine diagnoses included common infant concerns for patients younger than 2 years of age; pulmonary, asthma, and allergy concerns for toddler or school-age children; behavioral health concerns for younger adolescents; and genitourinary and gynecologic concerns for older adolescents. Conclusions: The high engagement across demographics suggests feasibility and interest in telemedicine in this low-income, primarily Latino population, which may be attributable to the strength of outreach. Language-based disparities were still present. Telemedicine was used for a wide range of diagnoses. As telemedicine remains a vital component of pediatric health care, targeted interventions may enhance engagement to serve diverse pediatric patient populations. ",
doi="10.2196/57702",
url="https://pediatrics.jmir.org/2024/1/e57702"
}


@Article{info:doi/10.2196/53720,
author="Hanach, Nivine
and Saqan, Roba
and Radwan, Hadia
and Baniissa, Wegdan
and de Vries, Nanne",
title="Perceived Experiences and Needs of Digital Resources Among Postpartum Women in the United Arab Emirates: Qualitative Focus Group Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="16",
volume="26",
pages="e53720",
keywords="digital health",
keywords="social support",
keywords="telemedicine",
keywords="postpartum women",
keywords="focus group",
keywords="maternal health",
keywords="postpartum mental health",
keywords="postpartum depression",
keywords="emotional support",
keywords="health information",
abstract="Background: The postpartum period is a critical phase in a woman's life, marked by various physical, psychological, and social challenges. In light of the rapid proliferation and uptake of digital technologies, particularly in the United Arab Emirates (UAE), mothers increasingly seek informational and emotional support from digital resources. No previous study has thoroughly explored the usage of various digital resources beyond telehealth services in the UAE. This literature gap is particularly relevant for the postpartum period, which remains largely understudied in the UAE. Objective: This study aims to delve into the digital experiences of postpartum women in the UAE by exploring the types of resources they navigate and the purposes those resources serve. In addition, it seeks to identify their perspectives and needs regarding digital resources that support their postpartum journey. Methods: Four focus groups were conducted synchronously on the web, involving a total of 27 multicultural mothers (mean age 32.47, SD 4.56 years), between 2 and 12 months post partum and living in the UAE. Descriptive interpretive thematic analysis was used to analyze the data. Results: Sixteen out of 27 women exhibited severe depressive symptoms at the time of the discussions (Edinburgh Postnatal Depression Scale score of >12). Two main themes were generated from the analysis: (1) Mothers' Experiences with Digital Resources: Participants valued digital resources for providing immediate information, convenience, and support. They primarily used these resources to seek information on infant health, parenting advice, and emotional support through web-based communities. However, the abundance of conflicting information and the pressure to conform to health recommendations often created stress and anxiety. (2) The Perceived Need for Digital Resources: Despite their extensive use of digital resources, mothers articulated the need for a reliable UAE government digital platform tailored specifically to postpartum care, offering trusted information on infant health and postpartum mental well-being. They also emphasized the need for tailored postpartum telemedicine services and moderated web-based discussion forums to foster peer support among mothers. Conclusions: This study reveals the multifaceted role of digital resources in supporting mothers during the postpartum period, highlighting unmet needs that present opportunities for advancing postpartum care in the UAE. It demonstrates the importance of developing reliable digital solutions for postpartum women, especially regarding mental health and to enhance access to care through tailored telemedicine services. Collaborative efforts are required to ensure the implementation of user-centered digital platforms. Future research should focus on the diverse needs of postpartum women, including cultural sensitivity, the feasibility of telemedicine services, and the integration of partner support in digital interventions to improve maternal health outcomes. ",
doi="10.2196/53720",
url="https://www.jmir.org/2024/1/e53720",
url="http://www.ncbi.nlm.nih.gov/pubmed/39680428"
}


@Article{info:doi/10.2196/58729,
author="Takesue, Atsuhide
and Hiratsuka, Yoshimune
and Kondo, Katsunori
and Aida, Jun
and Nakagomi, Atsushi
and Nakao, Shintaro",
title="Association Between Visual Impairment and Daily Internet Use Among Older Japanese Individuals: Cross-Sectional Questionnaire Study",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="9",
volume="8",
pages="e58729",
keywords="visual impairment",
keywords="visually impaired",
keywords="internet",
keywords="internet use",
keywords="internet usage",
keywords="older adults",
keywords="digital divide",
keywords="telemedicine",
keywords="mobile phone",
abstract="Background: Older adults might not use computers due to psychological barriers, environmental barriers such as not owning a computer or lack of internet access, and health-related barriers such as difficulties with fine motor skills, low cognitive function, or low vision. Given the health benefits of internet use among older adults, inadequate use of the internet is an urgent public health issue in many countries. Objective: We aimed to determine whether visual impairment is associated with internet use in a population-based sample of older adults. Methods: This cross-sectional study sourced data for the year 2016 from the Japan Gerontological Evaluation Study. It included functionally independent community-dwelling individuals aged ?65 years (N=19,452) in Japan. The respondents reported their visual status by answering the question, ``Is your eyesight (without or with usual glasses or corrective lenses) excellent, very good, good, fair, or poor?'' We defined ``internet user'' as a person who uses the internet ``almost daily.'' We used multivariate logistic regression with multiple imputations to analyze visual status, daily internet use, and any correlations between them. Results: We observed that 23.6\% (4599/19,452) of respondents used the internet almost daily. Respondents with good visual status notably tended to use the internet more frequently than those with poor visual status. Specifically, 13\% and 31\% of respondents with poor and excellent vision, respectively, used the internet almost daily. In contrast, 66\% and 45\% of respondents with poor and excellent vision, respectively, did not use the internet. Even after adjusting for several covariates (age, sex, equivalized income, years of education, marital status, depression, history of systemic comorbidities, frequency of meeting friends, and total social participation score), significant associations persisted between visual status and daily internet usage. The odds ratios (ORs) tended to increase as visual status improved (P for trend <.001). The adjusted ORs for individuals with excellent and very good visual status who used the internet almost daily were 1.38 (95\% CI 1.22-1.56) and 1.25 (95\% CI 1.15-1.36), respectively. Conversely, the adjusted OR for those with fair or poor visual status was 0.73 (95\% CI 0.62-0.86). Conclusions: In this study, we reaffirmed what several previous studies have pointed out using a very large dataset; visual impairment negatively impacted daily internet use by older adults. This highlights the need to address visual impairments to promote web use as health care services become more easily accessed on the web. ",
doi="10.2196/58729",
url="https://formative.jmir.org/2024/1/e58729"
}


@Article{info:doi/10.2196/63288,
author="Sj{\"o}str{\"o}m, Anna
and Hajdarevic, Senada
and H{\"o}rnsten, {\AA}sa
and Isaksson, Ulf",
title="eHealth Literacy and Health-Related Internet Use Among Swedish Primary Health Care Visitors: Cross-Sectional Questionnaire Study",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="5",
volume="8",
pages="e63288",
keywords="eHealth literacy",
keywords="primary health care",
keywords="health-related internet information",
keywords="health literacy",
keywords="digitalization",
keywords="eHealth",
keywords="cost-effective care",
keywords="internet",
keywords="health applications",
keywords="digital health",
keywords="patient participation",
keywords="health behaviors",
keywords="questionnaire",
keywords="well-being",
abstract="Background: Digitalization has profoundly transformed health care delivery, especially within primary health care, as a crucial avenue for providing accessible, cost-effective care. While eHealth services are frequently highlighted for improving health care availability and promoting equality, it is essential to recognize that digitalization can inadvertently exclude individuals who lack the prerequisites to use eHealth services, that is, those with low eHealth literacy. Previous research has identified lower eHealth literacy among older individuals, those with lower educational levels, and those who use the internet less frequently. However, in a Swedish context, only a few studies have investigated eHealth literacy. Objective: This study investigated eHealth literacy and its association with health-related internet use and sociodemographic characteristics among primary health care visitors. Methods: This cross-sectional study used a quantitative, descriptive approach. Swedish-speaking patients visiting a primary health care center participated by answering the multidimensional eHealth Literacy Questionnaire (eHLQ) and questions regarding sociodemographic characteristics and internet usage. The study compared mean scores using the Mann-Whitney U test and the Kruskal-Wallis test. A logistic regression analysis also explored the associations between eHealth literacy and significant independent variables identified in the univariate analyses. Results: As a group, the 172 participants rated highest in understanding and engagement with their health (median eHLQ score 3, IQR 2.8?3.4), as well as in feeling secure about the confidentiality of eHealth services (median eHLQ score 3, IQR 2?3), while they rated lower in motivation to use eHealth (median eHLQ score 2.6, IQR 2?3), the suitability of eHealth services to their personal needs (median eHLQ score 2.75, IQR 2?3), and their perceived ability to understand and use health-related internet information (median eHLQ score 2.6, IQR 2?3). The logistic regression analysis identified that lower eHealth literacy was associated with older age, particularly in domains related to finding, understanding, and using health-related internet information (odds ratio [OR] 1.02, 95\% CI 1?1.05; P=.03); digital technology use (OR 1.05, 95\% CI 1.02?1.08; P<.001); and accessing well-functioning eHealth services (OR 1.02, 95\% CI 1?1.05; P=.03). Additionally, in the logistic regression analysis, perceiving health-related internet information as not useful was linked to lower literacy in all eHLQ domains except one. Conclusions: Our findings regarding the primary challenges within our sample underscore the importance of developing and tailoring eHealth services to accommodate users' individual needs better, enhancing motivation for eHealth use, and continuing efforts to improve overall health literacy. These measures, which both eHealth developers and health care professionals should consider, are crucial for addressing the digital divide and expanding access to eHealth services for as many people as possible. ",
doi="10.2196/63288",
url="https://formative.jmir.org/2024/1/e63288"
}


@Article{info:doi/10.2196/54092,
author="Na, Kilhoe
and Zimdars, Melissa
and Cullinan, E. Megan",
title="Understanding Membership in Alternative Health Social Media Groups and Its Association with COVID-19 and Influenza Vaccination: Web-Based Cross-Sectional Survey",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="5",
volume="8",
pages="e54092",
keywords="alternative health",
keywords="social media",
keywords="misinformation",
keywords="vaccination",
keywords="COVID-19",
keywords="Coronavirus",
abstract="Background: Social media platforms have become home to numerous alternative health groups where people share health information and scientifically unproven treatments. Individuals share not only health information but also health misinformation in alternative health groups on social media. Yet, little research has been carried out to understand members of these groups. This study aims to better understand various characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and COVID-19 and influenza vaccination--related behaviors. Objective: This study aims to test hypotheses about different potential characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and vaccine-related behaviors. Methods: A web-based cross-sectional survey (N=1050) was conducted. Participants were recruited from 19 alternative health social media groups and Amazon's Mechanical Turk. A total of 596 participants were members of alternative health groups and 454 were nonmembers of alternative health groups. Logistic regressions were performed to test the hypotheses about the relationship between membership and the variables of interest. Results: Logistic regression revealed that there is a positive association between alternative health social media group membership and 3 personal characteristics: sharing trait (B=.83, SE=.11; P<.01; odds ratio [OR] 2.30, 95\% CI 1.85-2.86), fear of negative evaluations (B=.19, SE=.06; P<.001, OR 1.21, 95\% CI 1.06-1.37), and conspiratorial mentality (B=.33, SE=.08; P<.01; OR 1.40, 95\% CI 1.18-1.65). Also, the results indicate that there is a negative association between membership and 2 characteristics: health literacy (B=--1.09, SE=.17; P<.001; OR .33, 95\% CI 0.23-0.47) and attitudes toward vaccination (B=-- 2.33, SE=.09; P=.02; OR 0.79, 95\% CI 0.65-0.95). However, there is no association between membership and health consciousness (B=.12, SE=.10; P=.24; OR 1.13, 95\% CI 0.92-1.38). Finally, membership is negatively associated with COVID-19 vaccination status (B=--.84, SE=.17; P<.001; OR 48, 95\% CI 0.32-0.62), and influenza vaccination practice (B=--1.14, SE=.17; P<.001; OR .31, 95\% CI 0.22-0.45). Conclusions: Our findings indicate that people joining alternative health social media groups differ from nonmembers in different aspects, such as sharing, fear of negative evaluations, conspiratorial mentality, and health literacy. They also suggest that there is a significant relationship between membership and vaccination. By more thoroughly exploring the demographic, or by better understanding the people for whom interventions are designed, this study is expected to help researchers to more strategically and effectively develop and implement interventions. ",
doi="10.2196/54092",
url="https://formative.jmir.org/2024/1/e54092"
}


@Article{info:doi/10.2196/65541,
author="Qiu, Yuanbo
and Huang, Huang
and Gai, Junjie
and De Leo, Gianluca",
title="The Effects of the COVID-19 Pandemic on Age-Based Disparities in Digital Health Technology Use: Secondary Analysis of the 2017-2022 Health Information National Trends Survey",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="4",
volume="26",
pages="e65541",
keywords="age-based disparities",
keywords="health equity",
keywords="digital health technology use",
keywords="digital divide",
keywords="health policy",
keywords="COVID-19",
keywords="mobile phone",
abstract="Background: The COVID-19 pandemic accelerated the adoption of digital health technology, but it could also impact age-based disparities as existing studies have pointed out. Compared with the pre-pandemic period, whether the rapid digitalization of the health care system during the pandemic widened the age-based disparities over a long period remains unclear. Objective: This study aimed to analyze the long-term effects of the COVID-19 pandemic on the multifaceted landscape of digital health technology used across diverse age groups among US citizens. Methods: We conducted the retrospective observational study using the 2017-2022 Health Information National Trends Survey to identify the influence of the COVID-19 pandemic on a wide range of digital health technology use outcomes across various age groups. The sample included 15,505 respondents, which were categorized into 3 age groups: adults (18-44 years), middle-aged adults (45-64 years), and older adults (more than 65 years). We also designated the time point of March 11, 2020, to divide the pre- and post-pandemic periods. Based on these categorizations, multivariate linear probability models were used to assess pre-post changes in digital health technology use, controlling for demographic, socioeconomic, and health-related variables among different age groups. Results: Essentially, older adults were found to be significantly less likely to use digital health technology compared with adults, with a 26.28\% lower likelihood of using the internet for health information (P<.001) and a 32.63\% lower likelihood of using health apps (P<.001). The usage of digital health technology for all age groups had significantly increased after the onset of the pandemic, and the age-based disparities became smaller in terms of using the internet to look for health information. However, the disparities have widened for older adults in using the internet to look up test results (11.21\%, P<.001) and make appointments (10.03\%, P=.006) and using wearable devices to track health (8.31\%, P=.01). Conclusions: Our study reveals a significant increase in the use of digital health technology among all age groups during the pandemic. However, while the disparities in accessing online information have narrowed, age-based disparities, particularly for older adults, have widened in most areas such as looking up test results and making appointments with doctors. Therefore, older adults are more likely left behind by the rapidly digitalized US health care system during the pandemic. Policy makers and health care providers should focus on addressing these disparities to ensure equitable access to digital health resources for US baby boomers. ",
doi="10.2196/65541",
url="https://www.jmir.org/2024/1/e65541"
}


@Article{info:doi/10.2196/53685,
author="Moore, K. Sarah
and Boggis, S. Jesse
and Gauthier, R. Phoebe
and Lambert-Harris, A. Chantal
and Hichborn, G. Emily
and Bell, D. Kathleen
and Saunders, C. Elizabeth
and Montgomery, LaTrice
and Murphy, I. Eilis
and Turner, M. Avery
and Agosti, Nico
and McLeman, M. Bethany
and Marsch, A. Lisa",
title="Technology-Based Interventions for Substance Use Treatment Among People Who Identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="3",
volume="26",
pages="e53685",
keywords="technology-based interventions",
keywords="substance use",
keywords="treatment",
keywords="health equity",
keywords="underrepresented",
keywords="scoping review",
keywords="mobile phone",
abstract="Background: In the United States, racial and ethnic disparities in substance use treatment outcomes are persistent, especially among underrepresented minority (URM) populations. Technology-based interventions (TBIs) for substance use treatment show promise in reducing barriers to evidence-based treatment, yet no studies have described how TBIs may impact racial or ethnic health equity. Objective: This study explored whether TBIs in substance use treatment research promote health equity among people who identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native through their inclusion in research. We explored whether research that includes the aforementioned groups consciously considers race and/or ethnicity beyond including these populations as participants. Methods: We conducted a scoping review of 5 electronic databases to identify TBIs in substance use treatment studies published in English between January 2000 and March 2021. Studies were included if ?50\% of participants identified as African American or Black, Hispanic or Latino, or American Indian or Alaska Native when combined. Included studies were evaluated for conscious consideration of race and ethnicity in at least one manuscript section. Finally, we conducted a critical appraisal of each study's potential to facilitate insights into the impact of a TBI for members of specific URM groups. Results: Of 6897 titles and abstracts screened and 1158 full-text articles assessed for eligibility, nearly half (532/1158, 45.9\%) of the full-text articles were excluded due to the absence of data on race, ethnicity, or not meeting the aforementioned demographic eligibility criteria. Overall, 110 studies met the inclusion criteria. Study designs included 39.1\% (43/110) randomized trials, and 35.5\% (39/110) feasibility studies. In total, 47.3\% (52/110) of studies used computer-based interventions, including electronic screening, brief interventions, and referrals to treatment, whereas 33.6\% (37/110) used interactive voice response, ecological momentary assessment or interventions, or SMS text messaging via mobile phones. Studies focused on the following substances: alcohol or drugs (45/110, 40.9\%), alcohol alone (26/110, 23.6\%), opioids (8/110, 7.3\%), cannabis (6/110, 5.5\%), cocaine (4/110, 3.6\%), and methamphetamines (3/110, 2.7\%). Of the studies that consciously considered race or ethnicity (29/110, 26.4\%), 6.4\% (7/110) explicitly considered race or ethnicity in all manuscript sections. Overall, 28.2\% (31/110) of the studies were critically appraised as having a high confidence in the interpretability of the findings for specific URM groups. Conclusions: While the prevalence of TBIs in substance use treatment has increased recently, studies that include and consciously consider URM groups are rare, especially for American Indian or Alaska Native and Hispanic or Latino groups. This review highlights the limited research on TBIs in substance use treatment that promotes racial and ethnic health equity and provides context, insights, and direction for researchers working to develop and evaluate digital technology substance use interventions while promoting health equity. ",
doi="10.2196/53685",
url="https://www.jmir.org/2024/1/e53685"
}


@Article{info:doi/10.2196/57009,
author="DeLange Martinez, Pauline
and Tancredi, Daniel
and Pavel, Misha
and Garcia, Lorena
and Young, M. Heather",
title="The Role of Health in the Technology Acceptance Model Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="3",
volume="8",
pages="e57009",
keywords="aged",
keywords="older adults",
keywords="Asian American",
keywords="immigrant",
keywords="vulnerable populations",
keywords="internet",
keywords="information and communications technology",
keywords="ICT",
keywords="digital divide",
keywords="technology acceptance model",
keywords="mobile phone",
abstract="Background: Self-rated health is associated with information and communications technology (ICT) use among older adults. Non--US born, older Asian American individuals are more inclined to rate their health as fair or poor compared to individuals from other racial and ethnic backgrounds. This population is also less likely to use ICTs as compared to White older Americans. Furthermore, cognitive decline may impact technology acceptance. In a previous adaptation of the technology acceptance model for low-income, Asian American older adults, perceived usefulness (PU), perceived ease of use (PEOU), age, educational attainment, ethnicity, and English proficiency were significant predictors of ICT use. However, the association between health and technology acceptance has not been explored among Asian American older adults. Objective: This study examined the role of self-rated health and subjective cognitive decline in the acceptance and use of ICTs among low-income, Asian American older adults. Methods: This cross-sectional survey included Asian American individuals aged ?62 years living in affordable housing for older adults (N=392). Using hierarchical multiple regression, we explored the association between self-rated health and ICT use and technology acceptance model mediators (PU and PEOU) while adjusting for demographics, English proficiency, and subjective cognitive decline. Contrast statements were used to estimate contrasts of interest. To further examine the separate and joint association between age and subjective cognitive decline and the dependent variables, we examined scatterplots with locally estimated scatterplot smoothing lines, revealing that the relationship between subjective cognitive decline and ICT use varied in 3 age segments, which led to updating our analysis to estimate differences in ICT use among age categories with and without subjective cognitive decline. Results: Self-rated health was not significantly associated with ICT use ($\beta$=.087; P=.13), PU ($\beta$=.106; P=.10), or PEOU ($\beta$=.062; P=.31). However, the interaction terms of subjective cognitive decline and age significantly improved the model fit for ICT use ($\Delta$R2=0.011; P=.04). In reviewing scatterplots, we determined that, in the youngest age group (62-74 years), ICT use increased with subjective cognitive decline, whereas in the older age groups (75-84 and ?85 years), ICT use decreased with subjective cognitive decline, more so in the oldest age category. Through regression analysis, among participants with subjective cognitive decline, ICT use significantly decreased in the middle and older age groups as compared to the youngest age group. However, among participants without subjective cognitive decline, the difference in use among age groups was not significant. Conclusions: This study contributes to the understanding of the complex relationship between health and ICT acceptance among low-income, Asian American older adults and suggests the need for tailored interventions to promote digital engagement and quality of life for this population. ",
doi="10.2196/57009",
url="https://formative.jmir.org/2024/1/e57009",
url="http://www.ncbi.nlm.nih.gov/pubmed/39625744"
}


@Article{info:doi/10.2196/51470,
author="Luo, Lingzi
and Li, Gen
and Tang, Weiming
and Wu, Dan
and Hall, Brian",
title="Intention to Seek Mental Health Services During the 2022 Shanghai COVID-19 City-Wide Lockdown: Web-Based Cross-Sectional Study",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="2",
volume="8",
pages="e51470",
keywords="COVID-19",
keywords="mental health services",
keywords="intention",
keywords="mobile",
keywords="digital",
keywords="lockdowns",
keywords="depression",
keywords="anxiety",
keywords="help-seeking",
keywords="regression",
keywords="applications",
keywords="mHealth",
keywords="WeChat",
keywords="pandemic",
keywords="social isolation",
keywords="mental health",
keywords="intent",
keywords="outbreak",
keywords="SARS-CoV-2",
keywords="survey",
keywords="usage",
keywords="service",
abstract="Background: The implementation of COVID-19 lockdown measures had immediate and delayed psychological effects. From March 27, 2022, to June 1, 2022, the Shanghai government enforced a city-wide lockdown that affected 25 million residents. During this period, mental health services were predominantly provided through digital platforms. However, limited knowledge exists regarding the general population's intention to use mental health services during this time. Objective: This study aimed to assess the intention of Shanghai residents to use mental health services during the 2022 Shanghai lockdown and identify factors associated with the intention to use mobile mental health services. Methods: An online survey was distributed from April 29 to June 1, 2022, using a purposive sampling approach across 16 districts in Shanghai. Eligible participants were adults over 18 years of age who were physically present in Shanghai during the lockdown. Multivariable logistic regression was used to estimate the associations between demographic factors, lockdown-related stressors and experiences, physical and mental health status, and study outcomes--mobile mental health service use intention (mobile applications and WeChat Mini Programs [Tencent Holdings Limited]). Results: The analytical sample comprised 3230 respondents, among whom 29.7\% (weighted percentage; n=1030) screened positive for depression or anxiety based on the 9-item Patient Health Questionnaire or the 7-item Generalized Anxiety Disorder Scale. Less than one-fourth of the respondents (24.4\%, n=914) expressed an intention to use any form of mental health services, with mobile mental health service being the most considered option (19.3\%, n=728). Only 10.9\% (n=440) used digital mental health services during the lockdown. Factors associated with increased odds of mobile mental health service use intention included being female, being employed, being a permanent resident, experiencing COVID-19--related stressors (such as loss of income, food insecurity, and potentially traumatic experiences), and having social and financial support. Individuals with moderate or severe anxiety, as well as those with comorbid anxiety and depression, demonstrated a higher intention to use mobile mental health services. However, individuals with depression alone did not exhibit a significantly higher intention compared with those without common mental disorders. Conclusions: Despite a high prevalence of common mental disorders among Shanghai residents, less than one-fourth of the study respondents expressed an intention to use any form of mental health services during the lockdown. Mobile apps or WeChat Mini Programs were the most considered mental health service formats. The study provided insights for developing more person-centered mobile mental health services to meet the diverse needs of different populations. ",
doi="10.2196/51470",
url="https://formative.jmir.org/2024/1/e51470"
}


@Article{info:doi/10.2196/54015,
author="Narayan, Shawna
and Gooderham, Ellie
and Spencer, Sarah
and McCracken, K. Rita
and Hedden, Lindsay",
title="Virtual Primary Care for People With Opioid Use Disorder: Scoping Review of Current Strategies, Benefits, and Challenges",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="2",
volume="26",
pages="e54015",
keywords="telehealth",
keywords="virtual care",
keywords="primary care",
keywords="opioid use disorder",
keywords="opioid agonist therapy",
keywords="COVID-19",
keywords="mobile phone",
abstract="Background: There is a pressing need to understand the implications of the rapid adoption of virtual primary care for people with opioid use disorder. Potential impacts, including disruptions to opiate agonist therapies, and the prospect of improved service accessibility remain underexplored. Objective: This scoping review synthesized current literature on virtual primary care for people with opioid use disorder with a specific focus on benefits, challenges, and strategies. Methods: We followed the Joanna Briggs Institute methodological approach for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist for reporting our findings. We conducted searches in MEDLINE, Web of Science, CINAHL Complete, and Embase using our developed search strategy with no date restrictions. We incorporated all study types that included the 3 concepts (ie, virtual care, primary care, and people with opioid use disorder). We excluded research on minors, asynchronous virtual modalities, and care not provided in a primary care setting. We used Covidence to screen and extract data, pulling information on study characteristics, health system features, patient outcomes, and challenges and benefits of virtual primary care. We conducted inductive content analysis and calculated descriptive statistics. We appraised the quality of the studies using the Quality Assessment With Diverse Studies tool and categorized the findings using the Consolidated Framework for Implementation Research. Results: Our search identified 1474 studies. We removed 36.36\% (536/1474) of these as duplicates, leaving 938 studies for title and abstract screening. After a double review process, we retained 3\% (28/938) of the studies for extraction. Only 14\% (4/28) of the studies were conducted before the COVID-19 pandemic, and most (15/28, 54\%) used quantitative methodologies. We summarized objectives and results, finding that most studies (18/28, 64\%) described virtual primary care delivered via phone rather than video and that many studies (16/28, 57\%) reported changes in appointment modality. Through content analysis, we identified that policies and regulations could either facilitate (11/28, 39\%) or impede (7/28, 25\%) the provision of care virtually. In addition, clinicians' perceptions of patient stability (5/28, 18\%) and the heightened risks associated with virtual care (10/28, 36\%) can serve as a barrier to offering virtual services. For people with opioid use disorder, increased health care accessibility was a noteworthy benefit (13/28, 46\%) to the adoption of virtual visits, whereas issues regarding access to technology and digital literacy stood out as the most prominent challenge (12/28, 43\%). Conclusions: The available studies highlight the potential for enhancing accessibility and continuous access to care for people with opioid use disorder using virtual modalities. Future research and policies must focus on bridging gaps to ensure that virtual primary care does not exacerbate or entrench health inequities. ",
doi="10.2196/54015",
url="https://www.jmir.org/2024/1/e54015"
}


@Article{info:doi/10.2196/60949,
author="Hammarberg, Karin
and Bandyopadhyay, Mridula
and Nguyen, Hau
and Cicuttini, Flavia
and Stanzel, Andrea Karin
and Brown, Helen
and Hickey, Martha
and Fisher, Jane",
title="Development and Evaluation of 4 Short, Animated Videos for Women in Midlife Promoting Positive Health Behaviors: Survey Study",
journal="Interact J Med Res",
year="2024",
month="Dec",
day="2",
volume="13",
pages="e60949",
keywords="health promotion",
keywords="healthy aging",
keywords="self-management",
keywords="midlife",
keywords="menopause",
keywords="internet",
keywords="video",
keywords="animation",
keywords="survey",
keywords="questionnaire",
keywords="education",
keywords="women",
keywords="gynecology",
abstract="Background: Health and health behaviors in midlife are important determinants of healthy aging. There is evidence of unmet needs for health-promoting information for women from culturally and linguistically diverse backgrounds and women with low literacy. Objective: This study aimed to (1) develop accessible short, animated videos viewable and downloadable from YouTube aimed at promoting positive health behaviors in women in midlife and (2) evaluate their accessibility, acceptability, understanding, and usability and whether this was influenced by the level of education or socioeconomic disadvantage. Methods: In collaboration with a video production company, a multidisciplinary team of academics and health professionals developed 2 short, animated videos on self-management of menopause health and 2 promoting joint health. Their accessibility, acceptability, understanding, and usability to women were evaluated in an anonymous web-based survey. Results: A total of 490 women viewed the videos and responded to the survey. Of these, 353 (72\%) completed all questions. Almost all (from 321/353, 91\% to 334/363, 92\%) agreed that the information in the videos was ``very easy to understand.'' The proportions reporting that all or some of the information in the video was new to them varied between videos from 36\% (137/386) to 66\% (233/353), the reported likelihood of using the practical tips offered in the videos varied from 70\% (271/386) to 89\% (331/373), and between 61\% (235/386) and 70\% (263/373) of respondents stated that they would recommend the videos to others. Education-level group comparisons revealed few differences in opinions about the videos, except that women with lower education were more likely than those with higher education to state that they would recommend the 2 joint health videos to others (36/45, 80\% vs 208/318, 65\%; P=.051 for video 3; and 36/44, 80\% vs 197/309, 64\%; P=.04 for video 4). There were no differences between women living in the least advantaged areas (Socioeconomic Indexes for Areas quintile areas 1 and 2) and those living in the most advantaged areas (Socioeconomic Indexes for Areas quintile areas 3, 4, and 5) in their responses to any of the questions about the 4 videos. Conclusions: Most women found the videos easy to understand, learned something new from watching them, planned to use the practical tips they offered, and were likely to recommend them to other women. This suggests that short, animated videos about health self-management strategies in midlife to improve the chance of healthy aging are perceived as accessible, acceptable, easy to understand, and useful by women. ",
doi="10.2196/60949",
url="https://www.i-jmr.org/2024/1/e60949",
url="http://www.ncbi.nlm.nih.gov/pubmed/39621404"
}


@Article{info:doi/10.2196/57301,
author="Chen, Bowen
and Yang, Chun
and Ren, Shanshan
and Li, Penggao
and Zhao, Jin",
title="Relationship Between Internet Use and Cognitive Function Among Middle-Aged and Older Chinese Adults: 5-Year Longitudinal Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="2",
volume="26",
pages="e57301",
keywords="aging",
keywords="cognitive function",
keywords="internet use",
keywords="longitudinal study",
keywords="fixed effects model",
abstract="Background: Cognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the older adult population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet use among middle-aged and older adults. Objective: This study aims to explore the association between internet use and age-related cognitive decline among middle-aged and older Chinese adults. To gain a more comprehensive understanding of the effects of internet use, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet use on cognitive function for characteristics significantly linked to cognition in stratified analysis. Methods: We analyzed data based on 12,770 dementia-free participants aged ?45 years from the China Health and Retirement Longitudinal Study. We used a fixed effects model to assess the relationship between internet use and cognitive decline and further validated it using multiple linear regression analysis, generalized estimating equations, propensity score matching, inverse probability of treatment weighting, and overlap weighting. We further examined the varying effects of internet device type and frequency on cognitive function using fixed effects models and Spearman rank correlations. The Karlson-Holm-Breen method was used to estimate the mediating role of internet use in the urban-rural cognitive gap. Results: Participants using the internet (n=1005) were younger, more likely to be male, more educated, married, retired and living in an urban area and had higher cognitive assessment scores than nonusers (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function ($\beta$=0.551, 95\% CI 0.391-0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases, at 2.2\% (15/671), compared with nonusers, at 5.3\% (379/7099; P<.001). The negative impact of aging (>50 years) on cognitive function was consistently less pronounced among internet users than among nonusers. Furthermore, increased frequency of internet use was associated with greater cognitive benefits for middle-aged and older adults (rs=0.378, P<.001). Among digital devices used for internet access, cell phones ($\beta$=0.398, 95\% CI 0.283-0.495) seemed to have a higher level of cognitive protection than computers ($\beta$=0.147, 95\% CI 0.091-0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2\% of the total effect, P<.001). Conclusions: This study revealed that the use of internet by individuals aged 45 years and older is associated with a reduced risk of cognitive decline. Internet use?has the potential to be a viable, cost-effective, nonpharmacological intervention for?cognitive decline among middle-aged and older adults. ",
doi="10.2196/57301",
url="https://www.jmir.org/2024/1/e57301",
url="http://www.ncbi.nlm.nih.gov/pubmed/39539034"
}


@Article{info:doi/10.2196/53320,
author="Smith, C. Lisa
and Johnson, George
and Jadhav, Snehal
and Kabayundo, Josiane
and Ahuja, Muskan
and Wang, Hongmei
and Ratnapradipa, L. Kendra",
title="Ever Use of Telehealth in Nebraska by March 2021: Cross-Sectional Analysis",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="28",
volume="26",
pages="e53320",
keywords="COVID-19",
keywords="digital divide",
keywords="health care access",
keywords="telehealth",
keywords="cross-sectional study",
keywords="Nevada",
keywords="United States",
keywords="adult",
keywords="medical care",
keywords="geographical area",
keywords="disparity",
keywords="accessibility",
keywords="utilization",
keywords="survey",
keywords="chi-square test",
keywords="regression model",
keywords="socioeconomic",
keywords="demographic",
keywords="health condition",
keywords="digital health",
abstract="Background: Nationally, COVID-19 spurred the uptake of telehealth to facilitate patients' access to medical care, especially among individuals living in geographically isolated areas. Despite the potential benefits of telehealth to address health care access barriers and enhance health outcomes, there are still disparities in the accessibility and utilization of telehealth services. Hence, identifying facilitators and barriers to telehealth should be prioritized to ensure that disparities are mitigated rather than exacerbated. Objective: This study aims to identify factors associated with ever use of telehealth in Nebraska, a primarily rural state with a significant portion of its population living in nonmetropolitan areas. Methods: A stratified random sample of Nebraska households (n=5300), with oversampling of census tracts with at least 30\% African American, Hispanic, or Native American populations, received a mailed survey (English and Spanish) with web-based response options about social determinants of health and health care access (October 2020-March 2021). Survey weights were used for all calculations. Chi-square tests were used to compare telehealth use (yes or no) by participant sociodemographic, health, and access variables. Robust Poisson regression models were used to compute prevalence odds ratios (POR) with 95\% CIs of telehealth use after controlling for socioeconomic, demographic, and health conditions. Results: The overall response rate was 20.8\% (1101/5300). About 25.5\% of Nebraska adults had ever used telehealth (urban 26.4\%, rural 20.8\%), despite 97\% of respondents reporting internet access (98.3\% urban, 90.5\% rural). In the chi-square analysis, telehealth use was statistically significantly more common (P<.05) among those who are aged <45 years (32.4\%), female (30.7\%), and non-Hispanic (25.9\%); with at least a bachelor's degree (32.6\%); who had a routine checkup (30.2\%) or health care visit other than a routine checkup (34.2\%); and with any chronic health conditions (29.6\%) but did not differ (P?.05) by race, marital status, income, insurance, having a primary care provider, or 1-way travel time for medical visits. In univariate models, internet access, age, sex, ethnicity, education, any health care visit in the past year, and no chronic health condition were significant (P<.05). When adjusted, education (POR 1.87, 95\% CI 0.33-10.63) and sex (1.38, 0.93-2.04) were not significant, but internet access (5.43, 1.62-18.16), age <45 (5.33, 2.22-12.81) and 45-64 years (9.05, 2.37-34.62), non-Hispanic ethnicity (7.40, 2.39-22.90), any health care visit (2.43, 1.23-4.79), and any chronic condition (1.73, 1.09-2.76) were significantly associated with having ever used telehealth. Conclusions: This study highlights disparities in telehealth use. Despite high coverage, internet access was a significant predictor of telehealth use, highlighting the role of the digital divide in telehealth access and use. Telehealth use was significantly less prevalent among older adults, people without chronic health conditions, and Hispanic individuals. Targeted interventions that address barriers to telehealth use and improve health care access are warranted. ",
doi="10.2196/53320",
url="https://www.jmir.org/2024/1/e53320"
}


@Article{info:doi/10.2196/59684,
author="Li, Yumeng
and Liu, Chen
and Sun, Jiaqing
and Zhang, Junying
and Li, Xin
and Zhang, Zhanjun",
title="The Digital Divide and Cognitive Disparities Among Older Adults: Community-Based Cohort Study in China",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="27",
volume="26",
pages="e59684",
keywords="digital divide",
keywords="internet use",
keywords="cognitive aging",
keywords="mild cognitive impairment",
keywords="socioeconomic status",
keywords="resource inequality",
keywords="cognitive disparities",
keywords="cognitive function",
keywords="elderly",
keywords="older adult",
keywords="aging",
keywords="community-based",
keywords="cohort study",
keywords="China",
keywords="ANCOVA",
keywords="mixed linear model",
keywords="Cox proportional hazards",
keywords="mental health",
keywords="internet",
keywords="digital health",
keywords="information and communication technologies",
keywords="ICT",
keywords="mHealth",
abstract="Background: The widespread adoption of information and communication technologies (ICTs) further deepens disparities in resource access, particularly among the aging population. However, the relationship between these factors and their resulting impact on cognitive abilities remains uncertain. Objective: This study aims to investigate the potential impact of the digital divide on individuals' cognitive function and its association with the development and reversion of mild cognitive impairment (MCI). Methods: This cohort study used data from Beijing Aging Brain Rejuvenation (BABRI) study applying a multistage cluster sampling design between 2008 and 2020. The digital divide was quantified by the frequency of using ICTs. Analysis of covariance (ANCOVA), mixed linear models, and Cox proportional hazards models were used to model the association of digital divide and multidomain cognition. Results: Among the 10098 participants, nearly half (n=4941, 48.9\%) faced the digital divide, which was associated with a worse performance in processing speed (F10096=10.67; P<.001; effect size r=0.42), rather than memory, executive function, and language. The model indicated that individuals' physical and mental health, combined with their educational and occupational prestige, influenced the resources they attained, which ultimately caused the digital divide. Moreover, longitudinal data revealed that older adults who successfully crossed the digital divide during the tracking process and those who had already done so prior to tracking showed significantly slower rates of decline in processing speed (B=--1.98, P<.05; B=--2.62, P<.01) and general cognitive function (B=3.50, P<.001; B=3.13, P<.01). Additionally, overcoming the digital divide was also associated with a lower risk of developing MCI (hazard ratio [HR] 0.5, 95\% CI 0.34-0.74; HR 0.43, 95\% CI 0.29-0.62) and a greater probability of reversion from MCI to normal cognition (HR 6, 95\% CI 3.77-9.56; HR 9.22, 95\% CI 5.63-15.11). Conclusions: Overcoming the digital divide was significantly associated with improved cognitive function, a slower aging rate in cognitive performance, a reduced risk of developing MCI, and a higher likelihood of reverting from MCI to normal cognition. ",
doi="10.2196/59684",
url="https://www.jmir.org/2024/1/e59684"
}


@Article{info:doi/10.2196/56761,
author="Galinkala, Prathyusha
and Atkinson, Elise
and Campos-Castillo, Celeste",
title="Age Variation Among US Adults' Social Media Experiences and Beliefs About Who Is Responsible for Reducing Health-Related Falsehoods: Secondary Analysis of a National Survey",
journal="JMIR Aging",
year="2024",
month="Nov",
day="27",
volume="7",
pages="e56761",
keywords="social media",
keywords="health misinformation",
keywords="gray digital divide",
keywords="United States",
keywords="older adults",
keywords="aging",
keywords="health information",
keywords="false information",
keywords="falsehoods",
abstract="Background: We live in a digital age where social media has become an essential part of people's lives. It is also one of the leading platforms responsible for spreading health-related falsehoods. This study explores who adults of different age groups perceive as responsible for reducing health-related falsehoods on social media. Objective: Despite growing concern over older adults' exposure to false health information on social media, little research examines their beliefs on how to address the problem. This study examines how the age of US adults is associated with their reported experiences with health-related falsehoods on social media and their beliefs about who should be tasked with reducing such falsehoods. Methods: This study is a secondary analysis of data from the 2022 Health Information National Trends Survey, a nationally representative survey of US adults (18 years and older). Multivariable logistic regressions estimated how a respondent's age was associated with their self-reported social media use, their difficulty to detect health-related falsehoods on social media, their discussion of health information found on social media with medical providers, and their beliefs regarding who should be responsible for reducing health-related falsehoods on social media. Regression estimates were adjusted for respondents' sociodemographic and health characteristics. Results: Daily social media use decreased with respondents' age. Respondents aged 50?64 years (b=0.515, P=.01) and 65?74 years (b=0.697, P=.002) were more likely than respondents aged 18?34 years to report they strongly agree that it is difficult for them to detect health-related falsehoods on social media. Compared to younger adults, older adults (65?74 years: b=0.818, P=.002; 75 years and older: b=1.058, P<.001) were more likely to believe medical providers should be responsible for reducing online falsehoods. Conclusions: In addition to ongoing efforts by social media platforms to detect and remove falsehoods, the findings suggest medical providers should be tasked with discrediting health-related falsehoods on social media for older adults. However, time during the clinical visit is limited. Future research is needed to discover new approaches and tools tailored to older adults to assist with filtering and discrediting health-related falsehoods on social media. ",
doi="10.2196/56761",
url="https://aging.jmir.org/2024/1/e56761"
}


@Article{info:doi/10.2196/58275,
author="O'Malley, Andrew
and Veenhuizen, Miriam
and Ahmed, Ayla",
title="Ensuring Appropriate Representation in Artificial Intelligence--Generated Medical Imagery: Protocol for a Methodological Approach to Address Skin Tone Bias",
journal="JMIR AI",
year="2024",
month="Nov",
day="27",
volume="3",
pages="e58275",
keywords="artificial intelligence",
keywords="generative AI",
keywords="AI images",
keywords="dermatology",
keywords="anatomy",
keywords="medical education",
keywords="medical imaging",
keywords="skin",
keywords="skin tone",
keywords="United States",
keywords="educational material",
keywords="psoriasis",
keywords="digital imagery",
abstract="Background: In medical education, particularly in anatomy and dermatology, generative artificial intelligence (AI) can be used to create customized illustrations. However, the underrepresentation of darker skin tones in medical textbooks and elsewhere, which serve as training data for AI, poses a significant challenge in ensuring diverse and inclusive educational materials. Objective: This study aims to evaluate the extent of skin tone diversity in AI-generated medical images and to test whether the representation of skin tones can be improved by modifying AI prompts to better reflect the demographic makeup of the US population. Methods: In total, 2 standard AI models (Dall-E [OpenAI] and Midjourney [Midjourney Inc]) each generated 100 images of people with psoriasis. In addition, a custom model was developed that incorporated a prompt injection aimed at ``forcing'' the AI (Dall-E 3) to reflect the skin tone distribution of the US population according to the 2012 American National Election Survey. This custom model generated another set of 100 images. The skin tones in these images were assessed by 3 researchers using the New Immigrant Survey skin tone scale, with the median value representing each image. A chi-square goodness of fit analysis compared the skin tone distributions from each set of images to that of the US population. Results: The standard AI models (Dalle-3 and Midjourney) demonstrated a significant difference between the expected skin tones of the US population and the observed tones in the generated images (P<.001). Both standard AI models overrepresented lighter skin. Conversely, the custom model with the modified prompt yielded a distribution of skin tones that closely matched the expected demographic representation, showing no significant difference (P=.04). Conclusions: This study reveals a notable bias in AI-generated medical images, predominantly underrepresenting darker skin tones. This bias can be effectively addressed by modifying AI prompts to incorporate real-life demographic distributions. The findings emphasize the need for conscious efforts in AI development to ensure diverse and representative outputs, particularly in educational and medical contexts. Users of generative AI tools should be aware that these biases exist, and that similar tendencies may also exist in other types of generative AI (eg, large language models) and in other characteristics (eg, sex, gender, culture, and ethnicity). Injecting demographic data into AI prompts may effectively counteract these biases, ensuring a more accurate representation of the general population. ",
doi="10.2196/58275",
url="https://ai.jmir.org/2024/1/e58275"
}


@Article{info:doi/10.2196/60878,
author="Lukmanjaya, Wilson
and Butler, Tony
and Taflan, Patricia
and Simpson, Paul
and Ginnivan, Natasha
and Buchan, Iain
and Nenadic, Goran
and Karystianis, George",
title="Population Characteristics in Justice Health Research Based on PubMed Abstracts From 1963 to 2023: Text Mining Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="22",
volume="8",
pages="e60878",
keywords="epidemiology",
keywords="PubMed",
keywords="criminology",
keywords="text mining",
keywords="justice health",
keywords="offending and incarcerated populations",
keywords="population characteristics",
keywords="open research",
keywords="health research",
keywords="text mining study",
keywords="epidemiological criminology",
keywords="public health",
keywords="justice systems",
keywords="bias",
keywords="population",
keywords="men",
keywords="women",
keywords="prison",
keywords="prisoner",
keywords="researcher",
abstract="Background: The field of epidemiological criminology (or justice health research) has emerged in the past decade, studying the intersection between the public health and justice systems. To ensure research efforts are focused and equitable, it is important to reflect on the outputs in this area and address knowledge gaps. Objective: This study aimed to examine the characteristics of populations researched in a large sample of published outputs and identify research gaps and biases. Methods: A rule-based, text mining method was applied to 34,481 PubMed abstracts published from 1963 to 2023 to identify 4 population characteristics (sex, age, offender type, and nationality). Results: We evaluated our method in a random sample of 100 PubMed abstracts. Microprecision was 94.3\%, with microrecall at 85.9\% and micro--F1-score at 89.9\% across the 4 characteristics. Half (n=17,039, 49.4\%) of the 34,481 abstracts did not have any characteristic mentions and only 1.3\% (n=443) reported sex, age, offender type, and nationality. From the 5170 (14.9\%) abstracts that reported age, 3581 (69.3\%) mentioned young people (younger than 18 years) and 3037 (58.7\%) mentioned adults. Since 1990, studies reporting female-only populations increased, and in 2023, these accounted for almost half (105/216, 48.6\%) of the research outputs, as opposed to 33.3\% (72/216) for male-only populations. Nordic countries (Sweden, Norway, Finland, and Denmark) had the highest number of abstracts proportional to their incarcerated populations. Offenders with mental illness were the most common group of interest (840/4814, 17.4\%), with an increase from 1990 onward. Conclusions: Research reporting on female populations increased, surpassing that involving male individuals, despite female individuals representing 5\% of the incarcerated population; this suggests that male prisoners are underresearched. Although calls have been made for the justice health area to focus more on young people, our results showed that among the abstracts reporting age, most mentioned a population aged <18 years, reflecting a rise of youth involvement in the youth justice system. Those convicted of sex offenses and crimes relating to children were not as researched as the existing literature suggests, with a focus instead on populations with mental illness, whose rates rose steadily in the last 30 years. After adjusting for the size of the incarcerated population, Nordic countries have conducted proportionately the most research. Our findings highlight that despite the presence of several research reporting guidelines, justice health abstracts still do not adequately describe the investigated populations. Our study offers new insights in the field of justice health with implications for promoting diversity in the selection of research participants. ",
doi="10.2196/60878",
url="https://formative.jmir.org/2024/1/e60878"
}


@Article{info:doi/10.2196/52498,
author="DeLange Martinez, Pauline
and Tancredi, Daniel
and Pavel, Misha
and Garcia, Lorena
and Young, M. Heather",
title="Technology Acceptance Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="22",
volume="26",
pages="e52498",
keywords="aged",
keywords="older adults",
keywords="Asian American",
keywords="immigrant",
keywords="vulnerable populations",
keywords="internet",
keywords="information and communications technology",
keywords="ICT",
keywords="digital divide",
keywords="technology acceptance model",
keywords="mobile phone",
abstract="Background: Studies show that the use of information and communications technologies (ICTs), including smartphones, tablets, computers, and the internet, varies by demographic factors such as age, gender, and educational attainment. However, the connections between ICT use and factors such as ethnicity and English proficiency, especially among Asian American older adults, remain less explored. The technology acceptance model (TAM) suggests that 2 key attitudinal factors, perceived usefulness (PU) and perceived ease of use (PEOU), influence technology acceptance. While the TAM has been adapted for older adults in China, Taiwan, Singapore, and Korea, it has not been tested among Asian American older adults, a population that is heterogeneous and experiences language barriers in the United States. Objective: This study aims to examine the relationships among demographics (age, gender, educational attainment, ethnicity, and English proficiency), PU, PEOU, and ICT use among low-income Asian American older adults. Two outcomes were examined: smartphone use and ICT use, each measured by years of experience and current frequency of use. Methods: This was a secondary data analysis from a cross-sectional baseline survey of the Lighthouse Project, which provided free broadband, ICT devices, and digital literacy training to residents living in 8 affordable senior housing communities across California. This analysis focused on Asian participants aged ?62 years (N=392), specifically those of Korean, Chinese, Vietnamese, Filipino, and other Asian ethnicities (eg, Hmong and Japanese). Hypotheses were examined using descriptive statistics, correlation analysis, and hierarchical regression analysis. Results: Younger age, higher education, and greater English proficiency were positively associated with smartphone use (age: $\beta$=--.202; P<.001; education: $\beta$=.210; P<.001; and English proficiency: $\beta$=.124; P=.048) and ICT use (age: $\beta$=--.157; P=.002; education: $\beta$=.215; P<.001; and English proficiency: $\beta$=.152; P=.01). Male gender was positively associated with PEOU ($\beta$=.111; P=.047) but not with PU ($\beta$=--.031; P=.59), smartphone use ($\beta$=.023; P=.67), or ICT use ($\beta$=.078; P=.16). Ethnicity was a significant predictor of PU (F4,333=5.046; P<.001), PEOU (F4,345=4.299; P=.002), and ICT use (F4,350=3.177; P=.01), with Chinese participants reporting higher levels than Korean participants, who were the reference group ($\beta$=.143; P=.007). PU and PEOU were positively correlated with each other (r=0.139, 95\% CI=0.037-0.237; P=.007), and both were significant predictors of smartphone use (PU: $\beta$=.158; P=.002 and PEOU: $\beta$=.166; P=.002) and ICT use (PU: $\beta$=.117; P=.02 and PEOU: $\beta$=0.22; P<.001), even when controlling for demographic variables. Conclusions: The findings support the use of the TAM among low-income Asian American older adults. In addition, ethnicity and English proficiency are significant predictors of smartphone and ICT use among this population. Future interventions should consider heterogeneity and language barriers of this population to increase technology acceptance and use. ",
doi="10.2196/52498",
url="https://www.jmir.org/2024/1/e52498"
}


@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/10.2196/51477,
author="Ji, Lu
and Yao, Yifan
and Yu, Dandan
and Chen, Wen
and Yin, Shanshan
and Fu, Yun
and Tang, Shangfeng
and Yao, Lan",
title="Performance of a Full-Coverage Cervical Cancer Screening Program Using on an Artificial Intelligence-- and Cloud-Based Diagnostic System: Observational Study of an Ultralarge Population",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="20",
volume="26",
pages="e51477",
keywords="full coverage",
keywords="cervical cancer screening",
keywords="artificial intelligence",
keywords="primary health institutions",
keywords="accessibility",
keywords="efficiency",
abstract="Background: The World Health Organization has set a global strategy to eliminate cervical cancer, emphasizing the need for cervical cancer screening coverage to reach 70\%. In response, China has developed an action plan to accelerate the elimination of cervical cancer, with Hubei province implementing China's first provincial full-coverage screening program using an artificial intelligence (AI) and cloud-based diagnostic system. Objective: This study aimed to evaluate the performance of AI technology in this full-coverage screening program. The evaluation indicators included accessibility, screening efficiency, diagnostic quality, and program cost. Methods: Characteristics of 1,704,461 individuals screened from July 2022 to January 2023 were used to analyze accessibility and AI screening efficiency. A random sample of 220 individuals was used for external diagnostic quality control. The costs of different participating screening institutions were assessed. Results: Cervical cancer screening services were extended to all administrative districts, especially in rural areas. Rural women had the highest participation rate at 67.54\% (1,147,839/1,699,591). Approximately 1.7 million individuals were screened, achieving a cumulative coverage of 13.45\% in about 6 months. Full-coverage programs could be achieved by AI technology in approximately 1 year, which was 87.5 times more efficient than the manual reading of slides. The sample compliance rate was as high as 99.1\%, and compliance rates for positive, negative, and pathology biopsy reviews exceeded 96\%. The cost of this program was CN {\textyen}49 (the average exchange rate in 2022 is as follows: US \$1=CN {\textyen}6.7261) per person, with the primary screening institution and the third-party testing institute receiving CN {\textyen}19 and {\textyen}27, respectively. Conclusions: AI-assisted diagnosis has proven to be accessible, efficient, reliable, and low cost, which could support the implementation of full-coverage screening programs, especially in areas with insufficient health resources. AI technology served as a crucial tool for rapidly and effectively increasing screening coverage, which would accelerate the achievement of the World Health Organization's goals of eliminating cervical cancer. ",
doi="10.2196/51477",
url="https://www.jmir.org/2024/1/e51477"
}


@Article{info:doi/10.2196/56636,
author="Duan, Sainan
and Chen, Dongxu
and Wang, Jinping
and Paramboor, Sharooq Mohammed
and Xia, Zhen
and Xu, Wanting
and Han, Kun
and Zhu, Tao
and Jiang, Xiaoqin",
title="Digital Exclusion and Cognitive Function in Elderly Populations in Developing Countries: Insights Derived From 2 Longitudinal Cohort Studies",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="15",
volume="26",
pages="e56636",
keywords="digital exclusion",
keywords="cognition",
keywords="cohort study",
keywords="developing country",
keywords="China Health and Retirement Longitudinal Study",
keywords="CHARLS",
keywords="",
keywords="MHAS",
keywords="cognitive decline",
abstract="Background: Cognition disorders not only lead to adverse health consequences but also contribute to a range of socioeconomic challenges and diminished capacity for performing routine daily activities. In the digital era, understanding the impact of digital exclusion on cognitive function is crucial, especially in developing countries. Objective: This study aimed to evaluate the association between digital exclusion and cognitive function among elderly populations in developing countries. Methods: Using data from CHARLS (China Health and Retirement Longitudinal Study) from 2011 to 2020 and MHAS (Mexican Health \& Aging Study) from 2012 to 2021, we defined digital exclusion as self-reported absence from the internet. Cognitive function was assessed through 5 tests: orientation, immediate verbal recall, delayed verbal recall, serial 7s, and figure recall. Cognitive function was assessed in 2 categories: worse cognition (a categorical variable that classifies cognition as either better or worse compared to the entire cohort population) and cognitive scores (a continuous variable representing raw cognitive scores across multiple follow-up waves). Logistic regression analyses and generalized estimating equation (GEE) analyses were used to examine the relationship between cognitive function and digital exclusion, adjusting for potential confounders, including demographics, lifestyle factors, history of chronic diseases, basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and basic cognitive abilities. Results: After excluding participants with probable cognitive impairment at baseline and those who did not have a complete cognitive assessment in any given year (ie, all tests in the cognitive assessment must be completed in any follow-up wave), a total of 24,065 participants in CHARLS (n=11,505, 47.81\%) and MHAS (n=12,560, 52.19\%) were included. Of these, 96.78\% (n=11,135) participants in CHARLS and 70.02\% (n=8795) in MHAS experienced digital exclusion. Adjusted logistic regression analyses revealed that individuals with digital exclusion were more likely to exhibit worse cognitive performance in both CHARLS (odds ratio [OR] 2.04, 95\% CI 1.42-2.99; P<.001) and MHAS (OR 1.40, 95\% CI 1.26-1.55; P<.001). Gender and age did not significantly modify the relationship between digital exclusion and worse cognition (intervention P>.05). The fully adjusted mean differences in global cognitive scores between the 2 groups were 0.98 (95\% CI 0.70-1.28; P<.001) in CHARLS and 0.50 (95\% CI 0.40-0.59; P<.001) in MHAS. Conclusions: A substantial proportion of older adults, particularly in China, remain excluded from internet access. Our study examined longitudinal changes in cognitive scores and performed cross-sectional comparisons using Z-score standardization. The findings suggest that digital exclusion is linked to an increased risk of cognitive decline among older adults in developing countries. Promoting internet access may help mitigate this risk and support better cognitive health in these populations. ",
doi="10.2196/56636",
url="https://www.jmir.org/2024/1/e56636"
}


@Article{info:doi/10.2196/56807,
author="Rivera Rivera, Nathalie Jessica
and AuBuchon, E. Katarina
and Smith, Marjanna
and Starling, Claire
and Ganacias, G. Karen
and Danielson, Aimee
and Patchen, Loral
and Rethy, A. Janine
and Blumenthal, Joseph H.
and Thomas, D. Angela
and Arem, Hannah",
title="Development and Refinement of a Chatbot for Birthing Individuals and Newborn Caregivers: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Nov",
day="14",
volume="7",
pages="e56807",
keywords="postpartum care",
keywords="newborn care",
keywords="health education",
keywords="chatbot",
keywords="mHealth",
keywords="mobile health",
keywords="feedback",
keywords="health equity",
abstract="Background: The 42 days after delivery (``fourth trimester'') are a high-risk period for birthing individuals and newborns, especially those who are racially and ethnically marginalized due to structural racism. Objective: To fill a gap in the critical ``fourth trimester,'' we developed 2 ruled-based chatbots---one for birthing individuals and one for newborn caregivers---that provided trusted information about postbirth warning signs and newborn care and connected patients with health care providers. Methods: A total of 4370 individuals received the newborn chatbot outreach between September 1, 2022, and December 31, 2023, and 3497 individuals received the postpartum chatbot outreach between November 16, 2022, and December 31, 2023. We conducted surveys and interviews in English and Spanish to understand the acceptability and usability of the chatbot and identify areas for improvement. We sampled from hospital discharge lists that distributed the chatbot, stratified by prenatal care location, age, type of insurance, and racial and ethnic group. We analyzed quantitative results using descriptive analyses in SPSS (IBM Corp) and qualitative results using deductive coding in Dedoose (SocioCultural Research Consultants). Results: Overall, 2748 (63\%) individuals opened the newborn chatbot messaging, and 2244 (64\%) individuals opened the postpartum chatbot messaging. A total of 100 patients engaged with the chatbot and provided survey feedback; of those, 40\% (n=40) identified as Black, 27\% (n=27) identified as Hispanic/Latina, and 18\% (n=18) completed the survey in Spanish. Payer distribution was 55\% (n=55) for individuals with public insurance, 39\% (n=39) for those with commercial insurance, and 2\% (n=2) for uninsured individuals. The majority of surveyed participants indicated that chatbot messaging was timely and easy to use (n=80, 80\%) and found the reminders to schedule the newborn visit (n=59, 59\%) and postpartum visit (n=66, 66\%) useful. Across 23 interviews (n=14, 61\% Black; n=4, 17\% Hispanic/Latina; n=2, 9\% in Spanish; n=11, 48\% public insurance), 78\% (n=18) of interviewees engaged with the chatbot. Interviewees provided positive feedback on usability and content and recommendations for improving the outreach messages. Conclusions: Chatbots are a promising strategy to reach birthing individuals and newborn caregivers with information about postpartum recovery and newborn care, but intentional outreach and engagement strategies are needed to optimize interaction. Future work should measure the chatbot's impact on health outcomes and reduce disparities. ",
doi="10.2196/56807",
url="https://pediatrics.jmir.org/2024/1/e56807"
}


@Article{info:doi/10.2196/56320,
author="KC, Sukriti
and Papoutsi, Chrysanthi
and Reidy, Claire
and Gudgin, Bernard
and Powell, John
and Majeed, Azeem
and Greaves, Felix
and Laverty, A. Anthony",
title="Differences in Use of a Patient Portal Across Sociodemographic Groups: Observational Study of the NHS App in England",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="13",
volume="26",
pages="e56320",
keywords="digital health",
keywords="patient portals",
keywords="technological health divide",
keywords="eHealth",
keywords="inequality",
keywords="observational",
keywords="ecological",
keywords="England",
keywords="app",
keywords="patient portal",
keywords="disparities",
keywords="deprivation",
keywords="demographics",
keywords="long-term health care",
keywords="negative binomial regression model",
keywords="intervention",
keywords="patient support",
keywords="general practice",
keywords="digital technology",
keywords="patient",
keywords="youth",
keywords="",
abstract="Background: The adoption of patient portals, such as the National Health Service (NHS) App in England, may improve patient engagement in health care. However, concerns remain regarding differences across sociodemographic groups in the uptake and use of various patient portal features, which have not been fully explored. Understanding the use of various functions across diverse populations is essential to ensure any benefits are equally distributed across the population. Objective: This study aims to explore differences in the use of NHS App features across age, sex, deprivation, ethnicity, long-term health care needs, and general practice (GP) size categories. Methods: We used weekly NHS App use data from the NHS App dashboard for 6386 GPs in England from March 2020 to June 2022. Negative binomial regression models explored variations in weekly rates of NHS App features used (registrations, log-ins, prescriptions ordered, medical record views, and appointments booked). Outcomes were measured as weekly rates per 1000 GP-registered patients, and we conducted separate models for each outcome. Regression models included all covariates mentioned above and produced incident rate ratios, which we present here as relative percentages for ease of interpretation. GP-level covariate data on sociodemographic variables were used as categorical variables in 5 groups for deprivation (Q1=least deprived practices and Q5=most deprived practices) and 4 groups for all other variables (Q1=least deprived practices and Q4=most deprived practices). Results: We found variations in the use of different features overall and across sociodemographic categories. Fully adjusted regression models found lower use of features overall in more deprived practices (eg, Q5 vs Q1: registrations=--34\%, log-ins=--34.9\%, appointments booked=--39.7\%, medical record views=--32.3\%, and prescriptions ordered=--9.9\%; P<.001). Practices with greater proportions of male patients also had lower levels of NHS App use (eg, Q4 vs Q1: registration=--7.1\%, log-in=--10.4\%, and appointments booked=--36.4\%; P<.001). Larger practices had an overall higher use of some NHS App features (eg, Q4 vs Q1: registration=3.2\%, log-ins=11.7\%, appointments booked=73.4\%, medical record views=23.9\%, and prescriptions ordered=20.7\%; P<.001), as well as those with greater proportions of White patients (eg, Q4 vs Q1: registration=1.9\%, log-ins=9.1\%, appointments booked=14.1\%, medical record views=28.7\%, and prescriptions ordered=130.4\%; P<.001). Use patterns varied for practices with greater proportions of patients with long-term health care needs (eg, Q4 vs Q1: registrations=--3.6\%, appointments booked=--20\%, and medical record views=6\%; P?.001). Conclusions: This study highlights that the use of the NHS App features varied across sociodemographic groups. In particular, it is used less by people living in more deprived areas. Tailored interventions and patient support are required to ensure that any benefits from the NHS App are spread equally throughout the population. ",
doi="10.2196/56320",
url="https://www.jmir.org/2024/1/e56320"
}


@Article{info:doi/10.2196/50497,
author="ten Klooster, Iris
and Kip, Hanneke
and Beyer, L. Sina
and van Gemert-Pijnen, C. Lisette J. E. W.
and Kelders, M. Saskia",
title="Clarifying the Concepts of Personalization and Tailoring of eHealth Technologies: Multimethod Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="13",
volume="26",
pages="e50497",
keywords="eHealth",
keywords="personalization",
keywords="tailoring",
keywords="segmentation",
keywords="adaptation",
keywords="interviews",
keywords="definition",
abstract="Background: Although personalization and tailoring have been identified as alternatives to a ``one-size-fits-all'' approach for eHealth technologies, there is no common understanding of these two concepts and how they should be applied. Objective: This study aims to describe (1) how tailoring and personalization are defined in the literature and by eHealth experts, and what the differences and similarities are; (2) what type of variables can be used to segment eHealth users into more homogeneous groups or at the individual level; (3) what elements of eHealth technologies are adapted to these segments; and (4) how the segments are matched with eHealth adaptations. Methods: We used a multimethod qualitative study design. To gain insights into the definitions of personalization and tailoring, definitions were collected from the literature and through interviews with eHealth experts. In addition, the interviews included questions about how users can be segmented and how eHealth can be adapted accordingly, and responses to 3 vignettes of examples of eHealth technologies, varying in personalization and tailoring strategies to elicit responses about views from stakeholders on how the two components were applied and matched in different contexts. Results: A total of 28 unique definitions of tailoring and 16 unique definitions of personalization were collected from the literature and interviews. The definitions of tailoring and personalization varied in their components, namely adaptation, individuals, user groups, preferences, symptoms, characteristics, context, behavior, content, identification, feedback, channel, design, computerization, and outcomes. During the interviews, participants mentioned 9 types of variables that can be used to segment eHealth users, namely demographics, preferences, health variables, psychological variables, behavioral variables, individual determinants, environmental information, intervention interaction, and technology variables. In total, 5 elements were mentioned that can be adapted to those segments, namely channeling, content, graphical, functionalities, and behavior change strategy. Participants mentioned substantiation methods and variable levels as two components for matching the segmentations with adaptations. Conclusions: Tailoring and personalization are multidimensional concepts, and variability and technology affordances seem to determine whether and how personalization and tailoring should be applied to eHealth technologies. On the basis of our findings, tailoring and personalization can be differentiated by the way that segmentations and adaptations are matched. Tailoring matches segmentations and adaptations based on general group characteristics using if-then algorithms, whereas personalization involves the direct insertion of user information (such as name) or adaptations based on individual-level inferences. We argue that future research should focus on how inferences can be made at the individual level to further develop the field of personalized eHealth. ",
doi="10.2196/50497",
url="https://www.jmir.org/2024/1/e50497"
}


@Article{info:doi/10.2196/54200,
author="Chen, Xing-Ling
and Li, Jin
and Sun, Shu-Ning
and Zhao, Qiang-Qiang
and Lin, Sheng-Rong
and Wang, Ling-Jun
and Yang, Zhong-Qi
and Ni, Shi-Hao
and Lu, Lu",
title="Association Between Daily Internet Use and Intrinsic Capacity Among Middle-Aged and Older Adults in China: Large Prospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="12",
volume="26",
pages="e54200",
keywords="daily internet use",
keywords="intrinsic capacity",
keywords="IC",
keywords="middle-aged and older adult",
keywords="healthy aging",
keywords="social participation",
abstract="Background: Intrinsic capacity (IC), as a comprehensive measure of an individual's functional ability, has gained prominence in the framework for healthy aging introduced by the World Health Organization (WHO). As internet usage continues to integrate into daily life, it is imperative to scrutinize the association between internet use and IC to effectively promote healthy aging among the middle-aged and older population. Objective: This study aimed to investigate whether daily internet use in middle-aged and older adults delays or accelerates the decline in IC. Methods: Participants included in the China Health and Retirement Longitudinal Study (CHARLS) comprised individuals aged ?45 years residing in China. We analyzed 4 years of CHARLS data from the first wave (May 2011-March 2012) to the third wave (July 2015-January 2016). Data from the first and third waves were used for longitudinal studies. Self-reported data encompassed internet use, frequency of use, and demographic baseline characteristics. In addition, the IC evaluation involved physical examination and blood test data. Initially, linear regression was used to assess the relationship between daily internet use and IC, followed by regression splines to explore potential nonlinear associations. Subgroup and sensitivity analyses were used to investigate the heterogeneity of IC in specific conditions and the robustness of our results. Mediation effect analysis was conducted to identify the factors that mediate the relationship between daily internet use and IC, focusing on social participation, physical activity, and health status. Results: Among the 12,826 participants included in the longitudinal analyses, 12,305 (95.9\%) did not use the internet, while 521 (4.1\%) reported daily internet use with a mean age of 52.62 (SD 7.67) years. After adjusting for demographic variables, socioeconomic factors, lifestyle behaviors, and health conditions and examining the impact of daily internet use and frequency on changes in IC, our findings indicated important associations. Specifically, daily internet use is significantly linked to a slower decline in IC over time (marginal effect 1.58, 95\% CI 1.03-2.12; P<.001). Individuals with moderate and regular internet use frequency exhibit higher levels of maintenance in IC (marginal effect 0.74, 95\% CI 0.45-1.03, P<.001). In addition, the relationship between IC changes and internet use frequency demonstrated a nonlinear inverted U-shaped curve (nonlinear P=.003). Subgroup analysis further revealed that improvements in IC vary based on age and gender. Furthermore, mediation analysis denoted that more than 28.78\% (95\% CI 21.24-40.33) of the observed association is mediated by social participation (P<.001). Conclusions: The findings of our research underscore the potential benefits of consistent and moderate internet use in promoting and preserving IC, particularly in cognitive capacity, sensory, vitality, and locomotion. The observed effects may be related to social participation. These insights offer valuable guidance for crafting strategies aimed at fostering healthy aging within the middle-aged and older adult demographics. ",
doi="10.2196/54200",
url="https://www.jmir.org/2024/1/e54200"
}


@Article{info:doi/10.2196/59395,
author="Uemura, Kosuke
and Miyagami, Taiju
and Saita, Mizue
and Uchida, Takuro
and Yuasa, Shun
and Kondo, Keita
and Miura, Shun
and Matsushita, Mizuki
and Shirai, Yuka
and Misawa, Baku Richard
and Naito, Toshio",
title="Trends in Exercise-Related Internet Search Keywords by Sex, Age, and Lifestyle: Infodemiological Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="11",
volume="8",
pages="e59395",
keywords="exercise prescriptions",
keywords="sex",
keywords="age",
keywords="lifestyle",
keywords="internet search keywords",
keywords="infodemiology",
keywords="demographic",
keywords="physical activity",
abstract="Background: Exercise prescription by physicians is beneficial for initiating or intensifying physical activity. However, providing specific exercise prescriptions is challenging; therefore, few physicians prescribe exercise. Objective: This infodemiological study aimed to understand trends in exercise-related internet search keywords based on sex, age, and environmental factors to help doctors prescribe exercise more easily. Methods: Search keyword volume was collected from Yahoo! JAPAN for 2022. Ten exercise-related terms were analyzed to assess exercise interest. Total search activities were analyzed by sex and age. Characteristic scores were based on the Japanese prefecture. By performing hierarchical cluster analysis, regional features were examined, and Kruskal-Wallis tests were used to assess relationships with population and industry data. Results: The top-searched term was ``Pilates'' (266,000 queries). Male individuals showed higher interest in activities such as ``running'' (25,400/40,700, 62.4\%), ``muscle training'' (65,800/111,000, 59.3\%), and ``hiking'' (23,400/40,400, 57.9\%) than female individuals. Female individuals exhibited higher interest in ``Pilates'' (199,000/266,000, 74.8\%), ``yoga'' (86,200/117,000, 73.7\%), and ``tai chi'' (45,300/65,900, 68.7\%) than male individuals. Based on age, search activity was highest in the 40-49 years age group for both male and female individuals across most terms. For male individuals, 7 of the 10 searched terms' volume peaked for those in their 40s; ``stretch'' was most popular among those in their 50s; and ``tai chi'' and ``radio calisthenics'' had the highest search volume for those in their 70s. Female individuals in their 40s led the search volume for 9 of the 10 terms, with the exception of ``tai chi,'' which peaked for those in their 70s. Hierarchical cluster analysis using a characteristic score as a variable classified prefectures into 4 clusters. The characteristics of these clusters were as follows: cluster 1 had the largest population and a thriving tertiary industry, and individuals tended to search for Pilates and yoga. Following cluster 1, cluster 2, with its substantial population, had a thriving secondary industry, with searches for radio calisthenics and exercise bike. Cluster 4 had a small population, a thriving primary industry, and the lowest search volume for any term. Cluster 3 had a similar population to that of cluster 4 but had a larger secondary industry. Conclusions: Male individuals show more interest in individual activities, such as running, whereas female individuals are interested in group activities, such as Pilates. Despite the high search volume among individuals in their 40s, actual exercise habits are low among those in their 30s to 50s. Search volumes for instructor-led exercises are higher in cluster 1 than in other cluster areas, and the total number of searches decreases as the community size decreases. These results suggest that trends in search behavior depending on sex, age, and environment factors are essential when prescribing exercise for effective behavioral change. ",
doi="10.2196/59395",
url="https://formative.jmir.org/2024/1/e59395"
}


@Article{info:doi/10.2196/63814,
author="Gordon, P. Nancy
and Yin, Chelsea
and Lo, C. Joan",
title="Examining Whether Patient Portal and Video Visit Use Differs by Race and Ethnicity Among Older Adults in a US Integrated Health Care Delivery System: Cross-Sectional Electronic Health Record and Survey-Based Study",
journal="JMIR Aging",
year="2024",
month="Nov",
day="7",
volume="7",
pages="e63814",
keywords="patient portal use",
keywords="video visit use",
keywords="older adults",
keywords="racial and ethnic differences",
keywords="telehealth",
keywords="mobile phone",
abstract="Background: Health care systems are increasingly encouraging patients to use patient portals and participate in video visits. However, there is limited information about how portal use differs among older adults. Objective: This study aimed to understand how patient portal and video visit use differed by age, race, and ethnicity among older adult patients with access to the same digital health resources. Methods: This cross-sectional study used electronic health record and survey data for  adults aged 65 to 85 years who were members of a large Northern California health care delivery system throughout 2019 and 2020. The electronic health record cohort (N=471,152) included 320,686 White, 35,892 Black, 44,922 Latino, 20,786 Chinese, 28,732 Filipino, 8473 South Asian, 6716 Japanese, 2930 Vietnamese, and 2015 Korean adults. Racial and ethnic group and age group (65 to 75 years vs 76 to 85 years) differences in having a patient portal account by December 2020, the performance of 2 portal activities (sending ?1 message to a clinician in 2019 or 2020 and viewing ?1 laboratory test result in 2020), and having ?1 video visit during 2020 were examined. Modified log-Poisson regression was used to examine prevalence ratios for portal and video visit use, comparing racial and ethnic groups to White adults and Asian ethnic groups to Chinese adults after adjusting for sex and age. Data from a 2020 member survey were used to compare internet use factors among 2867 White, 306 Black, 343 Latino, 225 Chinese, and 242 Filipino adults. Results: Black, Latino, and Filipino adults were less likely to have a patient portal account than White adults, and Filipino adults were less likely to have a patient portal account than Chinese adults. Black, Latino, Filipino, Korean, Vietnamese, and South Asian adults were less likely to have sent messages and viewed test results than White adults, while Chinese and Japanese adults' use of these features was similar to that of White adults. Filipino, Vietnamese, and Korean adults were less likely to have performed the aforementioned activities than Chinese adults. Video visit use was lower among Black and Latino adults and higher among Chinese and South Asian adults compared with White adults (aged 76 to 85 years) and lower among Filipino, Korean, and Vietnamese adults compared to Chinese adults. Survey data suggested that underlying differences in internet use may partially explain the lower use of messaging by Black, Latino, and Filipino adults compared with White and Chinese adults. Conclusions: Patient portal and video visit use differed by race, ethnicity, and age group among older adult patients with access to the same patient portal. Internet use factors may contribute to these differences. Differences in patient portal and video visit use across Asian subgroups underscore the importance of disaggregating use data by Asian ethnicity. ",
doi="10.2196/63814",
url="https://aging.jmir.org/2024/1/e63814"
}


@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/10.2196/59360,
author="Menschik, Christian
and Kunze, Christophe
and Renner, Gregor
and Etges, Theresa",
title="Mainstream Technologies in Facilities for People With Intellectual Disabilities: Multiple-Methods Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Framework",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Nov",
day="5",
volume="11",
pages="e59360",
keywords="intellectual disabilities",
keywords="mainstream technology",
keywords="technology adoption",
keywords="technology implementation",
keywords="NASSS",
keywords="digital competencies",
keywords="facility for people with disabilities",
keywords="mobile phone",
abstract="Background: People with intellectual disabilities in residential or outpatient facilities for people with disabilities run the risk of being digitally excluded by not having opportunities for taking advantage of digitalization possibilities. Objective: We aimed to investigate how disability caregivers and managers describe barriers and facilitating factors to implement and adopt mainstream technology for people with intellectual disabilities in residential or outpatient facilities and how the competencies and capabilities of the caregivers are assessed in the process. Methods: For this reason, we conducted a multiple-methods study applying the nonadoption, abandonment, scale-up, spread, and sustainability framework. Results: As a result, we identified barriers and facilitators across the nonadoption, abandonment, scale-up, spread, and sustainability framework domains: (1) condition---people with intellectual disabilities are a diverse group, where the individual condition of the person and, for example, their communication skills were seen as a prerequisite for implementing mainstream technologies; (2) technology---the extent to which mainstream technology fits the individual needs and demands contributed to the implementation process; (3) value proposition---communication was seen as a life area where mainstream technology can add value; (4) adopters---the caregivers needed competencies and capabilities to accompany their care recipients' technology use; (5) organization---missing legal regulations and lack of personnel resources were described as barriers; (6) wider context---funding opportunities were seen as unclear in disability services as mainstream technologies could not be financed as participation benefits; (7) embedding and adaptation over time---the COVID-19 pandemic forced facilities to become digitalized to some extent. Conclusions: The disability services investigated were still in need of standardized procedures to promote the digital participation of their residents. ",
doi="10.2196/59360",
url="https://rehab.jmir.org/2024/1/e59360"
}


@Article{info:doi/10.2196/57040,
author="Sakhuja, Mayank
and Yelton, Brooks
and Kavarana, Simone
and Schaurer, Lauren
and Rumthao, Rachel Jancham
and Noblet, Samuel
and Arent, A. Michelle
and Macauda, M. Mark
and Donelle, Lorie
and Friedman, B. Daniela",
title="How Do Scholars Conceptualize and Conduct Health and Digital Health Literacy Research? Survey of Federally Funded Scholars",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="31",
volume="26",
pages="e57040",
keywords="health literacy",
keywords="digital health literacy",
keywords="eHealth literacy",
keywords="social determinants of health",
keywords="SDoH",
keywords="research scholarship",
keywords="health care",
keywords="public health research",
keywords="digital health tools",
keywords="community health",
abstract="Background: The concept of health literacy (HL) is constantly evolving, and social determinants of health (SDoH) have been receiving considerable attention in public health scholarship. Since a 1-size-fits-all approach for HL fails to account for multiple contextual factors and as a result poses challenges in improving literacy levels, there is a need to develop a deeper understanding of the current state of HL and digital health literacy (DHL) research. Objective: This study examined scholars' conceptualization and scope of work focused on HL and DHL. Methods: Using a search string, investigators (N=2042) focusing on HL, DHL, or both were identified from the grantee websites of the National Institutes of Health RePORTER (RePORT Expenditures and Results) and the Canadian Institutes of Health Research. The investigators were emailed a survey via Qualtrics. Survey questions examined the focus of work; whether the investigators studied HL/DHL in combination with other SDoH; the frameworks, definitions, and approaches used; and research settings. We analyzed survey data using SPSS Statistics version 28 and descriptive analysis, including frequencies and percentages, was conducted. Chi-square tests were performed to explore the association between the focus of work, settings, and age groups included in the investigators' research. Results: A total of 193 (9.5\%) of 2042 investigators responded to the online survey. Most investigators (76/153, 49.7\%) were from public health, 83/193 (43\%) reported their research focused on HL alone, 46/193 (23.8\%) mentioned DHL, and 64/193 (33.2\%) mentioned both. The majority (133/153, 86.9\%) studied HL/DHL in combination with other SDoH, 106/135 (78.5\%) conducted HL/DHL work in a community setting, and 100/156 (64.1\%) reported not using any specific definition to guide their work. Digital tools (89/135, 65.9\%), plain-language materials (82/135, 60.7\%), and visual guides (56/135, 41.5\%) were the top 3 approaches used. Most worked with adults (131/139, 94.2\%) and all races and ethnicities (47/121, 38.8\%). Conclusions: HL and DHL research largely considered SDoH. Multiple HL tools and approaches were used that support the examination and improvement of literacy and communication surrounding health care issues. ",
doi="10.2196/57040",
url="https://www.jmir.org/2024/1/e57040"
}


@Article{info:doi/10.2196/58196,
author="Abhari, Shahabeddin
and McMurray, Josephine
and Randhawa, Tanveer
and Bin Noon, Gaya
and Hanjahanja-Phiri, Thokozani
and McNeil, Heather
and Manning, Fiona
and Debergue, Patricia
and Teague, Jennifer
and Pelegrini Morita, Plinio",
title="Exploring the Landscape of Standards and Guidelines in AgeTech Design and Development: Scoping Review and Thematic Analysis",
journal="JMIR Aging",
year="2024",
month="Oct",
day="31",
volume="7",
pages="e58196",
keywords="aging in place",
keywords="technology",
keywords="gerontechnology",
keywords="AgeTech",
keywords="assistive technology",
keywords="older adult",
keywords="aging",
keywords="ambient assisted living",
keywords="active assisted living",
abstract="Background: AgeTech (technology for older people) offers digital solutions for older adults supporting aging in place, including digital health, assistive technology, Internet of Things, medical devices, robotics, wearables, and sensors. This study underscores the critical role of standards and guidelines in ensuring the safety and effectiveness of these technologies for the health of older adults. As the aging demographic expands, the focus on robust standards becomes vital, reflecting a collective commitment to improving the overall quality of life for older individuals through thoughtful and secure technology integration. Objective: This scoping review aims to investigate the current state of standards and guidelines applied in AgeTech design and development as reported in academic literature. We explore the existing knowledge of these standards and guidelines and identify key gaps in the design and development of AgeTech guidelines and standards in scholarly publications. Methods: The literature review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Searches were carried out across multiple databases, including Scopus, IEEE, PubMed, Web of Science, EBSCO, CINAHL, Cochrane, and Google Scholar, using a search string incorporating concepts such as ``older people,'' ``technology,'' and ``standards or guidelines.'' Alternative terms, Boolean operators, and truncation were used for comprehensive coverage in each database. The synthesis of results and data analysis involved both quantitative and qualitative methods. Results: Initially, 736 documents were identified across various databases. After applying specific inclusion and exclusion criteria and a screening process, 58 documents were selected for full-text review. The findings highlight that the most frequently addressed aspect of AgeTech standards or guidelines is related to ``design and development,'' constituting 36\% (21/58) of the literature; ``usability and user experience'' was the second most prevalent aspect, accounting for 19\% (11/58) of the documents. In contrast, ``privacy and security'' (1/58, 2\%) and ``data quality'' (1/58, 2\%) were the least addressed aspects. Similarly, ``ethics,'' ``integration and interoperability,'' ``accessibility,'' and ``acceptance or adoption'' each accounted for 3\% (2/58) of the documents. In addition, a thematic analysis identified qualitative themes that warrant further exploration of variables. Conclusions: This study investigated the available knowledge regarding standards and guidelines in AgeTech design and development to evaluate their current status in academic literature. The substantial focus on assistive technologies and ambient assisted living technologies confirmed their vital role in AgeTech. The findings provide valuable insights for interested parties and point to prioritized areas for further development and research in the AgeTech domain. ",
doi="10.2196/58196",
url="https://aging.jmir.org/2024/1/e58196"
}


@Article{info:doi/10.2196/53491,
author="Robertson, Noah
and Syed, J. Maryam
and Song, Bowen
and Kaur, Arshdeep
and Patel, G. Janaki
and Marawar, Rohit
and Basha, Maysaa
and Zutshi, Deepti",
title="Self-Reported Patient and Provider Satisfaction With Neurology Telemedicine Visits After Rapid Telemedicine Implementation in an Urban Academic Center: Cross-Sectional Survey",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="30",
volume="8",
pages="e53491",
keywords="telemedicine",
keywords="telehealth",
keywords="neurology",
keywords="eHealth",
keywords="teleneurology",
keywords="patient experience",
keywords="patient satisfaction",
abstract="Background: Many clinics and health systems implemented telemedicine appointment services out of necessity due to the COVID-19 pandemic. Objective: Our objective was to evaluate patient and general provider satisfaction with neurology telemedicine implementation at an urban academic medical center. Methods: Patients who had completed 1 or more teleneurology visits from April 1 to December 31, 2020, were asked to complete a survey regarding their demographic information and satisfaction with teleneurology visits. Providers of all specialties within the same hospital system were given a different survey to gather their experiences of providing telemedicine care. Results: Of the estimated 1500 patients who had completed a teleneurology visit within the given timeframe, 117 (7.8\%) consented to complete the survey. Of these 117 respondents, most appointments were regarding epilepsy (n=59, 50.4\%), followed by multiple sclerosis (n=33, 28.2\%) and neuroimmunology (n=7, 6\%). Overall, 74.4\% (n=87) of patients rated their experience as 8 out of 10 or higher, with 10 being the highest satisfaction. Furthermore, 75.2\% (n=88) of patients reported missing an appointment in the previous year due to transportation issues and thought telemedicine was more convenient instead. A significant relationship between racial or ethnic group and comfort sharing private information was found (P<.001), with 52\% (26/50) of Black patients reporting that an office visit is better, compared to 25\% (14/52) of non-Black patients. The provider survey gathered 40 responses, with 75\% (n=30) of providers agreeing that virtual visits are a valuable tool for patient care and 80\% (n=32) reporting few to no technical issues. The majority of provider respondents were physicians on faculty or staff (n=21, 52\%), followed by residents or fellows (n=15, 38\%) and nurse practitioners or physician assistants (n=4, 10\%). Of the specialties represented, 15 (38\%) of the providers were in neurology. Conclusions: Our study found adequate satisfaction among patients and providers regarding telemedicine implementation and its utility for patient care in a diverse urban population. Additionally, while access to technology and technology literacy are barriers to telemedical care, a substantial majority of patients who responded to the survey had access to devices (101/117, 86.3\%) and were able to connect with few to no technological difficulties (84/117, 71.8\%). One area identified by patients in need of improvement was comfortability in communicating via telemedicine with their providers. Furthermore, while providers agreed that telemedicine is a useful tool for patient care, it limits their ability to perform physical exams. More research and quality studies are needed to further appreciate and support the expansion of telemedical care into underserved and rural populations, especially in the area of subspecialty neurological care. ",
doi="10.2196/53491",
url="https://formative.jmir.org/2024/1/e53491"
}


@Article{info:doi/10.2196/59811,
author="Jayamini, Darsha Widana Kankanamge
and Mirza, Farhaan
and Bidois-Putt, Marie-Claire
and Naeem, Asif M.
and Chan, Yan Amy Hai",
title="Perceptions Toward Using Artificial Intelligence and Technology for Asthma Attack Risk Prediction: Qualitative Exploration of M?ori Views",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="30",
volume="8",
pages="e59811",
keywords="asthma risk prediction",
keywords="artificial intelligence",
keywords="machine learning",
keywords="m?ori perceptions",
keywords="health system development",
keywords="mobile phone",
abstract="Background: Asthma is a significant global health issue, impacting over 500,000 individuals in New Zealand and disproportionately affecting M?ori communities in New Zealand, who experience worse asthma symptoms and attacks. Digital technologies, including artificial intelligence (AI) and machine learning (ML) models, are increasingly popular for asthma risk prediction. However, these AI models may underrepresent minority ethnic groups and introduce bias, potentially exacerbating disparities. Objective: This study aimed to explore the views and perceptions that M?ori have toward using AI and ML technologies for asthma self-management, identify key considerations for developing asthma attack risk prediction models, and ensure M?ori are represented in ML models without worsening existing health inequities. Methods: Semistructured interviews were conducted with 20 M?ori participants with asthma, 3 male and 17 female, aged 18-76 years. All the interviews were conducted one-on-one, except for 1 interview, which was conducted with 2 participants. Altogether, 10 web-based interviews were conducted, while the rest were kanohi ki te kanohi (face-to-face). A thematic analysis was conducted to identify the themes. Further, sentiment analysis was carried out to identify the sentiments using a pretrained Bidirectional Encoder Representations from Transformers model. Results: We identified four key themes: (1) concerns about AI use, (2) interest in using technology to support asthma, (3) desired characteristics of AI-based systems, and (4) experience with asthma management and opportunities for technology to improve care. AI was relatively unfamiliar to many participants, and some of them expressed concerns about whether AI technology could be trusted, kanohi ki te kanohi interaction, and inadequate knowledge of AI and technology. These concerns are exacerbated by the M?ori experience of colonization. Most of the participants were interested in using technology to support their asthma management, and we gained insights into user preferences regarding computer-based health care applications. Participants discussed their experiences, highlighting problems with health care quality and limited access to resources. They also mentioned the factors that trigger their asthma control level. Conclusions: The exploration revealed that there is a need for greater information about AI and technology for M?ori communities and a need to address trust issues relating to the use of technology. Expectations in relation to computer-based applications for health purposes were expressed. The research outcomes will inform future investigations on AI and technology to enhance the health of people with asthma, in particular those designed for Indigenous populations in New Zealand. ",
doi="10.2196/59811",
url="https://formative.jmir.org/2024/1/e59811"
}


@Article{info:doi/10.2196/55531,
author="Lee, Eun
and Kim, Heejun
and Esener, Yildiz
and McCall, Terika",
title="Internet-Based Social Connections of Black American College Students in Pre--COVID-19 and Peri--COVID-19 Pandemic Periods: Network Analysis",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="28",
volume="26",
pages="e55531",
keywords="COVID-19 pandemic",
keywords="college students",
keywords="Black American",
keywords="African American",
keywords="social network analysis",
keywords="social media",
keywords="mental health",
keywords="depression",
abstract="Background: A global-scale pandemic, such as the COVID-19 pandemic, greatly impacted communities of color. Moreover, physical distancing recommendations during the height of the COVID-19 pandemic negatively affected people's sense of social connection, especially among young individuals. More research is needed on the use of social media and communication about depression, with a specific focus on young Black Americans. Objective: This paper aims to examine whether there are any differences in social-networking characteristics before and during the pandemic periods (ie, pre--COVID-19 pandemic vs peri--COVID-19 pandemic) among the students of historically black colleges and universities (HBCUs). For the study, the researchers focus on the students who have posted a depression-related tweet or have retweeted such posts on their timeline and also those who have not made such tweets. This is done to understand the collective patterns of both groups. Methods: This paper analyzed the social networks on Twitter (currently known as X; X Corp) of HBCU students through comparing pre--COVID-19 and peri--COVID-19 pandemic data. The researchers quantified the structural properties, such as reciprocity, homophily, and communities, to test the differences in internet-based socializing patterns between the depression-related and non--depression related groups for the 2 periods. Results: During the COVID-19 pandemic period, the group with depression-related tweets saw an increase in internet-based friendships, with the average number of friends rising from 1194 (SD 528.14) to 1371 (SD 824.61; P<.001). Their mutual relationships strengthened (reciprocity: 0.78-0.8; P=.01), and they showed higher assortativity with other depression-related group members (0.6-0.7; P<.001). In a network with only HBCU students, internet-based and physical affiliation memberships aligned closely during the peri--COVID-19 pandemic period, with membership entropy decreasing from 1.0 to 0.5. While users without depression-related tweets engaged more on the internet with other users who shared physical affiliations, those who posted depression-related tweets maintained consistent entropy levels (modularity: 0.75-0.76). Compared with randomized networks before and during the COVID-19 pandemic (P<.001), the users also exhibited high homophily with other members who posted depression-related tweets. Conclusions: The findings of this study provided insight into the social media activities of HBCU students' social networks and communication about depression on social media. Future social media interventions focused on the mental health of Black college students may focus on providing resources to students who communicate about depression. Efforts aimed at providing relevant resources and information to internet-based communities that share institutional affiliation may enhance access to social support, particularly for those who may not proactively seek assistance. This approach may contribute to increased social support for individuals within these communities, especially those with a limited social capacity. ",
doi="10.2196/55531",
url="https://www.jmir.org/2024/1/e55531"
}


@Article{info:doi/10.2196/59153,
author="Tang, Yan
and Yang, Juan
and Wang, Ni
and Wang, Xin
and Hu, Wenli",
title="The Use of Mobile Health Care Among Medical Professionals in the Sichuan-Chongqing Region: Cross-Sectional Survey Study",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="24",
volume="11",
pages="e59153",
keywords="health care professionals",
keywords="mobile health care",
keywords="technical training",
keywords="cross-sectional survey",
keywords="utilization",
keywords="mobile",
keywords="usage",
keywords="China",
keywords="web-based questionnaire",
keywords="logistic regression",
keywords="training",
keywords="support",
abstract="Background: The emergence and integration of mobile health care technology have fundamentally transformed the health care industry, providing unprecedented opportunities to improve health care services and professional practice. Despite its immense potential, the adoption of mobile health care technology among health care professionals remains uneven, particularly in resource-limited regions. Objective: This study aims to explore the use and influencing factors of mobile health care among health care professionals in the Sichuan-Chongqing region of China and make recommendations. Methods: Convenience sampling was used in a cross-sectional study conducted from November 8 to November 14, 2023, to survey frontline clinical health care professionals at 5 district-level secondary public hospitals in the Sichuan-Chongqing region. A web-based questionnaire was used to investigate the use of mobile health care and its influencing factors among the participants. Descriptive analysis and logistic regression analysis were used in the study. Results: A total of 550 valid questionnaires were completed. Among the surveyed health care professionals, only 18.7\% (103/550) used mobile health care, with a satisfaction rate of only 50.5\% (52/103). Around 81.3\% (447/550) did not use any form of mobile health care. The age group of 30?39 years was found to be a significant factor influencing the use of mobile health care by health care professionals (P=.03). The main reasons for not using mobile health care among health care professionals were lack of appropriate technical training and support (266/447, 59.5\%), lack of suitable management-specific apps (204/447, 45.6\%), and concerns about increased workload (180/447, 40.3\%). There were significant differences in the single-factor analysis of the reasons for the nonuse of mobile health care among health care professionals from different specialties (P=.04). Logistic regression analysis indicated that age was the only significant factor influencing the use of mobile health care by health care professionals (P=.04). Conclusions: The utilization rate of mobile health care among health care professionals in the Sichuan-Chongqing region is low. Age is a significant factor that influences whether health care professionals use mobile health care. Providing appropriate technical training and support may help improve the enthusiasm of health care professionals in using mobile health care. ",
doi="10.2196/59153",
url="https://humanfactors.jmir.org/2024/1/e59153"
}


@Article{info:doi/10.2196/60056,
author="Rousaki, Anastasia
and Zamani, D. Efpraxia
and Sbaffi, Laura
and Hamblin, Kate
and Black, Rachael",
title="The Digitalization of Social Care in England and Implications for Older, Unpaid Carers: Constructionist Thematic Analysis",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="24",
volume="26",
pages="e60056",
keywords="social care",
keywords="England",
keywords="digitalization",
keywords="digital transformation",
keywords="unpaid care",
keywords="mobile phone",
abstract="Background: Globally, populations are aging, generating concerns about the sustainability of health and social care provision. In terms of the public provision of social care in particular, unpaid carers provide much of the support to people with disabilities and older people. In addition, there is an increased onus in many countries on digital transformation projects, in the hope that the digitalization of services can create efficiencies and savings in both costs and care labor. In England, the focus of this paper, the shift to digital services is also framed as a means to enhance choice and control for older unpaid carers, while being part of a broader offering that includes nondigital alternatives and support to mitigate digital exclusion. Objective: This study examines the impact of digitalization on older, unpaid carers---a group more likely to be both expected to engage digitally with services and at risk of digital exclusion---in England, focusing on their lived experiences in terms of caring and access to social care. Methods: We used a constructionist approach to thematic analysis, where data from 48 older unpaid carers collected through focus groups were analyzed using thematic analysis, resulting in 4 prevailing themes. Results: Our findings indicated that while unpaid carers largely acknowledge the benefits of digitalization, they also highlight several points of failure, whereby engagement with digital spaces is experienced as coercive and exacerbates feelings of exclusion. These are further worsened by government failures to address issues of connectivity, imposing additional financial burdens and complicating tasks such as benefit applications. Conclusions: In this study, we have highlighted the need for greater involvement in shaping both policy and technological solutions, which in turn will be more inclusive and aligned to the aspirations and circumstances of older carers. ",
doi="10.2196/60056",
url="https://www.jmir.org/2024/1/e60056"
}


@Article{info:doi/10.2196/57338,
author="Ramasawmy, Mel
and Roland Persson, Dan
and Sunkersing, David
and Gill, Paramjit
and Khunti, Kamlesh
and Poole, Lydia
and Hanif, Wasim
and Blandford, Ann
and Sajid, Madiha
and Stevenson, Fiona
and Khan, Nushrat
and Banerjee, Amitava",
title="Uptake of Digital Health Interventions for Cardiometabolic Disease in British South Asian Individuals: Think Aloud Study",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="24",
volume="11",
pages="e57338",
keywords="digital health",
keywords="cardiometabolic disease",
keywords="cardiology",
keywords="cardiovascular risk",
keywords="health inequality",
keywords="health disparity",
keywords="usability",
keywords="user experience",
keywords="think aloud",
keywords="cultural barriers",
keywords="digital divide",
keywords="digital literacy",
abstract="Background: Digital health interventions (DHIs) could support prevention and management of cardiometabolic disease. However, those who may benefit most often experience barriers to awareness and adoption of these interventions. Objective: Among South Asian individuals, we evaluated user experience of DHIs for prevention and management of cardiometabolic disease, aiming to understand barriers and facilitators to initial and ongoing use. Methods: Among South Asian individuals recruited via primary care, community organizations, and snowball methods (n=18), we conducted ``think-aloud'' interviews using a reflective and reactive approach. Participants included nonusers, as well as those that used a range of DHIs as part of monitoring and improving their health. Participants were asked to think aloud while completing a task they routinely do in a familiar DHI, as well as while setting up and completing a search task in a novel DHI; they were encouraged to behave as if unobserved. Results: Lack of cultural specificity was highlighted as reducing relevance and usability, particularly relating to dietary change. Preferred features reflected individual health beliefs and behaviors, digital skills, and trust in DHIs. For example, tracking blood glucose was considered by some to be positive, while for others it caused distress and anxiety. Similarly, some users found the novel DHI to be extremely simple to set up and use, and others grew frustrated navigating through initial interfaces. Many participants raised concerns about data privacy and needing to agree to terms and conditions that they did not understand. Participants expressed that with information and support from trusted sources, they would be interested in using DHIs as part of self-management. Conclusions: DHIs may support South Asians to prevent and manage cardiometabolic disease, but it is important to consider the needs of specific user groups in DHI development, design, and implementation. Despite motivation to make health changes, digital barriers are common. Cultural appropriateness and trusted sources (such as health care providers and community organizations) have roles in increasing awareness and enabling individuals to access and use DHIs. ",
doi="10.2196/57338",
url="https://humanfactors.jmir.org/2024/1/e57338"
}


@Article{info:doi/10.2196/51291,
author="Zhou, Weijiao
and Shang, Shaomei
and Cho, Youmin",
title="Associations of Wearable Activity Tracker Use With Physical Activity and Health Outcomes in Patients With Cancer: Findings from a Population-Based Survey Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="22",
volume="26",
pages="e51291",
keywords="physical activity",
keywords="exercise",
keywords="wearable tracker",
keywords="wearable device",
keywords="cancer",
keywords="oncology",
keywords="cancer survivorship",
keywords="wearable",
keywords="wearables",
keywords="tracker",
keywords="trackers",
keywords="health outcome",
keywords="health outcomes",
keywords="HINTS",
keywords="survey",
keywords="surveys",
keywords="national",
keywords="bivariate",
keywords="epidemiology",
keywords="epidemiological",
keywords="association",
keywords="associations",
abstract="Background: Physical inactivity is a global issue for cancer survivors. Wearable activity trackers are promising to address physical inactivity by providing real-time feedback on physical activity and offering opportunities for self-monitoring and goal setting. Meta-analysis has reported the effects of interventions that incorporate wearable activity trackers on improved physical inactivity and related health outcomes (eg, BMI, anxiety and depression, and self-rated health status). However, wearable activity trackers were often used as an adjunct to physical activity interventions, and the effectiveness of wearable activity trackers alone is unknown. Objective: This study aims to determine the association of wearable activity trackers with physical activity and health outcomes in patients with cancer. Methods: Data from 957 cancer survivors from the Health Information National Trends Survey--Surveillance, Epidemiology, and End Results (HINTS-SEER) were analyzed. The outcome variables examined were time spent in moderate to vigorous physical activity, weekly frequency of strength training, BMI, anxiety and depression levels, and self-assessed health status. The primary independent variable was whether cancer survivors had used wearable activity trackers within the past 12 months. Design-based linear regression for continuous outcome variables and ordinal logistic regression for ordinal outcome variables were conducted to determine the associations after controlling for sociodemographic, cancer-related, and health-related factors. All data analyses accounted for the complex survey design and sample weights. Results: Only 29\% of cancer survivors reported wearable activity tracker use. Bivariate analyses showed that younger age (P<.001), higher education (P=.04), higher income (P<.001), and an employed status (P<.001) were significantly associated with wearable activity tracker use. Wearable activity tracker use was significantly associated with higher time spent in moderate to vigorous physical activity (adjusted =37.94, 95\% CI 8.38-67.5; P=.01), more frequent strength training per week (adjusted odds ratio [OR] 1.50, 95\% CI 1.09-2.06; P=.01), and better self-rated health status (adjusted OR 1.58, 95\% CI 1.09-2.29; P=.01), but not with BMI or anxiety and depression. Conclusions: This study suggests that the uptake of wearable activity trackers is low and highlights the digital divide among patients with cancer. This study has confirmed the associations of wearable activity tracker use with physical activity and self-rated health, supporting using wearable activity trackers as a promising tool to facilitate physical activity promotion. ",
doi="10.2196/51291",
url="https://www.jmir.org/2024/1/e51291",
url="http://www.ncbi.nlm.nih.gov/pubmed/39436693"
}


@Article{info:doi/10.2196/54223,
author="Sabben, Ga{\"e}lle
and Telfort, Courtney
and Morales, Marissa
and Zhang, Stella Wenjia
and Espinoza, C. Juan
and Pasquel, J. Francisco
and Winskell, Kate",
title="Technology and Continuous Glucose Monitoring Access, Literacy, and Use Among Patients at the Diabetes Center of an Inner-City Safety-Net Hospital: Mixed Methods Study",
journal="JMIR Diabetes",
year="2024",
month="Oct",
day="15",
volume="9",
pages="e54223",
keywords="diabetes mellitus",
keywords="type 1",
keywords="type 2",
keywords="digital health",
keywords="continuous glucose monitoring",
keywords="mobile phone",
abstract="Background: Despite the existence of an increasing array of digital technologies and tools for diabetes management, there are disparities in access to and uptake and use of continuous glucose monitoring (CGM) devices, particularly for those most at risk of poor diabetes outcomes. Objective: This study aims to assess communication technology and CGM access, literacy, and use among patients receiving treatment for diabetes at an inner-city safety-net hospital. Methods: A survey on digital technology ownership and use was self-administered by 75 adults with type 1 and type 2 diabetes at the diabetes clinic of Grady Memorial Hospital in Atlanta, Georgia. In-depth interviews were conducted with 16\% (12/75) of these patient participants and 6 health care providers (HCPs) to obtain additional insights into the use of communication technology and CGM to support diabetes self-management. Results: Most participants were African American (66/75, 88\%), over half (39/75, 52\%) were unemployed or working part time, and 29\% (22/75) had no health insurance coverage, while 61\% (46/75) had federal coverage. Smartphone ownership and use were near universal; texting and email use were common (63/75, 84\% in both cases). Ownership and use of tablets and computers and use and daily use of various forms of media were more prevalent among younger participants and those with type 1 diabetes, who also rated them as easier to use. Technology use specifically for diabetes and health management was low. Participants were supportive of a potential smartphone app for diabetes management, with a high interest in such an app helping them track blood sugar levels and communicate with their care teams. Younger participants showed higher levels of interest, perceived value, and self-efficacy for using an app with these capabilities. History of CGM use was reported by 56\% (42/75) of the participants, although half (20/42, 48\%) had discontinued use, above all due to the cost of the device and issues with its adhesive. Nonuse was primarily due to not being offered CGM by their HCP. Reasons given for continued use included convenience, improved blood glucose control, and better tracking of blood glucose. The in-depth interviews (n=18) revealed high levels of satisfaction with CGM by users and supported the survey findings regarding reasons for continued use. They also highlighted the value of CGM data to enhance communication between patients and HCPs. Conclusions: Smartphone ownership was near universal among patients receiving care at an inner-city hospital. Alongside the need to address barriers to CGM access and continued use, there is an opportunity to leverage increased access to communication technology in combination with CGM to improve diabetes outcomes among underresourced populations. ",
doi="10.2196/54223",
url="https://diabetes.jmir.org/2024/1/e54223"
}


@Article{info:doi/10.2196/50748,
author="Hichborn, Emily
and Turner, Avery
and Moore, Sarah
and Gauthier, Phoebe
and Bell, Kathleen
and Montgomery, LaTrice
and Boggis, Jesse
and Lambert-Harris, Chantal
and Saunders, Elizabeth
and Dallery, Jesse
and McLeman, Bethany
and Marsch, Lisa",
title="Technology-Based Interventions in Tobacco Use Treatment Among People Who Identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="10",
volume="26",
pages="e50748",
keywords="health disparities",
keywords="underrepresented",
keywords="social determinants of health",
keywords="tobacco use",
keywords="technology-based interventions",
keywords="scoping review",
keywords="mobile phone",
abstract="Background: Although tobacco use has significantly declined in the general population, traditional tobacco use treatment uptake and success rates remain disproportionately low among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. Technology-based interventions (TBIs) for tobacco use are promising alternatives to traditional tobacco use treatments. Objective: This scoping review aims to investigate the extent to which the use of digital TBIs in tobacco use treatment research promotes health equity among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. Methods: This scoping review identifies US-based studies (between January 2000 and March 2021) that enlist TBIs for tobacco use treatment and include people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native at ?50\% of the sample when combined; features studies that are also race and ethnicity conscious; and highlights health equity--promoting insights from included studies. Results: In 85\% (22/26) of the studies, the largest proportion of the sample was African American/Black, most participants had low socioeconomic status, and recruitment was most commonly from medical settings. In total, 58\% (15/26) of the studies were race and ethnicity conscious, and 67\% (10/15) of these studies sought to partner with potential end users. An array of TBIs were represented; however, SMS text messaging was most prevalent. Most TBIs were combined with other evidence-based intervention components (eg, nicotine replacement therapy). Approximately one-third of the studies (8/26, 31\%) required participants to have their own device or internet access. The majority were underpowered to detect substantial differences. Conclusions: The modest number of studies, particularly for persons who identify as Hispanic/Latina/o and American Indian/Alaska Native, demonstrates the limited application of TBIs for tobacco use and that additional research is needed to determine the extent to which TBIs for tobacco use promote health equity among these populations. International Registered Report Identifier (IRRID): RR2-10.2196/34508 ",
doi="10.2196/50748",
url="https://www.jmir.org/2024/1/e50748"
}


@Article{info:doi/10.2196/58035,
author="Bober, Timothy
and Rollman, L. Bruce
and Handler, Steven
and Watson, Andrew
and Nelson, A. Lyndsay
and Faieta, Julie
and Rosland, Ann-Marie",
title="Digital Health Readiness: Making Digital Health Care More Inclusive",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Oct",
day="9",
volume="12",
pages="e58035",
keywords="digital health",
keywords="digital health literacy",
keywords="informatics",
keywords="digital disparities",
keywords="digital health readiness",
keywords="inclusivity",
keywords="digital health tool",
keywords="literacy",
keywords="patient support",
keywords="health system",
doi="10.2196/58035",
url="https://mhealth.jmir.org/2024/1/e58035"
}


@Article{info:doi/10.2196/57801,
author="Donawa, Alyssa
and Powell, Christian
and Wang, Rong
and Chih, Ming-Yuan
and Patel, Reema
and Zinner, Ralph
and Aronoff-Spencer, Eliah
and Baker, E. Corey",
title="Designing Survey-Based Mobile Interfaces for Rural Patients With Cancer Using Apple's ResearchKit and CareKit: Usability Study",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="26",
volume="8",
pages="e57801",
keywords="usability",
keywords="usability testing",
keywords="digital literacy",
keywords="ehealth literacy",
keywords="digital divide",
keywords="mobile health",
keywords="mHealth",
keywords="patients with cancer",
keywords="rural health",
keywords="distress",
keywords="apps",
keywords="ehealth adoption",
keywords="HealthKit",
keywords="CareKit",
abstract="Background: Despite the increased accessibility and availability of technology in recent years, equality and access to health-related technology remain limited to some demographics. In particular, patients who are older or from rural communities represent a large segment of people who are currently underusing mobile health (mHealth) solutions. System usability continues to hinder mHealth adoption among users with nontraditional digital literacy. Objective: This study aims to investigate if state-of-the-art mobile app interfaces from open-source libraries provide sufficient usability for rural patients with cancer, with minimal design changes and forgoing the co-design process. Methods: We developed Assuage (Network Reconnaissance Lab) as a research platform for any mHealth study. We conducted a pilot study using Assuage to assess the usability of 4 mobile user interfaces (UIs) based on open-source libraries from Apple's ResearchKit and CareKit. These UIs varied in complexity for reporting distress symptoms. Patients with cancer were recruited at the Markey Cancer Center, and all research procedures were conducted in person. Participants completed the distress assessment using a randomly selected UI in Assuage with little to no assistance. Data were collected on participant age, location, mobile app use, and familiarity with mHealth apps. Participants rated usability with the System Usability Scale (SUS), and usability issues were documented and compared. A one-way ANOVA was used to compare the effect of the UIs on the SUS scores. Results: We recruited 30 current or postsurgery patients with cancer for this pilot study. Most participants were aged >50 years (24/30, 80\%), from rural areas (25/30, 83\%), had up to a high school education (19/30, 63\%), and were unfamiliar with mHealth apps (21/30, 70\%). General mobile app use was split, with 43\% (14/30) of the patients not regularly using mobile apps. The mean SUS score across the UIs was 75.8 (SD 22.2), with UI 3 and UI 4 achieving an SUS score ?80, meeting the industry standard for good usability of 80. Critical usability issues were related to data input and navigation with touch devices, such as scale-format questions, vertical scrolling, and traversing multiple screens. Conclusions: The findings from this study show that most patients with cancer (20/30, 67\%) who participated in this study rated the different interfaces of Assuage as above-average usability (SUS score >68). This suggests that Apple's ResearchKit and CareKit libraries can provide usable UIs for older and rural users with minimal interface alterations. When resources are limited, the design stage can be simplified by omitting the co-design process while preserving suitable usability for users with nontraditional technical proficiency. Usability comparable to industry standards can be achieved by considering heuristics for interface and electronic survey design, specifically how to segment and navigate surveys, present important interface elements, and signal gestural interactions. ",
doi="10.2196/57801",
url="https://formative.jmir.org/2024/1/e57801"
}


@Article{info:doi/10.2196/53224,
author="Savage, C. Leah
and Soto-Cossio, Estefhany Luz
and Minardi, Francesca
and Beyrouty, Matthew
and Schoonover, Julie
and Musella, Jay
and Frazier, Michaela
and Villagra, N. Cristina
and Sly, R. Jamilia
and Erblich, Joel
and Itzkowitz, H. Steven
and Jandorf, H. Lina
and Calman, S. Neil
and Atreja, Ashish
and Miller, J. Sarah",
title="The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="25",
volume="8",
pages="e53224",
keywords="digital navigation",
keywords="digital health",
keywords="Federally Qualified Health Center",
keywords="colorectal cancer",
keywords="cancer screening",
keywords="mobile phone",
abstract="Background: Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. Objective: This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. Methods: We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a ``think aloud'' exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website's acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. Results: Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website's content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. Conclusions: Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool's usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs. ",
doi="10.2196/53224",
url="https://formative.jmir.org/2024/1/e53224"
}


@Article{info:doi/10.2196/52345,
author="Daneshvar, Hadi
and Carver, Hannah
and Strachan, Graeme
and Greenhalgh, Jessica
and Matheson, Catriona",
title="From Digital Inclusion to Digital Transformation in the Prevention of Drug-Related Deaths in Scotland: Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="24",
volume="26",
pages="e52345",
keywords="digital inclusion",
keywords="digital transformation",
keywords="digital health",
keywords="drug-related death",
keywords="digitalization",
keywords="drug overdose",
keywords="drug overdose death",
keywords="harm reduction",
keywords="mobile phone",
keywords="digital divide",
abstract="Background: Globally, drug-related deaths (DRDs) are increasing, posing a significant challenge. Scotland has the highest DRD rate in Europe and one of the highest globally. The Scottish Government launched the Digital Lifelines Scotland (DLS) program to increase the provision of digital technology in harm reduction services and other support services. Digital technology responses to DRDs can include education through digital platforms, improved access to treatment and support via telehealth and mobile apps, analysis of data to identify risk factors, and the use of digital tools for naloxone distribution. However, digital technology should be integrated into a comprehensive approach that increases access to services and addresses underlying causes. Digital transformation could enhance harm reduction service and support, but challenges must be addressed for successful implementation. The DLS program aims to enhance digital inclusion and improve health outcomes for people who use or are affected by drug use to reduce the risk of DRDs. Objective: This study aims to explore the role of digital technology as an enabler and supporter in enhancing existing services and innovating new solutions, rather than being a stand-alone solution. Specifically focusing on individuals who use drugs, the research investigates the potential of digital inclusion and technology provision for preventing DRDs within the context of the DLS program. Methods: Semistructured interviews were conducted with 47 people: 21 (45\%) service users, 14 (30\%) service providers, and 12 (26\%) program staff who were all involved in DLS. Interviews were audio recorded, transcribed, and then coded. Analysis was done in three phases: (1) thematic analysis of interview data to identify the benefits of digital technologies in this sector; (2) identification of the challenges and enablers of using digital technologies using the Technology, People, Organizations, and Macroenvironment conceptual framework; and (3) mapping digital technology provision to services offered to understand the extent of digital transformation of the field. Results: Participants identified increased connectivity, enhanced access to services, and improved well-being as key benefits. Digital devices facilitated social connections, alleviated loneliness, and fostered a sense of community. Devices enabled engagement with services and support workers, providing better access to resources. In addition, digital technology was perceived as a preventive measure to reduce harmful drug use. Lack of technical knowledge, organizational constraints, and usability challenges, including device preferences and security issues, were identified. Conclusions: The study found that digital inclusion through the provision of devices and connections has the potential to enhance support in the harm reduction sector. However, it highlighted the limitations of existing digital inclusion programs in achieving comprehensive digital transformation. To progress, there is a need for sustained engagement, cultural change, and economic considerations to overcome barriers. ",
doi="10.2196/52345",
url="https://www.jmir.org/2024/1/e52345"
}


@Article{info:doi/10.2196/59191,
author="Delaney, Tessa
and Jackson, K. Jacklyn
and Brown, L. Alison
and Lecathelinais, Christophe
and Wolfenden, Luke
and Hudson, Nayerra
and Young, Sarah
and Groombridge, Daniel
and Pinfold, Jessica
and Craven, David Paul
and Redman, Sinead
and Wiggers, John
and Kingsland, Melanie
and Hayes, Margaret
and Sutherland, Rachel",
title="Perceived Acceptability of Technology Modalities for the Provision of Universal Child and Family Health Nursing Support in the First 6-8 Months After Birth: Cross-Sectional Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Sep",
day="24",
volume="7",
pages="e59191",
keywords="maternal",
keywords="postnatal",
keywords="postpartum",
keywords="acceptability",
keywords="technology",
keywords="digital health",
keywords="first 2000 days",
keywords="child health",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="acceptance",
keywords="cross sectional",
keywords="survey",
keywords="surveys",
keywords="questionnaire",
keywords="questionnaires",
keywords="pediatric",
keywords="pediatrics",
keywords="infant",
keywords="infants",
keywords="infancy",
keywords="baby",
keywords="babies",
keywords="neonate",
keywords="neonates",
keywords="neonatal",
keywords="newborn",
keywords="newborns",
keywords="nurse",
keywords="nurses",
keywords="nursing",
abstract="Background: Child and Family Health Nursing (CFHN) services provide universal care to families during the first 2000 days (conception: 5 years) to support optimal health and developmental outcomes of children in New South Wales, Australia. The use of technology represents a promising means to encourage family engagement with CFHN services and enable universal access to evidenced-based age and stage information. Currently, there is little evidence exploring the acceptability of various models of technology-based support provided during the first 2000 days, as well as the maternal characteristics that may influence this. Objective: This study aims to describe (1) the acceptability of technology-based models of CFHN support to families in the first 6 months, and (2) the association between the acceptability of technology-based support and maternal characteristics. Methods: A cross-sectional survey was undertaken between September and November 2021 with women who were 6-8 months post partum within the Hunter New England Local Health District of New South Wales, Australia. Survey questions collected information on maternal demographics and pregnancy characteristics, perceived stress, access to CFHN services, as well as preferences and acceptability of technology-based support. Descriptive statistics were used to describe the characteristics of the sample, the proportion of women accessing CFHN services, maternal acceptability of technology-based support from CFHN services, and the appropriateness of timing of support. Multivariable logistic regression models were conducted to assess the association between maternal characteristics and the acceptability of technology-based CFHN support. Results: A total of 365 women participated in the study, most were 25 to 34 years old (n=242, 68\%), had completed tertiary level education or higher (n=250, 71\%), and were employed or on maternity leave (n=280, 78\%). Almost all (n=305, 89\%) women reported accessing CFHN services in the first 6 months following their child's birth. The majority of women (n=282-315, 82\%-92\%) ``strongly agreed or agreed'' that receiving information from CFHN via technology would be acceptable, and most (n=308) women ``strongly agreed or agreed'' with being provided information on a variety of relevant health topics. Acceptability of receiving information via websites was significantly associated with maternal employment status (P=.01). The acceptability of receiving support via telephone and email was significantly associated with maternal education level (adjusted odds ratio 2.64, 95\% CI 1.07-6.51; P=.03 and adjusted odds ratio 2.90, 95\% CI 1.20-7.00; P=.02, respectively). Maternal age was also associated with the acceptability of email support (P=.04). Conclusions: Technology-based CFHN support is generally acceptable to mothers. Maternal characteristics, including employment status, education level, and age, were found to modify the acceptability of specific technology modalities. The findings of this research should be considered when designing technology-based solutions to providing universal age and stage child health and developmental support for families during the first 2000 days. ",
doi="10.2196/59191",
url="https://pediatrics.jmir.org/2024/1/e59191",
url="http://www.ncbi.nlm.nih.gov/pubmed/39316424"
}


@Article{info:doi/10.2196/52670,
author="Martin, Kevin
and Peh, Chun Rachel Wei
and Tembo, Mandikudza
and Mavodza, Vimbayi Constancia
and Doyle, M. Aoife
and Dziva Chikwari, Chido
and Dauya, Ethel
and Bandason, Tsitsi
and Azizi, Steven
and Simms, Victoria
and Ferrand, A. Rashida",
title="Factors Associated With the Use of Digital Technology Among Youth in Zimbabwe: Findings From a Cross-Sectional Population-Based Survey",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="23",
volume="26",
pages="e52670",
keywords="Zimbabwe",
keywords="youth",
keywords="digital technology",
keywords="household wealth",
abstract="Background: Globally, the increasing use of digital technologies such as mobile phones and the internet has allowed for the development of innovative mobile health interventions, particularly for reaching and engaging with youth. However, there is a risk that using such technologies may exclude those who lack access to them. Objective: In this study, we investigated the sociodemographic factors associated with mobile phone ownership, internet use, and social media use among youth in Zimbabwe. Methods: A population-based prevalence survey was conducted in 24 urban and periurban communities across 3 provinces of Zimbabwe (Harare, Mashonaland East, and Bulawayo). Youths aged 18 to 24 years resident in randomly selected households in the study communities completed an interviewer-administered questionnaire. The primary outcomes were mobile phone ownership and current internet and social media use. A household wealth indicator was developed using principal components analysis, based on household asset ownership. Multivariable logistic regression was used to investigate the factors associated with each primary outcome. Age, sex, and province were considered a priori confounders. Household wealth, marital status, education level, employment status, time lived at current address, and HIV status were included in the final multivariable model if there was an age-, sex-, and province-adjusted association with a primary outcome on univariable analysis at a significance level of P<.10. Results: Of the 17,636 participants assessed for the primary outcome, 16,370 (92.82\%) had access to a mobile phone, and 15,454 (87.63\%) owned a mobile phone. Among participants with access to a mobile phone, 58.61\% (9594/16,370) and 57.79\% (9460/16,370), respectively, used internet and social media at least weekly. Older age (adjusted odds ratio [aOR] 1.76, 95\% CI 1.55-2.00), increasing wealth (ranging from aOR 1.85, 95\% CI 1.58-2.16, for wealth quintile 2 to aOR 3.80, 95\% CI 3.00-4.80, for wealth quintile 5, with quintile 1 as reference), and higher education level (secondary: aOR 1.96, 95\% CI 1.60-2.39; tertiary: aOR 8.36, 95\% CI 5.29-13.20) were associated with mobile phone ownership. Older age, male sex, increasing wealth, having never been married, higher education level, being in education or formal employment, and having lived at the same address for ?2 years were associated with higher levels of internet and social media use. Conclusions: While mobile phone ownership was near-universal, over one-third of youths in urban and periurban settings did not have access to the internet and social media. Access to the internet and social media use were strongly associated with household wealth and education level. Mobile health interventions must ensure that they do not amplify existing inequalities in access to health care. Such interventions must be accompanied by alternative strategies to engage and enroll individuals without internet or social media access to prevent the exclusion of young people by sex and socioeconomic status. ",
doi="10.2196/52670",
url="https://www.jmir.org/2024/1/e52670",
url="http://www.ncbi.nlm.nih.gov/pubmed/39312390"
}


@Article{info:doi/10.2196/53384,
author="Tajika, Atsuko
and Nakagomi, Atsushi
and Miyaguni, Yasuhiro
and Koga, Chie
and Kondo, Katsunori
and Ojima, Toshiyuki",
title="Internet Use and Higher-Level Functional Capacity Decline Suppression in Japanese Older Adults With Low Education: JAGES 2016-2019 Longitudinal Study",
journal="JMIR Aging",
year="2024",
month="Sep",
day="20",
volume="7",
pages="e53384",
keywords="functional capacity",
keywords="instrumental activities of daily living",
keywords="older adults' cognitive engagement",
keywords="older adults' social role",
keywords="internet impact on seniors",
keywords="educational attainment",
keywords="low education",
keywords="independent living",
keywords="older adults",
keywords="health disparities",
abstract="Background: Higher-level functional capacity (HLFC) is crucial for the independent living of older adults. While internet use positively impacts the health of older adults, its effect on HLFC and how this effect varies with educational attainment remains uncertain. Objective: This longitudinal study aimed to investigate whether internet use could mitigate the risk of HLFC decline and if this benefit extends to older adults with lower levels of education. Methods: The data were sourced from the Japan Gerontological Evaluation Study (JAGES), encompassing 8050 community-dwelling adults aged 65 years and older from 2016 to 2019. The study focused on those who remained self-sufficient from 2016 to 2019, identifying participants with independent HLFC in 2016. The Tokyo Metropolitan Institute of Gerontology Index of Competence defined HLFC operationally, consisting of 3 subscales, namely instrumental activities of daily living, intellectual activity, and social role. The primary variable was the frequency of internet use in 2016; participants who reported using the internet were classified as internet users, while those who answered ``No'' were identified as nonusers. The study compared the effects of internet use on HLFC decline across educational levels of ?9 years, 10-12 years, and ?13 years using Poisson regression analysis adjusted for robust SE to calculate the risk ratio (RR) and 95\% CI for HLFC decline in 2019. Results: After adjusting for demographic and health condition risk factors, internet use was significantly linked to a decreased risk of HLFC decline in older adults over 3 years, including those with lower educational levels. Internet users with ?9 years of educational attainment experienced a suppressed decline in the total score (RR 0.57, 95\% CI 0.43-0.76; P<.001); instrumental activities of daily living (RR 0.58, 95\% CI 0.38-0.91; P=.02), intellectual activity (RR 0.60, 95\% CI 0.41-0.89; P=.01), and social role (RR 0.74, 95\% CI 0.56-0.97; P=.03) compared with nonusers. Participants with 10-12 years of education showed suppression rates of 0.78 (95\% CI 0.63-0.98; P=.03), 0.59 (95\% CI 0.39-0.90; P=.01), 0.91 (95\% CI 0.63-1.31; P=.61), and 0.82 (95\% CI 0.68-1.00; P=.05), respectively, and those with ?13 years displayed suppression rates of 0.65 (95\% CI 0.51-0.85; P=.001), 0.55 (95\% CI 0.36-0.83; P=.01), 0.64 (95\% CI 0.37-1.10; P=.11), and 0.83 (95\% CI 0.64-1.08; P=.17), respectively. Conclusions: These findings indicate that internet use supports the maintenance of HLFC independence in older adults with higher education and those with lower educational levels. Encouraging internet use among older adults with lower levels of education through future policies could help narrow functional health disparities associated with educational attainment. ",
doi="10.2196/53384",
url="https://aging.jmir.org/2024/1/e53384"
}


@Article{info:doi/10.2196/48654,
author="Wang, Ning
and Zhou, Siyu
and Liu, Zhuo
and Han, Ying",
title="Perceptions and Satisfaction With the Use of Digital Medical Services in Urban Older Adults of China: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="20",
volume="26",
pages="e48654",
keywords="digital medical services",
keywords="older adults",
keywords="Technology Acceptance Model",
keywords="perception",
keywords="behavioral intention",
keywords="satisfaction",
abstract="Background: In an aging and information-driven society, older adults have distinct perceptions of and specific demands for digital medical services. It is essential for society to understand these needs and develop a more thoughtful approach to digital health care. Objective: This study aims to evaluate the behavioral intention and satisfaction of older adults with digital medical services by identifying the perceived factors and the pathways through which these factors influence their behavior. Methods: This study used a mixed methods approach, combining qualitative and quantitative analyses. A focus group interview was conducted with 30 randomly selected older adults, and the interviews were transcribed verbatim and coded using grounded theory. In addition, 876 valid questionnaires were collected to describe older adults' perceptions of and satisfaction with digital medical care. Then, t tests and ANOVA were used to explore differences among various demographic groups, while hierarchical multiple regression was conducted to identify the factors most closely related to satisfaction. Structural equation modeling was used to identify multiple mediating effects. Results: The qualitative study identified the core category of ``medical service relief and transformation paths for older adults in the context of digital reform.'' Quantitative analysis revealed that more than half of the older adults were satisfied with digital medical services, and behavioral intentions were higher among those with higher incomes and education levels. Structural equation modeling confirmed that external variables, such as digital skills training, positively influenced perceived ease of use ($\beta$=.594, P<.001), perceived usefulness ($\beta$=.544, P<.001), and promoted digital medical behavioral intentions ($\beta$=.256, P<.001), while also reducing perceived risk ($\beta$=--.295, P<.001). Additionally, perceived ease of use ($\beta$=.168, P<.001) and perceived usefulness ($\beta$=.508, P<.001) positively impacted behavioral intention, whereas perceived risk ($\beta$=--.05, P=.037) exerted a negative influence. Furthermore, behavioral intention ($\beta$=.641, P<.001) significantly and positively affected older adults' satisfaction with digital medical care. The mediation test identified 4 significant paths: (1) external variables {\textrightarrow} perceived ease of use {\textrightarrow} behavioral intention (effect size of 13.9\%); (2) external variables {\textrightarrow} perceived usefulness {\textrightarrow} behavioral intention (effect size of 38.4\%); (3) external variables {\textrightarrow} perceived ease of use {\textrightarrow} perceived usefulness {\textrightarrow} behavioral intention (effect size of 10.1\%); and (4) a direct effect (35.5\%) from external variables to behavioral intention. Conclusions: Based on the study's findings, addressing the needs of older adults and enhancing perceived usefulness are the most effective ways to encourage the use of digital health care devices. Community support plays a crucial role in helping older adults integrate into digital health care, and adapting the design of services and products to suit their needs improves their perceptions of digital health care. This, in turn, promotes usage behavior and satisfaction, while the negative impact of perceived risk remains minimal. ",
doi="10.2196/48654",
url="https://www.jmir.org/2024/1/e48654"
}


@Article{info:doi/10.2196/54025,
author="Vargas Meza, Xanat
and Oikawa, Masanori",
title="Japanese Perception of Brain Death and Implications for New Medical Technologies: Quantitative and Qualitative Social Media Analysis",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="18",
volume="8",
pages="e54025",
keywords="brain death",
keywords="Japan",
keywords="social media",
keywords="multidimensional analysis",
keywords="Twitter",
keywords="YouTube",
abstract="Background: Brain death has been used to decide whether to keep sustained care and treatment. It can facilitate tissue, organ, and body donation for several purposes, such as transplantation and medical education and research. In Japan, brain death has strict diagnostic criteria and family consent is crucial, but it has been a challenging concept for the public since its introduction, including knowledge and communication issues. Objective: We analyzed data across YouTube and Twitter in Japan to uncover actors and assess the quality of brain death communication, providing recommendations to communicate new medical technologies. Methods: Using the keyword ``??'' (brain death), we collected recent data from YouTube and Twitter, classifying the data into 5 dimensions: time, individuality (type of users), place, activity, and relations (hyperlinks). We employed a scale to evaluate brain death information quality. We divided YouTube videos into 3 groups and assessed their differences through statistical analysis. We also provided a text-based analysis of brain death--related narratives. Results: Most videos (20/61, 33\%) were uploaded in 2019, while 10,892 tweets peaked between July 3 and 9, 2023, and June 12 and 18, 2023. Videos about brain death were mostly uploaded by citizens (18/61, 27\%), followed by media (13/61, 20\%) and unknown actors (10/61, 15\%). On the other hand, most identified users in a random sample of 100 tweets were citizens (73/100, 73\%), and the top 10 retweeted and liked tweets were also mostly authored by citizens (75/100, 75\%). No specific information on location was uncovered. Information videos contained guides for accreditation of the National Nursing Exam and religious points of view, while misinformation videos mostly contained promotions by spirituality actors and webtoon artists. Some tweets involved heart transplantation and patient narratives. Most hyperlinks pointed to YouTube and Twitter. Conclusions: Brain death has become a common topic in everyday life, with some actors disseminating high-quality information, others disseminating no medical information, and others disseminating misinformation. Recommendations include partnering with interested actors, discussing medical information in detail, and teaching people to recognize pseudoscience. ",
doi="10.2196/54025",
url="https://formative.jmir.org/2024/1/e54025"
}


@Article{info:doi/10.2196/45530,
author="Edler, Johanna-Sophie
and Terhorst, Yannik
and Pryss, R{\"u}diger
and Baumeister, Harald
and Cohrdes, Caroline",
title="Messenger Use and Video Calls as Correlates of Depressive and Anxiety Symptoms: Results From the Corona Health App Study of German Adults During the COVID-19 Pandemic",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="16",
volume="26",
pages="e45530",
keywords="passive data",
keywords="depression",
keywords="anxiety",
keywords="predicting mental health",
keywords="mobile phone",
abstract="Background: Specialized studies have shown that smartphone-based social interaction data are predictors of depressive and anxiety symptoms. Moreover, at times during the COVID-19 pandemic, social interaction took place primarily remotely. To appropriately test these objective data for their added value for epidemiological research during the pandemic, it is necessary to include established predictors. Objective: Using a comprehensive model, we investigated the extent to which smartphone-based social interaction data contribute to the prediction of depressive and anxiety symptoms, while also taking into account well-established predictors and relevant pandemic-specific factors. Methods: We developed the Corona Health App and obtained participation from 490 Android smartphone users who agreed to allow us to collect smartphone-based social interaction data between July 2020 and February 2021. Using a cross-sectional design, we automatically collected data concerning average app use in terms of the categories video calls and telephony, messenger use, social media use, and SMS text messaging use, as well as pandemic-specific predictors and sociodemographic covariates. We statistically predicted depressive and anxiety symptoms using elastic net regression. To exclude overfitting, we used 10-fold cross-validation. Results: The amount of variance explained (R2) was 0.61 for the prediction of depressive symptoms and 0.57 for the prediction of anxiety symptoms. Of the smartphone-based social interaction data included, only messenger use proved to be a significant negative predictor of depressive and anxiety symptoms. Video calls were negative predictors only for depressive symptoms, and SMS text messaging use was a negative predictor only for anxiety symptoms. Conclusions: The results show the relevance of smartphone-based social interaction data in predicting depressive and anxiety symptoms. However, even taken together in the context of a comprehensive model with well-established predictors, the data only add a small amount of value. ",
doi="10.2196/45530",
url="https://www.jmir.org/2024/1/e45530"
}


@Article{info:doi/10.2196/55384,
author="Tuitert, Inge
and Marinus, D. Jesse
and Dalenberg, R. Jelle
and van 't Veer, TB Job",
title="Digital Health Technology Use Across Socioeconomic Groups Prior to and During the COVID-19 Pandemic: Panel Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="13",
volume="10",
pages="e55384",
keywords="digital divide",
keywords="vulnerable groups",
keywords="digital health apps",
keywords="adoption",
keywords="socioeconomics",
keywords="health technology",
keywords="digital health",
keywords="longitudinal",
keywords="surveys",
keywords="technology use",
abstract="Background: Digital technologies have become more important in the health care sector in the past decades. This transition from conventional to digital health care has been accelerated by the impact of the COVID-19 pandemic, which poses the risk of creating a ``digital divide,'' inadvertently placing those who are older, economically disadvantaged, and have a lower level of education at a disadvantage. Objective: This study focuses on the influence of socioeconomic factors on the adoption of digital health technology in the Frisian population and how this relation is affected by the COVID-19 pandemic. Methods: In 2019 and 2020, a panel study was conducted on digital health in the Frisian population in the Netherlands. In the survey, the use of digital health technology was operationalized in a broad sense, going beyond the care context by also including preventative health-promoting solutions generally available on the consumer market, such as wearables and lifestyle apps. First, to assess the influence of socioeconomic factors on the total use of digital health apps, a generalized linear model was fitted with use of digital health app as the dependent variable and socioeconomic factors as between-subject factors on the 2019 data. Second, to analyze whether the use of separate health apps increased from 2019 to 2020, we conducted chi-square tests on different digital health app types. Third, to examine the influence of COVID-19 on the use of digital health apps, a generalized linear mixed model was fitted with the use of digital health apps as the dependent variable, COVID-19 as the within-subject variable, and socioeconomic factors as between-subject factors. Results: The results indicated that prior to the COVID-19 pandemic, digital health technology use was higher in women, younger people, and those who are well educated and economically more privileged. Moreover, the percentage of people who reported using digital health technology rose from 70\% (1580/2258) to 82.5\% (1812/2197) due to the COVID-19 pandemic. This increase was significant for all separate types of digital health technology (all P<.001). In addition, we found the interaction effects of COVID-19 with age and education attainment, indicating that the lower total use among older people and people with lower education attainment became slightly less apparent from 2019 to 2020. Conclusions: These findings on the influence of the COVID-19 pandemic on the digital divide indicated that the use of all types of digital health apps increased and that older individuals and people with a lower level of education caught up a little during COVID-19. Future research should gain more insight into this effect and examine whether it persists beyond the COVID-19 pandemic. Additionally, future endeavors should focus on vulnerable groups, ensuring they receive adequate attention to guarantee access to health care, preventative health-promoting solutions, and social services. ",
doi="10.2196/55384",
url="https://publichealth.jmir.org/2024/1/e55384"
}


@Article{info:doi/10.2196/54215,
author="Risher, Kathryn
and Janulis, Patrick
and McConnell, Elizabeth
and Motley, Darnell
and Serrano, Alonso Pedro
and Jackson, D. Joel
and Brown, Alonzo
and Williams, Meghan
and Mendez, Daniel
and Phillips II, Gregory
and Melville, Joshua
and Birkett, Michelle",
title="Racial and Ethnic Differences in Mobile App Use for Meeting Sexual Partners Among Young Men Who Have Sex With Men and Young Transgender Women: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="11",
volume="10",
pages="e54215",
keywords="young men who have sex with men and young transgender women",
keywords="hookup or dating apps",
keywords="sexual partners",
keywords="race and ethnicity",
keywords="race",
keywords="ethnicity",
keywords="mobile app",
keywords="racial bias",
keywords="sexual partner",
keywords="young",
keywords="transgender",
keywords="Chicago",
keywords="United States",
keywords="online",
keywords="dating app",
keywords="racism",
keywords="analysis",
keywords="youth",
keywords="social network",
keywords="hookup",
keywords="black",
keywords="Hispanic",
keywords="Tinder",
keywords="Grindr",
keywords="Scruff",
keywords="sexual mixing patterns",
keywords="sexual patterns",
keywords="sexual pattern",
keywords="sexually transmitted infection",
keywords="sexually transmitted infections",
abstract="Background: Young men who have sex with men and young transgender women (YMSM-YTW) use online spaces to meet sexual partners with increasing regularity, and research shows that experiences of racism online mimics the real world. Objective: We analyzed differences by race and ethnicity in web-based and mobile apps used to meet sexual partners as reported by Chicago-based YMSM-YTW in 2016?2017. Methods: A racially and ethnically diverse sample of 643 YMSM-YTW aged 16?29 years were asked to name websites or mobile apps used to seek a sexual partner in the prior 6 months, as well as provide information about sexual partnerships from the same period. We used logistic regression to assess the adjusted association of race and ethnicity with (1) use of any website or mobile apps to find a sexual partner, (2) use of a ``social network'' to find a sexual partner compared to websites or mobile apps predominantly used for dating or hookups, (3) use of specific websites or mobile apps, and (4) reporting successfully meeting a sexual partner online among website or mobile app users. Results: While most YMSM-YTW (454/643, 70.6\%) used websites or mobile apps to find sexual partners, we found that Black non-Hispanic YMSM-YTW were significantly less likely to report doing so (comparing White non-Hispanic to Black non-Hispanic: adjusted odds ratio [aOR] 1.74, 95\% CI 1.10?2.76). Black non-Hispanic YMSM-YTW were more likely to have used a social network site to find a sexual partner (comparing White non-Hispanic to Black non-Hispanic: aOR 0.20, 95\% CI 0.11?0.37), though this was only reported by one-third (149/454, 32.8\%) of all app-using participants. Individual apps used varied by race and ethnicity, with Grindr, Tinder, and Scruff being more common among White non-Hispanic YMSM-YTW (93/123, 75.6\%; 72/123, 58.5\%; and 30/123, 24.4\%, respectively) than among Black non-Hispanic YMSM-YTW (65/178, 36.5\%; 25/178, 14\%; and 4/178, 2.2\%, respectively) and Jack'd and Facebook being more common among Black non-Hispanic YMSM-YTW (105/178, 59\% and 64/178, 36\%, respectively) than among White non-Hispanic YMSM-YTW (6/123, 4.9\% and 8/123, 6.5\%, respectively). Finally, we found that while half (230/454, 50.7\%) of YMSM-YTW app users reported successfully meeting a new sexual partner on an app, Black non-Hispanic YMSM-YTW app users were less likely to have done so than White non-Hispanic app users (comparing White non-Hispanic to Black non-Hispanic: aOR 2.46, 95\% CI 1.50?4.05). Conclusions: We found that Black non-Hispanic YMSM-YTW engaged with websites or mobile apps and found sexual partners systematically differently than White non-Hispanic YMSM-YTW. Our findings give a deeper understanding of how racial and ethnic sexual mixing patterns arise and have implications for the spread of sexually transmitted infections among Chicago's YMSM-YTW. ",
doi="10.2196/54215",
url="https://publichealth.jmir.org/2024/1/e54215"
}


@Article{info:doi/10.2196/49688,
author="Fu, Liping
and Liu, Caiping
and Dong, Yongqing
and Ma, Xiaodong
and Cai, Quanling
and Li, Dongli
and Di, Kaisheng",
title="Mediating Effects of Information Access on Internet Use and Multidimensional Health Among Middle-Aged and Older Adults: Nationwide Cross-Sectional Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="9",
volume="26",
pages="e49688",
keywords="internet use",
keywords="health",
keywords="middle-aged and older adults",
keywords="information access",
keywords="mediation analysis",
abstract="Background: With the exacerbation of population aging, the health issues of middle-aged and older adults have increasingly become a focus of attention. The widespread use of the internet has created conditions for promoting the health of this demographic. However, little is known about the effects of information access in promoting the relationship between internet use and the health of middle-aged and older adults. Objective: This study aims to examine the relationship between internet use and multidimensional health in middle-aged and older adults, as well as the mediating effect of information access. Moreover, this study will explore the relationship between other dimensions of internet use (purposes and frequency) and health. Methods: Data were sourced from the China General Social Survey conducted in 2018. Health outcomes, including self-rated, physical, and mental health, were assessed using the 5-level self-rated health scale, the 5-level basic activities of daily living scale, and the 5-level depression scale, respectively. The ordinal logistic regression model was used to examine the relationship between internet use and health among middle-aged and older adults. Additionally, the Karlson-Holm-Breen decomposition method was used to examine the mediation effect of information access. To address endogeneity issues, the two-stage least squares approach was applied. Results: In our sample, nearly half (n=3036, 46.3\%) of the respondents use the internet. Regression analyses revealed that internet use was positively associated with self-rated health (odds ratio [OR] 1.55, 95\% CI 1.39-1.74; P<.001), physical health (OR 1.39, 95\% CI 1.25-1.56; P<.001), and mental health (OR 1.33, 95\% CI 1.19-1.49; P<.001) of middle-aged and older adults. Various dimensions of internet use positively contribute to health. In addition, information access significantly mediated the relationship between internet use and self-rated health ($\beta$=.28, 95\% CI 0.23-0.32), physical health ($\beta$=.40, 95\% CI 0.35-0.45), and mental health ($\beta$=.16, 95\% CI 0.11-0.20). Furthermore, there were significant differences in the relationship between internet use and health among advantaged and disadvantaged groups. Conclusions: The study showed that different dimensions of internet use are associated with better self-rated health, better physical health, and better mental health in middle-aged and older adults. Information access mediates the relationship between internet use and health. This result emphasizes the significance of promoting internet access as a means to enhance the health of middle-aged and older adults in China. ",
doi="10.2196/49688",
url="https://www.jmir.org/2024/1/e49688"
}


@Article{info:doi/10.2196/59089,
author="Ferguson, M. Jacqueline
and Van Campen, James
and Slightam, Cindie
and Greene, Liberty
and Heyworth, Leonie
and Zulman, M. Donna",
title="Evaluation of the Veterans Health Administration's Digital Divide Consult for Tablet Distribution and Telehealth Adoption: Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="9",
volume="26",
pages="e59089",
keywords="veterans",
keywords="health care access",
keywords="video-based care",
keywords="telehealth",
keywords="barriers to care",
keywords="telemedicine",
abstract="Background: Video telehealth offers a mechanism to help Veterans Health Administration (VHA) patients overcome health care access barriers; however, many veterans lack a suitable device and sufficient internet connectivity. To address disparities in technology access, VHA established a Connected Device Program that offers veterans loaned video-capable tablets and internet service. In 2020, VHA introduced a national Digital Divide Consult to facilitate and standardize referrals for this resource. Objective: We sought to evaluate the reach and impact of VHA's Connected Device Program, leveraging Digital Divide Consult data to determine whether resources are supporting veterans with health care needs and access barriers. Methods: We examined the reach of VHA's Connected Device Program using national secondary data from VHA's electronic health records among 119,926 tablet recipients who received a tablet (April 1, 2020, to February 28, 2023) and 683,219 veterans from the general VHA population. We assessed changes in tablet recipients' demographic and clinical characteristics before and after implementation of the Digital Divide Consult compared with the general VHA population. We examined the impact of tablets and the consult on adoption of telehealth (ie, video visit use and number of visits) adjusting for differences between tablet recipients and the general VHA population. Finally, we evaluated consult implementation by assessing the use of video-based services by tablet referral reason. Results: Common reasons for tablet referral included mental health diagnoses (50,367/79,230, 63.9\%), distance from a VHA facility >30 miles (17,228/79,230, 21.7\%), and social isolation (16,161/79,230, 20.4\%). Moreover, 63.0\% (49,925/79,230) of individuals who received a tablet after implementation of the Digital Divide Consult had a video visit in the first 6 months of tablet receipt. Some consult reasons were associated with a higher-than-average percentage of video telehealth use, including enrollment in evidence-based mental health programs (74.8\% [830/1100] with video use), living >30 miles from a VHA facility (68.3\% [10,557/17,228] with video use), and having a mental health diagnosis (68.1\% [34,301/50,367] with video use). Tablet recipients had nearly 3 times the likelihood of having a video visit within a month once provided a tablet compared to the general VHA population, with an adjusted risk ratio of 2.95 (95\% CI 2.91-2.99) before consult implementation and 2.73 (95\% CI 2.70-2.76) after consult implementation. Analyses of telehealth adoption suggested that veterans receiving tablets for mental health care and evidence-based programs have higher rates of video visits, while those who are homebound or receiving tablets for hospice have higher rates of nonuse. Conclusions: This evaluation of VHA's Connected Device Program suggests that tablets are facilitating video-based care among veterans with complex needs. Standardization of referrals through the Digital Divide Consult has created opportunities to identify groups of tablet recipients with lower telehealth adoption rates who might benefit from a targeted intervention. ",
doi="10.2196/59089",
url="https://www.jmir.org/2024/1/e59089",
url="http://www.ncbi.nlm.nih.gov/pubmed/39250183"
}


@Article{info:doi/10.2196/53512,
author="Hermsen, Sander
and Tump, Danielle
and Wentink, Eva
and Duijvestein, Marjolijn",
title="Investigating Patient Perspectives on Using eHealth Technologies for the Self-Management of Inflammatory Bowel Disease: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="6",
volume="26",
pages="e53512",
keywords="information and communication technology",
keywords="ICT",
keywords="self-management",
keywords="inflammatory bowel disease",
keywords="IBD",
keywords="smart toilet seat",
keywords="mobile phone",
abstract="Background: Inflammatory bowel disease (IBD) poses significant challenges for patients, requiring continuous monitoring and self-management to improve quality of life. Objective: This study aims to investigate the viewpoints of individuals living with IBD on the use of information and communication technology (ICT) for the self-management of their condition, with a particular focus on the concept of a ``smart'' toilet seat as an example of ICT for IBD self-management. Methods: We conducted an analysis of questionnaire responses obtained from 724 participants. They were encouraged to share their use cases and identify any perceived barriers associated with ICT adoption for managing their condition. To assess their responses, we used descriptive quantitative analysis, summative content analysis, and thematic qualitative analysis. We combined these results in an epistemic network analysis to look for meaningful patterns in the responses. Results: Of the 724 participants, more than half (n=405, 55.9\%) were already using various forms of ICT for IBD self-management. The primary factor influencing their use of ICT was their affinity for interacting with technology. Distinct differences emerged between individuals who were using ICT and those who were not, particularly regarding their perceived use cases and concerns. Conclusions: This study provides valuable insights into the perspectives of individuals with IBD on the use of ICT for self-management. To facilitate wider adoption, addressing privacy concerns, ensuring data security, and establishing reliable ICT integration will be critical. ",
doi="10.2196/53512",
url="https://www.jmir.org/2024/1/e53512",
url="http://www.ncbi.nlm.nih.gov/pubmed/39240663"
}


@Article{info:doi/10.2196/49366,
author="Kazi, Momin Abdul
and Ahsan, Nazia
and Jabeen, Rawshan
and Allana, Raheel
and Jamal, Saima
and Mughal, Khan Muhammad Ayub
and Hopkins, L. Kathryn
and Malik, Aman Fauzia",
title="Effects of COVID-19 Illness and Vaccination Infodemic Through Mobile Health, Social Media, and Electronic Media on the Attitudes of Caregivers and Health Care Providers in Pakistan: Qualitative Exploratory Study",
journal="JMIR Infodemiology",
year="2024",
month="Sep",
day="4",
volume="4",
pages="e49366",
keywords="infodemics",
keywords="mHealth",
keywords="social media",
keywords="electronic media",
keywords="Pakistan",
keywords="vaccination",
keywords="misinformation",
keywords="infodemiology",
keywords="mobile phone",
abstract="Background: The COVID-19 pandemic has had a significant impact on different countries because of which various health and safety measures were implemented, with digital media playing a pivotal role. However, digital media also pose significant concerns such as misinformation and lack of direction. Objective: We aimed to explore the effects of COVID-19--related infodemics through digital, social, and electronic media on the vaccine-related attitudes of caregivers and health care providers in Pakistan. Methods: This study employs a qualitative exploratory study design with purposive sampling strategies, and it was conducted at 3 primary health care facilities in the province of Sindh, Pakistan. Seven focus group discussions with health care providers and 60 in-depth interviews with caregivers were conducted using semistructured interviews through virtual platforms (ConnectOnCall and Zoom). Transcripts were analyzed through thematic analysis. Results: Our study reveals the pivotal role of electronic media, mobile health (mHealth), and social media during the COVID-19 pandemic. Four major themes were identified: (1) sources of information on COVID-19 and its vaccination, (2) electronic media value and misleading communication, (3) mHealth leveraging and limitations during COVID-19, and (4) social media influence and barriers during COVID-19. Health care providers and caregivers reported that the common sources of information were electronic media and mHealth, followed by social media. Some participants also used global media for more reliable information related to COVID-19. mHealth solutions such as public awareness messages, videos, call ringtones, and helplines promoted COVID-19 prevention techniques and vaccine registration. However, the overwhelming influx of news and sociobehavioral narratives, including misinformation/disinformation through social media such as WhatsApp, Facebook, and Twitter, were found to be the primary enablers of vaccine-related infodemics. Electronic media and mHealth were utilized more widely to promote information and communication on the COVID-19 pandemic and vaccination. However, social media and electronic media--driven infodemics were identified as the major factors for misinformation related to COVID-19 and vaccine hesitancy. Further, we found a digital divide between the urban and rural populations, with the use of electronic media in rural settings and social media in urban settings. Conclusions: In a resource-constrained setting like Pakistan, the usage of mHealth, social media, and electronic media for information spread (both factual and mis/disinformation) related to COVID-19 and its vaccination had a significant impact on attitudes toward COVID-19 vaccination. Based on the qualitative findings, we generated a model of digital communications and information dissemination to increase knowledge about COVID-19 and its prevention measures, including vaccination, which can be replicated in similar settings for other disease burdens and related infodemics. Further, to mitigate the infodemics, both digital and nondigital interventions are needed at a larger scale. ",
doi="10.2196/49366",
url="https://infodemiology.jmir.org/2024/1/e49366"
}


@Article{info:doi/10.2196/57435,
author="Luke, J. Michael
and Craig, Sansanee
and Pak-Gorstein, Suzinne
and Arellano, Marl{\'i}se
and Zhang, Jessica
and Wright, Margaret S.
and Chuo, John
and Scribano, V. Philip",
title="Narrowing the Digital Divide: Framework for Creating Telehealth Equity Dashboards",
journal="Interact J Med Res",
year="2024",
month="Sep",
day="4",
volume="13",
pages="e57435",
keywords="telehealth",
keywords="equity",
keywords="dashboard",
keywords="data",
keywords="framework",
keywords="televisit",
keywords="healthcare",
keywords="disparity",
keywords="disparities",
keywords="clinician",
keywords="clinicians",
keywords="informaticist",
keywords="informaticists",
keywords="researcher",
keywords="researchers",
keywords="pediatric",
keywords="pediatrics",
keywords="health system",
keywords="health systems",
keywords="dashboards",
keywords="access to care",
keywords="data source mapping",
doi="10.2196/57435",
url="https://www.i-jmr.org/2024/1/e57435"
}


@Article{info:doi/10.2196/59168,
author="Knotnerus, R. Hanna
and Ngo, N. H{\`a} T.
and Maarsingh, R. Otto
and van Vugt, A. Vincent",
title="Understanding Older Adults' Experiences With a Digital Health Platform in General Practice: Qualitative Interview Study",
journal="JMIR Aging",
year="2024",
month="Aug",
day="30",
volume="7",
pages="e59168",
keywords="digital health care",
keywords="digital health platform",
keywords="general practice",
keywords="qualitative research",
keywords="older adults",
keywords="primary care",
keywords="mobile phone",
abstract="Background: In our aging population, primary care is under pressure to remain accessible to all. Effective use of digital health care could potentially lower general practitioners' (GPs) workload. Some general practices are already implementing a digital health platform as a primary method to contact their patients. However, it is unknown how older people experience this novel way to communicate with their GP. Objective: The aim of this study was to study the experiences of patients aged 65 years and older in general practices who use digital health as a primary communication tool. The secondary aims were to identify barriers and facilitators for the use of digital health care and whether a practice focus on digital health influences older patients' choice to enlist. Methods: We invited all patients aged 65 years and older at 2 general practices in Amsterdam that work with a novel digital health platform. We used purposive sampling to select a heterogeneous group of patients in terms of age, sex, level of education, digital literacy, and experiences with the digital app of their general practice. We conducted 18 semistructured interviews from May through July 2023. All interviews were audio-recorded, transcribed, coded, and thematically analyzed. Results: We generated three themes: (1) experiences of older people with digital health care in general practice, (2) impact of individual factors on digital health experiences, and (3) reasons for choosing a digitally oriented general practice. Participants reported both positive and negative experiences. The main perceived advantages of the digital health platform were increased accessibility, direct GP contact without an intermediary, and saving time through asynchronous communication. The disadvantages mentioned were log-in difficulties and problems with the automated explanatory questionnaire. Individual factors such as age, digital literacy, and expectations of general practice care seemed to impact people's experiences and could act as barriers or facilitators for using digital health. Reasons for older patients to enlist at a general practice were mainly practical. The digital orientation of the practice hardly played a role in this choice. Conclusions: Older patients in general practice see benefits to using a digital health platform that offers 2-way chat-based communication between the patient and GP. We found that individual factors such as skills, norms and values, attitudes toward digitalization, and expectations of general practice care impacted older patients' experiences with digital health care. For many older participants, the digital profile of the general practice did not play a role in their choice to enlist. Further improvement of digital health platforms will be necessary to ensure digital health for all in general practice. ",
doi="10.2196/59168",
url="https://aging.jmir.org/2024/1/e59168"
}


@Article{info:doi/10.2196/54186,
author="Vidas, Dianna
and Carrasco, Romina
and Kelly, M. Ryan
and Waycott, Jenny
and Tamplin, Jeanette
and McMahon, Kate
and Flynn, M. Libby
and Stretton-Smith, A. Phoebe
and Sousa, Vieira Tanara
and Baker, A. Felicity",
title="Everyday Uses of Music Listening and Music Technologies by Caregivers and People With Dementia: Survey and Focus Group Study",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="27",
volume="26",
pages="e54186",
keywords="dementia",
keywords="dementia care",
keywords="technology",
keywords="music technology",
keywords="mobile phone",
abstract="Background: Music has long been identified as a nonpharmacological tool that can provide benefits for people with dementia, and there is considerable interest in designing technologies to support the use of music in dementia care. However, to ensure that music technologies are appropriately designed for supporting caregivers and people living with dementia, there remains a need to better understand how music is currently used in everyday dementia care at home. Objective: This study aims to understand how people living with dementia and their caregivers use music and music technologies in everyday caring, as well as the challenges they experience using music and technology. Methods: This study used a mixed methods design. First, a survey was administered to 13 people living with dementia and 64 caregivers to understand their use of music and technology. Subsequently, 18 survey respondents (family caregivers: n=12, 67\%; people living with dementia: n=6, 33\%) participated in focus groups regarding their experiences of using music and technology in care. Interview transcripts were analyzed using reflexive thematic analysis. Results: Most of the survey respondents (people living with dementia: 9/13, 69\%; family caregivers: 47/63, 75\%) reported using music often or very often in their daily lives. Participants reported a range of technologies used for listening to music, such as CDs, radio, and streaming services. Focus groups highlighted the benefits and challenges of using music and music technologies in everyday care. Participants identified using music and music technologies to regulate mood, provide joy, facilitate social interaction and connection, encourage reminiscence, provide continuity of music use before and after the dementia diagnosis, and make caregiving easier. The challenges of using music technology in everyday caring included difficulties with staying up to date with evolving technology and low self-efficacy with technology for people living with dementia. Conclusions: This study shows that people with a dementia diagnosis and their caregivers already use music and music technologies to support their everyday care needs. The results suggest opportunities to design technologies that enable easier access to music and to support people living with dementia with recreational and therapeutic music listening as well as music-based activities. ",
doi="10.2196/54186",
url="https://www.jmir.org/2024/1/e54186"
}


@Article{info:doi/10.2196/50944,
author="Chambers, C. Laura
and Malyuta, Yelena
and Goedel, C. William
and Chan, A. Philip
and Sutten Coats, Cassandra
and Allen, Ken
and Nunn, S. Amy",
title="Identifying Effective Components of a Social Marketing Campaign to Improve Engagement With Express Sexual Health Services Among Gay, Bisexual, and Other Men Who Have Sex With Men: Case Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Aug",
day="23",
volume="10",
pages="e50944",
keywords="social marketing",
keywords="sexually transmitted infection",
keywords="HIV",
keywords="sexual and gender minorities",
keywords="sexual health",
keywords="gay",
keywords="MSM",
keywords="men who have sex with men",
keywords="STI",
keywords="testing",
keywords="digital marketing",
keywords="digital",
keywords="campaign",
keywords="promote",
keywords="treatment",
keywords="prevention",
keywords="bisexual",
keywords="advertisement",
keywords="Google display",
keywords="Grindr",
keywords="Facebook",
abstract="Background: Little is known about how best to reach people with social marketing messages promoting use of clinical HIV and sexually transmitted infection (STI) services. Objective: We evaluated a multiplatform, digital social marketing campaign intended to increase use of HIV/STI testing, treatment, and prevention services among gay, bisexual, and other men who have sex with men (MSM) at an LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and/or questioning) community health center. Methods: We evaluated engagement with a social marketing campaign launched by Open Door Health, the only LGBTQ+ community health center in Rhode Island, during the first 8 months of implementation (April to November 2021). Three types of advertisements encouraging use of HIV/STI services were developed and implemented on Google Search, Google Display, Grindr, and Facebook. Platforms tracked the number of times that an advertisement was displayed to a user (impressions), that a user clicked through to a landing page that facilitated scheduling (clicks), and that a user requested a call to schedule an appointment from the landing page (conversions). We calculated the click-through rate (clicks per impression), conversion rate (conversions per click), and the dollar amount spent per 1000 impressions and per click and conversion. Results: Overall, Google Search yielded the highest click-through rate (7.1\%) and conversion rate (7.0\%) compared to Google Display, Grindr, and Facebook (click-through rates=0.4\%?3.3\%; conversion rates=0\%?0.03\%). Although the spend per 1000 impressions and per click was higher for Google Search compared to other platforms, the spend per conversion---which measures the number of people intending to attend the clinic for services---was substantially lower for Google Search (US \$48.19 vs US \$3120.42-US \$3436.03). Conclusions: Campaigns using the Google Search platform may yield the greatest return on investment for engaging MSM in HIV/STI services at community health clinics. Future studies are needed to measure clinical outcomes among those who present to the clinic for services after viewing campaign advertisements and to compare the return on investment with use of social marketing campaigns relative to other approaches. ",
doi="10.2196/50944",
url="https://publichealth.jmir.org/2024/1/e50944"
}


@Article{info:doi/10.2196/58594,
author="Fealy, Shanna
and McLaren, Suzanne
and Seaman, Ellen Claire
and Nott, Melissa
and Jones, Donovan
and Irwin, Pauletta
and Logan, Patricia
and Rossiter, Rachel
and McDonald, Simon",
title="Exploring the Sociodemographic and Health-Related Determinants of Telehealth Use Among a Cohort of Older Australians During the COVID-19 Pandemic: Repeated Cross-Sectional Study",
journal="JMIR Aging",
year="2024",
month="Aug",
day="23",
volume="7",
pages="e58594",
keywords="telehealth",
keywords="telemedicine",
keywords="aging",
keywords="older people",
keywords="COVID-19",
keywords="Australia",
keywords="45 and Up Study",
keywords="health-related determinates",
keywords="Technology Acceptance Model",
keywords="mobile phone",
abstract="Background: During the COVID-19 pandemic, there was a rapid adoption of telehealth care services as a public health strategy to maintain access to essential health care. In Australia, there has been increasing optimism for the expansion of telehealth services. However, little is known about the patterns and determinants of telehealth adoption among older adults, with concerns that an expansion of telehealth services may only be of benefit to those who already have better access to health care. Objective: Leveraging data collected by The Sax Institute's 45 and Up COVID Insights study between November 2020 and April 2022, the objective of this study was to identify and describe the sociodemographic and health-related determinants of telehealth adoption and use among a cohort of older Australians. We hypothesized that health-related factors would be key determinants of telehealth adoption for Australians aged ?65 years during the COVID-19 pandemic. Methods: A repeated cross-sectional design was used. The relationships between telehealth use (classified as low, moderate, or high) and selected sociodemographic and health-related characteristics were assessed using logistic regression techniques. Variable selection and findings were situated within the Technology Acceptance Model, the Unified Theory of Acceptance, and the Use of Technology theoretical frameworks. Results: Of the 21,830 participants aged ?65 years, the proportion who indicated adopting telehealth ranged from 50.77\% (11,082/21,830) at survey 1 in 2020 to 39.4\% (7401/18,782) at survey 5 in 2022. High levels of telehealth use were associated with being female, aged <85 years, living in a major city, cohabiting with others, and being from the most socioeconomically disadvantaged areas (deciles 1-3). Individuals with a disability, chronic disease, multimorbidity, and lower perceived quality of life and those experiencing missed or delayed care were significantly more likely to use telehealth across all levels (P<.001). A temporal association was observed, whereby participants who engaged with telehealth services before or early in the pandemic (as assessed in survey 1) were more likely to continue telehealth use when assessed in survey 5 in 2022 (P<.001). Conclusions: This research contributes to the broader understanding of telehealth adoption and use among older adults. As telehealth models of care expand, there is an opportunity to tailor these services to the needs of older adults, particularly those living with chronic diseases and multimorbidity, by using targeted strategies that overcome barriers to accessing specialized health care services. ",
doi="10.2196/58594",
url="https://aging.jmir.org/2024/1/e58594",
url="http://www.ncbi.nlm.nih.gov/pubmed/39178035"
}


@Article{info:doi/10.2196/49897,
author="Kaneda, Yudai
and Ozaki, Akihiko
and Murakami, Michio
and Sawano, Toyoaki
and Nomura, Shuhei
and Bhandari, Divya
and Saito, Hiroaki
and Tsubokura, Masaharu
and Yamaoka, Kazue
and Nakata, Yoshinori
and Tsukada, Manabu
and Ohira, Hiromichi",
title="Health Information Seeking on the Internet Among Patients With and Without Cancer in a Region Affected by the 2011 Fukushima Triple Disaster: Cross-Sectional Study",
journal="JMIR Cancer",
year="2024",
month="Aug",
day="21",
volume="10",
pages="e49897",
keywords="health information",
keywords="patients with cancer",
keywords="disaster",
keywords="Japan",
keywords="internet",
keywords="patient with cancer",
keywords="cancer",
keywords="internet health",
keywords="mobile phone",
abstract="Background: Health information seeking via the internet among patients with cancer in disaster-affected areas is underresearched. Objective: This study aims not only to assess the extent and means of web-based health information seeking among patients with cancer living in the disaster-affected area of the 2011 Fukushima triple disaster but also to compare these patterns with those without cancer, identifying distinct and shared factors influencing their web-based health information behaviors. Methods: We surveyed 404 patients (263 with and 141 without cancer) from the surgery department outpatient office at Minamisoma Municipal General Hospital, from October 2016 to January 2017. The survey included self-administered questions on internet and digital device use. Descriptive analyses were performed to examine the use patterns of digital devices and the internet and their impact on health information seeking across different age groups of patients with and without cancer. Multivariable logistic regression was used to examine factors associated with web-based health information seeking, stratifying by cancer diagnosis. Results: The proportion of participants who sought health information on the internet was comparable between patients with cancer and patients without cancer (19\% vs 17.4\%; P=.71). Digital device use varied significantly with age, with peak smartphone use occurring among the youngest cohorts for both groups. Multivariable logistic regression revealed that patients with cancer using smartphones or tablets daily were significantly more likely to gather web-based health information (odds ratio [OR] for smartphones 3.73, 95\% CI 1.58-8.80; OR for tablets 5.08, 95\% CI 1.27-20.35). Trust in institutional websites also significantly influenced web-based health information gathering among patients with cancer (OR 2.87, 95\% CI 1.13-7.25). Conversely, among patients without cancer, unemployment was associated with a lower likelihood of seeking web-based health information (OR 0.26, 95\% CI 0.08-0.85), whereas trust in both institutional and personal websites significantly increased this likelihood (OR for institutional websites 6.76, 95\% CI 2.19-20.88; OR for personal websites 6.97, 95\% CI 1.49-32.58). Conclusions: This study reveals that a small proportion of both patients with cancer and patients without cancer engage in health information seeking via the internet, influenced by age, digital device use, and trust in institutional websites. Given the growing prevalence of digital literacy, strategies to enhance accessible and reliable web-based health information should be developed, particularly for patients with cancer in postdisaster settings. Future efforts should focus on tailored health communication strategies that address the unique needs of these populations. ",
doi="10.2196/49897",
url="https://cancer.jmir.org/2024/1/e49897"
}


@Article{info:doi/10.2196/47733,
author="Muehlensiepen, Felix
and Petit, Pascal
and Knitza, Johannes
and Welcker, Martin
and Vuillerme, Nicolas",
title="Identification of Motivational Determinants for Telemedicine Use Among Patients With Rheumatoid Arthritis in Germany: Secondary Analysis of Data From a Nationwide Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="19",
volume="26",
pages="e47733",
keywords="telemedicine",
keywords="rheumatoid arthritis",
keywords="rheumatology",
keywords="primary care",
keywords="health services research",
keywords="eHealth",
keywords="data analysis",
keywords="survey",
keywords="Germany",
keywords="tool",
keywords="care",
keywords="willingness",
keywords="sociodemographic",
keywords="age",
keywords="telehealth",
keywords="digital transition",
abstract="Background: Previous studies have demonstrated telemedicine to be an effective tool to complement rheumatology care and address workforce shortage. With the COVID-19 outbreak, telemedicine experienced a massive upswing. An earlier analysis revealed that the motivation of patients with rheumatic and musculoskeletal diseases to use telemedicine is closely connected to their disease. It remains unclear which factors are associated with patients' motivation to use telemedicine in certain rheumatic and musculoskeletal diseases groups, such as rheumatoid arthritis (RA). Objective: This study aims to identify factors that determine the willingness to try telemedicine among patients diagnosed with RA. Methods: We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with RA. Bayesian univariate logistic regression analysis was applied to the data to determine which factors were associated with willingness to try telemedicine. Predictor variables (covariates) studied individually included sociodemographic factors (eg, age, sex) and health characteristics (eg, health status). All the variables positively and negatively associated with willingness to try telemedicine in the univariate analyses were then considered for Bayesian model averaging analysis after a selection based on the variance inflation factor (? 2.5) to identify determinants of willingness to try telemedicine. Results: Among 438 surveyed patients in the initial study, 210 were diagnosed with RA (47.9\%). Among them, 146 (69.5\%) answered either yes or no regarding willingness to try telemedicine and were included in the analysis. A total of 22 variables (22/55, 40\%) were associated with willingness to try telemedicine (region of practical equivalence \%?5). A total of 9 determinant factors were identified using Bayesian model averaging analysis. Positive determinants included desiring telemedicine services provided by a rheumatologist (odds ratio [OR] 13.7, 95\% CI 5.55-38.3), having prior knowledge of telemedicine (OR 2.91, 95\% CI 1.46-6.28), residing in a town (OR 2.91, 95\% CI 1.21-7.79) or city (OR 0.56, 95\% CI 0.23-1.27), and perceiving one's health status as moderate (OR 1.87, 95\% CI 0.94-3.63). Negative determinants included the lack of an electronic device (OR 0.1, 95\% CI 0.01-0.62), absence of home internet access (OR 0.1, 95\% CI 0.02-0.39), self-assessment of health status as bad (OR 0.44, 95\% CI 0.21-0.89) or very bad (OR 0.47, 95\% CI 0.06-2.06), and being aged between 60 and 69 years (OR 0.48, 95\% CI 0.22-1.04) or older than 70 years (OR 0.38, 95\% CI 0.16-0.85). Conclusions: The results suggest that some patients with RA will not have access to telemedicine without further support. Older patients, those not living in towns, those without adequate internet access, reporting a bad health status, and those not owning electronic devices might be excluded from the digital transformation in rheumatology and might not have access to adequate RA care. These patient groups certainly require support for the use of digital rheumatology care. ",
doi="10.2196/47733",
url="https://www.jmir.org/2024/1/e47733"
}


@Article{info:doi/10.2196/54745,
author="Vazquez, Elias Christian
and Mauldin, L. Rebecca
and Mitchell, N. Denise
and Ohri, Faheem",
title="Sociodemographic Factors Associated With Using eHealth for Information Seeking in the United States: Cross-Sectional Population-Based Study With 3 Time Points Using Health Information National Trends Survey Data",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="14",
volume="26",
pages="e54745",
keywords="health information seeking",
keywords="eHealth use",
keywords="disparities",
keywords="sex",
keywords="age",
keywords="education",
keywords="mobile phone",
abstract="Background: Despite the potential benefits of using eHealth, sociodemographic disparities exist in eHealth use, which threatens to further widen health equity gaps. The literature has consistently shown age and education to be associated with eHealth use, while the findings for racial and ethnic disparities are mixed. However, previous disparities may have narrowed as health care interactions shifted to web-based modalities for everyone because of the COVID-19 pandemic. Objective: This study aims to provide an updated examination of sociodemographic disparities that contribute to the health equity gap related to using eHealth for information seeking using 3 time points. Methods: Data for this study came from the nationally representative 2018 (n=3504), 2020 (n=3865), and 2022 (n=6252) time points of the Health Information National Trends Survey. Logistic regression was used to regress the use of eHealth for information seeking on race and ethnicity, sex, age, education, income, health status, and year of survey. Given the consistent association of age with the dependent variable, analyses were stratified by age cohort (millennials, Generation X, baby boomers, and silent generation) to compare individuals of similar age. Results: For millennials, being female, attaining some college or a college degree, and reporting an annual income of US \$50,000-\$74,999 or >US \$75,000 were associated with the use of eHealth for information seeking. For Generation X, being female, having attained some college or a college degree, reporting an annual income of US \$50,000-\$74,999 or >US \$75,000, better self-reported health, and completing the survey in 2022 (vs 2018; odds ratio [OR] 1.80, 95\% CI 1.11-2.91) were associated with the use of eHealth for information seeking. For baby boomers, being female, being older, attaining a high school degree, attaining some college or a college degree, reporting an annual income of US \$50,000-\$74,999 or >US \$75,000, and completing the survey in 2020 (OR 1.56, 95\% CI 1.15-2.12) and 2022 (OR 4.04, 95\% CI 2.77-5.87) were associated with the use of eHealth for information seeking. Among the silent generation, being older, attaining some college or a college degree, reporting an annual income of US \$50,000-\$74,999 or >US \$75,000, and completing the survey in 2022 (OR 5.76, 95\% CI 3.05-10.89) were associated with the use of eHealth for information seeking. Conclusions: Baby boomers may have made the most gains in using eHealth for information seeking over time. The race and ethnicity findings, or lack thereof, may indicate a reduction in racial and ethnic disparities. Disparities based on sex, education, and income remained consistent across all age groups. This aligns with health disparities literature focused on individuals with lower socioeconomic status, and more recently on men who are less likely to seek health care compared to women. ",
doi="10.2196/54745",
url="https://www.jmir.org/2024/1/e54745"
}


@Article{info:doi/10.2196/55138,
author="Ayo-Ajibola, Oluwatobiloba
and Davis, J. Ryan
and Lin, E. Matthew
and Riddell, Jeffrey
and Kravitz, L. Richard",
title="Characterizing the Adoption and Experiences of Users of Artificial Intelligence--Generated Health Information in the United States: Cross-Sectional Questionnaire Study",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="14",
volume="26",
pages="e55138",
keywords="artificial intelligence",
keywords="ChatGPT",
keywords="health information",
keywords="patient information-seeking",
keywords="online health information",
keywords="health literacy",
keywords="ResearchMatch",
keywords="users",
keywords="diagnosis",
keywords="decision-making",
keywords="cross-sectional",
keywords="survey",
keywords="surveys",
keywords="adoption",
keywords="utilization",
keywords="AI",
keywords="less-educated",
keywords="poor health",
keywords="worse health",
keywords="experience",
keywords="experiences",
keywords="user",
keywords="non user",
keywords="non users",
keywords="AI-generated",
keywords="implication",
keywords="implications",
keywords="medical practice",
keywords="medical practices",
keywords="public health",
keywords="descriptive statistics",
keywords="t test",
keywords="t tests",
keywords="chi-square test",
keywords="chi-square tests",
keywords="health-seeking behavior",
keywords="health-seeking behaviors",
keywords="patient-provider",
keywords="interaction",
keywords="interactions",
keywords="patient",
keywords="patients",
abstract="Background: OpenAI's ChatGPT is a source of advanced online health information (OHI) that may be integrated into individuals' health information-seeking routines. However, concerns have been raised about its factual accuracy and impact on health outcomes. To forecast implications for medical practice and public health, more information is needed on who uses the tool, how often, and for what. Objective: This study aims to characterize the reasons for and types of ChatGPT OHI use and describe the users most likely to engage with the platform. Methods: In this cross-sectional survey, patients received invitations to participate via the ResearchMatch platform, a nonprofit affiliate of the National Institutes of Health. A web-based survey measured demographic characteristics, use of ChatGPT and other sources of OHI, experience characterization, and resultant health behaviors. Descriptive statistics were used to summarize the data. Both 2-tailed t tests and Pearson chi-square tests were used to compare users of ChatGPT OHI to nonusers. Results: Of 2406 respondents, 21.5\% (n=517) respondents reported using ChatGPT for OHI. ChatGPT users were younger than nonusers (32.8 vs 39.1 years, P<.001) with lower advanced degree attainment (BA or higher; 49.9\% vs 67\%, P<.001) and greater use of transient health care (ED and urgent care; P<.001). ChatGPT users were more avid consumers of general non-ChatGPT OHI (percentage of weekly or greater OHI seeking frequency in past 6 months, 28.2\% vs 22.8\%, P<.001). Around 39.3\% (n=206) respondents endorsed using the platform for OHI 2-3 times weekly or more, and most sought the tool to determine if a consultation was required (47.4\%, n=245) or to explore alternative treatment (46.2\%, n=239). Use characterization was favorable as many believed ChatGPT to be just as or more useful than other OHIs (87.7\%, n=429) and their doctor (81\%, n=407). About one-third of respondents requested a referral (35.6\%, n=184) or changed medications (31\%, n=160) based on the information received from ChatGPT. As many users reported skepticism regarding the ChatGPT output (67.9\%, n=336), most turned to their physicians (67.5\%, n=349). Conclusions: This study underscores the significant role of AI-generated OHI in shaping health-seeking behaviors and the potential evolution of patient-provider interactions. Given the proclivity of these users to enact health behavior changes based on AI-generated content, there is an opportunity for physicians to guide ChatGPT OHI users on an informed and examined use of the technology. ",
doi="10.2196/55138",
url="https://www.jmir.org/2024/1/e55138"
}


@Article{info:doi/10.2196/56061,
author="Kyaw, Yadana Myat
and Aung, Nyein Myo
and Koyanagi, Yuka
and Moolphate, Saiyud
and Aung, Nyein Thin Nyein
and Ma, Carol Hok Ka
and Lee, Hocheol
and Nam, Hae-Kweun
and Nam, Woo Eun
and Yuasa, Motoyuki",
title="Sociodigital Determinants of eHealth Literacy and Related Impact on Health Outcomes and eHealth Use in Korean Older Adults: Community-Based Cross-Sectional Survey",
journal="JMIR Aging",
year="2024",
month="Aug",
day="13",
volume="7",
pages="e56061",
keywords="eHealth literacy",
keywords="eHEALS",
keywords="electronic health information",
keywords="eHealth information",
keywords="health literacy",
keywords="health education",
keywords="eHealth education",
keywords="health training",
keywords="eHealth training",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="digital interventions",
keywords="gray digital divide",
keywords="healthy aging",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="older person",
keywords="older people",
keywords="aging",
keywords="eHealth Literacy Scale",
abstract="Background: eHealth literacy is an essential skill for pursuing electronic health information, particularly for older people whose health needs increase with age. South Korea is now at the intersection of a rapidly digitalizing society and an increasingly aged population. eHealth literacy enables older people to maximize the effective use of emerging digital technology for their health and quality of life. Understanding the eHealth literacy of Korean older adults is critical to eliminating the gray digital divide and inequity in health information access. Objective: This study aims to investigate factors influencing eHealth literacy in older Korean adults and its impact on health outcomes and eHealth use. Methods: This was a cross-sectional survey. Community-dwelling older adults 65 years and older in 2 urban cities in South Korea were included. eHealth literacy was measured by the eHealth Literacy Scale. Ordinal logistic regression was used to analyze factors associated with eHealth literacy and multivariate ANOVA for the impact of eHealth literacy on health outcomes and eHealth use. Results: In total, 434 participants were analyzed. A total of 22.3\% (97/434) of participants had high eHealth literacy skills. Increasing age, higher monthly income, and time spent on the internet were significantly associated with eHealth literacy (P<.001), and social media users were 3.97 times (adjusted odds ratio 3.97, 95\% CI 1.02?15.43; P=.04) more likely to have higher skill. Higher eHealth literacy was associated with better self-perceived health and frequent use of digital technologies for accessing health and care services (P<.001). Conclusions: Disparity in socioeconomic status and engagement on the internet and social media can result in different levels of eHealth literacy skills, which can have consequential impacts on health outcomes and eHealth use. Tailored eHealth interventions, grounded on the social and digital determinants of eHealth literacy, could facilitate eHealth information access among older adults and foster a digitally inclusive healthy aging community. ",
doi="10.2196/56061",
url="https://aging.jmir.org/2024/1/e56061"
}


@Article{info:doi/10.2196/47100,
author="O'Shea, MJ Amy
and Mulligan, Kailey
and Carter, D. Knute
and Haraldsson, Bjarni
and Wray, M. Charlie
and Shahnazi, Ariana
and Kaboli, J. Peter",
title="Comparing Federal Communications Commission and Microsoft Estimates of Broadband Access for Mental Health Video Telemedicine Among Veterans: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="8",
volume="26",
pages="e47100",
keywords="broadband",
keywords="telemedicine",
keywords="Federal Communications Commission",
keywords="veterans",
keywords="United States Department of Veterans Affairs",
keywords="internet",
keywords="mental health care",
keywords="veteran health",
keywords="broadband access",
keywords="web-based",
keywords="digital",
abstract="Background: The COVID-19 pandemic highlighted the importance of telemedicine in health care. However, video telemedicine requires adequate broadband internet speeds. As video-based telemedicine grows, variations in broadband access must be accurately measured and characterized. Objective: This study aims to compare the Federal Communications Commission (FCC) and Microsoft US broadband use data sources to measure county-level broadband access among veterans receiving mental health care from the Veterans Health Administration (VHA). Methods: Retrospective observational cohort study using administrative data to identify mental health visits from January 1, 2019, to December 31, 2020, among 1161 VHA mental health clinics. The exposure is county-level broadband percentages calculated as the percentage of the county population with access to adequate broadband speeds (ie, download >25 megabits per second) as measured by the FCC and Microsoft. All veterans receiving VHA mental health services during the study period were included and categorized based on their use of video mental health visits. Broadband access was compared between and within data sources, stratified by video versus no video telemedicine use. Results: Over the 2-year study period, 1,474,024 veterans with VHA mental health visits were identified. Average broadband percentages varied by source (FCC mean 91.3\%, SD 12.5\% vs Microsoft mean 48.2\%, SD 18.1\%; P<.001). Within each data source, broadband percentages generally increased from 2019 to 2020. Adjusted regression analyses estimated the change after pandemic onset versus before the pandemic in quarterly county-based mental health visit counts at prespecified broadband percentages. Using FCC model estimates, given all other covariates are constant and assuming an FCC percentage set at 70\%, the incidence rate ratio (IRR) of county-level quarterly mental video visits during the COVID-19 pandemic was 6.81 times (95\% CI 6.49-7.13) the rate before the pandemic. In comparison, the model using Microsoft data exhibited a stronger association (IRR 7.28; 95\% CI 6.78-7.81). This relationship held across all broadband access levels assessed. Conclusions: This study found FCC broadband data estimated higher and less variable county-level broadband percentages compared to those estimated using Microsoft data. Regardless of the data source, veterans without mental health video visits lived in counties with lower broadband access, highlighting the need for accurate broadband speeds to prioritize infrastructure and intervention development based on the greatest community-level impacts. Future work should link broadband access to differences in clinical outcomes. ",
doi="10.2196/47100",
url="https://www.jmir.org/2024/1/e47100"
}


@Article{info:doi/10.2196/57823,
author="Erbas, Ege Mert
and Ziehfreund, Stefanie
and Wecker, Hannah
and Biedermann, Tilo
and Zink, Alexander",
title="Digital Media Usage Behavior and Its Impact on the Physician-Patient Relationship: Cross-Sectional Study Among Individuals Affected by Psoriasis in Germany",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="7",
volume="26",
pages="e57823",
keywords="psoriasis",
keywords="dermatology",
keywords="digital health",
keywords="digital media",
keywords="internet use",
keywords="questionnaire",
keywords="physician-patient relationship",
abstract="Background: Psoriasis is a chronic skin disorder with a high burden of disease. People affected with psoriasis increasingly use the internet for health-related reasons, especially those with younger age, higher education, and higher disease severity. Despite advantages such as enhancing the individuals' knowledge with the use of digital media for health-related issues, disadvantages were also present such as quality control, and variability in the individuals' health information literacy. While patients with psoriasis within medical settings generally trust physicians over digital media, they commonly withhold their web-based research findings from health care providers. Objective: The study aims to (1) identify further factors associated with regular psoriasis-related internet use, (2) rank specific digital media platforms used, and (3) examine digital media within the physician-patient relationship among individuals with and without dermatological treatment. Methods: A cross-sectional, questionnaire-based study was conducted among individuals with self-reported psoriasis in Germany between September 2021 and February 2022. Participants were recruited via digital media platforms and in person at a University Hospital Department of Dermatology in southern Germany. The questionnaire asked about demographic and medical information, individual psoriasis-related digital media use, and the impact of digital media on the physician-patient relationship. Data were analyzed descriptively, and logistic regression models were performed to assess the factors associated with regular psoriasis-related internet use. Results: Among 321 individuals with a median age of 53 (IQR 41-61) years (nonnormally distributed; females: 195/321), female sex, shorter disease duration, moderate mental burden of disease, and good self-assessed psoriasis-related knowledge were associated with regular psoriasis-related internet use. Of the 188 participants with a mean age of 51.2 (SD 13.9) years (normally distributed) who used digital media 106 (56.4\%) usually searched for information on psoriasis-based websites and 98 (52.1\%) on search engines, primarily for obtaining information about the disease and therapy options, while social media were less frequently used (49/188, 26.1\%). Nearly two-thirds of internet users (125/188) claimed that their physicians did not recommend digital media platforms. About 44\% (82/188) of the individuals reported to seek for additional information due to the insufficient information provided by their physician. Conclusions: This study revealed the importance of digital media in the context of psoriasis, especially among women, individuals with shorter disease duration, and moderate mental disease severity. The lack of physicians' digital media recommendations despite their patients' desire to receive such and being more involved in health-related decisions seems to be a shortcoming within the physician-patient relationships. Physicians should guide their patients on digital media by recommending platforms with evidence-based information, thereby potentially creating an adequate framework for shared decision-making. Future research should focus on strategies to prevent the spread of false information on digital media and address the needs of patients and physicians to enhance health-related digital media offerings. ",
doi="10.2196/57823",
url="https://www.jmir.org/2024/1/e57823"
}


@Article{info:doi/10.2196/53371,
author="Howell, R. Carrie
and Zhang, Li
and Clay, J. Olivio
and Dutton, Gareth
and Horton, Trudi
and Mugavero, J. Michael
and Cherrington, L. Andrea",
title="Social Determinants of Health Phenotypes and Cardiometabolic Condition Prevalence Among Patients in a Large Academic Health System: Latent Class Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Aug",
day="7",
volume="10",
pages="e53371",
keywords="social determinants of health",
keywords="electronic medical record",
keywords="phenotypes",
keywords="diabetes",
keywords="obesity",
keywords="cardiovascular disease",
keywords="obese",
keywords="social determinants",
keywords="social determinant",
keywords="cardiometabolic",
keywords="risk factors",
keywords="risk factor",
keywords="latent class analysis",
keywords="cardiometabolic disease",
keywords="EMR",
keywords="EHR",
keywords="electronic health record",
abstract="Background: Adverse social determinants of health (SDoH) have been associated with cardiometabolic disease; however, disparities in cardiometabolic outcomes are rarely the result of a single risk factor. Objective: This study aimed to identify and characterize SDoH phenotypes based on patient-reported and neighborhood-level data from the institutional electronic medical record and evaluate the prevalence of diabetes, obesity, and other cardiometabolic diseases by phenotype status. Methods: Patient-reported SDoH were collected (January to December 2020) and neighborhood-level social vulnerability, neighborhood socioeconomic status, and rurality were linked via census tract to geocoded patient addresses. Diabetes status was coded in the electronic medical record using International Classification of Diseases codes; obesity was defined using measured BMI ?30 kg/m2. Latent class analysis was used to identify clusters of SDoH (eg, phenotypes); we then examined differences in the prevalence of cardiometabolic conditions based on phenotype status using prevalence ratios (PRs). Results: Complete data were available for analysis for 2380 patients (mean age 53, SD 16 years; n=1405, 59\% female; n=1198, 50\% non-White). Roughly 8\% (n=179) reported housing insecurity, 30\% (n=710) reported resource needs (food, health care, or utilities), and 49\% (n=1158) lived in a high-vulnerability census tract. We identified 3 patient SDoH phenotypes: (1) high social risk, defined largely by self-reported SDoH (n=217, 9\%); (2) adverse neighborhood SDoH (n=1353, 56\%), defined largely by adverse neighborhood-level measures; and (3) low social risk (n=810, 34\%), defined as low individual- and neighborhood-level risks. Patients with an adverse neighborhood SDoH phenotype had higher prevalence of diagnosed type 2 diabetes (PR 1.19, 95\% CI 1.06?1.33), hypertension (PR 1.14, 95\% CI 1.02?1.27), peripheral vascular disease (PR 1.46, 95\% CI 1.09?1.97), and heart failure (PR 1.46, 95\% CI 1.20?1.79). Conclusions: Patients with the adverse neighborhood SDoH phenotype had higher prevalence of poor cardiometabolic conditions compared to phenotypes determined by individual-level characteristics, suggesting that neighborhood environment plays a role, even if individual measures of socioeconomic status are not suboptimal. ",
doi="10.2196/53371",
url="https://publichealth.jmir.org/2024/1/e53371"
}


@Article{info:doi/10.2196/55759,
author="Campos-Castillo, Celeste
and Tamla Rai, Vijaya
and Laestadius, I. Linnea",
title="The Double-Edged Sword of Online Learning for Ethnoracial Differences in Adolescent Mental Health During Late Period of the COVID-19 Pandemic in the United States: National Survey",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="5",
volume="8",
pages="e55759",
keywords="mental health",
keywords="school modality",
keywords="race and ethnicity",
keywords="confidants",
keywords="sleep",
keywords="equity",
keywords="remote learning",
keywords="virtual learning",
keywords="racial justice",
keywords="anxiety",
keywords="depression",
keywords="depressive",
keywords="student",
keywords="students",
keywords="school",
keywords="schools",
keywords="adolescent",
keywords="adolescents",
keywords="teen",
keywords="teens",
keywords="teenager",
keywords="teenagers",
keywords="race",
keywords="racial",
keywords="eLearning",
keywords="online learning",
keywords="education",
keywords="equality",
keywords="inequality",
keywords="inequity",
keywords="disparity",
keywords="disparities",
keywords="teaching",
keywords="ethnic",
keywords="ethnicities",
abstract="Background: Despite several theories suggesting online learning during the COVID-19 pandemic would aggravate ethnoracial disparities in mental health among adolescents, extant findings suggest no ethnoracial differences in mental health or that those from minoritized ethnoracial groups reported better mental health than their White counterparts. Objective: This study aimed to identify why findings from prior studies appear to not support that ethnoracial disparities in mental health were aggravated by testing 2 pathways. In pathway 1 pathway, online learning was associated with reporting fewer confidants, which in turn was associated with poorer mental health. In pathway 2, online learning was associated with reporting better sleep, which in turn was associated with better mental health. Methods: We analyzed survey data from a US sample (N=540) of 13- to 17-year-olds to estimate how school modality was associated with mental health via the 2 pathways. The sample was recruited from the AmeriSpeak Teen Panel during spring of 2021, with an oversample of Black and Latino respondents. Ethnoracial categories were Black, Latino, White, and other. Mental health was measured with the 4-item Patient Health Questionnaire, which assesses self-reported frequency of experiencing symptoms consistent with anxiety and depression. School modality was recorded as either fully online or with some in-person component (fully in-person or hybrid). We recorded self-reports of the number of confidants and quality of sleep. Covariates included additional demographics and access to high-speed internet. We estimated bivariate associations between ethnoracial group membership and both school modality and mental health. To test the pathways, we estimated a path model. Results: Black and Latino respondents were more likely to report being in fully online learning than their White counterparts (P<.001). Respondents in fully online learning reported fewer confidants than those with any in-person learning component ($\beta$=--.403; P=.001), and reporting fewer confidants was associated with an increased likelihood of reporting symptoms consistent with anxiety ($\beta$=--.121; P=.01) and depression ($\beta$=--.197; P<.001). Fully online learning respondents also reported fewer concerns of insufficient sleep than their in-person learning counterparts ($\beta$=--.162; P=.006), and reporting fewer concerns was associated with a decreased likelihood of reporting symptoms consistent with anxiety ($\beta$=.601; P<.001) and depression ($\beta$=.588; P<.001). Because of these countervailing pathways, the total effect of membership in a minoritized ethnoracial group on mental health was nonsignificant. Conclusions: The findings compel more nuanced discussions about the consequences of online learning and theorizing about the pandemic's impact on minoritized ethnoracial groups. While online learning may be a detriment to social connections, it appears to benefit sleep. Interventions should foster social connections in online learning and improve sleep, such as implementing policies to enable later start times for classes. Future research should incorporate administrative data about school modality, rather than relying on self-reports. ",
doi="10.2196/55759",
url="https://formative.jmir.org/2024/1/e55759",
url="http://www.ncbi.nlm.nih.gov/pubmed/39102274"
}


@Article{info:doi/10.2196/52536,
author="Yuan, Lei
and Jiang, Qinqin
and Liu, Yuqing
and Liu, Yijun
and Du, Maolin
and Sun, Jinhai
and Li, Meina",
title="Decomposition Analysis of Depressive Symptom Differences Among Older Adults With Hypertension Between Urban and Rural Areas: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Aug",
day="1",
volume="10",
pages="e52536",
keywords="depression",
keywords="older",
keywords="hypertension",
keywords="Fairlie decomposition",
keywords="China",
keywords="older adult",
keywords="elderly",
abstract="Background: Hypertension is the most prevalent chronic disease among China's older population, which comprises a growing proportion of the overall demographic. Older individuals with chronic diseases have a higher risk of developing depressive symptoms than their healthy counterparts, as evidenced in China's older population, where patients with hypertension exhibit varying rates of depression depending on residing in urban or rural areas. Objective: This study aimed to investigate factors influencing and contributing to the disparities in depressive symptoms among older urban and rural patients with hypertension in China. Methods: We used a cross-sectional study design and derived data from the 8th Chinese Longitudinal Health Longevity Survey of 2018. The Fairlie model was applied to analyze the factors contributing to disparities in depressive symptoms between urban and rural older populations with hypertension. Results: The sample size for this study was 5210, and 12.8\% (n=669) of participants exhibited depressive symptoms. The proportions of depressive symptoms in rural and urban areas were 14.1\% (n=468) and 10.7\% (n=201), respectively. In rural areas, years of education (1-6 years: odds ratio [OR] 0.68, 95\% CI 1.10-1.21; ?7 years: OR 0.47, 95\% CI 0.24-0.94), alcohol consumption (yes: OR 0.52, 95\% CI 0.29-0.93), exercise (yes: OR 0.78, 95\% CI 0.56-1.08), and sleep duration (6.0-7.9 hours: OR 0.29, 95\% CI 0.17-0.52; 8.0-9.9 hours: OR 0.24, 95\% CI 0.13-0.43; ?10.0 hours: OR 0.22, 95\% CI 0.11-0.41) were protective factors against depressive symptoms in older adults with hypertension, while gender (female: OR 1.94, 95\% CI 1.33-2.81), self-reported income status (poor: OR 3.07, 95\% CI 2.16-4.37), and activities of daily living (ADL) dysfunction (mild: OR 1.69, 95\% CI 1.11-2.58; severe: OR 3.03, 95\% CI 1.46-6.32) were risk factors. In urban areas, age (90-99 years: OR 0.37, 95\% CI 0.16-0.81; ?100 years: OR 0.19, 95\% CI 0.06-0.66), exercise (yes: OR 0.33, 95\% CI 0.22-0.51), and sleep duration (6.0-7.9 hours: OR 0.27, 95\% CI 0.10-0.71; 8.0-9.9 hours: OR 0.16, 95\% CI 0.06-0.44; ?10.0 hours: OR 0.18, 95\% CI 0.06-0.57) were protective factors, while years of education (1-6 years: OR 1.91, 95\% CI 1.05-3.49), self-reported income status (poor: OR 2.94, 95\% CI 1.43-6.08), and ADL dysfunction (mild: OR 2.38, 95\% CI 1.39-4.06; severe: OR 3.26, 95\% CI 1.21-8.76) were risk factors. The Fairlie model revealed that 91.61\% of differences in depressive symptoms could be explained by covariates, including years of education (contribution 63.1\%), self-reported income status (contribution 13.2\%), exercise (contribution 45.7\%), sleep duration (contribution 20.8\%), ADL dysfunction (contribution ?9.6\%), and comorbidities (contribution ?22.9\%). Conclusions: Older patients with hypertension in rural areas had more depressive symptoms than their counterparts residing in urban areas, which could be explained by years of education, self-reported income status, exercise, sleep duration, ADL dysfunction, and comorbidities. Factors influencing depressive symptoms had similarities regarding exercise, sleep duration, self-reported income status, and ADL dysfunction as well as differences regarding age, gender, years of education, and alcohol consumption. ",
doi="10.2196/52536",
url="https://publichealth.jmir.org/2024/1/e52536"
}


@Article{info:doi/10.2196/51355,
author="Kepper, M. Maura
and Fowler, A. Lauren
and Kusters, S. Isabelle
and Davis, W. Jean
and Baqer, Manal
and Sagui-Henson, Sara
and Xiao, Yunyu
and Tarfa, Adati
and Yi, C. Jean
and Gibson, Bryan
and Heron, E. Kristin
and Alberts, M. Nicole
and Burgermaster, Marissa
and Njie-Carr, PS Veronica
and Klesges, M. Lisa",
title="Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="1",
volume="26",
pages="e51355",
keywords="digital health",
keywords="health equity",
keywords="mobile health",
keywords="mHealth",
keywords="health care access",
keywords="digital divide",
keywords="behavioral medicine",
keywords="implementation",
keywords="mobile phone",
doi="10.2196/51355",
url="https://www.jmir.org/2024/1/e51355",
url="http://www.ncbi.nlm.nih.gov/pubmed/39088246"
}


@Article{info:doi/10.2196/51537,
author="Sasayama, Kiriko
and Nishimura, Etsuko
and Yamaji, Noyuri
and Ota, Erika
and Tachimori, Hisateru
and Igarashi, Ataru
and Arata, Naoko
and Yoneoka, Daisuke
and Saito, Eiko",
title="Current Use and Discrepancies in the Adoption of Health-Related Internet of Things and Apps Among Working Women in Japan: Large-Scale, Internet-Based, Cross-Sectional Survey",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="31",
volume="10",
pages="e51537",
keywords="women's health",
keywords="IoT",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="decision tree",
keywords="internet survey",
keywords="women",
keywords="health",
keywords="adoption",
keywords="Internet of Things",
keywords="survey",
keywords="surveys",
keywords="management",
keywords="working women",
keywords="worker",
keywords="workers",
keywords="employee",
keywords="employees",
keywords="occupational health",
keywords="job",
keywords="jobs",
keywords="working",
keywords="employed",
keywords="usage",
abstract="Background: Demographic changes and a low birth rate have led to a workforce shortage in Japan. To address this issue, the government has promoted engagement of female employment. However, increased female employment can impact women's health. Using Internet of Things (IoT) and apps to manage women's health has gained attention, but few studies have focused on working women. Objective: This study aimed to clarify the current situation of working women and their use of IoT or apps to manage their health. Methods: A large-scale, nationwide internet survey was conducted among 10,000 female participants aged from 20 years to 64 years in Japan. Participants were recruited from a marketing research company's active survey panel of 5.24 million members. The survey included questions about health status, sociodemographic factors, psychological characteristics, and the use of IoT or apps for health management. We compared perceived health status and reasons for current IoT use using t tests and assessed participant characteristics that predicted IoT use using the C5.0 decision tree algorithm. Ethical approval was granted by St. Luke's International University. Results: Among participants, 14.6\% (1455/10,000) currently used IoT or apps, 7\% (695/10,000) used them previously, and 78.5\% (7850/10,000) had never used them. Current users (42.7 years old) were older than past users (39.7 years old). Discrepancies were observed between participants' perceived health problems and the purpose for using IoT or apps, with 21.3\% (2130/10,000) of all women reporting they experienced menstrual symptoms or disorders but only 3.5\% (347/10,000) used IoT or apps to manage the same symptom. On the other hand, current users were more likely to use IoT or apps to manage nutrition-related problems such as underweight or obesity (405/1455, 27.8\%). Device use was highest among current users, with 87.3\% (1270/1455) using smartphones, 19.7\% (287/1455) using smartwatches, and 13.3\% (194/1455) using PCs. Decision tree analysis identified 6 clusters, the largest consisting of 81.6\% (5323/6523) of non-IoT users who did not exercise regularly, while pregnant women were more likely to use IoT or apps. Conclusions: Our findings highlight the idea that woman with particular health problems (ie, menstrual symptoms or disorders and premenstrual syndrome) have lower use of IoT or apps, suggesting an unmet need for IoT and apps in specific areas. ",
doi="10.2196/51537",
url="https://publichealth.jmir.org/2024/1/e51537",
url="http://www.ncbi.nlm.nih.gov/pubmed/39083338"
}


@Article{info:doi/10.2196/46888,
author="Yuen, Eva
and Winter, Natalie
and Savira, Feby
and Huggins, E. Catherine
and Nguyen, Lemai
and Cooper, Paul
and Peeters, Anna
and Anderson, Kate
and Bhoyroo, Rahul
and Crowe, Sarah
and Ugalde, Anna",
title="Digital Health Literacy and Its Association With Sociodemographic Characteristics, Health Resource Use, and Health Outcomes: Rapid Review",
journal="Interact J Med Res",
year="2024",
month="Jul",
day="26",
volume="13",
pages="e46888",
keywords="digital health literacy",
keywords="eHealth literacy",
keywords="health literacy",
keywords="digital health",
keywords="web-based database",
keywords="health information",
abstract="Background: Digital health literacy has emerged as a critical skill set to navigate the digital age. Objective: This review sought to broadly summarize the literature on associations between digital health literacy and (1) sociodemographic characteristics, (2) health resource use, and (3) health outcomes in the general population, patient groups, or parent or caregiver groups. Methods: A rapid review of literature published between January 2016 and May 2022 was conducted through a search of 4 web-based databases. Articles were included on the basis of the following keywords: ``measured digital health literacy,'' ``digital literacy,'' ``ehealth literacy,'' ``e-health literacy,'' ``electronic health literacy,'' or ``internet health literacy'' in adult populations; participants were from countries where English was the primary language; studies had to be cross-sectional, longitudinal, prospective, or retrospective, and published in English. Results: Thirty-six articles met the inclusion criteria. Evidence on the associations between digital health literacy and sociodemographic characteristics varied (27/36, 75\% included studies), with higher education (16/21, 76.2\% studies that examined the association) and younger age (12/21, 57.1\% studies) tending to predict higher digital health literacy; however, other studies found no associations. No differences between genders were found across the majority of studies. Evidence across ethnic groups was too limited to draw conclusions; some studies showed that those from racial and ethnic minority groups had higher digital health literacy than White individuals, while other studies showed no associations. Higher digital health literacy was associated with digital health resource use in the majority of studies (20/36, 55.6\%) that examined this relationship. In addition, higher digital health literacy was also associated with health outcomes across 3 areas (psychosocial outcomes; chronic disease and health management behaviors; and physical outcomes) across 17 included studies (17/36, 47.2\%) that explored these relationships. However, not all studies on the relationship among digital health literacy and health resource use and health outcomes were in the expected direction. Conclusions: The review presents mixed results regarding the relationship between digital health literacy and sociodemographic characteristics, although studies broadly found that increased digital health literacy was positively associated with improved health outcomes and behaviors. Further investigations of digital health literacy on chronic disease outcomes are needed, particularly across diverse groups. Empowering individuals with the skills to critically access and appraise reliable health information on digital platforms and devices is critical, given emerging evidence that suggests that those with low digital health literacy seek health information from unreliable sources. Identifying cost-effective strategies to rapidly assess and enhance digital health literacy capacities across community settings thus warrants continued investigation. ",
doi="10.2196/46888",
url="https://www.i-jmr.org/2024/1/e46888"
}


@Article{info:doi/10.2196/56504,
author="Nagappan, Ashwini
and Krasniansky, Adriana
and Knowles, Madelyn",
title="Patterns of Ownership and Usage of Wearable Devices in the United States, 2020-2022: Survey Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="26",
volume="26",
pages="e56504",
keywords="digital health",
keywords="health equity",
keywords="adoption",
keywords="usage patterns",
keywords="wearable devices",
keywords="United States",
keywords="technology",
keywords="sociodemographic",
keywords="survey",
keywords="health insurance",
keywords="public health",
abstract="Background: Although wearable technology has become increasingly common, comprehensive studies examining its ownership across different sociodemographic groups are limited.? Objective: The aims of this study were to (1) measure wearable device ownership by sociodemographic characteristics in a cohort of US consumers and (2) investigate how these devices are acquired and used for health-related purposes. Methods: Data from the Rock Health Digital Health Consumer Adoption Survey collected from 2020 to 2022 with 23,974 US participants were analyzed. The sample was US Census--matched for demographics, including age, race/ethnicity, gender, and income. The relationship between sociodemographic factors and wearable ownership was explored using descriptive analysis and multivariate logistic regression. Results: Of the 23,974 respondents, 10,679 (44.5\%) owned wearables. Ownership was higher among younger individuals, those with higher incomes and education levels, and respondents living in urban areas. Compared to those aged 18-24 years, respondents 65 years and older had significantly lower odds of wearable ownership (odds ratio [OR] 0.18, 95\% CI 0.16-0.21). Higher annual income (?US \$200,000; OR 2.27, 95\% CI 2.01-2.57) and advanced degrees (OR 2.23, 95\% CI 2.01-2.48) were strong predictors of ownership. Living in rural areas reduced ownership odds (OR 0.65, 95\% CI 0.60-0.72). There was a notable difference in ownership based on gender and health insurance status. Women had slightly higher ownership odds than men (OR 1.10, 95\% CI 1.04-1.17). Private insurance increased ownership odds (OR 1.28, 95\% CI 1.17-1.40), whereas being uninsured (OR 0.41, 95\% CI 0.36-0.47) or on Medicaid (OR 0.75, 95\% CI 0.68-0.82) decreased the odds of ownership. Interestingly, minority groups such as non-Hispanic Black (OR 1.14, 95\% CI 1.03-1.25) and Hispanic/Latine (OR 1.20, 95\% CI 1.10-1.31) respondents showed slightly higher ownership odds than other racial/ethnic groups. Conclusions: Our findings suggest that despite overall growth in wearable ownership, sociodemographic divides persist. The data indicate a need for equitable access strategies as wearables become integral to clinical and public health domains. ",
doi="10.2196/56504",
url="https://www.jmir.org/2024/1/e56504"
}


@Article{info:doi/10.2196/51315,
author="Oliver, Amy
and Chandler, Ella
and Gillard, A. Julia",
title="Impact of Digital Inclusion Initiative to Facilitate Access to Mental Health Services: Service User Interview Study",
journal="JMIR Ment Health",
year="2024",
month="Jul",
day="26",
volume="11",
pages="e51315",
keywords="digital exclusion",
keywords="digital inclusion",
keywords="video consultation",
keywords="COVID-19",
keywords="tablet loan scheme",
keywords="mental health",
keywords="telemedicine",
keywords="digital divide",
keywords="digital inequality",
keywords="technology",
abstract="Background: Digital exclusion, characterized by a lack of access to digital technology, connectivity, or digital skills, disproportionally affects marginalized groups. An important domain impacted by digital exclusion is access to health care. During COVID-19, health care services had to restrict face-to-face contact to limit the spread of the virus. The subsequent shift toward remote delivery of mental health care exacerbated the digital divide, with limited access to remote mental health care delivery. In response, Camden and Islington National Health Service Foundation Trust launched the innovative Digital Inclusion Scheme (DIS). Objective: This study aimed to examine the impact of facilitating digital inclusion in mental health access. Camden and Islington National Health Service Foundation Trust implemented the trust-wide DIS for service users who were digitally excluded, that is, were without devices or connectivity or reported poor digital skills. The scheme provided access to a loan digital device (a tablet), internet connectivity devices, and mobile data, as well as personalized digital skills support. Methods: The DIS went live in October 2021 and received 106 referrals by June 2022. Semistructured interviews were conducted with 12 service users to ask about their experience of accessing the DIS. A thematic analysis identified themes and subthemes relating to the extent of their digital exclusion before engaging with the scheme and the impact of accessing a scheme on their ability to engage with digital technology and well-being. Results: There were 10 major themes. A total of 6 themes were related to factors impacting the engagement with the scheme, including digital exclusion, relationship to the trust, the importance of personalized digital support, partnership working, device usability and accessibility, and personal circumstances. The remaining 4 themes spoke to the impact of accessing the scheme, including improved access to services, impact on well-being, financial implications, and a greater sense of empowerment. Conclusions: Participants reported an increased reliance on technology driving the need for digital inclusion; however, differences in motivation for engaging with the scheme were noted, as well as potential barriers, including lack of awareness, disability, and age. Overall, the experience of accessing the DIS was reported as positive, with participants feeling supported to access the digital world. The consequences of engaging with the scheme included greater perceived access to and control of physical and mental health care, improved well-being, and a greater sense of empowerment. An overview of the lessons learned are provided along with suggestions for other health care settings that are looking to implement similar schemes. ",
doi="10.2196/51315",
url="https://mental.jmir.org/2024/1/e51315"
}


@Article{info:doi/10.2196/51272,
author="Ge, Xiaochen
and Chappell, Paul
and Ledger, Jean
and Bakhai, Minal
and Clarke, M. Geraldine",
title="The Use of Online Consultation Systems and Patient Experience of Primary Care: Cross-Sectional Analysis Using the General Practice Patient Survey",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="26",
volume="26",
pages="e51272",
keywords="general practice",
keywords="online consultation",
keywords="patient experience",
keywords="modern general practice",
keywords="sociodemographic health inequalities",
keywords="General Practice Patient Survey",
keywords="cross-sectional study",
abstract="Background: NHS England encourages the use of online consultation (OC) systems alongside traditional access methods for patients to contact their general practice online and for practices to manage workflow. Access is a key driver of patients' primary care experience. The use of online technology and patient experience vary by sociodemographic characteristics. Objective: This study aims to assess the association between OC system use and patient experience of primary care in English general practice and how that varies by OC system model and practice sociodemographic characteristics (rurality, deprivation, age, and ethnicity). Methods: We categorized practices as ``low-use'' or ``high-use'' according to the volume of patient-initiated contacts made via the OC system. We considered practices using one of 2 OC systems with distinct designs and implementation models---shorter ``free text'' input with an embedded single workflow OC system (FT practices) and longer ``mixed text'' input with variation in implemented workflow OC system (MT practices). We used 2022 General Practice Patient Survey data to capture 4 dimensions of patient experience---overall experience, experience of making an appointment, continuity of care, and use of self-care before making an appointment. We used logistic regression at the practice level to explore the association between OC system use and patient experience, including interaction terms to assess sociodemographic variation. Results: We included 287,194 responses from 2423 MT and 170 FT practices. The proportions of patients reporting positive experiences at MT and FT practices were similar or better than practices nationally, except at high-use MT practices. At high-use MT practices, patients were 19.8\% (odds ratio [OR] 0.802, 95\% CI 0.782-0.823) less likely to report a good overall experience; 24.5\% (OR 0.755, 95\% CI 0.738-0.773) less likely to report a good experience of making an appointment; and 18.9\% (OR 0.811, 95\% CI 0.792-0.83) less likely to see their preferred general practitioner; but 27.8\% (OR 1.278, 95\% CI 1.249-1.308) more likely to use self-care, compared with low-use MT practices. Opposite trends were seen at FT practices. Sociodemographic inequalities in patient experience were generally lower at high-use than low-use practices; for example, gaps in overall experience between practices with the most and fewest White patients decreased by 2.7 percentage points at MT practices and 6.4 percentage points at FT practices. Trends suggested greater improvements in experience for traditionally underserved groups---patients from urban and deprived areas, younger patients, and non-White patients. Conclusions: An OC system with shorter free text input and an integrated single workflow can enhance patient experience and reduce sociodemographic inequalities. Variation in patient experience between practices with different sociodemographic characteristics and OC systems underscores the importance of tailored design and implementation. Generalizing results across different OC systems is difficult due to variations in how they are integrated into practice workflows and communicated to patients. ",
doi="10.2196/51272",
url="https://www.jmir.org/2024/1/e51272"
}


@Article{info:doi/10.2196/52762,
author="Dotson, Timothy
and Price, Brad
and Witrick, Brian
and Davis, Sherri
and Kemper, Emily
and Whanger, Stacey
and Hodder, Sally
and Hendricks, Brian",
title="Factors Associated With Surveillance Testing in Individuals With COVID-19 Symptoms During the Last Leg of the Pandemic: Multivariable Regression Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="18",
volume="10",
pages="e52762",
keywords="COVID-19",
keywords="testing",
keywords="symptomatic",
keywords="RADx",
keywords="rural",
keywords="health disparities",
keywords="regression analysis",
keywords="surveillance",
keywords="SARS-CoV-2",
keywords="United States",
keywords="asymptomatic",
keywords="survey",
keywords="demographic",
keywords="clinical",
keywords="behavioral",
keywords="logistic regression",
keywords="bivariate map",
keywords="child",
keywords="children",
keywords="youth",
keywords="adolescent",
keywords="adolescents",
keywords="teen",
keywords="teens",
keywords="teenager",
keywords="teenagers",
keywords="public health",
keywords="machine learning",
keywords="mHealth",
keywords="mobile health",
keywords="digital health",
keywords="cross-sectional study",
keywords="physical health",
keywords="mental health",
keywords="Rapid Acceleration of Diagnostics",
abstract="Background: Rural underserved areas facing health disparities have unequal access to health resources. By the third and fourth waves of SARS-CoV-2 infections in the United States, COVID-19 testing had reduced, with more reliance on home testing, and those seeking testing were mostly symptomatic. Objective: This study identifies factors associated with COVID-19 testing among individuals who were symptomatic versus asymptomatic seen at a Rapid Acceleration of Diagnostics for Underserved Populations phase 2 (RADx-UP2) testing site in West Virginia. Methods: Demographic, clinical, and behavioral factors were collected via survey from tested individuals. Logistic regression was used to identify factors associated with the presence of individuals who were symptomatic seen at testing sites. Global tests for spatial autocorrelation were conducted to examine clustering in the proportion of symptomatic to total individuals tested by zip code. Bivariate maps were created to display geographic distributions between higher proportions of tested individuals who were symptomatic and social determinants of health. Results: Among predictors, the presence of a physical (adjusted odds ratio [aOR] 1.85, 95\% CI 1.3-2.65) or mental (aOR 1.53, 95\% CI 0.96-2.48) comorbid condition, challenges related to a place to stay/live (aOR 307.13, 95\% CI 1.46-10,6372), no community socioeconomic distress (aOR 0.99, 95\% CI 0.98-1.00), no challenges in getting needed medicine (aOR 0.01, 95\% CI 0.00-0.82) or transportation (aOR 0.23, 95\% CI 0.05-0.64), an interaction between community socioeconomic distress and not getting needed medicine (aOR 1.06, 95\% CI 1.00-1.13), and having no community socioeconomic distress while not facing challenges related to a place to stay/live (aOR 0.93, 95\% CI 0.87-0.99) were statistically associated with an individual being symptomatic at the first test visit. Conclusions: This study addresses critical limitations to the current COVID-19 testing literature, which almost exclusively uses population-level disease screening data to inform public health responses. ",
doi="10.2196/52762",
url="https://publichealth.jmir.org/2024/1/e52762"
}


@Article{info:doi/10.2196/55438,
author="Freeman, Q. Jincong
and Zhao, Fangyuan
and Howard, M. Frederick
and Nanda, Rita
and Olopade, I. Olufunmilayo
and Huo, Dezheng",
title="Assessing the Relationship Between Neighborhood Socioeconomic Disadvantage and Telemedicine Use Among Patients With Breast Cancer and Examining Differential Provisions of Oncology Services Between Telehealth and In-Person Visits: Quantitative Study",
journal="JMIR Cancer",
year="2024",
month="Jul",
day="18",
volume="10",
pages="e55438",
keywords="telemedicine",
keywords="telehealth equity",
keywords="Area Deprivation Index",
keywords="neighborhood socioeconomic disadvantage",
keywords="disparities",
keywords="oncology services",
keywords="treatment consultation",
keywords="genetic counseling",
keywords="in-person visits",
keywords="breast cancer",
keywords="mobile phone",
abstract="Background: Since the COVID-19 pandemic began, we have seen rapid growth in telemedicine use. However, telehealth care and services are not equally distributed, and not all patients with breast cancer have equal access across US regions. There are notable gaps in existing literature regarding the influence of neighborhood-level socioeconomic status on telemedicine use in patients with breast cancer and oncology services offered through telehealth versus in-person visits. Objective: We assessed the relationship between neighborhood socioeconomic disadvantage and telemedicine use among patients with breast cancer and examined differential provisions of oncology services between telehealth and in-person visits. Methods: Neighborhood socioeconomic disadvantage was measured using the Area Deprivation Index (ADI), with higher scores indicating greater disadvantages. Telemedicine and in-person visits were defined as having had a telehealth and in-person visit with a provider, respectively, in the past 12 months. Multivariable logistic regression was performed to examine the association between ADI and telemedicine use. The McNemar test was used to assess match-paired data on types of oncology services comparing telehealth and in-person visits. Results: The mean age of the patients with breast cancer (n=1163) was 61.8 (SD 12.0) years; 4.58\% (52/1161) identified as Asian, 19.72\% (229/1161) as Black, 3.01\% (35/1161) as Hispanic, and 72.78\% (845/1161) as White. Overall, 35.96\% (416/1157) had a telemedicine visit in the past 12 months. Of these patients, 65\% (266/409) had a videoconference visit only, 22.7\% (93/409) had a telephone visit only, and 12.2\% (50/409) had visits by both videoconference and telephone. Higher ADI scores were associated with a lower likelihood of telemedicine use (adjusted odds ratio [AOR] 0.89, 95\% CI 0.82-0.97). Black (AOR 2.38, 95\% CI 1.41-4.00) and Hispanic (AOR 2.65, 95\% CI 1.07-6.58) patients had greater odds of telemedicine use than White patients. Compared to patients with high school or less education, those with an associate's degree (AOR 2.67, 95\% CI 1.33-5.35), a bachelor's degree (AOR 2.75, 95\% CI 1.38-5.48), or a graduate or professional degree (AOR 2.57, 95\% CI 1.31-5.04) had higher odds of telemedicine use in the past 12 months. There were no significant differences in providing treatment consultation (45/405, 11.1\% vs 55/405, 13.6\%; P=.32) or cancer genetic counseling (11/405, 2.7\% vs 19/405, 4.7\%; P=.14) between telehealth and in-person visits. Of the telemedicine users, 95.8\% (390/407) reported being somewhat to extremely satisfied, and 61.8\% (254/411) were likely or very likely to continue using telemedicine. Conclusions: In this study of a multiethnic cohort of patients with breast cancer, our findings suggest that neighborhood-level socioeconomic disparities exist in telemedicine use and that telehealth visits could be used to provide treatment consultation and cancer genetic counseling. Oncology programs should address these disparities and needs to improve care delivery and achieve telehealth equity for their patient populations. ",
doi="10.2196/55438",
url="https://cancer.jmir.org/2024/1/e55438"
}


@Article{info:doi/10.2196/51931,
author="Atherton, Helen
and Eccles, Abi
and Poltawski, Leon
and Dale, Jeremy
and Campbell, John
and Abel, Gary",
title="Investigating Patient Use and Experience of Online Appointment Booking in Primary Care: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="8",
volume="26",
pages="e51931",
keywords="appointment",
keywords="patient appointments",
keywords="online systems",
keywords="primary health care",
keywords="general practice",
keywords="qualitative research",
keywords="secondary data analysis",
keywords="mobile phone",
abstract="Background: Online appointment booking is a commonly used tool in several industries. There is limited evidence about the benefits and challenges of using online appointment booking in health care settings. Potential benefits include convenience and the ability to track appointments, although some groups of patients may find it harder to engage with online appointment booking. We sought to understand how patients in England used and experienced online appointment booking. Objective: This study aims to describe and compare the characteristics of patients in relation to their use of online appointment booking in general practice and investigate patients' views regarding online appointment booking arrangements. Methods: This was a mixed methods study set in English general practice comprising a retrospective analysis of the General Practice Patient Survey (GPPS) and semistructured interviews with patients. Data used in the retrospective analysis comprised responses to the 2018 and 2019 GPPS analyzed using mixed-effects logistic regression. Semistructured interviews with purposively sampled patients from 11 general practices in England explored experiences of and views on online appointment booking. Framework analysis was used to allow for comparison with the findings of the retrospective analysis. Results: The retrospective analysis included 1,327,693 GPPS responders (2018-2019 combined). We conducted 43 interviews with patients with a variety of experiences and awareness of online appointment booking; of these 43 patients, 6 (14\%) were from ethnic minority groups. In the retrospective analysis, more patients were aware that online appointment booking was available (581,224/1,288,341, 45.11\%) than had experience using it (203,184/1,301,694, 15.61\%). There were deprivation gradients for awareness and use and a substantial decline in both awareness and use in patients aged >75 years. For interview participants, age and life stage were factors influencing experiences and perceptions, working patients valued convenience, and older patients preferred to use the telephone. Patients with long-term conditions were more aware of (odds ratio [OR] 1.43, 95\% CI 1.41-1.44) and more likely to use (OR 1.65, 95\% CI 1.63-1.67) online appointment booking. Interview participants with long-term conditions described online appointment booking as useful for routine nonurgent appointments. Patients in deprived areas were clustered in practices with low awareness and use of online appointment booking among GPPS respondents (OR for use 0.65, 95\% CI 0.64-0.67). Other key findings included the influence of the availability of appointments online and differences in the registration process for accessing online booking. Conclusions: Whether and how patients engage with online appointment booking is influenced by the practice with which they are registered, whether they live with long-term conditions, and their deprivation status. These factors should be considered in designing and implementing online appointment booking and have implications for patient engagement with the wider range of online services offered in general practice. ",
doi="10.2196/51931",
url="https://www.jmir.org/2024/1/e51931"
}


@Article{info:doi/10.2196/58440,
author="Garcia-Calvente, Mar Mar{\'i}a del
and Mora, Juanita Diana
and Del R{\'i}o-Lozano, Mar{\'i}a",
title="Gender Inequalities of Health and Quality of Life in Informal Caregivers in Spain: Protocol for the Longitudinal and Multicenter CUIDAR-SE Study",
journal="JMIR Res Protoc",
year="2024",
month="Jul",
day="2",
volume="13",
pages="e58440",
keywords="caregivers",
keywords="gender equity",
keywords="sex differences",
keywords="health status",
keywords="quality of life",
keywords="longitudinal studies",
keywords="multicenter studies",
abstract="Background: The aging population and increased disability prevalence in Spain have heightened the demand for long-term care. Informal caregiving, primarily performed by women, plays a crucial role in this scenario. This protocol outlines the CUIDAR-SE study, focusing on the gender-specific impact of informal caregiving on health and quality of life among caregivers in Andalusia and the Basque Country from 2013 to 2024. Objective: This study aims to analyze the gender differences in health and quality of life indicators of informal caregivers residing in 2 Spanish autonomous communities (Granada, Andalusia, and Gipuzkoa; Basque Country) and their evolution over time, in relation to the characteristics of caregivers, the caregiving situation, and support received. Methods: The CUIDAR-SE study uses a longitudinal, multicenter design across 3 phases, tracking health and quality of life indicators among informal caregivers. Using a questionnaire adapted to the Spanish context that uses validated scales and multilevel analysis, the research captures changes in caregivers' experiences amid societal crises, notably the 2008 economic crisis and the COVID-19 pandemic. A multistage randomized cluster sampling technique is used to minimize study design effects. Results: Funding for the CUIDAR-SE study was in 3 phases starting in January 2013, 2017, and 2021, spanning a 10-year period. Data collection commenced in 2013 and continued annually, except for 2016 and 2020 due to financial and pandemic-related challenges. As of March 2024, a total of 1294 participants have been enrolled, with data collection ongoing for 2023. Initial data analysis focused on gender disparities in caregiver health, quality of life, burden, perceived needs, and received support, with results from phase I published. Currently, analysis is ongoing for phases II and III, as well as longitudinal analysis across all phases. Conclusions: This protocol aims to provide comprehensive insights into caregiving dynamics and caregivers' experiences over time, as well as understand the role of caregiving on gender inequality in health, considering regional variations. Despite limitations in participant recruitment, focusing on registered caregivers, the study offers a detailed exploration of the health impacts of caregiving in Spain. The incorporation of a gender perspective and the examination of diverse contextual factors enrich the study's depth, contributing significantly to the discourse on caregiving health complexities in Spain. International Registered Report Identifier (IRRID): DERR1-10.2196/58440 ",
doi="10.2196/58440",
url="https://www.researchprotocols.org/2024/1/e58440"
}


@Article{info:doi/10.2196/52686,
author="Karakis, Ioannis
and Kostandini, Genti
and Tsamakis, Konstantinos
and Zahirovic-Herbert, Velma",
title="The Association of Broadband Internet Use With Drug Overdose Mortality Rates in the United States: Cross-Sectional Analysis",
journal="Online J Public Health Inform",
year="2024",
month="Jun",
day="26",
volume="16",
pages="e52686",
keywords="opioids",
keywords="broadband internet",
keywords="mortality",
keywords="public health",
keywords="digital divide",
keywords="access",
keywords="availability",
keywords="causal",
keywords="association",
keywords="correlation",
keywords="overdose",
keywords="drug abuse",
keywords="addiction",
keywords="substance abuse",
keywords="demographic",
keywords="United States",
keywords="population",
abstract="Background: The availability and use of broadband internet play an increasingly important role in health care and public health. Objective: This study examined the associations between broadband internet availability and use with drug overdose deaths in the United States. Methods: We linked 2019 county-level drug overdose death data in restricted-access multiple causes of death files from the National Vital Statistics System at the US Centers for Disease Control and Prevention with the 2019 county-level broadband internet rollout data from the Federal Communications Commission and the 2019 county-level broadband usage data available from Microsoft's Airband Initiative. Cross-sectional analysis was performed with the fixed-effects regression method to assess the association of broadband internet availability and usage with opioid overdose deaths. Our model also controlled for county-level socioeconomic characteristics and county-level health policy variables. Results: Overall, a 1\% increase in broadband internet use was linked with a 1.2\% increase in overall drug overdose deaths. No significant association was observed for broadband internet availability. Although similar positive associations were found for both male and female populations, the association varied across different age subgroups. The positive association on overall drug overdose deaths was the greatest among Hispanic and Non-Hispanic White populations. Conclusions: Broadband internet use was positively associated with increased drug overdose deaths among the overall US population and some subpopulations, even after controlling for broadband availability, sociodemographic characteristics, unemployment, and median household income. ",
doi="10.2196/52686",
url="https://ojphi.jmir.org/2024/1/e52686",
url="http://www.ncbi.nlm.nih.gov/pubmed/38922664"
}


@Article{info:doi/10.2196/54074,
author="Gomes, Cunha Mateus
and Castro, Robert
and Silva Serra, Willian
and Sagica de Vasconcelos, Jhak
and Parente, Andressa
and Botelho, Pinheiro Eli{\~a}
and Ferreira, Glenda
and Sousa, Fabianne",
title="Demographic Profile, Health, and Associated Factors of Family Caregivers and Functionality of Hospitalized Older Adults: Cross-Sectional, Exploratory, and Descriptive Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="21",
volume="8",
pages="e54074",
keywords="family caregiver",
keywords="older adult",
keywords="hospitalization",
keywords="functionality",
keywords="caregiver",
keywords="health",
abstract="Background: The longevity of the world population can contribute to an increase in hospitalizations and, consequently, to the emergence of functional limitations, resulting in the need for family caregivers. Hospitalized older adults may become dependent and require more care, increasing the burden on family caregivers. Thus, the nursing team in the hospital environment faces a new situation: an increase in the number of older adults occupying hospital beds and the presence of their family caregivers. Objective: We aimed to analyze the association between the demographic variables of interest and the self-rated health of family caregivers and to describe the functionality of older adults hospitalized in a university hospital in the Amazonian context. Methods: This cross-sectional, quantitative, exploratory, and descriptive study was carried out through individual interviews with 98 interviewees, divided into 49 family caregivers and 49 older adults hospitalized in the surgical clinic sector of a university hospital in Brazil between February and March 2023. Demographic data and health conditions were collected from family caregivers, and to describe the functionality of hospitalized older adults, the Barthel Index was applied. Descriptive (frequency and percentage) and inferential analyses were used, and the student t test was applied. The significance level of 5\% was adopted. Results: Among the 49 family caregivers, the majority were women (n=40, 81.6\%) with an average age of 46.9 (SD 13.3) years. Most were single (n=28, 57.1\%) and had completed an average level of education (n=26, 53.1\%). Additionally, 25 (51\%) caregivers were caring for their parents. Regarding health conditions, respondents self-assessed their health as good (25/49, 51\%; P=.01), and they considered that their health status was not affected by the provision of care (36/49, 73.5\%; P=.01). There was a significant association between demographic variables (ie, gender, age, and education) and self-assessment of family caregivers (P=.01, P=.01, and P=.04, respectively). Of the 49 older adults hospitalized, the majority (n=31, 63.2\%) were men, with a mean age of 69.2 (SD 7.12) years. Regarding the assessment of functionality, most older adults were classified as having mild dependence on care (n=23, 46.9\%), specifically in the age group between 60 and 69 years (21/49, 67.8\%). Conclusions: The data revealed that female gender, age, and education of family caregivers contributed favorably to the provision of care to hospitalized older adults with a lower degree of functional dependence. It is important to emphasize that during the older adult's hospitalization, the family caregiver should not be seen as a delegation of responsibilities or as a complement of human resources to assist in their recovery. Health professionals need to implement assertive interventions so that the family caregiver functions as a therapeutic resource. ",
doi="10.2196/54074",
url="https://formative.jmir.org/2024/1/e54074"
}


@Article{info:doi/10.2196/56493,
author="Philpot, M. Lindsey
and Ramar, Priya
and Roellinger, L. Daniel
and Njeru, W. Jane
and Ebbert, O. Jon",
title="Individual-Level Digital Determinants of Health and Technology Acceptance of Patient Portals: Cross-Sectional Assessment",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="10",
volume="8",
pages="e56493",
keywords="electronic health records",
keywords="digital determinants of health",
keywords="patient portals",
keywords="eHealth",
keywords="digital health",
keywords="technology acceptance model",
keywords="digital health literacy",
keywords="digital inclusion",
keywords="mobile phone",
abstract="Background: Digital determinants of health (DDoH), including access to technological tools and digital health literacy, function independently as barriers to health. Assessment for DDoH is not routine within most health care systems, although addressing DDoH could help mitigate differential health outcomes and the digital divide. Objective: This study aims to assess the role of individual-level DDoH factors on patient enrollment in and use of the patient portal. Methods: We developed a multimodal, cross-sectional survey and deployed it to 11,424 individuals based on their preferred mode and language documented within the electronic medical record. Based on the Technology Acceptance Model, enrollment in and intent to use the patient portal were the outcomes of interest. Perceived usefulness and ease of use were assessed to determine construct validity, and exploratory investigations included individual-level DDoH, including internet and device access, availability of technological support, medical complexity, individual relationship with the health care system, and digital health literacy. Counts (n) and proportions (\%) were used to describe response categories, and adjusted and unadjusted odds ratios are reported. Results: This study included 1850 respondents (11,424 invited, 16.2\% response rate), who were mostly female (1048/1850, 56.6\%) and White (1240/1850, 67\%), with an average age of 63 years. In the validation of the Technology Acceptance Model, measures of perceived ease of use (ie, using the patient portal will require a lot of mental effort; the patient portal will be very easy to use) and perceived usefulness (ie, the usefulness of the patient portal to send and receive messages with providers, schedule appointments, and refill medications) were positively associated with both enrollment in and intent to use the patient portal. Within adjusted models, perceived ease of use and perceived usefulness constructs, in addition to constructs of digital health literacy, knowing what health resources are available on the internet (adjusted odds ratio [aOR] 3.5, 95\% CI 1.8-6.6), portal ease of use (aOR 2.8, 95\% CI 1.6-5), and portal usefulness (aOR 2.4, 95\% CI 1.4-4.2) were significantly associated with patient portal enrollment. Other factors associated with patient portal enrollment and intent to use included being comfortable reading and speaking English, reported use of the internet to surf the web or to send or receive emails, home internet access, and access to technology devices (computer, tablet, smartphone, etc). Conclusions: Assessing for and addressing individual-level DDoH, including digital health literacy, access to digital tools and technologies, and support of the relational aspects between patients, social support systems, and health care providers, could help mitigate disparities in health. By focusing efforts to assess for and address individual-level DDoH, an opportunity exists to improve digitally driven health care delivery outcomes like access and structural outcomes like bias built within algorithms created with incomplete representation across communities. ",
doi="10.2196/56493",
url="https://formative.jmir.org/2024/1/e56493",
url="http://www.ncbi.nlm.nih.gov/pubmed/38695754"
}


@Article{info:doi/10.2196/51666,
author="Heitkemper, Elizabeth
and Hulse, Scott
and Bekemeier, Betty
and Schultz, Melinda
and Whitman, Greg
and Turner, M. Anne",
title="The Solutions in Health Analytics for Rural Equity Across the Northwest (SHARE-NW) Dashboard for Health Equity in Rural Public Health: Usability Evaluation",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="5",
volume="11",
pages="e51666",
keywords="data dashboard",
keywords="rural health",
keywords="health equity",
keywords="usability",
keywords="nursing informatics",
keywords="dashboard",
keywords="rural",
keywords="informatics",
keywords="satisfaction",
keywords="think aloud",
keywords="content analysis",
keywords="user experience",
keywords="public health",
keywords="visualization",
keywords="information systems",
abstract="Background: Given the dearth of resources to support rural public health practice, the solutions in health analytics for rural equity across the northwest dashboard (SHAREdash) was created to support rural county public health departments in northwestern United States with accessible and relevant data to identify and address health disparities in their jurisdictions. To ensure the development of useful dashboards, assessment of usability should occur at multiple stages throughout the system development life cycle. SHAREdash was refined via user-centered design methods, and upon completion, it is critical to evaluate the usability of SHAREdash. Objective: This study aims to evaluate the usability of SHAREdash based on the system development lifecycle stage 3 evaluation goals of efficiency, satisfaction, and validity. Methods: Public health professionals from rural health departments from Washington, Idaho, Oregon, and Alaska were enrolled in the usability study from January to April 2022. The web-based evaluation consisted of 2 think-aloud tasks and a semistructured qualitative interview. Think-aloud tasks assessed efficiency and effectiveness, and the interview investigated satisfaction and overall usability. Verbatim transcripts from the tasks and interviews were analyzed using directed content analysis. Results: Of the 9 participants, all were female and most worked at a local health department (7/9, 78\%). A mean of 10.1 (SD 1.4) clicks for task 1 (could be completed in 7 clicks) and 11.4 (SD 2.0) clicks for task 2 (could be completed in 9 clicks) were recorded. For both tasks, most participants required no prompting---89\% (n=8) participants for task 1 and 67\% (n=6) participants for task 2, respectively. For effectiveness, all participants were able to complete each task accurately and comprehensively. Overall, the participants were highly satisfied with the dashboard with everyone remarking on the utility of using it to support their work, particularly to compare their jurisdiction to others. Finally, half of the participants stated that the ability to share the graphs from the dashboard would be ``extremely useful'' for their work. The only aspect of the dashboard cited as problematic is the amount of missing data that was present, which was a constraint of the data available about rural jurisdictions. Conclusions: Think-aloud tasks showed that the SHAREdash allows users to complete tasks efficiently. Overall, participants reported being very satisfied with the dashboard and provided multiple ways they planned to use it to support their work. The main usability issue identified was the lack of available data indicating the importance of addressing the ongoing issues of missing and fragmented public health data, particularly for rural communities. ",
doi="10.2196/51666",
url="https://humanfactors.jmir.org/2024/1/e51666",
url="http://www.ncbi.nlm.nih.gov/pubmed/38837192"
}


@Article{info:doi/10.2196/50376,
author="Turnbull, Joanne
and Prichard, Jane
and MacLellan, Jennifer
and Pope, Catherine",
title="eHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="4",
volume="26",
pages="e50376",
keywords="urgent care",
keywords="digital health",
keywords="access to health care",
keywords="eHealth",
keywords="health care system",
keywords="COVID-19",
keywords="urgent",
keywords="emergency",
keywords="health literacy",
keywords="eHealth literacy",
keywords="digital literacy",
keywords="access",
keywords="cross-sectional",
abstract="Background: Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. ``Digital first'' may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. Objective: This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. Methods: A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. Results: Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95\% CI 1.46-2.38) and 1.51 (95\% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95\% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95\% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4\%) or for illness in children (n=1117, 79\%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service ($\chi$12=138.57; P<.001). Conclusions: These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand. ",
doi="10.2196/50376",
url="https://www.jmir.org/2024/1/e50376",
url="http://www.ncbi.nlm.nih.gov/pubmed/38833297"
}


@Article{info:doi/10.2196/53321,
author="Li, Jiaying
and Fong, Tak Daniel Yee
and Ho, Man Mandy
and Choi, Hang Edmond Pui
and Lok, Wan Kris Yuet
and Lee, Jae Jung
and Duan, WenJie
and Wong, Ha Janet Yuen
and Lin, Chia-Chin",
title="Prevalence and Factors Associated With Willingness to Sustain Pandemic-Induced Digital Work in the General Population and Moderating Effects of Screen Hours: Cross-Sectional Study",
journal="J Med Internet Res",
year="2024",
month="May",
day="28",
volume="26",
pages="e53321",
keywords="COVID-19 pandemic",
keywords="digital work",
keywords="willingness to sustain",
keywords="screen time",
keywords="general population",
abstract="Background: The pandemic has accelerated digital work transformation, yet little is known about individuals' willingness to sustain such digital modes and its associated factors. A better understanding of this willingness and its drivers is crucial for guiding the development of future digital work infrastructure, training programs, and strategies to monitor and prevent related health issues. Objective: This study aims to quantify the general population's willingness to sustain pandemic-induced digital work, identify its associated factors, and examine how screen time moderates these relationships. Methods: A cross-sectional study was conducted targeting Hong Kong residents aged ?18 years who have increased engagement in digital work since the pandemic. Data were collected through self-reported, web-based surveys. Descriptive statistics determined prevalence rates, while structured multiphase logistic regression identified associated factors and explored the moderating effects of screen hour levels. Results: This unfunded study enrolled 1014 participants from May 2 to June 24, 2022, and completed data analysis within 3 months after data collection. A total of 391 (38.6\%; 95\% CI 35.6\%-41.6\%) participants expressed willingness to sustain digital work. Positive factors associated with this willingness included being an employee (odds ratio [OR] 3.12, 95\% CI 1.59-6.45; P=.001), being health professionals (OR 3.32, 95\% CI 1.49-7.82; P=.004), longer screen hours (OR 1.09, 95\% CI 1.03-1.15; P=.002), and higher depression levels (OR 1.20, 95\% CI 1.01-1.44; P=.04). Conversely, negatively associated factors included older age (OR 0.87, 95\% CI 0.81-0.94; P=.001), extroversion (OR 0.66, 95\% CI 0.51-0.86; P=.002), higher eHealth literacy (OR 0.96, 95\% CI 0.93-0.98; P<.001), perceived greater susceptibility to COVID-19 (OR 0.84, 95\% CI 0.74-0.96; P=.009), residence in a high-severity COVID-19 community (OR 0.73, 95\% CI 0.63-0.84; P<.001), having infected individuals in the immediate social circle (OR 0.64, 95\% CI 0.46-0.88; P=.006), higher BMI (OR 0.94, 95\% CI 0.90-0.99; P=.02), feelings of being out of control (OR 0.96, 95\% CI 0.93-0.98; P=.002), and higher fear of COVID-19 (OR 0.96, 95\% CI 0.94-0.98; P=.001). In addition, a moderating effect of screen hour level (high: >8 h/d; low: ?8 h/d) influenced the association among 10 factors related to willingness to sustain pandemic-induced digital work, including age, education level, household size, needs for regular medical care, BMI, frequency of both vigorous and moderate physical activities, perceived COVID-19 severity, immediate social circle COVID-19 presence, and fear of COVID-19 (all P values for interaction <.05). Conclusions: The substantial willingness of the general population to sustain digital work after the pandemic highlights the need for robust telework infrastructure, thorough monitoring of adverse health outcomes, and the potential to expand telehealth services among this group. The identification of factors influencing this willingness and the moderating role of screen hours inform the development of personalized strategies to enhance digital work acceptance where needed. ",
doi="10.2196/53321",
url="https://www.jmir.org/2024/1/e53321",
url="http://www.ncbi.nlm.nih.gov/pubmed/38805704"
}


@Article{info:doi/10.2196/54010,
author="Dinh, Mackenzie
and Lin, Chieh Chun
and Whitfield, Candace
and Farhan, Zahera
and Meurer, J. William
and Bailey, Sarah
and Skolarus, E. Lesli",
title="Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial",
journal="JMIR Form Res",
year="2024",
month="May",
day="28",
volume="8",
pages="e54010",
keywords="hypertension",
keywords="cognition",
keywords="mobile health",
keywords="Bluetooth",
keywords="remote",
keywords="monitoring",
keywords="monitor",
keywords="low income",
keywords="mHealth",
keywords="hypertensive",
keywords="cardiology",
keywords="cardiovascular",
keywords="feasibility",
keywords="acceptability",
keywords="satisfaction",
keywords="RCT",
keywords="randomized controlled trial",
keywords="assessment",
keywords="blood pressure",
keywords="neurological",
abstract="Background: Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease--related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. Objective: The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. Methods: Reach Out was a randomized, controlled, mobile health--based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25\% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message--linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). Results: Of the 211 Reach Out participants, 107 (50.7\%) consented and 71 (33.6\%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4\% were female and 57.8\% identified as Black. Among the 71 participants, 51 (72\%) completed cognitive assessments at 3 months and 34 (48\%) completed these assessments at 6 months. BP assessments were completed by 37 (52\%) and 20 (28\%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. Conclusions: Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 ",
doi="10.2196/54010",
url="https://formative.jmir.org/2024/1/e54010",
url="http://www.ncbi.nlm.nih.gov/pubmed/38805251"
}


@Article{info:doi/10.2196/57041,
author="Shimkhada, Riti
and Ponce, A. Ninez",
title="Social Media Use and Serious Psychological Distress Among Adolescents",
journal="JMIR Pediatr Parent",
year="2024",
month="May",
day="23",
volume="7",
pages="e57041",
keywords="social media",
keywords="socials",
keywords="youth",
keywords="adolescents",
keywords="teens",
keywords="teenager",
keywords="mental health",
keywords="mental illness",
keywords="mental disease",
keywords="mental illnesses",
keywords="psychological distress",
keywords="psychological",
keywords="psychology",
doi="10.2196/57041",
url="https://pediatrics.jmir.org/2024/1/e57041"
}


@Article{info:doi/10.2196/50205,
author="Odebunmi, O. Olufeyisayo
and Hughes, D. Tamera
and Waters, R. Austin
and Urick, Y. Benjamin
and Herron, Caroline
and Wangen, Mary
and Rohweder, Catherine
and Ferrari, M. Ren{\'e}e
and Marciniak, W. Macary
and Wheeler, B. Stephanie
and Brenner, T. Alison
and Shah, D. Parth",
title="Findings From a National Survey of Older US Adults on Patient Willingness to Use Telehealth Services: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2024",
month="May",
day="23",
volume="26",
pages="e50205",
keywords="community pharmacy",
keywords="telehealth",
keywords="telemedicine",
keywords="telepharmacy",
keywords="pharmacy service quality",
keywords="patient willingness",
keywords="willingness",
keywords="cross-sectional",
keywords="national survey",
keywords="telehealth cost",
abstract="Background: Telehealth (telemedicine and telepharmacy) services increase access to patient services and ensure continuity of care. However, few studies have assessed factors that influence patients' willingness to use telehealth services, and we sought to investigate this. Objective: This study aims to examine respondents' (aged between 45 and 75 years) willingness to use telehealth services (telepharmacy and telemedicine) and the correlates of the willingness to use telehealth services. Methods: We administered a cross-sectional national survey of 1045 noninstitutionalized US adults aged between 45 and 75 years in March and April 2021. Multiple logistic regression analyses were used to identify demographic and health service use correlates of self-reported willingness to use telehealth services. Results: Overall willingness to use telemedicine was high (674/1045, 64.5\%). Adults aged 55 years and older were less willing to use telemedicine (aged between 55 and 64 years: odds ratio [OR] 0.61, 95\% CI 0.42-0.86; aged 65 years or older: OR 0.33, 95\% CI 0.22-0.49) than those younger than 55 years. Those with a regular provider (OR 1.01, 95\% CI 1-1.02) and long travel times (OR 1.75, 95\% CI 1.03-2.98) were more willing to use telemedicine compared to those without a regular provider and had shorter travel times, respectively. Willingness to use telemedicine services increased from 64.5\% (674/1045) to 83\% (867/1045) if the service was low-cost or insurance-covered, was with their existing health care provider, or was easy-to-use. Overall willingness to use telepharmacy was 76.7\% (801/1045). Adults aged older than 55 years were less willing to use telepharmacy (aged between 55 and 64 years: OR 0.57, 95\% CI 0.38-0.86; aged 65 years or older: OR 0.24, 95\% CI 0.15-0.37) than those younger than 55 years. Those who rated pharmacy service quality higher were more willing to use telepharmacy (OR 1.06, 95\% CI 1.03-1.09) than those who did not. Conclusions: Respondents were generally willing to use telehealth (telemedicine and telepharmacy) services, but the likelihood of their being willing to use telehealth decreased as they were older. For those initially unwilling (aged 55 years or older) to use telemedicine services, inexpensive or insurance-covered services were acceptable. ",
doi="10.2196/50205",
url="https://www.jmir.org/2024/1/e50205",
url="http://www.ncbi.nlm.nih.gov/pubmed/38780994"
}


@Article{info:doi/10.2196/49189,
author="McDuff, Daniel
and Barakat, Andrew
and Winbush, Ari
and Jiang, Allen
and Cordeiro, Felicia
and Crowley, Ryann
and Kahn, E. Lauren
and Hernandez, John
and Allen, B. Nicholas",
title="The Google Health Digital Well-Being Study: Protocol for a Digital Device Use and Well-Being Study",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="14",
volume="13",
pages="e49189",
keywords="digital",
keywords="health",
keywords="well-being",
keywords="mobile",
keywords="google health",
keywords="digital health",
keywords="mhealth",
keywords="digital device",
keywords="smartphone",
abstract="Background: The impact of digital device use on health and well-being is a pressing question. However, the scientific literature on this topic, to date, is marred by small and unrepresentative samples, poor measurement of core constructs, and a limited ability to address the psychological and behavioral mechanisms that may underlie the relationships between device use and well-being. Recent authoritative reviews have made urgent calls for future research projects to address these limitations. The critical role of research is to identify which patterns of use are associated with benefits versus risks and who is more vulnerable to harmful versus beneficial outcomes, so that we can pursue evidence-based product design, education, and regulation aimed at maximizing benefits and minimizing the risks of smartphones and other digital devices. Objective: The objective of this study is to provide normative data on objective patterns of smartphone use. We aim to (1) identify how patterns of smartphone use impact well-being and identify groups of individuals who show similar patterns of covariation between smartphone use and well-being measures across time; (2) examine sociodemographic and personality or mental health predictors and which patterns of smartphone use and well-being are associated with pre-post changes in mental health and functioning; (3) discover which nondevice behavior patterns mediate the association between device use and well-being; (4) identify and explore recruitment strategies to increase and improve the representation of traditionally underrepresented populations; and (5) provide a real-world baseline of observed stress, mood, insomnia, physical activity, and sleep across a representative population. Methods: This is a prospective, nonrandomized study to investigate the patterns and relationships among digital device use, sensor-based measures (including both behavioral and physiological signals), and self-reported measures of mental health and well-being. The study duration is 4 weeks per participant and includes passive sensing based on smartphone sensors, and optionally a wearable (Fitbit), for the complete study period. The smartphone device will provide activity, location, phone unlocks and app usage, and battery status information. Results: At the time of submission, the study infrastructure and app have been designed and built, the institutional review board of the University of Oregon has approved the study protocol, and data collection is underway. Data from 4182 enrolled and consented participants have been collected as of March 27, 2023. We have made many efforts to sample a study population that matches the general population, and the demographic breakdown we have been able to achieve, to date, is not a perfect match. Conclusions: The impact of digital devices on mental health and well-being raises important questions. The Digital Well-Being Study is designed to help answer questions about the association between patterns of smartphone use and well-being. International Registered Report Identifier (IRRID): DERR1-10.2196/49189 ",
doi="10.2196/49189",
url="https://www.researchprotocols.org/2024/1/e49189",
url="http://www.ncbi.nlm.nih.gov/pubmed/38743938"
}


@Article{info:doi/10.2196/49168,
author="Morales-Cahuancama, Bladimir
and Verdezoto, Nervo
and Gonzales-Achuy, Elena
and Quispe-Gala, Cinthia
and Bautista-Olortegui, William
and Hinojosa-Mamani, Paul
and Aparco, Pablo Juan",
title="Exploring Children's Knowledge of Healthy Eating, Digital Media Use, and Caregivers' Perspectives to Inform Design and Contextual Considerations for Game-Based Interventions in Schools for Low-Income Families in Lima, Peru: Survey Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="14",
volume="8",
pages="e49168",
keywords="child",
keywords="children",
keywords="schoolchildren",
keywords="youth",
keywords="student",
keywords="students",
keywords="adolescent",
keywords="formative research",
keywords="digital media",
keywords="digital games",
keywords="serious game",
keywords="serious games",
keywords="nutrition",
keywords="obesity",
keywords="obese",
keywords="overweight",
keywords="mHealth",
keywords="caregivers' perspectives",
keywords="perspective",
keywords="perspectives",
keywords="diet",
keywords="healthy eating",
abstract="Background: The prevalence of overweight and obesity in schoolchildren is increasing in Peru. Given the increased use of digital media, there is potential to develop effective digital health interventions to promote healthy eating practices at schools. This study investigates the needs of schoolchildren in relation to healthy eating and the potential role of digital media to inform the design of game-based nutritional interventions. Objective: This study aims to explore schoolchildren's knowledge about healthy eating and use of and preferences for digital media to inform the future development of a serious game to promote healthy eating. Methods: A survey was conducted in 17 schools in metropolitan Lima, Peru. The information was collected virtually with specific questions for the schoolchild and their caregiver during October 2021 and November 2021 and following the COVID-19 public health restrictions. Questions on nutritional knowledge and preferences for and use of digital media were included. In the descriptive analysis, the percentages of the variables of interest were calculated. Results: We received 3937 validated responses from caregivers and schoolchildren. The schoolchildren were aged between 8 years and 15 years (2030/3937, 55.8\% girls). Of the caregivers, 83\% (3267/3937) were mothers, and 56.5\% (2223/3937) had a secondary education. Only 5.2\% (203/3937) of schoolchildren's homes did not have internet access; such access was through WiFi (2151/3937, 54.6\%) and mobile internet (1314/3937, 33.4\%). In addition, 95.3\% (3753/3937) of schoolchildren's homes had a mobile phone; 31.3\% (1233/3937) had computers. In relation to children's knowledge on healthy eating, 42.2\% (1663/3937) of schoolchildren did not know the recommendation to consume at least 5 servings of fruits and vegetables daily, 46.7\% (1837/3937) of schoolchildren did not identify front-of-package warning labels (FOPWLs), and 63.9\% (2514/3937) did not relate the presence of an FOPWL with dietary risk. Most schoolchildren (3100/3937, 78.7\%) preferred to use a mobile phone. Only 38.3\% (1509/3937) indicated they preferred a computer. In addition, 47.9\% (1885/3937) of caregivers considered that the internet helps in the education of schoolchildren, 82.7\% (3254/3937) of caregivers gave permission for schoolchildren to play games with digital devices, and 38\% (1495/3937) of caregivers considered that traditional digital games for children are inadequate. Conclusions: The results suggest that knowledge about nutrition in Peruvian schoolchildren has limitations. Most schoolchildren have access to the internet, with mobile phones being the device type with the greatest availability and preference for use. Caregivers' perspectives on games and schoolchildren, including a greater interest in using digital games, provide opportunities for the design and development of serious games to improve schoolchildren's nutritional knowledge in Peru. Future research is needed to explore the potential of serious games that are tailored to the needs and preferences of both schoolchildren and their caregivers in Peru in order to promote healthy eating. ",
doi="10.2196/49168",
url="https://formative.jmir.org/2024/1/e49168",
url="http://www.ncbi.nlm.nih.gov/pubmed/38743472"
}


@Article{info:doi/10.2196/52124,
author="Spaulding, M. Erin
and Fang, Michael
and Commodore-Mensah, Yvonne
and Himmelfarb, R. Cheryl
and Martin, S. Seth
and Coresh, Josef",
title="Prevalence and Disparities in Telehealth Use Among US Adults Following the COVID-19 Pandemic: National Cross-Sectional Survey",
journal="J Med Internet Res",
year="2024",
month="May",
day="10",
volume="26",
pages="e52124",
keywords="telehealth",
keywords="telemedicine",
keywords="delivery of health care",
keywords="health care disparities",
keywords="COVID-19",
abstract="Background: Telemedicine expanded during the COVID-19 pandemic, though use differed by age, sex, race or ethnicity, educational attainment, income, and location. It is unclear if high telehealth use or inequities persisted late into the pandemic. Objective: This study aims to evaluate the prevalence of, inequities in, and primary reasons for telehealth visits a year after telemedicine expansion. Methods: We used cross-sectional data from the 2022 Health Information National Trends Survey (HINTS 6), the first cycle with data on telemedicine. In total, 4830 English- and Spanish-speaking US adults (aged ?18 years) were included in this study. The primary outcomes were telehealth visit attendance in the 12 months before March 7, 2022, to November 8, 2022, and the primary reason for the most recent telehealth visit. We evaluated sociodemographic and clinical predictors of telehealth visit attendance and the primary reason for the most recent telehealth visit through Poisson regression. Analyses were weighted according to HINTS 6 standards. Results: We included 4830 participants (mean age 48.3, SD 17.5 years; 50.28\% women; 65.21\% White). Among US adults, 38.78\% reported having a telehealth visit in the previous year. Telehealth visit attendance rates were similar across age, race or ethnicity, income, and urban versus rural location. However, individuals with a telehealth visit were less likely to live in the Midwest (adjusted prevalence ratio [aPR] 0.65, 95\% CI 0.54-0.77), and more likely to be women (aPR 1.21, 95\% CI 1.06-1.38), college graduates or postgraduates (aPR 1.24, 95\% CI 1.05-1.46), covered by health insurance (aPR 1.56, 95\% CI 1.08-2.26), and married or cohabitating (aPR 1.17, 95\% CI 1.03-1.32), adjusting for sociodemographic characteristics, frequency of health care visits, and comorbidities. Among participants with a telehealth visit in the past year, the primary reasons for their most recent visit were minor or acute illness (32.15\%), chronic disease management (21\%), mental health or substance abuse (16.94\%), and an annual exam (16.22\%). Older adults were more likely to report that the primary reason for their most recent telehealth visit was for chronic disease management (aPR 2.08, 95\% CI 1.33-3.23), but less likely to report that it was for a mental health or substance abuse issue (aPR 0.19, 95\% CI 0.10-0.35), adjusting for sociodemographic characteristics and frequency of health care visits. Conclusions: Among US adults, telehealth visit attendance was high more than a year after telemedicine expansion and did not differ by age, race or ethnicity, income, or urban versus rural location. Telehealth could continue to be leveraged following COVID-19 to improve access to care and health equity. ",
doi="10.2196/52124",
url="https://www.jmir.org/2024/1/e52124",
url="http://www.ncbi.nlm.nih.gov/pubmed/38728070"
}


@Article{info:doi/10.2196/50826,
author="Cruz, Stefany
and Lu, Claire
and Ulloa, Mara
and Redding, Alexander
and Hester, Josiah
and Jacobs, Maia",
title="Perceptions of Wearable Health Tools Post the COVID-19 Emergency in Low-Income Latin Communities: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="May",
day="8",
volume="12",
pages="e50826",
keywords="mHealth",
keywords="mobile health",
keywords="wearable",
keywords="wearables",
keywords="Health wearables",
keywords="COVID-19",
keywords="digital divide",
keywords="low-socioeconomic status",
keywords="socioeconomic",
keywords="adoption",
keywords="underserved",
keywords="poverty",
keywords="low income",
keywords="low resource",
keywords="marginalized",
keywords="equity",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="opinions",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="acceptance",
keywords="Spanish",
keywords="Hispanic",
keywords="Latinx",
keywords="Hispanics",
keywords="interview",
keywords="interviews",
abstract="Background: Mobile health (mHealth) wearable devices are increasingly being adopted by individuals to help manage and monitor physiological signals. However, the current state of wearables does not consider the needs of racially minoritized low--socioeconomic status (SES) communities regarding usability, accessibility, and price. This is a critical issue that necessitates immediate attention and resolution. Objective: This study's aims were 3-fold, to (1) understand how members of minoritized low-SES communities perceive current mHealth wearable devices, (2) identify the barriers and facilitators toward adoption, and (3) articulate design requirements for future wearable devices to enable equitable access for these communities. Methods: We performed semistructured interviews with low-SES Hispanic or Latine adults (N=19) from 2 metropolitan cities in the Midwest and West Coast of the United States. Participants were asked questions about how they perceive wearables, what are the current benefits and barriers toward use, and what features they would like to see in future wearable devices. Common themes were identified and analyzed through an exploratory qualitative approach. Results: Through qualitative analysis, we identified 4 main themes. Participants' perceptions of wearable devices were strongly influenced by their COVID-19 experiences. Hence, the first theme was related to the impact of COVID-19 on the community, and how this resulted in a significant increase in interest in wearables. The second theme highlights the challenges faced in obtaining adequate health resources and how this further motivated participants' interest in health wearables. The third theme focuses on a general distrust in health care infrastructure and systems and how these challenges are motivating a need for wearables. Lastly, participants emphasized the pressing need for community-driven design of wearable technologies. Conclusions: The findings from this study reveal that participants from underserved communities are showing emerging interest in using health wearables due to the COVID-19 pandemic and health care access issues. Yet, the needs of these individuals have been excluded from the design and development of current devices. ",
doi="10.2196/50826",
url="https://mhealth.jmir.org/2024/1/e50826",
url="http://www.ncbi.nlm.nih.gov/pubmed/38717816"
}


@Article{info:doi/10.2196/52575,
author="Kikkenborg, Julie
and Magelund, Emma
and Riise, Silke Maria
and Kayser, Lars
and Terp, Rikke",
title="Knowledge, Skills, and Experience With Technology in Relation to Nutritional Intake and Physical Activity Among Older Adults at Risk of Falls: Semistructured Interview Study",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="8",
volume="11",
pages="e52575",
keywords="eHealth",
keywords="self-management",
keywords="fall prevention",
keywords="older adults",
keywords="physical activity",
keywords="nutritional intake",
keywords="Readiness and Enablement Index for Health Technology",
keywords="READHY",
keywords="social support",
keywords="support",
keywords="management",
keywords="fall",
keywords="nutrition",
keywords="diet",
keywords="qualitative study",
keywords="malnutrition",
keywords="physical inactivity",
keywords="injury",
keywords="injuries",
keywords="food",
keywords="food intake",
keywords="nutritional needs",
keywords="outpatient clinic",
keywords="social network",
keywords="mobile phone",
abstract="Background: More than one-third of older adults (aged ?65 y) experience falls every year. The prevalent modifiable risk factors for falling are malnutrition and physical inactivity, among others. The involvement of older adults in the prevention of falls can decrease injuries, hospitalizations, and dependency on health care professionals. In this regard, eHealth can support older adults' self-management through more physical activity and adequate food intake. eHealth must be tailored to older adults' needs and preferences so that they can reap its full benefits. Therefore, it is necessary to gain insight into the knowledge, skills, and mindset of older adults living at home who are at risk of falls regarding eHealth. Objective: This qualitative study aims to explore older adults' use of everyday digital services and technology and how they acquire knowledge about and manage their nutritional intake and physical activity in relation to their health. Methods: Semistructured interviews were conducted with 15 older adults (n=9, 60\% women; n=6, 40\% men; age range 71-87 y) who had all experienced falls or were at risk of falling. These individuals were recruited from a geriatric outpatient clinic. The interviews were analyzed using deductive content analysis based on a modification of the Readiness and Enablement Index for Health Technology framework. Results: The qualitative data showed that the informants' social networks had a positive impact on their self-management, use of technology, and mindset toward nutritional intake and physical activity. Although the informants generally lived active lives, they all lacked knowledge about how their food intake influenced their physical health, including their risk of falling. Another finding was the large diversity in the use of technology among the informants, which was related to their mindset toward technology. Conclusions: Older adults can use technology for everyday purposes, but some need additional introduction and support to be able to use it for managing their health. They also need to learn about the importance of proper nutritional intake and physical activity in preventing falls. Older adults need a more personalized introduction to technology, nutrition, and physical activity in their contact with health professionals. ",
doi="10.2196/52575",
url="https://humanfactors.jmir.org/2024/1/e52575",
url="http://www.ncbi.nlm.nih.gov/pubmed/38717810"
}


@Article{info:doi/10.2196/52691,
author="Mohebbi, Fahimeh
and Forati, Masoud Amir
and Torres, Lucas
and deRoon-Cassini, A. Terri
and Harris, Jennifer
and Tomas, W. Carissa
and Mantsch, R. John
and Ghose, Rina",
title="Exploring the Association Between Structural Racism and Mental Health: Geospatial and Machine Learning Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="3",
volume="10",
pages="e52691",
keywords="machine learning",
keywords="geospatial",
keywords="racial disparities",
keywords="social determinant of health",
keywords="structural racism",
keywords="mental health",
keywords="health disparities",
keywords="deep learning",
abstract="Background: Structural racism produces mental health disparities. While studies have examined the impact of individual factors such as poverty and education, the collective contribution of these elements, as manifestations of structural racism, has been less explored. Milwaukee County, Wisconsin, with its racial and socioeconomic diversity, provides a unique context for this multifactorial investigation. Objective: This research aimed to delineate the association between structural racism and mental health disparities in Milwaukee County, using a combination of geospatial and deep learning techniques. We used secondary data sets where all data were aggregated and anonymized before being released by federal agencies. Methods: We compiled 217 georeferenced explanatory variables across domains, initially deliberately excluding race-based factors to focus on nonracial determinants. This approach was designed to reveal the underlying patterns of risk factors contributing to poor mental health, subsequently reintegrating race to assess the effects of racism quantitatively. The variable selection combined tree-based methods (random forest) and conventional techniques, supported by variance inflation factor and Pearson correlation analysis for multicollinearity mitigation. The geographically weighted random forest model was used to investigate spatial heterogeneity and dependence. Self-organizing maps, combined with K-means clustering, were used to analyze data from Milwaukee communities, focusing on quantifying the impact of structural racism on the prevalence of poor mental health. Results: While 12 influential factors collectively accounted for 95.11\% of the variability in mental health across communities, the top 6 factors---smoking, poverty, insufficient sleep, lack of health insurance, employment, and age---were particularly impactful. Predominantly, African American neighborhoods were disproportionately affected, which is 2.23 times more likely to encounter high-risk clusters for poor mental health. Conclusions: The findings demonstrate that structural racism shapes mental health disparities, with Black community members disproportionately impacted. The multifaceted methodological approach underscores the value of integrating geospatial analysis and deep learning to understand complex social determinants of mental health. These insights highlight the need for targeted interventions, addressing both individual and systemic factors to mitigate mental health disparities rooted in structural racism. ",
doi="10.2196/52691",
url="https://publichealth.jmir.org/2024/1/e52691",
url="http://www.ncbi.nlm.nih.gov/pubmed/38701436"
}


@Article{info:doi/10.2196/50759,
author="Lee, Shinduk
and Ory, G. Marcia
and Vollmer Dahlke, Deborah
and Smith, Lee Matthew",
title="Technology Use Among Older Adults and Their Caregivers: Cross-Sectional Survey Study",
journal="JMIR Aging",
year="2024",
month="May",
day="1",
volume="7",
pages="e50759",
keywords="technology",
keywords="caregiving",
keywords="social determinants of health",
keywords="health disparities",
keywords="disparity",
keywords="disparities",
keywords="caregiver",
keywords="caregivers",
keywords="carers",
keywords="technology use",
keywords="usage",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="aging",
keywords="cross-sectional",
keywords="survey",
keywords="surveys",
keywords="computer use",
keywords="device",
keywords="devices",
keywords="adoption",
keywords="dyad",
keywords="dyads",
abstract="Background: Informal caregivers are called upon to provide substantial care, but more needs to be known about technology use among older adult and caregiver dyads. Objective: This study described technology use among older adults and their caregivers, explored potential correlates of technology use, and highlighted implications for practice. Methods: A cross-sectional survey was conducted among unpaid caregivers of older adults (n=486). Primary outcomes were self-reported technology (devices and functions) use among caregivers and their oldest care recipient. The concordance of technology use among caregivers and care recipients was also examined. Multivariable regression models were conducted separately for caregivers and care recipients. Results: Greater proportions of caregivers used all examined technologies, except for the medication alerts or tracking function, than care recipients. Caregivers used an average of 3.4 devices and 4.2 functions, compared to 1.8 devices and 1.6 functions used by their care recipients. Among caregivers, younger age, higher income, and higher education were associated with more technology use (P<.05). Among care recipients, younger age, not having cognitive dysfunction, and caregiver's technology use were associated with more technology use (P<.05). Conclusions: Understanding technology use patterns and device adoption across diverse caregiver and care recipient populations is increasingly important for enhancing geriatric care. Findings can guide recommendations about appropriate technology interventions and help providers communicate and share information more effectively with patients and their caregivers. ",
doi="10.2196/50759",
url="https://aging.jmir.org/2024/1/e50759"
}


@Article{info:doi/10.2196/54120,
author="Ausserhofer, Dietmar
and Piccoliori, Giuliano
and Engl, Adolf
and Mahlknecht, Angelika
and Plagg, Barbara
and Barbieri, Verena
and Colletti, Nicoletta
and Lombardo, Stefano
and G{\"a}rtner, Timon
and Tappeiner, Waltraud
and Wieser, Heike
and Wiedermann, Josef Christian",
title="Community-Dwelling Older Adults' Readiness for Adopting Digital Health Technologies: Cross-Sectional Survey Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="30",
volume="8",
pages="e54120",
keywords="frail older adults",
keywords="Italy",
keywords="Italian",
keywords="Europe",
keywords="European",
keywords="digital health",
keywords="health technologies",
keywords="health technology",
keywords="telemedicine",
keywords="telehealth",
keywords="eHealth",
keywords="e-health",
keywords="adoption",
keywords="readiness",
keywords="usage",
keywords="survey",
keywords="surveys",
keywords="questionnaire",
keywords="questionnaires",
keywords="robotics",
keywords="cross-sectional study",
keywords="population-based survey",
keywords="stratified probabilistic sampling",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="aging",
abstract="Background: Digital health technologies offer the potential to improve the daily lives of older adults, maintain their health efficiently, and allow aging in place. Despite increasing evidence of benefits and advantages, readiness for adopting digital interventions among older people remains underexplored. Objective: This study aims to explore the relationships between sociodemographic-, health-, and lifestyle-related factors and technology use in everyday life and community-dwelling older adults' readiness to adopt telemedicine, smartphones with texting apps, wearables, and robotics. Methods: This was a cross-sectional, population-based survey study with a stratified probabilistic sample of adults aged 75 years or older living in South Tyrol (autonomous province of Bolzano/Bozen, Italy). A random sample of 3600 community-dwelling older adults living at home was invited to complete a questionnaire including single items (older adults' readiness to use health technology) and scales (PRISMA-7; Program of Research on Integration of Services for the Maintenance of Autonomy). Descriptive and logistic regression analyses were performed to analyze the data. Results: In total, 1695 community-dwelling older adults completed the survey (for a response rate of 47\%). In terms of potential digital health technology adoption, wearable devices were favored by 33.7\% (n=571), telemedicine by 30.1\% (n=510), smartphones and texting apps by 24.5\% (n=416), and assistant robots by 13.7\% (n=232). Sociodemographic-, health- and lifestyle-related factors, as well as the use of technology in everyday life, played a significant role in explaining readiness to adopt digital health technologies. For telemedicine, age ?85 years (odds ratio [OR] 0.74, 95\% CI 0.56-0.96), financial constraints (OR 0.68, 95\% CI 0.49-0.95), and less than 2 hours of physical activity per week (OR 0.75, 95\% CI 0.58-0.98) were associated with nonreadiness, while Italian-speaking participants (OR 1.54, 95\% CI 1.16-2.05) and those regularly using computers (OR 1.74, 95\% CI 1.16-2.60), smartphones (OR 1.69, 95\% CI 1.22-2.35), and the internet (OR 2.26, 95\% CI 1.47-3.49) reported readiness for adoption. Conclusions: Community-dwelling older adults display varied readiness toward the adoption of digital health technologies, influenced by age, mother tongue, living situation, financial resources, physical activity, and current use of technology. The findings underscore the need for tailored interventions and educational programs to boost digital health technology adoption among community-dwelling older adults. ",
doi="10.2196/54120",
url="https://formative.jmir.org/2024/1/e54120",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687989"
}


@Article{info:doi/10.2196/51127,
author="Gaysynsky, Anna
and Senft Everson, Nicole
and Heley, Kathryn
and Chou, Sylvia Wen-Ying",
title="Perceptions of Health Misinformation on Social Media: Cross-Sectional Survey Study",
journal="JMIR Infodemiology",
year="2024",
month="Apr",
day="30",
volume="4",
pages="e51127",
keywords="social media",
keywords="misinformation",
keywords="health communication",
keywords="health literacy",
keywords="patient-provider communication",
abstract="Background: Health misinformation on social media can negatively affect knowledge, attitudes, and behaviors, undermining clinical care and public health efforts. Therefore, it is vital to better understand the public's experience with health misinformation on social media. Objective: The goal of this analysis was to examine perceptions of the social media information environment and identify associations between health misinformation perceptions and health communication behaviors among US adults. Methods: Analyses used data from the 2022 Health Information National Trends Survey (N=6252). Weighted unadjusted proportions described respondents' perceptions of the amount of false or misleading health information on social media (``perceived misinformation amount'') and how difficult it is to discern true from false information on social media (``perceived discernment difficulty''). Weighted multivariable logistic regressions examined (1) associations of sociodemographic characteristics and subjective literacy measures with misinformation perceptions and (2) relationships between misinformation perceptions and health communication behaviors (ie, sharing personal or general health information on social media and using social media information in health decisions or in discussions with health care providers). Results: Over one-third of social media users (35.61\%) perceived high levels of health misinformation, and approximately two-thirds (66.56\%) reported high perceived discernment difficulty. Odds of perceiving high amounts of misinformation were lower among non-Hispanic Black/African American (adjusted odds ratio [aOR] 0.407, 95\% CI 0.282-0.587) and Hispanic (aOR 0.610, 95\% CI 0.449-0.831) individuals compared to White individuals. Those with lower subjective health literacy were less likely to report high perceived misinformation amount (aOR 0.602, 95\% CI 0.374-0.970), whereas those with lower subjective digital literacy were more likely to report high perceived misinformation amount (aOR 1.775, 95\% CI 1.400-2.251). Compared to White individuals, Hispanic individuals had lower odds of reporting high discernment difficulty (aOR 0.620, 95\% CI 0.462-0.831). Those with lower subjective digital literacy (aOR 1.873, 95\% CI 1.478-2.374) or numeracy (aOR 1.465, 95\% CI 1.047-2.049) were more likely to report high discernment difficulty. High perceived misinformation amount was associated with lower odds of sharing general health information on social media (aOR 0.742, 95\% CI 0.568-0.968), using social media information to make health decisions (aOR 0.273, 95\% CI 0.156-0.479), and using social media information in discussions with health care providers (aOR 0.460, 95\% CI 0.323-0.655). High perceived discernment difficulty was associated with higher odds of using social media information in health decisions (aOR 1.724, 95\% CI 1.208-2.460) and health care provider discussions (aOR 1.389, 95\% CI 1.035-1.864). Conclusions: Perceptions of high health misinformation prevalence and discernment difficulty are widespread among social media users, and each has unique associations with sociodemographic characteristics, literacy, and health communication behaviors. These insights can help inform future health communication interventions. ",
doi="10.2196/51127",
url="https://infodemiology.jmir.org/2024/1/e51127",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687591"
}


@Article{info:doi/10.2196/45702,
author="Loriot, Am{\'e}lie
and Larceneux, Fabrice
and Guillard, Val{\'e}rie
and Bertocchio, Jean-Philippe",
title="Patients' Representations of Perceived Distance and Proximity to Telehealth in France: Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="26",
volume="26",
pages="e45702",
keywords="telehealth",
keywords="teleconsultation",
keywords="social representations",
keywords="perceived proximity",
keywords="semiotic square",
abstract="Background: In the last 2 decades, new technologies have emerged in health care. The COVID-19 pandemic further accelerated the adoption of technology by both health care professionals and patients. These technologies create remote care practices that bring several benefits to the health care system: easier access to care, improved communication with physicians, and greater continuity of care. However, disparities in the acceptance and use of telehealth tools still exist among patients. These tools also disrupt conventional medical practices and prompt a new reassessment of the perceptions of distance and proximity as physical (ie, time and space dimensions) and nonphysical (ie, behavioral dimensions) concepts. The reasons why patients do or do not adopt telehealth tools for their care and therefore their perspectives on telehealth remain unanswered questions. Objective: We explored the barriers as well as the motivations for patients to adopt telehealth tools. We specifically focused on the social representations of telehealth to establish a comprehensive conceptual framework to get a better understanding of how telehealth is perceived by patients. Methods: This study uses a qualitative design through in-depth individual interviews. Participants were recruited using a convenience sampling method with balanced consideration of gender, age, location (urban/rural), and socioeconomic background. After collecting informed consent, interviews were transcribed and analyzed using the thematic analysis methodology. Results: We conducted 14 interviews, with which data saturation was reached. The 2 main opposed dimensions, perceived proximity and distance, emerged as an essential structure for understanding the social representations of telehealth. A logic of engagement versus hostility emerged as the main tension in adopting telehealth, almost ideological. Interestingly, practical issues emerged regarding the adoption of telehealth: A logic of integration was opposed to a logic of constraints. Altogether, those dimensions enabled us to conceptualize a semiotic square, providing 4 categories with a coherent body of social representations. Due to the dynamic nature of these representations, we proposed 2 ``paths'' through which adherence to telehealth may improve. Conclusions: Our semiotic square illustrating patients' adherence to telehealth differentiates socially beneficial versus socially dangerous considerations and pragmatic from ideological postures. It shows how crucial it is to consider perceived distance and proximity to better understand barriers and motivations to adopting telehealth. These representations can also be considered as leverage that could be modified to encourage the step-by-step adhesion process. Even if reducing the perceived temporal distance to in-person meeting and enhancing the perceived proximity of access to care may be seen as efficient ways to adopt telehealth tools, telehealth can also be perceived as a care practice that threatens the patient-physician relationship. The patient-oriented perceived value turns out to be critical in the future development of and adherence to telehealth tools. ",
doi="10.2196/45702",
url="https://www.jmir.org/2024/1/e45702",
url="http://www.ncbi.nlm.nih.gov/pubmed/38669676"
}


@Article{info:doi/10.2196/52687,
author="Hu, Lu
and Wyatt, C. Laura
and Mohsin, Farhan
and Lim, Sahnah
and Zanowiak, Jennifer
and Mammen, Shinu
and Hussain, Sarah
and Ali, H. Shahmir
and Onakomaiya, Deborah
and Belli, M. Hayley
and Aifah, Angela
and Islam, S. Nadia",
title="Characterizing Technology Use and Preferences for Health Communication in South Asian Immigrants With Prediabetes or Diabetes: Cross-Sectional Descriptive Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="26",
volume="8",
pages="e52687",
keywords="South Asian immigrants",
keywords="type 2 diabetes",
keywords="technology access",
keywords="technology use",
keywords="prediabetes",
keywords="health disparities",
keywords="mHealth",
keywords="health equity",
keywords="immigrant health",
keywords="mobile health",
keywords="smartphone",
keywords="diabetes",
keywords="diabetic",
keywords="DM",
keywords="diabetes mellitus",
keywords="immigrants",
keywords="prevention",
keywords="regression",
keywords="regression model",
keywords="logistic regression",
keywords="mobile health interventions",
abstract="Background: Type 2 diabetes disproportionately affects South Asian subgroups. Lifestyle prevention programs help prevent and manage diabetes; however, there is a need to tailor these programs for mobile health (mHealth). Objective: This study examined technology access, current use, and preferences for health communication among South Asian immigrants diagnosed with or at risk for diabetes, overall and by sex. We examined factors associated with interest in receiving diabetes information by (1) text message, (2) online (videos, voice notes, online forums), and (3) none or skipped, adjusting for sociodemographic characteristics and technology access. Methods: We used baseline data collected in 2019-2021 from two clinical trials among South Asian immigrants in New York City (NYC), with one trial focused on diabetes prevention and the other focused on diabetes management. Descriptive statistics were used to examine overall and sex-stratified impacts of sociodemographics on technology use. Overall logistic regression was used to examine the preference for diabetes information by text message, online (videos, voice notes, or forums), and no interest/skipped response. Results: The overall sample (N=816) had a mean age of 51.8 years (SD 11.0), and was mostly female (462/816, 56.6\%), married (756/816, 92.6\%), with below high school education (476/816, 58.3\%) and limited English proficiency (731/816, 89.6\%). Most participants had a smartphone (611/816, 74.9\%) and reported interest in receiving diabetes information via text message (609/816, 74.6\%). Compared to male participants, female participants were significantly less likely to own smartphones (317/462, 68.6\% vs 294/354, 83.1\%) or use social media apps (Viber: 102/462, 22.1\% vs 111/354, 31.4\%; WhatsApp: 279/462, 60.4\% vs 255/354, 72.0\%; Facebook: Messenger 72/462, 15.6\% vs 150/354, 42.4\%). A preference for receiving diabetes information via text messaging was associated with male sex (adjusted odds ratio [AOR] 1.63, 95\% CI 1.01-2.55; P=.04), current unemployment (AOR 1.62, 95\% CI 1.03-2.53; P=.04), above high school education (AOR 2.17, 95\% CI 1.41-3.32; P<.001), and owning a smart device (AOR 3.35, 95\% CI 2.17-5.18; P<.001). A preference for videos, voice notes, or online forums was associated with male sex (AOR 2.38, 95\% CI 1.59-3.57; P<.001) and ownership of a smart device (AOR 5.19, 95\% CI 2.83-9.51; P<.001). No interest/skipping the question was associated with female sex (AOR 2.66, 95\% CI 1.55-4.56; P<.001), high school education or below (AOR 2.02, 95\% CI 1.22-3.36; P=.01), not being married (AOR 2.26, 95\% CI 1.13-4.52; P=.02), current employment (AOR 1.96, 95\% CI 1.18-3.29; P=.01), and not owning a smart device (AOR 2.06, 95\% CI 2.06-5.44; P<.001). Conclusions: Technology access and social media usage were moderately high in primarily low-income South Asian immigrants in NYC with prediabetes or diabetes. Sex, education, marital status, and employment were associated with interest in mHealth interventions. Additional support to South Asian women may be required when designing and developing mHealth interventions. Trial Registration: ClinicalTrials.gov NCT03333044; https://classic.clinicaltrials.gov/ct2/show/NCT03333044, ClinicalTrials.gov NCT03188094; https://classic.clinicaltrials.gov/ct2/show/NCT03188094 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3711-y ",
doi="10.2196/52687",
url="https://formative.jmir.org/2024/1/e52687",
url="http://www.ncbi.nlm.nih.gov/pubmed/38669062"
}


@Article{info:doi/10.2196/52292,
author="Lu, Yinn Si
and Yoon, Sungwon
and Yee, Qi Wan
and Heng Wen Ngiam, Nerice
and Ng, Yi Kennedy Yao
and Low, Leng Lian",
title="Experiences of a Community-Based Digital Intervention Among Older People Living in a Low-Income Neighborhood: Qualitative Study",
journal="JMIR Aging",
year="2024",
month="Apr",
day="25",
volume="7",
pages="e52292",
keywords="digital divide",
keywords="digital learning",
keywords="smartphones",
keywords="social gerontology",
keywords="older adults",
keywords="COVID-19 pandemic",
keywords="technology adoption",
abstract="Background: Older adults worldwide experienced heightened risks of depression, anxiety, loneliness, and poor mental well-being during the COVID-19 pandemic. During this period, digital technology emerged as a means to mitigate social isolation and enhance social connectedness among older adults. However, older adults' behaviors and attitudes toward the adoption and use of digital technology are heterogeneous and shaped by factors such as age, income, and education. Few empirical studies have examined how older adults experiencing social and economic disadvantages perceive the learning of digital tools. Objective: This study aims to examine the motivations, experiences, and perceptions toward a community-based digital intervention among older adults residing in public rental flats in a low-income neighborhood. Specifically, we explored how their attitudes and behaviors toward learning the use of smartphones are shaped by their experiences related to age and socioeconomic challenges. Methods: This study adopted a qualitative methodology. Between December 2020 and March 2021, we conducted semistructured in-depth interviews with 19 participants aged ?60 years who had completed the community-based digital intervention. We asked participants questions about the challenges encountered amid the pandemic, their perceived benefits of and difficulties with smartphone use, and their experiences with participating in the intervention. All interviews were audio recorded and analyzed using a reflexive thematic approach. Results: Although older learners stated varying levels of motivation to learn, most expressed ambivalence about the perceived utility and relevance of the smartphone to their current needs and priorities. While participants valued the social interaction with volunteers and the personalized learning model of the digital intervention, they also articulated barriers such as age-related cognitive and physical limitations and language and illiteracy that hindered their sustained use of these digital devices. Most importantly, the internalization of ageist stereotypes of being less worthy learners and the perception of smartphone use as being in the realm of the privileged other further reduced self-efficacy and interest in learning. Conclusions: To improve learning and sustained use of smartphones for older adults with low income, it is essential to explore avenues that render digital tools pertinent to their daily lives, such as creating opportunities for social connections and relationship building. Future studies should investigate the relationships between older adults' social, economic, and health marginality and their ability to access digital technologies. We recommend that the design and implementation of digital interventions should prioritize catering to the needs and preferences of various segments of older adults, while working to bridge rather than perpetuate the digital divide. ",
doi="10.2196/52292",
url="https://aging.jmir.org/2024/1/e52292",
url="http://www.ncbi.nlm.nih.gov/pubmed/38662423"
}


@Article{info:doi/10.2196/52317,
author="Haimi, Motti
and Sergienko, Ruslan",
title="Adoption and Use of Telemedicine and Digital Health Services Among Older Adults in Light of the COVID-19 Pandemic: Repeated Cross-Sectional Analysis",
journal="JMIR Aging",
year="2024",
month="Apr",
day="24",
volume="7",
pages="e52317",
keywords="telemedicine",
keywords="digital health",
keywords="older adults",
keywords="COVID-19",
keywords="use",
keywords="digital divide",
keywords="usability",
keywords="pandemic",
keywords="telehealth",
keywords="Israel",
keywords="working-hours telehealth visits",
keywords="after-hours consultation",
keywords="teleconsultation",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="wearables",
keywords="mobile phone",
abstract="Background: As the population ages and the prevalence of long-term diseases rises, the use of telecare is becoming increasingly frequent to aid older people. Objective: This study aims to explore the use and adoption of 3 types of telehealth services among the older population in Israel before, during, and after the COVID-19 pandemic. Methods: We explored the use characteristics of older adults (aged ?65 years) belonging to Clalit Health Services in several aspects in the use of 3 types of telehealth services: the use of digital services for administrative tasks; the use of synchronous working-hours telehealth visits with the patient's personal physician during clinic business hours; and the use of after-hours consultations during evenings, nights, and weekends when the clinics are closed. The data were collected and analyzed throughout 3 distinct periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic, and following the COVID-19 peak. Results: Data of 618,850 patients who met the inclusion criteria were extracted. Telehealth services used for administrative purposes were the most popular. The most intriguing finding was that the older population significantly increased their use of all types of telehealth services during the COVID-19 pandemic, and in most types, this use decreased after the COVID-19 peak, but to a level that was higher than the baseline level before the COVID-19 pandemic. Before the COVID-19 pandemic, 23.1\% (142,936/618,850) of the study population used working-hours telehealth visits, and 2.2\% (13,837/618,850) used after-hours consultations at least once. The percentage of use for these services increased during the COVID-19 pandemic to 59.2\% (366,566/618,850) and 5\% (30,777/618,850) and then decreased during the third period to 39.5\% (244,572/618,850) and 2.4\% (14,584/618,850), respectively (P<.001). Multiple patient variables have been found to be associated with the use of the different telehealth services in each period. Conclusions: Despite the limitations and obstacles, the older population uses telehealth services and can increase their use when they are needed. These people can learn how to use digital health services effectively, and they should be given the opportunity to do so by creating suitable and straightforward telehealth solutions tailored to this population and enhancing their usability. ",
doi="10.2196/52317",
url="https://aging.jmir.org/2024/1/e52317",
url="http://www.ncbi.nlm.nih.gov/pubmed/38656768"
}


@Article{info:doi/10.2196/51859,
author="Allcock, Alan Jake
and Zhuang, Mengdie
and Li, Shuyang
and Zhao, Xin",
title="Landscape of Digital Technologies Used in the National Health Service in England: Content Analysis",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="19",
volume="8",
pages="e51859",
keywords="digital health",
keywords="healthcare service",
keywords="regional difference",
keywords="National Health Service",
keywords="NHS",
keywords="digital technology",
keywords="health equity",
abstract="Background: In England, digital technologies are exploited to transform the way health and social care is provided and encompass a wide range of hardware devices and software that are used in all aspects of health care. However, little is known about the extent to which health care providers differ in digital health technology capabilities and how this relates to geographical and regional differences in health care capacities and resources. Objective: This paper aims to identify the set of digital technologies that have been deployed by the National Health Services clinical commissioning groups (NHS CCGs) in England. In doing this, we respond to calls to shed light on the internal dynamics and variation in the form of digital capability in England in terms of health service regional differences and health diversity, equity, and inclusion. Methods: We collected 135 annual reports that belong to 106 NHS CCGs in England, comprising more than 18,000 pages in total, released from 2020 to 2021. Using this data set, we identified 2163 pages related to digital technologies and labeled them using content analysis. We follow the construct taxonomy used by digital options theory, a theory from the management information systems field analyzing organizational resource investment choices, in classifying observed technologies according to digital themes---inherent design patterns that we identified and explained. We then used a hierarchical clustering method to extract groups of NHS CCGs that implement similar technology themes. Results: We found 31 technologies from the reports and grouped them into 9 digital themes. The 9 themes were further assigned to 1 of the 3 constructs of digital options theory, the identification of patients' requirements (we identified information portals [76/106], digital health engagement [67/106], and digital inclusion support [45/106]), the development of new work patterns (we identified telehealth [87/106], telemedicine [35/106], and care home technologies [40/106]), the realization of improvements in efficiency and public accessibility (we identified online booking [26/106], online triage [104/106], and digital mental health services [74/106]). The 3 clusters of CCGs are identified based on the 8 themes (Hopkins=0.9914, silhouette=0.186), namely (1) digitally disengaged, (2) digitally engaged, and (3) digital torchbearer. Conclusions: Our findings show prominent digital themes within each construct group, namely information portals, telehealth, and online triage, covering people's fundamental health information needs. Almost half of CCGs fell into the digitally disengaged group, and all London CCGs (5/106) belonged to this group. We propose that practitioners should offer specialized assistance to regions with limited digital engagement, emphasizing digital health literacy, inclusion support, and ongoing evaluation, rather than concentrating solely on technical advancements. ",
doi="10.2196/51859",
url="https://formative.jmir.org/2024/1/e51859",
url="http://www.ncbi.nlm.nih.gov/pubmed/38639996"
}


@Article{info:doi/10.2196/51518,
author="Opper, A. Claudia
and Browne, A. Felicia
and Howard, N. Brittni
and Zule, A. William
and Wechsberg, M. Wendee",
title="Assessing Differences in mHealth Usability and App Experiences Among Young African American Women: Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="16",
volume="11",
pages="e51518",
keywords="HIV",
keywords="Black women",
keywords="mobile apps",
keywords="social determinants of health",
keywords="prevention",
keywords="substance use",
keywords="usability",
abstract="Background: In North Carolina, HIV continues to disproportionately affect young African American women. Although mobile health (mHealth) technology appears to be a tool capable of making public health information more accessible for key populations, previous technology use and social determinants may impact users' mHealth experiences. Objective: The objective of this study was to evaluate mHealth usability, assessing differences based on previous technology use and social determinants among a sample of African American women in emerging adulthood. Methods: As part of a National Institute on Drug Abuse--funded randomized controlled trial with African American women (aged 18-25 years), counties were assigned to receive an evidence-based HIV risk reduction intervention through mHealth and participants were asked to complete usability surveys at 6- and 12-month follow-ups. Participants' first survey responses were analyzed through 2-tailed t tests and linear regression models to examine associations with previous technology use and social determinants (P<.05). Results: The mean System Usability Scale (SUS) score was 69.2 (SD 17.9; n=159), which was higher than the threshold of acceptability (68.0). Participants who had previously used a tablet indicated higher usability compared to participants without previous use (mean 72.9, SD 18.1 vs mean 57.6, SD 11.4; P<.001), and participants with previous smartphone use also reported higher usability compared to participants without previous use (mean 71.9, SD 18.3 vs mean 58.0, SD 10.7; P<.001). Differences in SUS scores were observed among those reporting homelessness (mean 58.3, SD 19.0 vs mean 70.8, SD 17.2; P=.01), unemployment (mean 65.9, SD 17.2 vs mean 71.6, SD 18.1; P=.04), or current school enrollment (mean 73.2, SD 18.5 vs mean 65.4, SD 16.5; P=.006). Statistically significant associations were not observed for food insecurity (mean 67.3, SD 18.6 vs mean 69.9, SD 17.7; P=.45). Conclusions: Although above-average usability was observed overall, these findings demonstrate differences in mHealth usability based on past and current life experiences. As mHealth interventions become more prevalent, these findings may have important implications for ensuring that mHealth apps improve the reach of evidence-based interventions. Trial Registration: ClinicalTrials.gov NCT02965014; https://clinicaltrials.gov/study/NCT02965014 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5796-8 ",
doi="10.2196/51518",
url="https://humanfactors.jmir.org/2024/1/e51518",
url="http://www.ncbi.nlm.nih.gov/pubmed/38625721"
}


@Article{info:doi/10.2196/50410,
author="Choy, Ada Melinda
and O'Brien, Kathleen
and Barnes, Katelyn
and Sturgiss, Ann Elizabeth
and Rieger, Elizabeth
and Douglas, Kirsty",
title="Evaluating the Digital Health Experience for Patients in Primary Care: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="11",
volume="26",
pages="e50410",
keywords="digital health",
keywords="eHealth",
keywords="primary care",
keywords="general practice",
keywords="digital divide",
keywords="health inequities",
keywords="health inequality",
keywords="disparities",
keywords="digital cost",
keywords="financial cost",
keywords="health technology",
keywords="mixed methods",
keywords="barriers",
keywords="barrier",
abstract="Background: The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally hindered through less access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential for improving the digital health divide. Primary care patients, especially those with chronic disease, have experience of the stages of initial help seeking and self-management of their health, which renders them a key demographic for research on patient-initiated digital health access. Objective: This study aims to provide comprehensive primary mixed methods data on the patient experience of barriers to digital health access, with a focus on the digital health divide. Methods: We applied an exploratory mixed methods design to ensure that our survey was primarily shaped by the experiences of our interviewees. First, we qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease and second, we quantitatively measured some of these findings by designing and administering a survey to 487 Australian general practice patients from 24 general practices. Results: In our qualitative first phase, the key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health. In our quantitative second phase, 31\% (151/487) of the survey participants were found to have never used a form of digital health, while 10.7\% (52/487) were low- to medium-frequency users and 48.5\% (236/487) were high-frequency users. High-frequency users were more likely to be interested in digital health and had higher self-efficacy. Low-frequency users were more likely to report difficulty affording the financial costs needed for digital access. Conclusions: While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers. Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be part of addressing the digital health divide. ",
doi="10.2196/50410",
url="https://www.jmir.org/2024/1/e50410",
url="http://www.ncbi.nlm.nih.gov/pubmed/38602768"
}


@Article{info:doi/10.2196/47278,
author="Gybel Jensen, Christian
and Gybel Jensen, Frederik
and Loft, Ingerslev Mia",
title="Patients' Experiences With Digitalization in the Health Care System: Qualitative Interview Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="11",
volume="26",
pages="e47278",
keywords="digitalization",
keywords="digital health",
keywords="eHealth",
keywords="digital health literacy",
keywords="digital practices",
keywords="patient experiences",
keywords="digital health services",
keywords="inequity in health",
keywords="qualitative research",
keywords="interview",
keywords="implementation",
keywords="tool",
keywords="neurology",
keywords="digital tool",
keywords="communication",
keywords="mobile phone",
abstract="Background: The digitalization of public and health sectors worldwide is fundamentally changing health systems. With the implementation of digital health services in health institutions, a focus on digital health literacy and the use of digital health services have become more evident. In Denmark, public institutions use digital tools for different purposes, aiming to create a universal public digital sector for everyone. However, this digitalization risks reducing equity in health and further marginalizing citizens who are disadvantaged. Therefore, more knowledge is needed regarding patients' digital practices and experiences with digital health services. Objective: This study aims to examine digital practices and experiences with public digital health services and digital tools from the perspective of patients in the neurology field and address the following research questions: (1) How do patients use digital services and digital tools? (2) How do they experience them? Methods: We used a qualitative design with a hermeneutic approach. We conducted 31 semistructured interviews with patients who were hospitalized or formerly hospitalized at the department of neurology in a hospital in Denmark. The interviews were audio recorded and subsequently transcribed. The text from each transcribed interview was analyzed using manifest content analysis. Results: The analysis provided insights into 4 different categories regarding digital practices and experiences of using digital tools and services in health care systems: social resources as a digital lifeline, possessing the necessary capabilities, big feelings as facilitators or barriers, and life without digital tools. Our findings show that digital tools were experienced differently, and specific conditions were important for the possibility of engaging in digital practices, including having access to social resources; possessing physical, cognitive, and communicative capabilities; and feeling motivated, secure, and comfortable. These prerequisites were necessary for participants to have positive experiences using digital tools in the health care system. Those who did not have these prerequisites experienced challenges and, in some cases, felt left out. Conclusions: Experiences with digital practices and digital health services are complex and multifaceted. Engagement in digital practices for the examined population requires access to continuous assistance from their social network. If patients do not meet requirements, digital health services can be experienced as exclusionary and a source of concern. Physical, cognitive, and communicative difficulties might make it impossible to use digital tools or create more challenges. To ensure that digitalization does not create inequities in health, it is necessary for developers and institutions to be aware of the differences in digital health literacy, focus on simplifying communication with patients and next of kin, and find flexible solutions for citizens who are disadvantaged. ",
doi="10.2196/47278",
url="https://www.jmir.org/2024/1/e47278",
url="http://www.ncbi.nlm.nih.gov/pubmed/38602748"
}


@Article{info:doi/10.2196/49780,
author="Lorenzo-Luaces, Lorenzo
and Wasil, Akash
and Kacmarek, N. Corinne
and DeRubeis, Robert",
title="Race and Socioeconomic Status as Predictors of Willingness to Use Digital Mental Health Interventions or One-On-One Psychotherapy: National Survey Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="11",
volume="8",
pages="e49780",
keywords="digital mental health",
keywords="ethnicity",
keywords="health disparities",
keywords="internet-based CBT",
keywords="cognitive behavioral therapy",
keywords="intervention",
keywords="mental health",
keywords="mental health care",
keywords="race",
keywords="therapy",
abstract="Background: There is an ongoing debate about whether digital mental health interventions (DMHIs) can reduce racial and socioeconomic inequities in access to mental health care. A key factor in this debate involves the extent to which racial and ethnic minoritized individuals and socioeconomically disadvantaged individuals are willing to use, and pay for, DMHIs. Objective: This study examined racial and ethnic as well as socioeconomic differences in participants' willingness to pay for DMHIs versus one-on-one therapy (1:1 therapy). Methods: We conducted a national survey of people in the United States (N=423; women: n=204; mean age 45.15, SD 16.19 years; non-Hispanic White: n=293) through Prolific. After reading descriptions of DMHIs and 1:1 therapy, participants rated their willingness to use each treatment (1) for free, (2) for a small fee, (3) as a maximum dollar amount, and (4) as a percentage of their total monthly income. At the end of the study, there was a decision task to potentially receive more information about DMHIs and 1:1 therapy. Results: Race and ethnicity was associated with willingness to pay more of one's income, as a percent or in dollar amounts, and was also associated with information-seeking for DMHIs in the behavioral task. For most outcomes, race and ethnicity was not associated with willingness to try 1:1 therapy. Greater educational attainment was associated to willingness to try DMHIs for free, the decision to learn more about DMHIs, and willingness to pay for 1:1 therapy. Income was inconsistently associated to willingness to try DMHIs or 1:1 therapy. Conclusions: If they are available for free or at very low costs, DMHIs may reduce inequities by expanding access to mental health care for racial and ethnic minoritized individuals and economically disadvantaged groups. ",
doi="10.2196/49780",
url="https://formative.jmir.org/2024/1/e49780",
url="http://www.ncbi.nlm.nih.gov/pubmed/38602769"
}


@Article{info:doi/10.2196/48783,
author="Choi, Soyoung",
title="Comparison of Self-Tracking Health Practices, eHealth Literacy, and Subjective Well-Being Between College Students With and Without Disabilities: Cross-Sectional Survey",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="10",
volume="8",
pages="e48783",
keywords="college students",
keywords="personal health data",
keywords="self-tracking",
keywords="eHealth literacy",
keywords="well-being",
keywords="tracking",
keywords="students",
keywords="disability",
keywords="cross-sectional survey",
keywords="pediatric care",
keywords="adult care",
keywords="smartphone health app",
keywords="application",
keywords="literacy",
abstract="Background: College students with disabilities need to transition from pediatric-centered care to adult care. However, they may become overwhelmed by multiple responsibilities, such as academic activities, peer relationships, career preparation, job seeking, independent living, as well as managing their health and promoting healthy behaviors. Objective: As the use of smartphones and wearable devices for collecting personal health data becomes popular, this study aimed to compare the characteristics of self-tracking health practices between college students with disabilities and their counterparts. In addition, this study examined the relationships between disability status, self-tracking health practices, eHealth literacy, and subjective well-being among college students. Methods: The web-based questionnaire was designed using Qualtrics for the cross-sectional online survey. The survey data were collected from February 2023 to April 2023 and included responses from 702 participants. Results: More than 80\% (563/702, 80.2\%) of the respondents participated voluntarily in self-tracking health practices. College students with disabilities (n=83) showed significantly lower levels of eHealth literacy and subjective well-being compared with college students without disabilities (n=619). The group with disabilities reported significantly lower satisfaction (t411=--5.97, P<.001) and perceived efficacy (t411=--4.85, P<.001) when using smartphone health apps and wearable devices. Finally, the study identified a significant correlation between subjective well-being in college students and disability status ($\beta$=3.81, P<.001), self-tracking health practices ($\beta$=2.22, P=.03), and eHealth literacy ($\beta$=24.29, P<.001). Conclusions: Given the significant relationships among disability status, self-tracking health practices, eHealth literacy, and subjective well-being in college students, it is recommended to examine their ability to leverage digital technology for self-care. Offering learning opportunities to enhance eHealth literacy and self-tracking health strategies within campus environments could be a strategic approach to improve the quality of life and well-being of college students. ",
doi="10.2196/48783",
url="https://formative.jmir.org/2024/1/e48783",
url="http://www.ncbi.nlm.nih.gov/pubmed/38598285"
}


@Article{info:doi/10.2196/46971,
author="Shaw, James
and Glover, Wiljeana",
title="The Political Economy of Digital Health Equity: Structural Analysis",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="26",
volume="26",
pages="e46971",
keywords="digital health equity",
keywords="health equity",
keywords="health policy",
keywords="telemedicine",
keywords="digital care",
keywords="political economy",
keywords="race",
keywords="ethnicity",
keywords="socioeconomic",
keywords="policy",
doi="10.2196/46971",
url="https://www.jmir.org/2024/1/e46971",
url="http://www.ncbi.nlm.nih.gov/pubmed/38530341"
}


@Article{info:doi/10.2196/36441,
author="Freeman, Eric
and Patel, Darshilmukesh
and Odeniyi, Folasade
and Pasquinelli, Mary
and Jain, Shikha",
title="Where Do Oncology Patients Seek and Share Health Information? Survey Study",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="25",
volume="26",
pages="e36441",
keywords="oncology",
keywords="social media",
keywords="patient-physician relationship",
keywords="patient-physician",
keywords="patient-provider",
keywords="cancer",
keywords="information sharing",
keywords="information seeking",
keywords="information behavior",
keywords="technology access",
keywords="digital divide",
doi="10.2196/36441",
url="https://www.jmir.org/2024/1/e36441",
url="http://www.ncbi.nlm.nih.gov/pubmed/38526546"
}


@Article{info:doi/10.2196/52071,
author="Ganeshan, Smitha
and Liu, W. Andrew
and Kroeger, Anne
and Anand, Prerna
and Seefeldt, Richard
and Regner, Alexis
and Vaughn, Diana
and Odisho, Y. Anobel
and Mourad, Michelle",
title="An Electronic Health Record--Based Automated Self-Rescheduling Tool to Improve Patient Access: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="19",
volume="26",
pages="e52071",
keywords="appointment",
keywords="consultation",
keywords="cost",
keywords="digital health",
keywords="digital tools",
keywords="electronic health record",
keywords="EHR",
keywords="informatics",
keywords="patient access",
keywords="retrospective review",
keywords="revenue",
keywords="self-rescheduling tool",
keywords="self-scheduling",
keywords="waiting time",
abstract="Background: In many large health centers, patients face long appointment wait times and difficulties accessing care. Last-minute cancellations and patient no-shows leave unfilled slots in a clinician's schedule, exacerbating delays in care from poor access. The mismatch between the supply of outpatient appointments and patient demand has led health systems to adopt many tools and strategies to minimize appointment no-show rates and fill open slots left by patient cancellations. Objective: We evaluated an electronic health record (EHR)--based self-scheduling tool, Fast Pass, at a large academic medical center to understand the impacts of the tool on the ability to fill cancelled appointment slots, patient access to earlier appointments, and clinical revenue from visits that may otherwise have gone unscheduled. Methods: In this retrospective cohort study, we extracted Fast Pass appointment offers and scheduling data, including patient demographics, from the EHR between June 18, 2022, and March 9, 2023. We analyzed the outcomes of Fast Pass offers (accepted, declined, expired, and unavailable) and the outcomes of scheduled appointments resulting from accepted Fast Pass offers (completed, canceled, and no-show). We stratified outcomes based on appointment specialty. For each specialty, the patient service revenue from appointments filled by Fast Pass was calculated using the visit slots filled, the payer mix of the appointments, and the contribution margin by payer. Results: From June 18 to March 9, 2023, there were a total of 60,660 Fast Pass offers sent to patients for 21,978 available appointments. Of these offers, 6603 (11\%) were accepted across all departments, and 5399 (8.9\%) visits were completed. Patients were seen a median (IQR) of 14 (4-33) days sooner for their appointments. In a multivariate logistic regression model with primary outcome Fast Pass offer acceptance, patients who were aged 65 years or older (vs 20-40 years; P=.005 odds ratio [OR] 0.86, 95\% CI 0.78-0.96), other ethnicity (vs White; P<.001, OR 0.84, 95\% CI 0.77-0.91), primarily Chinese speakers (P<.001; OR 0.62, 95\% CI 0.49-0.79), and other language speakers (vs English speakers; P=.001; OR 0.71, 95\% CI 0.57-0.87) were less likely to accept an offer. Fast Pass added 2576 patient service hours to the clinical schedule, with a median (IQR) of 251 (216-322) hours per month. The estimated value of physician fees from these visits scheduled through 9 months of Fast Pass scheduling in professional fees at our institution was US \$3 million. Conclusions: Self-scheduling tools that provide patients with an opportunity to schedule into cancelled or unfilled appointment slots have the potential to improve patient access and efficiently capture additional revenue from filling unfilled slots. The demographics of the patients accepting these offers suggest that such digital tools may exacerbate inequities in access. ",
doi="10.2196/52071",
url="https://www.jmir.org/2024/1/e52071",
url="http://www.ncbi.nlm.nih.gov/pubmed/38502159"
}


@Article{info:doi/10.2196/52049,
author="Gately, Elizabeth Megan
and Waller, E. Dylan
and Metcalf, E. Emily
and Moo, R. Lauren",
title="Caregivers' Role in In-Home Video Telehealth: National Survey of Occupational Therapy Practitioners",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Mar",
day="14",
volume="11",
pages="e52049",
keywords="telemedicine",
keywords="caregivers",
keywords="occupational therapy",
keywords="caregiver",
keywords="care worker",
keywords="telehealth",
keywords="older adults",
keywords="older adult",
keywords="geriatric",
keywords="rural",
keywords="remote",
keywords="OT practitioner",
keywords="web-based",
keywords="national survey",
keywords="role",
keywords="home care",
keywords="clinical support",
keywords="mobile phone",
abstract="Background: Older adults face barriers to specialty care, such as occupational therapy (OT), and these challenges are worse for rural older adults. While in-home video telehealth may increase access to OT, older adults' health- and technology-related challenges may necessitate caregiver assistance. Objective: This study examines caregiver assistance with in-home OT video telehealth visits from the perspectives of OT practitioners at Veterans Health Administration (VHA). Methods: A web-based national survey of VHA OT practitioners about caregivers' role in video telehealth was conducted between January and February 2022. Survey items were developed with input from subject matter experts in geriatrics and OT and identified patient factors that necessitate caregiver participation; the extent to which caregivers assist with different types of tasks (technological and clinical tasks); and the perceived facilitators of, benefits of, and barriers to caregiver involvement. Results: Of approximately 1787 eligible VHA OT practitioners, 286 (16\% response rate) participated. Not all survey items required completion, resulting in different denominators. Most respondents were female (183/226, 81\%), White (163/225, 72.4\%), and occupational therapists (275/286, 96.2\%). Respondents were from 87 VHA medical centers, the catchment areas of which served a patient population that was 34\% rural, on average (SD 0.22). Most participants (162/232, 69.8\%) had >10 years of OT experience serving a patient cohort mostly aged ?65 years (189/232, 81.5\%) in primarily outpatient rehabilitation (132/232, 56.9\%). The top patient factors necessitating caregiver involvement were lack of technical skills, cognitive impairment, and advanced patient age, with health-related impairments (eg, hearing or vision loss) less frequent. Technological tasks that caregivers most frequently assisted with were holding, angling, moving, repositioning, or operating the camera (136/250, 54.4\%) and enabling and operating the microphone and setting the volume (126/248, 50.8\%). Clinical tasks that caregivers most frequently assisted with were providing patient history (143/239, 59.8\%) and assisting with patient communication (124/240, 51.7\%). The top facilitator of caregiver participation was clinician-delivered caregiver education about what to expect from video telehealth (152/275, 55.3\%), whereas the top barrier was poor connectivity (80/235, 34\%). Increased access to video telehealth (212/235, 90.2\%) was the top-rated benefit of caregiver participation. Most respondents (164/232, 70.7\%) indicated that caregivers were at least sometimes unavailable or unable to assist with video telehealth, in which case the appointment often shifted to phone. Conclusions: Caregivers routinely assist VHA patients with in-home OT video visits, which is invaluable to patients who are older and have complex medical needs. Barriers to caregiver involvement include caregivers' challenges with video telehealth or inability to assist, or lack of available caregivers. By elucidating the caregiver support role in video visits, this study provides clinicians with strategies to effectively partner with caregivers to enhance older patients' access to video visits. ",
doi="10.2196/52049",
url="https://rehab.jmir.org/2024/1/e52049",
url="http://www.ncbi.nlm.nih.gov/pubmed/38483462"
}


@Article{info:doi/10.2196/48977,
author="Sinha, Jayati
and Serin, Nuket",
title="Online Health Information Seeking and Preventative Health Actions: Cross-Generational Online Survey Study",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="11",
volume="26",
pages="e48977",
keywords="digital natives",
keywords="digital immigrants",
keywords="online health information seeking",
keywords="preventative health actions",
keywords="mobile phone",
abstract="Background: The popularity of online health information seeking (OHIS) has increased significantly owing to its accessibility and affordability. To facilitate better health management, it is essential to comprehend the generational differences in OHIS behavior and preventative health actions after seeking online health information (OHI). Objective: This study investigates the variations in OHIS and engagement in preventative health actions between 2 generations based on their technology use (digital natives [aged 18-42 years] and digital immigrants [aged ?43 years]). Additionally, this research explores the mediating role of OHIS types on the generational effect on preventative health actions and the moderating role of OHI search frequency, gender, and the presence of chronic diseases on the generational effect on OHIS types and preventative health actions. Methods: A preregistered online survey was conducted on the Prolific online data collection platform using stratified sampling of 2 generations (digital natives and digital immigrants) from the United States in November 2023. Overall, 3 types of OHIS were collected: health wellness information search, health guidance information search, and health management information search. A 1-way analysis of covariance tested the generational differences in types of OHIS and preventative health actions, and a 2-way analysis of covariance tested the moderating role of OHIS search frequency, gender, and the presence of chronic diseases using 7 control variables. The PROCESS Macro Model 4 was used to conduct mediation analyses, testing OHI search types as mediators. Linear regression analyses tested age as a predictor of OHIS and preventative health actions. Results: The analysis of 1137 responses revealed generational differences in OHIS. Digital natives searched for health wellness information more frequently (P<.001), whereas digital immigrants searched for health guidance (P<.001) and health management information (P=.001) more frequently. There were no significant differences between the 2 generations regarding preventative health actions (P=.85). Moreover, all 3 types of OHIS mediated the relationship between generational differences and preventative health actions. Furthermore, as people aged, they searched for significantly less health wellness information (P<.001) and more health guidance (P<.001), and health management information (P=.003). Age was not a significant predictor of preventative health actions (P=.48). The frequency of OHI searches did not moderate the effect of generations on OHIS types and preventative health actions. Gender only moderated the relationship between generation and health guidance information search (P=.02), and chronic diseases only moderated the relationship between generation and health wellness information search (P=.03). Conclusions: To the best of our knowledge, this study is the first to explore how 2 digital generations vary in terms of searching for OHI and preventative health behaviors. As the older adult population grows, it is crucial to understand their OHIS behavior and how they engage in preventative health actions to enhance their quality of life. ",
doi="10.2196/48977",
url="https://www.jmir.org/2024/1/e48977",
url="http://www.ncbi.nlm.nih.gov/pubmed/38466985"
}


@Article{info:doi/10.2196/47448,
author="Vincent, Wilson",
title="Willingness to Use Digital Health Screening and Tracking Tools for Public Health in Sexual Minority Populations in a National Probability Sample: Quantitative Intersectional Analysis",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="8",
volume="26",
pages="e47448",
keywords="COVID-19",
keywords="demographics",
keywords="digital health",
keywords="disparities",
keywords="intersectionality",
keywords="mHealth",
keywords="mobile health",
keywords="psychometric properties",
keywords="sexual minority populations",
abstract="Background: Little is known about sexual minority adults' willingness to use digital health tools, such as pandemic-related tools for screening and tracking, outside of HIV prevention and intervention efforts for sexual minority men, specifically. Additionally, given the current cultural climate in the United States, heterosexual and sexual minority adults may differ in their willingness to use digital health tools, and there may be within-group differences among sexual minority adults. Objective: This study compared sexual minority and heterosexual adults' willingness to use COVID-19--related digital health tools for public health screening and tracking and tested whether sexual minority adults differed from each other by age group, gender, and race or ethnicity. Methods: We analyzed data from a cross-sectional, national probability survey (n=2047) implemented from May 30 to June 8, 2020, in the United States during the height of the public health response to the COVID-19 pandemic. Using latent-variable modeling, heterosexual and sexual minority adults were tested for differences in their willingness to use digital health tools for public health screening and tracking. Among sexual minority adults, specifically, associations with age, gender, and race or ethnicity were assessed. Results: On average, sexual minority adults showed greater willingness to use digital health tools for screening and tracking than heterosexual adults (latent factor mean difference 0.46, 95\% CI 0.15-0.77). Among sexual minority adults, there were no differences by age group, gender, or race or ethnicity. However, African American (b=0.41, 95\% CI 0.19-0.62), Hispanic or Latino (b=0.36, 95\% CI 0.18-0.55), and other racial or ethnic minority (b=0.54, 95\% CI 0.31-0.77) heterosexual adults showed greater willingness to use digital health tools for screening and tracking than White heterosexual adults. Conclusions: In the United States, sexual minority adults were more willing to use digital health tools for screening and tracking than heterosexual adults. Sexual minority adults did not differ from each other by age, gender, or race or ethnicity in terms of their willingness to use these digital health tools, so no sexual orientation-based or intersectional disparities were identified. Furthermore, White heterosexual adults were less willing to use these tools than racial or ethnic minority heterosexual adults. Findings support the use of digital health tools with sexual minority adults, which could be important for other public health-related concerns (eg, the recent example of mpox). Additional studies are needed regarding the decision-making process of White heterosexual adults regarding the use of digital health tools to address public health crises, including pandemics or outbreaks that disproportionately affect minoritized populations. ",
doi="10.2196/47448",
url="https://www.jmir.org/2024/1/e47448",
url="http://www.ncbi.nlm.nih.gov/pubmed/38457790"
}


@Article{info:doi/10.2196/53956,
author="Abraham, Olufunmilola
and Agoke, Adeola
and Sanuth, Kazeem
and Fapohunda, Abimbola
and Ogunsanya, Motolani
and Piper, Megan
and Trentham-Dietz, Amy",
title="Need for Culturally Competent and Responsive Cancer Education for African Immigrant Families and Youth Living in the United States",
journal="JMIR Cancer",
year="2024",
month="Mar",
day="6",
volume="10",
pages="e53956",
keywords="African immigrant",
keywords="youth",
keywords="adolescent",
keywords="adolescents",
keywords="teen",
keywords="teens",
keywords="teenager",
keywords="teenagers",
keywords="cancer awareness",
keywords="health disparities",
keywords="culturally competent education",
keywords="African",
keywords="Black",
keywords="immigrant",
keywords="cultural",
keywords="culturally",
keywords="cancer",
keywords="oncology",
keywords="patient education",
keywords="awareness",
keywords="prevention",
keywords="disparity",
keywords="disparities",
doi="10.2196/53956",
url="https://cancer.jmir.org/2024/1/e53956",
url="http://www.ncbi.nlm.nih.gov/pubmed/38447129"
}


@Article{info:doi/10.2196/46522,
author="Money, Annemarie
and Hall, Alex
and Harris, Danielle
and Eost-Telling, Charlotte
and McDermott, Jane
and Todd, Chris",
title="Barriers to and Facilitators of Older People's Engagement With Web-Based Services: Qualitative Study of Adults Aged >75 Years",
journal="JMIR Aging",
year="2024",
month="Feb",
day="28",
volume="7",
pages="e46522",
keywords="digital exclusion",
keywords="digital inclusion",
keywords="older people",
keywords="technology",
keywords="aged",
keywords="web-based",
keywords="internet",
abstract="Background: The COVID-19 pandemic has accelerated the shift toward the digital provision of many public services, including health and social care, public administration, and financial and leisure services. COVID-19 services including test appointments, results, vaccination appointments and more were primarily delivered through digital channels to the public. Many social, cultural, and economic activities (appointments, ticket bookings, tax and utility payments, shopping, etc) have transitioned to web-based platforms. To use web-based public services, individuals must be digitally included. This is influenced by 3 main factors: access (whether individuals have access to the internet), ability (having the requisite skills and confidence to participate over the web), and affordability (ability to pay for infrastructure [equipment] and data packages). Many older adults, especially those aged >75 years, are still digitally excluded. Objective: This study aims to explore the views of adults aged >75 years on accessing public services digitally. Methods: We conducted semistructured qualitative interviews with a variety of adults aged ?75 years residing in Greater Manchester, United Kingdom. We also interviewed community support workers. Thematic analysis was used to identify the key themes from the data. Results: Overall, 24 older adults (mean age 81, SD 4.54 y; 14/24, 58\% female; 23/24, 96\% White British; and 18/24, 75\% digitally engaged to some extent) and 2 support workers participated. A total of five themes were identified as key in understanding issues around motivation, engagement, and participation: (1) ``initial motivation to participate digitally''---for example, maintaining social connections and gaining skills to be able to connect with family and friends; (2) ``narrow use and restricted activity on the web''---undertaking limited tasks on the web and in a modified manner, for example, limited use of web-based public services and selected use of specific services, such as checking but never transferring funds during web-based banking; (3) ``impact of digital participation on well-being''---choosing to go to the shops or general practitioner's surgery to get out of the house and get some exercise; (4) ``the last generation?''---respondents feeling that there were generational barriers to adapting to new technology and change; and (5) ``making digital accessible''---understanding the support needed to keep those engaged on the web. Conclusions: As we transition toward greater digitalization of public services, it is crucial to incorporate the perspectives of older people. Failing to do so risks excluding them from accessing services they greatly rely on and need. ",
doi="10.2196/46522",
url="https://aging.jmir.org/2024/1/e46522",
url="http://www.ncbi.nlm.nih.gov/pubmed/38416543"
}


@Article{info:doi/10.2196/48685,
author="K{\"o}nig, Lars
and Kuhlmey, Adelheid
and Suhr, Ralf",
title="Digital Health Literacy of the Population in Germany and Its Association With Physical Health, Mental Health, Life Satisfaction, and Health Behaviors: Nationally Representative Survey Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Feb",
day="21",
volume="10",
pages="e48685",
keywords="digital health",
keywords="digital health literacy",
keywords="eHealth",
keywords="eHealth literacy",
keywords="health behaviors",
keywords="health literacy",
keywords="life satisfaction",
keywords="mental health",
keywords="physical health",
keywords="representative survey",
abstract="Background: Digital health literacy, also known as eHealth literacy, describes the ability to seek, find, understand, and apply health information from the internet to address health problems. The World Health Organization calls for actions to improve digital health literacy. To develop target group--specific digital health literacy interventions, it is necessary to know the digital health literacy of the general population and relevant subgroups. Objective: This study aims to representatively assess the digital health literacy of the population in Germany and relevant subgroups. The results are meant to facilitate the development of target group--specific digital health literacy interventions. Additionally, this study further explores the associations between digital health literacy and physical health, mental health, life satisfaction, and diverse health behaviors. Methods: Study participants were drawn from a representative panel of the German-speaking population with internet access. To further increase the representativeness of the sample, survey weights were calculated using an iterative proportional fitting procedure. Participants answered a series of questionnaires regarding their digital health literacy, physical health, mental health, life satisfaction, and diverse health behaviors. Two-sided independent sample t tests were conducted to determine the significant differences between societal subgroups. Pearson correlation coefficients were calculated to explore the correlates of digital health literacy. Results: Digital health literacy is unevenly distributed within German society. The results of this study suggest that people with a low level of formal education and people with a low social status would benefit from digital health literacy interventions that address their competencies in the domains of information seeking and information appraisal. Furthermore, the results suggest that older people would likely benefit from digital health literacy interventions that address their competencies in the domains of information seeking and also information appraisal. Regarding sex, this study suggests that men might benefit from digital health literacy interventions that specifically address their competencies in the domain of information seeking. Furthermore, digital health literacy is weakly positively correlated with physical health, mental health, life satisfaction, exercise routines, fruit consumption, and vegetable consumption. Conclusions: Overall, the results of this study demonstrate that digital health literacy is associated with diverse health outcomes and behaviors. Furthermore, the results provide a starting point for the development of target group--specific digital health literacy interventions. ",
doi="10.2196/48685",
url="https://publichealth.jmir.org/2024/1/e48685",
url="http://www.ncbi.nlm.nih.gov/pubmed/38381497"
}


@Article{info:doi/10.2196/50012,
author="Chang, Jinghui
and Mai, Yanshan
and Zhang, Dayi
and Yang, Xixi
and Li, Anqi
and Yan, Wende
and Wu, Yibo
and Chen, Jiangyun",
title="Media Use Behavior Mediates the Association Between Family Health and Intention to Use Mobile Health Devices Among Older Adults: Cross-Sectional Study",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="19",
volume="26",
pages="e50012",
keywords="older adults",
keywords="family health",
keywords="media use",
keywords="intention to use mobile health devices",
keywords="China",
abstract="Background: With the advent of a new era for health and medical treatment, characterized by the integration of mobile technology, a significant digital divide has surfaced, particularly in the engagement of older individuals with mobile health (mHealth). The health of a family is intricately connected to the well-being of its members, and the use of media plays a crucial role in facilitating mHealth care. Therefore, it is important to examine the mediating role of media use behavior in the connection between the family health of older individuals and their inclination to use mHealth devices. Objective: This study aims to investigate the impact of family health and media use behavior on the intention of older individuals to use mHealth devices in China. The study aims to delve into the intricate dynamics to determine whether media use behavior serves as a mediator in the relationship between family health and the intention to use mHealth devices among older adults. The ultimate goal is to offer well-founded and practical recommendations to assist older individuals in overcoming the digital divide. Methods: The study used data from 3712 individuals aged 60 and above, sourced from the 2022 Psychology and Behavior Investigation of Chinese Residents study. Linear regression models were used to assess the relationships between family health, media use behavior, and the intention to use mHealth devices. To investigate the mediating role of media use behavior, we used the Sobel-Goodman Mediation Test. This analysis focused on the connection between 4 dimensions of family health and the intention to use mHealth devices. Results: A positive correlation was observed among family health, media use behavior, and the intention to use mHealth devices (r=0.077-0.178, P<.001). Notably, media use behavior was identified as a partial mediator in the relationship between the overall score of family health and the intention to use mHealth devices, as indicated by the Sobel test (z=5.451, P<.001). Subgroup analysis further indicated that a complete mediating effect was observed specifically between family health resources and the intention to use mHealth devices in older individuals with varying education levels. Conclusions: The study revealed the significance of family health and media use behavior in motivating older adults to adopt mHealth devices. Media use behavior was identified as a mediator in the connection between family health and the intention to use mHealth devices, with more intricate dynamics observed among older adults with lower education levels. Going forward, the critical role of home health resources must be maximized, such as initiatives to develop digital education tailored for older adults and the creation of media products specifically designed for them. These measures aim to alleviate technological challenges associated with using media devices among older adults, ultimately bolstering their inclination to adopt mHealth devices. ",
doi="10.2196/50012",
url="https://www.jmir.org/2024/1/e50012",
url="http://www.ncbi.nlm.nih.gov/pubmed/38373031"
}


@Article{info:doi/10.2196/43770,
author="Tohme, Pia
and Abi Fadel, Nour
and Yaktine, Nour
and Abi-Habib, Rudy",
title="Predictors of Mental Health Literacy in a Sample of Health Care Major Students: Pilot Evaluation Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="8",
volume="8",
pages="e43770",
keywords="awareness",
keywords="COVID-19",
keywords="digital health literacy",
keywords="digital health",
keywords="disorder",
keywords="empathy",
keywords="health literacy",
keywords="literacy",
keywords="mental health literacy",
keywords="mental health",
keywords="mentalizing",
keywords="questionnaire",
keywords="students",
abstract="Background: The numerous mental health awareness campaigns during the COVID-19 pandemic have shifted our understanding and perception of mental health. Objective: The purpose of this study is to evaluate predictors of mental health literacy (MHL), that is, one's knowledge and beliefs about mental disorders. We evaluate whether digital health literacy, empathy, and mentalizing contribute to MHL. Methods: Our sample consisted of 89 health care major students, aged between 17 and 32 years, studying at a university in Lebanon. The Mental Health Literacy Scale for Healthcare Students (MHLS-HS), the eHealth Literacy Questionnaire (eHLQ), the Basic Empathy Scale (BES), and the Reflective Functioning Questionnaire-8 (RFQ-8) were used. Results: Multiple regression analyses revealed that the Engagement in Own Health subscale of digital health literacy constituted a predictor of MHL. While empathy and mentalizing did not directly predict MHL, they were found to predict components of MHL. Conclusions: This is the first study to evaluate digital health literacy, empathy, and mentalizing as predictors of MHL in Lebanon, a country where mental health is still considered taboo. Moreover, this pilot study is the first to provide some support for the predictive role of some digital health literacy subscales on MHL in light of the rise of the digital era following the COVID-19 pandemic. ",
doi="10.2196/43770",
url="https://formative.jmir.org/2024/1/e43770",
url="http://www.ncbi.nlm.nih.gov/pubmed/38329801"
}


@Article{info:doi/10.2196/46824,
author="Yu, Chuen Chou
and Tou, Xiang Nien
and Low, Alvin James",
title="Internet Use and Effects on Mental Well-being During the Lockdown Phase of the COVID-19 Pandemic in Younger Versus Older Adults: Observational Cross-Sectional Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="6",
volume="8",
pages="e46824",
keywords="COVID-19",
keywords="digital divide",
keywords="well-being",
keywords="older adults",
keywords="information and communication technology",
keywords="internet of things",
keywords="online",
keywords="mental health",
keywords="lockdown",
keywords="depression",
keywords="stress",
keywords="anxiety",
keywords="digital technology",
keywords="pandemic",
abstract="Background: Majority of individuals, including both younger and older adults, had to adapt to digital means to cope with lockdown measures and pandemic-induced lifestyle changes during the COVID-19 pandemic. While internet accessibility was beneficial during the pandemic, existing literature suggests that excessive use could lead to the rise of problematic internet use in adolescents and younger adults. However, the effects on older adults remain unclear. Objective: This study aimed to examine differences in internet use during the lockdown phase of the COVID-19 pandemic and explore how age differences in mental health could be explained by time spent on the internet. Methods: A door-to-door survey of a nationally representative sample of 602 adults in Singapore was carried out using computer-assisted personal interviewing during the early phase of the COVID-19 pandemic (October to November 2020). Participants were categorized into younger (21-59 years old) and older (60 years or above) age groups. We assessed self-reported measures of depression, anxiety, and stress; psychosocial adaptability; ability to perform essential activities; social support; health status; digital media use patterns, and time spent on the internet. Procedures complied with existing safe distancing measures. Results: Older adults reported being less able to use digital platforms to meet needs and acquire information updates compared with younger adults during the lockdown period of the pandemic. Older adults spent significantly less time on the internet for both work and personal uses per day (mean 146.00 min, SD 9.18 min) compared with younger adults (mean 433.27 min, SD 14.32 min). Significant age differences in depression, anxiety, and stress were found, with younger adults showing poorer mental health. Mediation analysis showed that age differences in depression, anxiety, and stress were partially explained by time spent on the internet. These variables together explained 43\%, 40\%, and 40\% of the variances in depression, anxiety, and stress scores, respectively. Conclusions: The findings showed that younger adults spent significantly more time on the internet compared with older adults during the lockdown phase of the pandemic. They were also ahead in their ability to use digital resources to meet needs and engage socially compared with older adults. Despite this, the mental health of younger adults was poor, and this was partially accounted for by the amount of time spent on the internet. Since past research suggests that excessive time spent on the internet could lead to disordered use, the benefits brought by digital technologies could have been attenuated during the lockdown phase of the pandemic. Considering this potential negative effect, it is imperative to educate both young and old adults in the appropriate use of information and communication technology. ",
doi="10.2196/46824",
url="https://formative.jmir.org/2024/1/e46824",
url="http://www.ncbi.nlm.nih.gov/pubmed/38319700"
}


@Article{info:doi/10.2196/46746,
author="Burke, Colin
and Triplett, Cynthia
and Rubanovich, Kseniya Caryn
and Karnaze, M. Melissa
and Bloss, S. Cinnamon",
title="Attitudes Toward School-Based Surveillance of Adolescents' Social Media Activity: Convergent Parallel Mixed Methods Survey",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="6",
volume="8",
pages="e46746",
keywords="social media",
keywords="surveillance",
keywords="privacy",
keywords="public health",
keywords="students",
keywords="schools",
keywords="social media monitoring",
keywords="SMM",
keywords="school safety",
keywords="mental health",
keywords="adolescents",
abstract="Background: US schools increasingly implement commercially available technology for social media monitoring (SMM) of students, purportedly to address youth mental health and school safety. However, little is known about how SMM is perceived by stakeholders, including the students who are the focus of these efforts. Objective: We aimed to assess attitudes toward SMM in schools among 4 stakeholder groups and examine reasons for holding supportive, neutral, or unsupportive views toward the technology. We also sought to explore whether any differences in attitudes were associated with binary sex, race, ethnicity, sexual orientation, or gender identity. Methods: In October 2019, we conducted a convergent parallel mixed methods web-based survey of young adults (aged 18-22 y; n=206), parents (n=205), teachers (n=77), and school administrators (n=41) via Qualtrics web-based panels. We included Likert-type survey items to assess perceived benefits, risks, and overall support of SMM in schools and test for differences based on stakeholder group or demographic characteristics. We also included open-ended questions, and the responses to these items were analyzed using thematic content analysis of reasons given for holding supportive, neutral, or unsupportive views. Results: The tests of group differences showed that young adults perceived lower benefit (P<.001) as well as higher risk (P<.001) and expressed lower overall support (P<.001) of the use of SMM in schools than all other stakeholder groups. Individuals identifying as nonheterosexual also perceived lower benefit (P=.002) and higher risk (P=.02) and expressed lower overall support (P=.02) than their heterosexual counterparts; respondents who identified as people of racial and ethnic minorities also perceived higher risk (P=.04) than their White counterparts. Qualitative thematic content analysis revealed greater nuance in concerns about SMM. Specifically, the primary reasons given for not supporting SMM across all stakeholder groups were (1) skepticism about its utility, (2) perceived privacy violations, and (3) fears of inappropriate or discriminatory use of the data. Within the young adult group in particular, concerns were also raised about (4) unintended and adverse consequences, including the erosion of trust between students and school institutions and administrators, and the chronic adverse effects of constant or prolonged surveillance. Thematic analysis also showed that individuals in every stakeholder group who indicated overall support of SMM were likely to cite the potential for enhanced school safety as the reason. Young adults' overall stances toward SMM were the most polarized, either strongly for or strongly against SMM, and responses from teachers indicated similar polarization but more often favored support of SMM in schools. Conclusions: This study found differing perspectives among stakeholder groups regarding SMM in schools. More work is needed to assess the ways in which this type of surveillance is being implemented and the range and complexity of possible effects, particularly on students. ",
doi="10.2196/46746",
url="https://formative.jmir.org/2024/1/e46746",
url="http://www.ncbi.nlm.nih.gov/pubmed/38319696"
}


@Article{info:doi/10.2196/50780,
author="De Jes{\'u}s-Romero, Robinson
and Holder-Dixon, R. Amani
and Buss, F. John
and Lorenzo-Luaces, Lorenzo",
title="Race, Ethnicity, and Other Cultural Background Factors in Trials of Internet-Based Cognitive Behavioral Therapy for Depression: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="1",
volume="26",
pages="e50780",
keywords="diversity",
keywords="cognitive behavioral therapy",
keywords="internet-based",
keywords="depression",
keywords="race",
keywords="racial",
keywords="ethnicity",
keywords="culture",
keywords="depressive",
keywords="diverse",
keywords="inclusive",
keywords="inclusivity",
keywords="DEI",
keywords="diversity, equity, and inclusion",
keywords="internet-based cognitive behavioral therapy",
keywords="mental health",
keywords="ethnic",
keywords="cultures",
keywords="culturally",
keywords="review methods",
keywords="review methodology",
keywords="systematic",
keywords="clinical trial",
keywords="clinical trials",
keywords="randomized controlled trial",
keywords="randomized controlled trials",
keywords="controlled trial",
keywords="controlled trials",
keywords="reporting",
keywords="immigrant",
keywords="migrant",
keywords="migrants",
keywords="immigrants",
keywords="psychotherapy",
keywords="underrepresented",
keywords="underrepresentation",
keywords="representation",
keywords="mobile phone",
abstract="Background: There is a growing interest in developing scalable interventions, including internet-based cognitive behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at least, report information on the race, ethnicity, or other background indicators of their samples. Unfortunately, the field lacks data on how well diversity is currently reported and represented in the iCBT literature. Objective: Thus, the main objective of this systematic review was to examine the overall reporting of racial and ethnic identities in published clinical trials of iCBT for depression. We also aimed to review the representation of specific racial and ethnic minoritized groups and the inclusion of alternative background indicators such as migration status or country of residence. Methods: Studies were included if they were randomized controlled trials in which iCBT was compared to a waiting list, care-as-usual, active control, or another iCBT. The included papers also had to have a focus on acute treatment (eg, 4 weeks to 6 months) of depression, be delivered via the internet on a website or a smartphone app and use guided or unguided self-help. Studies were initially identified from the METAPSY database (n=59) and then extended to include papers up to 2022, with papers retrieved from Embase, PubMed, PsycINFO, and Cochrane (n=3). Risk of bias assessment suggested that reported studies had at least some risk of bias due to use of self-report outcome measures. Results: A total of 62 iCBT randomized controlled trials representing 17,210 participants are summarized in this study. Out of those 62 papers, only 17 (27\%) of the trials reported race, and only 12 (19\%) reported ethnicity. Reporting outside of the United States was very poor, with the United States accounting for 15 (88\%) out of 17 of studies that reported race and 9 (75\%) out of 12 for ethnicity. Out of 3,623 participants whose race was reported in the systematic review, the racial category reported the most was White (n=2716, 74.9\%), followed by Asian (n=209, 5.8\%) and Black (n=274, 7.6\%). Furthermore, only 25 (54\%) out of the 46 papers conducted outside of the United States reported other background demographics. Conclusions: It is important to note that the underreporting observed in this study does not necessarily indicate an underrepresentation in the actual study population. However, these findings highlight the poor reporting of race and ethnicity in iCBT trials for depression found in the literature. This lack of diversity reporting may have significant implications for the scalability of these interventions. ",
doi="10.2196/50780",
url="https://www.jmir.org/2024/1/e50780",
url="http://www.ncbi.nlm.nih.gov/pubmed/38300699"
}


@Article{info:doi/10.2196/46821,
author="Shu, Tingting
and Tang, Ming
and He, Bo
and Liu, Xiaozhu
and Han, Yu
and Liu, Chang
and Jose, A. Pedro
and Wang, Hongyong
and Zhang, Qing-Wei
and Zeng, Chunyu",
title="Assessing Global, Regional, and National Time Trends and Associated Risk Factors of the Mortality in Ischemic Heart Disease Through Global Burden of Disease 2019 Study: Population-Based Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Jan",
day="24",
volume="10",
pages="e46821",
keywords="age-period-cohort analysis",
keywords="GBD 2019",
keywords="Global Burden of Disease 2019 study",
keywords="ischemic heart disease",
keywords="mortality",
keywords="risk factors",
abstract="Background: Ischemic heart disease (IHD) is the leading cause of death among noncommunicable diseases worldwide, but data on current epidemiological patterns and associated risk factors are lacking. Objective: This study assessed the global, regional, and national trends in IHD mortality and attributable risks since 1990. Methods: Mortality data were obtained from the Global Burden of Disease 2019 Study. We used an age-period-cohort model to calculate longitudinal age curves (expected longitudinal age-specific rate), net drift (overall annual percentage change), and local drift (annual percentage change in each age group) from 15 to >95 years of age and estimate cohort and period effects between 1990 and 2019. Deaths from IHD attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and theoretical minimum risk exposure level. Results: IHD is the leading cause of death in noncommunicable disease--related mortality (118.1/598.8, 19.7\%). However, the age-standardized mortality rate for IHD decreased by 30.8\% (95\% CI --34.83\% to --27.17\%) over the past 30 years, and its net drift ranged from --2.89\% (95\% CI --3.07\% to --2.71\%) in high sociodemographic index (SDI) region to --0.24\% (95\% CI --0.32\% to --0.16\%) in low-middle--SDI region. The greatest decrease in IHD mortality occurred in the Republic of Korea (high SDI) with net drift --6.06\% (95\% CI --6.23\% to --5.88\%), followed by 5 high-SDI nations (Denmark, Norway, Estonia, the Netherlands, and Ireland) and 2 high-middle--SDI nations (Israel and Bahrain) with net drift less than --5.00\%. Globally, age groups of >60 years continued to have the largest proportion of IHD-related mortality, with slightly higher mortality in male than female group. For period and birth cohort effects, the trend of rate ratios for IHD mortality declined across successive period groups from 2000 to 2004 and birth cohort groups from 1985 to 2000, with noticeable improvements in high-SDI regions. In low-SDI regions, IHD mortality significantly declined in female group but fluctuated in male group across successive periods; sex differences were greater in those born after 1945 in middle- and low-middle--SDI regions and after 1970 in low-SDI regions. Metabolic risks were the leading cause of mortality from IHD worldwide in 2019. Moreover, smoking, particulate matter pollution, and dietary risks were also important risk factors, increasingly occurring at a younger age. Diets low in whole grains and legumes were prominent dietary risks in both male and female groups, and smoking and high-sodium diet mainly affect male group. Conclusions: IHD, a major concern, needs focused health care attention, especially for older male individuals and those in low-SDI regions. Metabolic risks should be prioritized for prevention, and behavioral and environmental risks should attract more attention to decrease IHD mortality. ",
doi="10.2196/46821",
url="https://publichealth.jmir.org/2024/1/e46821",
url="http://www.ncbi.nlm.nih.gov/pubmed/38265846"
}


@Article{info:doi/10.2196/44923,
author="Alwuqaysi, Bdour
and Abdul-Rahman, Alfie
and Borgo, Rita",
title="The Impact of Social Media Use on Mental Health and Family Functioning Within Web-Based Communities in Saudi Arabia: Ethnographic Correlational Study",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="16",
volume="8",
pages="e44923",
keywords="social media use",
keywords="mental health",
keywords="family functioning",
abstract="Background: In recent years, increasing numbers of parents, activists, and decision-makers have raised concerns about the potential adverse effects of social media use on both mental health and family functioning. Although some studies have indicated associations between social media use and negative mental health outcomes, others have found no evidence of mental health harm. Objective: This correlation study investigated the interplay between social media use, mental health, and family functioning. Analyzing data from 314 users, this study explores diverse mental health outcomes. The study places particular emphasis on the Saudi Arabian sample, providing valuable insights into the cultural context and shedding light on the specific dynamics of social media's impact on mental well-being and family dynamics in this demographic context. Methods: We collected data through a subsection of an anonymous web-based survey titled ``The Effect of COVID-19 on Social Media Usage, Mental Health, and Family Functioning.'' The survey was distributed through diverse web-based platforms in Saudi Arabia, emphasizing the Saudi sample. The participants indicated their social media accounts and estimated their daily use. Mental health was assessed using the General Health Questionnaire and family functioning was evaluated using the Family Assessment Device Questionnaire. In addition, 6 mental health conditions (anxiety, self-esteem, depression, body dysmorphia, social media addiction, and eating disorders) were self-reported by participants. Results: The study demonstrates a pattern of frequent social media use, with a significant portion dedicating 3-5 hours daily for web-based activities, and most of the sample accessed platforms multiple times a day. Despite concerns about social media addiction and perceived unhealthiness, participants cited staying connected with friends and family as their primary motivation for social media use. WhatsApp was perceived as the most positively impactful, whereas TikTok was considered the most negative for our Saudi sample. YouTube, Instagram, and Snapchat users reported poorer mental health compared with nonusers of these platforms. Mental health effects encompassed anxiety and addiction, with age and gender emerging as significant factors. Associations between social media use and family functioning were evident, with higher social media quartiles correlating with a greater likelihood of mental health and unhealthy family functioning. Logistic regression identified age and gender as factors linked to affected mental health, particularly noting that female participants aged 25-34 years were found to be more susceptible to affected mental health. In addition, multivariable analysis identified age and social media use quartiles as factors associated with poor family functioning. Conclusions: This study examined how social media affects mental health and family functioning in Saudi Arabia. These findings underscore the need for culturally tailored interventions to address these challenges, considering diverse demographic needs. Recognizing these nuances can guide the development of interventions to promote digital well-being, acknowledging the importance of familial connections in Saudi society. ",
doi="10.2196/44923",
url="https://formative.jmir.org/2024/1/e44923",
url="http://www.ncbi.nlm.nih.gov/pubmed/38227352"
}


@Article{info:doi/10.2196/49749,
author="Garg, Ashvita
and Nyitray, G. Alan
and Roberts, R. James
and Shungu, Nicholas
and Ruggiero, J. Kenneth
and Chandler, Jessica
and Damgacioglu, Haluk
and Zhu, Yenan
and Brownstein, C. Naomi
and Sterba, R. Katherine
and Deshmukh, A. Ashish
and Sonawane, Kalyani",
title="Consumption of Health-Related Videos and Human Papillomavirus Awareness: Cross-Sectional Analyses of a US National Survey and YouTube From the Urban-Rural Context",
journal="J Med Internet Res",
year="2024",
month="Jan",
day="15",
volume="26",
pages="e49749",
keywords="awareness",
keywords="health awareness",
keywords="health information",
keywords="health videos",
keywords="HINTS",
keywords="HPV vaccine",
keywords="HPV",
keywords="information behavior",
keywords="information behaviors",
keywords="information seeking",
keywords="online information",
keywords="reproductive health",
keywords="rural",
keywords="sexual health",
keywords="sexually transmitted",
keywords="social media",
keywords="STD",
keywords="STI",
keywords="urban",
keywords="video",
keywords="videos",
keywords="YouTube",
abstract="Background: Nearly 70\% of Americans use the internet as their first source of information for health-related questions. Contemporary data on the consumption of web-based videos containing health information among American adults by urbanity or rurality is currently unavailable, and its link with health topic awareness, particularly for human papillomavirus (HPV), is not known. Objective: We aim to describe trends and patterns in the consumption of health-related videos on social media from an urban-rural context, examine the association between exposure to health-related videos on social media and awareness of health topics (ie, HPV and HPV vaccine), and understand public interest in HPV-related video content through search terms and engagement analytics. Methods: We conducted a cross-sectional analysis of the US Health Information National Trends Survey 6, a nationally representative survey that collects data from civilian, noninstitutionalized adults aged 18 years or older residing in the United States. Bivariable analyses were used to estimate the prevalence of consumption of health-related videos on social media among US adults overall and by urbanity or rurality. Multivariable logistic regression models were used to examine the association between the consumption of health-related videos and HPV awareness among urban and rural adults. To provide additional context on the public's interest in HPV-specific video content, we examined search volumes (quantitative) and related query searches (qualitative) for the terms ``HPV'' and ``HPV vaccine'' on YouTube. Results: In 2022, 59.6\% of US adults (152.3 million) consumed health-related videos on social media, an increase of nearly 100\% from 2017 to 2022. Prevalence increased among adults living in both urban (from 31.4\% in 2017 to 59.8\% in 2022; P<.001) and rural (from 22.4\% in 2017 to 58\% in 2022; P<.001) regions. Within the urban and rural groups, consumption of health-related videos on social media was most prevalent among adults aged between 18 and 40 years and college graduates or higher-educated adults. Among both urban and rural groups, adults who consumed health-related videos had a significantly higher probability of being aware of HPV and the HPV vaccine compared with those who did not watch health videos on the internet. The term ``HPV'' was more frequently searched on YouTube compared with ``HPV vaccine.'' Individuals were most commonly searching for videos that covered content about the HPV vaccine, HPV in males, and side effects of the HPV vaccine. Conclusions: The consumption of health-related videos on social media in the United States increased dramatically between 2017 and 2022. The rise was prominent among both urban and rural adults. Watching a health-related video on social media was associated with a greater probability of being aware of HPV and the HPV vaccine. Additional research on designing and developing social media strategies is needed to increase public awareness of health topics. ",
doi="10.2196/49749",
url="https://www.jmir.org/2024/1/e49749",
url="http://www.ncbi.nlm.nih.gov/pubmed/38224476"
}


@Article{info:doi/10.2196/46656,
author="Shaw Jr, George
and Castro, A. Bianca
and Gunn, H. Laura
and Norris, Keith
and Thorpe Jr, J. Roland",
title="The Association of eHealth Literacy Skills and mHealth Application Use Among US Adults With Obesity: Analysis of Health Information National Trends Survey Data",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="10",
volume="12",
pages="e46656",
keywords="accessibility",
keywords="eHealth literacy",
keywords="mHealth",
keywords="multivariable logistic regression",
keywords="obesity",
keywords="smartphones",
abstract="Background: Physical inactivity and a poor diet are modifiable behaviors that contribute to obesity. Obesity is a well-recognized risk factor for chronic diseases, including diabetes. Mobile health (mHealth) apps can play an important adjuvant role in preventing and treating chronic diseases and promoting positive health behavior change among people with obesity, and eHealth literacy skills have the potential to impact mHealth app use. Objective: The purpose of this study was to explore the associations between the 2 dimensions, access and application, of eHealth literacy skills and mHealth app use among US adults (?18 years of age) with obesity (BMI ?30 kg/m2). Methods: Data were obtained from February to June 2020 using the Health Information National Trends Survey 5. A total of 1079 respondents met the inclusion criteria of adults with obesity and owners of smartphones. Individual associations between mHealth app use and sociodemographic variables were explored using weighted chi-square and 2-tailed t tests. A multivariable weighted logistic regression model was fitted, and adjusted odds ratios (ORs) of using mHealth apps with corresponding 95\% CIs were reported across multiple sociodemographic variables. An Ising model-weighted network visualization was produced. A receiver operating characteristic curve was calculated, and the area under the curve was reported with the corresponding Delong 95\% CI. Results: A majority of respondents were female (550/923, 59.6\%) or non-Hispanic White (543/923, 58.8\%). Individuals in households earning less than US \$50,000 comprised 41.4\% (382/923) of the sample. All sociodemographic variables were found to be univariately significant at the 5\% level, except employment and region. Results from the multivariable weighted logistic regression model showed that the adjusted odds of using an mHealth app are 3.13 (95\% CI 1.69-5.80) and 2.99 (95\% CI 1.67-5.37) times higher among those with an access eHealth literacy skill of using an electronic device to look for health or medical information for themselves and an application eHealth literacy skill of using electronic communications with a doctor or doctor's office, respectively. Several sociodemographic variables were found to be significant, such as education, where adjusted ORs comparing subgroups to the lowest educational attainment were substantial (ORs ?7.77). The network visualization demonstrated that all eHealth literacy skills and the mHealth app use variable were positively associated to varying degrees. Conclusions: This work provides an initial understanding of mHealth app use and eHealth literacy skills among people with obesity, identifying people with obesity subpopulations who are at risk of a digital health divide. Future studies should identify equitable solutions for people with obesity (as well as other groups) and their use of mHealth apps. ",
doi="10.2196/46656",
url="https://mhealth.jmir.org/2024/1/e46656",
url="http://www.ncbi.nlm.nih.gov/pubmed/38198196"
}


@Article{info:doi/10.2196/52031,
author="Buawangpong, Nida
and Pinyopornpanish, Kanokporn
and Pliannuom, Suphawita
and Nantsupawat, Nopakoon
and Wiwatkunupakarn, Nutchar
and Angkurawaranon, Chaisiri
and Jiraporncharoen, Wichuda",
title="Designing Telemedicine for Older Adults With Multimorbidity: Content Analysis Study",
journal="JMIR Aging",
year="2024",
month="Jan",
day="10",
volume="7",
pages="e52031",
keywords="telemedicine",
keywords="telehealth",
keywords="chronic disease",
keywords="multimorbidity",
keywords="older adults",
keywords="mobile phone",
abstract="Background: Telemedicine is a potential option for caring for older adults with multimorbidity. There is a need to explore the perceptions about telemedicine among older adults with multimorbidity to tailor it to the needs of older adults with multiple chronic conditions. Objective: This study aims to explore the perceptions about telemedicine among older patients with multimorbidity. Methods: A qualitative study was conducted using semistructured interviews. The interview questions examined older adults' perspectives about telemedicine, including their expectations regarding telemedicine services and the factors that affect its use. Thematic analysis was performed using NVivo (version 12; Lumivero). The study was reported using the Standards for Reporting Qualitative Research guidelines. Results: In total, 29 patients with multimorbidity---21 (72\%) female patients and 8 (28\%) male patients with a mean age of 69 (SD 10.39) years---were included. Overall, 4 themes and 7 subthemes emerged: theme 1---perceived benefit of telemedicine among older adults with multimorbidities, theme 2---appropriate use of telemedicine for multimorbid care, theme 3---telemedicine system catering to the needs of older patients, and theme 4---respect patients' decision to decline to use telemedicine. Conclusions: Telemedicine for older adults with multimorbidity should focus on those with stable conditions. This can help increase access to care for those requiring continuous condition monitoring. A structured telemedicine program and patient-centered services can help increase patient acceptance of telemedicine. However, health care providers must accept the limitations of older patients that may prevent them from receiving telemedicine services. ",
doi="10.2196/52031",
url="https://aging.jmir.org/2024/1/e52031",
url="http://www.ncbi.nlm.nih.gov/pubmed/38198201"
}


@Article{info:doi/10.2196/47802,
author="Rodriguez, Ramiro
and Anderson, Lachlan
and Woolhiser, Emily
and Balmorez, Timothy
and Cook, Bailey
and Hauptman, Megan
and Kirk, Jessica
and Keime, Noah
and Dellavalle, P. Robert",
title="Diversity Among American Dermatological Association Members by Sex and Geographic Region",
journal="JMIR Dermatol",
year="2024",
month="Jan",
day="10",
volume="7",
pages="e47802",
keywords="American Dermatological Association",
keywords="disparity",
keywords="representation",
keywords="dermatology",
keywords="urban",
keywords="rural",
keywords="dermatological society",
keywords="diversity",
keywords="inclusion",
keywords="equity",
keywords="sex",
keywords="membership",
keywords="acquisition",
keywords="demographic",
doi="10.2196/47802",
url="https://derma.jmir.org/2024/1/e47802",
url="http://www.ncbi.nlm.nih.gov/pubmed/38198199"
}


@Article{info:doi/10.2196/46277,
author="Chen, Yuling
and Turkson-Ocran, Ruth-Alma
and Koirala, Binu
and Davidson, M. Patricia
and Commodore-Mensah, Yvonne
and Himmelfarb, Dennison Cheryl",
title="Association Between the Composite Cardiovascular Risk and mHealth Use Among Adults in the 2017-2020 Health Information National Trends Survey: Cross-Sectional Study",
journal="J Med Internet Res",
year="2024",
month="Jan",
day="4",
volume="26",
pages="e46277",
keywords="mobile health",
keywords="usage",
keywords="cardiovascular risk",
keywords="association",
keywords="mobile phone",
abstract="Background: Numerous studies have suggested that the relationship between cardiovascular disease (CVD) risk and the usage of mobile health (mHealth) technology may vary depending on the total number of CVD risk factors present. However, whether higher CVD risk is associated with a greater likelihood of engaging in specific mHealth use among US adults is currently unknown. Objective: We aim to assess the associations between the composite CVD risk and each component of mHealth use among US adults regardless of whether they have a history of CVD or not. Methods: This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey. The exposure was CVD risk (diabetes, hypertension, smoking, physical inactivity, and overweight or obesity). We defined low, moderate, and high CVD risk as having 0-1, 2-3, and 4-5 CVD risk factors, respectively. The outcome variables of interest were each component of mHealth use, including using mHealth to make health decisions, track health progress, share health information, and discuss health decisions with health providers. We used multivariable logistic regression models to examine the association between CVD risk and mHealth use adjusted for demographic factors. Results: We included 10,531 adults, with a mean age of 54 (SD 16.2) years. Among the included participants, 50.2\% were men, 65.4\% were non-Hispanic White, 41.9\% used mHealth to make health decisions, 50.8\% used mHealth to track health progress toward a health-related goal, 18.3\% used mHealth to share health information with health providers, and 37.7\% used mHealth to discuss health decisions with health providers (all are weighted percentages). Adults with moderate CVD risk were more likely to use mHealth to share health information with health providers (adjusted odds ratio 1.49, 95\% CI 1.24-1.80) and discuss health decisions with health providers (1.22, 95\% CI 1.04-1.44) compared to those with low CVD risk. Similarly, having high CVD risk was associated with higher odds of using mHealth to share health information with health providers (2.61, 95\% CI 1.93-3.54) and discuss health decisions with health providers (1.56, 95\% CI 1.17-2.10) compared to those with low CVD risk. Upon stratifying by age and gender, we observed age and gender disparities in the relationship between CVD risk and the usage of mHealth to discuss health decisions with health providers. Conclusions: Adults with a greater number of CVD risk factors were more likely to use mHealth to share health information with health providers and discuss health decisions with health providers. These findings suggest a promising avenue for enhancing health care communication and advancing both primary and secondary prevention efforts related to managing CVD risk factors through the effective usage of mHealth technology. ",
doi="10.2196/46277",
url="https://www.jmir.org/2024/1/e46277",
url="http://www.ncbi.nlm.nih.gov/pubmed/38175685"
}


@Article{info:doi/10.2196/46515,
author="Loewen, {\'A}lvaro
and Blasco-Fontecilla, Hilario
and Li, Chao
and Bella-Fern{\'a}ndez, Marcos
and Ruiz-Antor{\'a}n, Bel{\'e}n",
title="Prevalence of Body Dysmorphic Disorder in the Spanish Population: Cross-Sectional Web-Based Questionnaire Study",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="4",
volume="8",
pages="e46515",
keywords="body dysmorphic disorder",
keywords="prevalence",
keywords="adults",
keywords="Spain",
keywords="comorbidities",
keywords="mental health",
keywords="depression",
keywords="anxiety",
keywords="OCD",
keywords="obsessive-compulsive disorder",
abstract="Background: Body dysmorphic disorder (BDD) is defined as excessive concern with mild or nonexistent defects in personal physical appearance, which are not perceived by others. The worldwide prevalence of BDD ranges between 0.5\% and 3.2\%, with no differences across genders. The mean age of onset of BDD is 16.9 years. BDD is typically associated with young age, psychiatric disorders, and dermatological procedures. Patients with BDD typically display poorer mental health status than patients diagnosed with other mental disorders. Objective: The aim of this study was to estimate the prevalence of BDD in Spain and to identify the variables associated with BDD. Methods: We performed a cross-sectional descriptive study by collecting data through an anonymous web-based survey targeting the Spanish population aged 18 years or older. The measures in this study were (1) sociodemographic variables, (2) variables associated with dermatological and psychiatric disorders and cosmetic procedures, (3) scales measuring quality of life (12-item Short Form health survey, version 2) and (4) BDD (BDD Questionnaire). Statistical analysis was performed with SPSS software version 21. P values less than .05 were considered significant. Results: Of the 2091 participants who took the survey, 322 (15.2\%) met the criteria of having BDD. The mean age of the participants with BDD was 23.5 (SD 9.6) years. In terms of BDD prevalence, women accounted for 19.9\% (284/1421), men accounted for 5.2\% (34/653), and students accounted for 25.2\% (263/1043). Approximately 46.6\% (150/322) of the participants with BDD reported a history of psychiatric comorbidities, including anxiety disorders, depressive disorders, and eating disorders. BDD was significantly associated with female gender, younger age (18-24 years), students, monthly income of less than {\texteuro}500 ({\texteuro}1=US \$1.11), and the presence of dermatological and some psychiatric disorders such as depression, anxiety, and eating disorders (P<.05). The number of body parts of concern in participants with BDD was significantly higher than that in those without BDD (4.6 vs 2.2, respectively; P<.001). Regarding the body parts of concern, body fat was the most common concern for both groups with BDD and without BDD, followed by thighs, face, hips, and skin in the BDD group and thighs, teeth, and hair in the non-BDD group. Participants with BDD showed a significantly poorer self-perception of their mental health, irrespective of the presence of any mental disorder (P<.001). Conclusions: Our findings showed that the prevalence of BDD in Spain was higher than expected. Further, BDD is frequently associated with other psychiatric disorders, particularly depressive disorder, anxiety disorder, and eating disorder. Participants with BDD had a poorer perception of quality of life associated with mental but not physical health problems. Finally, the perception of quality of mental health life in participants with BDD was independent of diagnosis of any mental disorder. ",
doi="10.2196/46515",
url="https://formative.jmir.org/2024/1/e46515",
url="http://www.ncbi.nlm.nih.gov/pubmed/38175692"
}


@Article{info:doi/10.2196/50191,
author="Howell, Khadesia
and Alvarado, Gabriela
and Waymouth, Molly
and Demirci, Jill
and Rogers, Rhianna
and Ray, Kristin
and Uscher-Pines, Lori",
title="Acceptability of Telelactation Services for Breastfeeding Support Among Black Parents: Semistructured Interview Study",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="29",
volume="25",
pages="e50191",
keywords="acceptance",
keywords="barrier",
keywords="black parent",
keywords="black",
keywords="breastfeeding",
keywords="concordance",
keywords="consultant",
keywords="consultation",
keywords="digital divide",
keywords="digital equity",
keywords="disparity",
keywords="ethnic",
keywords="health equity",
keywords="lactation",
keywords="mother",
keywords="parent",
keywords="racial",
keywords="telehealth",
keywords="telelactation",
keywords="user",
abstract="Background: While breastfeeding rates have increased in the United States in recent years, racial and ethnic disparities persist. Telelactation may help reduce disparities by increasing access to lactation consultants, but there is limited research on acceptability among minoritized individuals. Objective: We aimed to explore experiences with telelactation among Black parents and identify strategies to make services more culturally appropriate. Methods: We selected 20 Black parents who were given access to telelactation services from an ongoing National Institutes of Health--funded randomized controlled trial (the Tele-MILC trial) to participate in semistructured interviews. Interviews addressed birth experiences, use and opinions about telelactation, comparison of telelactation to in-person lactation support, and recommendations to improve telelactation services. The thematic analysis was informed by a previously reported theoretical framework of acceptability and RAND Corporation's equity-centered model. Results: Users appreciated the convenience of telelactation and reported that lactation consultants were knowledgeable and helpful. Participants wanted more options to engage with lactation consultants outside of video visits (eg, SMS text messaging and asynchronous resources). Users who had a lactation consultant of color mentioned that racial concordance improved the experience; however, few felt that racial concordance was needed for high-quality telelactation support. Conclusions: While Black parents in our sample found telelactation services to be acceptable, telelactation could not, in isolation, address the myriad barriers to long-duration breastfeeding. Several changes could be made to telelactation services to increase their use by minoritized populations. ",
doi="10.2196/50191",
url="https://www.jmir.org/2023/1/e50191",
url="http://www.ncbi.nlm.nih.gov/pubmed/38157241"
}


@Article{info:doi/10.2196/49349,
author="Young, Karen
and Xiong, Ting
and Lee, Rachel
and Banerjee, Tina Ananya
and Leslie, Myles
and Ko, Yu Wellam
and Guo, Jia Julia Yu
and Pham, Quynh",
title="Honoring the Care Experiences of Chinese Canadian Survivors of Prostate Cancer to Cultivate Cultural Safety and Relationality in Digital Health: Exploratory-Descriptive Qualitative Study",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="28",
volume="25",
pages="e49349",
keywords="digital health",
keywords="virtual care",
keywords="digital therapeutics",
keywords="prostate cancer",
keywords="cancer survivorship",
keywords="social determinants of health",
keywords="structural determinants of health",
keywords="supportive care",
keywords="cultural adaptation",
keywords="Chinese Canadians",
abstract="Background: Prostate cancer (PCa) is the most commonly diagnosed nonskin cancer for Canadian men and has one of the highest 5-year survival rates, straining systems to provide care. Virtual care can be one way to relieve this strain, but survivors' care needs and technology use are influenced by intersecting social and cultural structures. Cultural adaptation has been posited as an effective method to tailor existing interventions to better serve racialized communities, including Chinese men. However, cultural adaptations may inadvertently draw attention away from addressing structural inequities. Objective: This study used qualitative methods to (1) explore the perceptions and experiences of Chinese Canadian PCa survivors with follow-up and virtual care, and (2) identify implications for the cultural adaptation of a PCa follow-up care app, the Ned (no evidence of disease) Clinic. Methods: An axiology of relational accountability and a relational paradigm underpinned our phenomenologically informed exploratory-descriptive qualitative study design. A community-based participatory approach was used, informed by cultural safety and user-centered design principles, to invite Chinese Canadian PCa survivors and their caregivers to share their stories. Data were inductively analyzed to explore their unmet needs, common experiences, and levels of digital literacy. Results: Unmet needs and technology preferences were similar to broader trends within the wider community of PCa survivors. However, participants indicated that they felt uncomfortable, unable to, or ignored when expressing their needs. Responses spoke to a sense of isolation and reflected a reliance on culturally informed coping mechanisms, such as ``eating bitterness,'' and familial assistance to overcome systemic barriers and gaps in care. Moreover, virtual care was viewed as ``better than nothing;'' it did not change a perceived lack of focus on improving quality of life or care continuity in survivorship care. Systemic changes were identified as likely to be more effective in improving care delivery and well-being rather than the cultural adaptation of Ned for Chinese Canadians. Participants' desires for care reflected accessibility issues that were not culturally specific to Chinese Canadians. Conclusions: Chinese Canadian survivors are seeking to strengthen their connections in a health care system that provides privacy and accessibility, protects relationality, and promotes transparency, accountability, and responsibility. Designing ``trickle-up'' adaptations that address structural inequities and emphasize accessibility, relationality, and privacy may be more effective and efficient at improving care than creating cultural adaptations of interventions. ",
doi="10.2196/49349",
url="https://www.jmir.org/2023/1/e49349",
url="http://www.ncbi.nlm.nih.gov/pubmed/38153784"
}


@Article{info:doi/10.2196/45451,
author="Novak Lauscher, Helen
and Blacklaws, Brydon
and Pritchard, Erika
and Wang, Jiaxi Elsie
and Stewart, Kurtis
and Beselt, Jeff
and Ho, Kendall
and Pawlovich, John",
title="Real-Time Virtual Support as an Emergency Department Strategy for Rural, Remote, and Indigenous Communities in British Columbia: Descriptive Case Study",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="22",
volume="25",
pages="e45451",
keywords="telemedicine",
keywords="access",
keywords="rural",
keywords="emergency medicine",
keywords="interprofessional collaboration",
abstract="Background: British Columbia has over 200 rural, remote, and Indigenous communities that have limited health care resources due to physician isolation, sparsity in clinical resources, the lack of collegial support, and provider burnout. Real-time virtual support (RTVS) peer-to-peer pathways provide support to patients and providers. Amid the COVID-19 pandemic exacerbating existing health care disparities and equitable access to timely care, RTVS presents a portable and additional opportunity to be deployed in a hospital or patient home setting in rural communities. We highlight the story of the Rural Urgent Doctor in-aid (RUDi) pathway within RTVS that successfully supported the Dawson Creek District Hospital (DCDH) emergency department (ED) in 2021. Objective: This study aims to describe the rapid implementation process and identify facilitators and barriers to successful implementation. Methods: This case study is grounded in the Quadruple Aim and Social Accountability frameworks for health systems learning. The entire study period was approximately 6 months. After 1 week of implementation, we interviewed RUDi physicians, DCDH staff, health authority leadership, and RTVS staff to gather their experiences. Content analysis was used to identify themes that emerged from the interviews. Results: RUDi physicians covered 39 overnight shifts and were the most responsible providers (MRPs) for 245 patients who presented to the DCDH ED. A total of 17 interviews with key informants revealed important themes related to leadership and relationships as facilitators of the coverage's success, the experience of remote physician support, providing a ``safety net,'' finding new ways of interprofessional collaboration, and the need for extensive IT support throughout. Quality improvement findings identified barriers and demonstrated tangible recommendations for how this model of support can be improved in future cases. Conclusions: By acting as the MRP during overnight ED shifts, RUDi prevented the closure of the DCDH ED and the diversion of patients to another rural hospital. Rapid codevelopment and implementation of digital health solutions can be leveraged with existing partnerships and mutual trust between RTVS and rural EDs to ease the pressures of a physician shortage, particularly during COVID-19. By establishing new and modified clinical workflows, RTVS provides a safety net for rural patients and providers challenged by burnout. This case study provides learnings to be implemented to serve future rural, remote, and Indigenous communities in crisis. ",
doi="10.2196/45451",
url="https://www.jmir.org/2023/1/e45451",
url="http://www.ncbi.nlm.nih.gov/pubmed/38133906"
}


@Article{info:doi/10.2196/40172,
author="Chen, Weichao
and Ding, Mengjun
and Wang, Xiaoyan",
title="The Contribution of the Internet to Promoting Mental Health for Older Adults: Cross-Sectional Survey in China",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="19",
volume="25",
pages="e40172",
keywords="older adults",
keywords="internet use",
keywords="mental health",
keywords="influence mechanism",
keywords="participation in voluntary activities",
keywords="subjective age",
keywords="mobile phone",
abstract="Background: Health is an important topic for everyone and essential to high-quality economic and social development. Recently, some researchers have suggested that older adults' internet use may have a health effect. Objective: This study specifically aims to clarify the relationship between internet use and the mental health of older adults, for which other surveys present contradictory results. Methods: Data were obtained from the China Longitudinal Aging Social Survey conducted in 2018. A total of 6648 participants were included. Mental health was assessed by the 12-item Center for Epidemiological Studies Depression Scale. Ordinary least squares regression was adopted to explore the relationship between internet use (independent variable) and the mental health of older adults. Robustness analysis, sensitivity analysis, and heterogeneity analysis were conducted in detail to verify the empirical result. A mediating effect analysis was further conducted to discover the effect mechanism between the dependent and independent variables. Results: It was found that internet use and smartphone use can significantly improve the mental health of older adults (ordinary least squares, $\beta$=.075; P<.001). After endogenous and robustness tests were conducted, the aforementioned conclusion remained robust. In particular, participation in voluntary activities played a mediating role in the relationship between internet use and the mental health of older adults. In addition, younger subjective age enhanced the positive effect of internet use on the mental health of older adults. Conclusions: Internet users showed higher levels of mental health among Chinese older adults. To improve the mental health of older adults, the government should not only cultivate the ability to use the internet but also encourage greater participation in voluntary activities among older adults. ",
doi="10.2196/40172",
url="https://www.jmir.org/2023/1/e40172",
url="http://www.ncbi.nlm.nih.gov/pubmed/38113096"
}


@Article{info:doi/10.2196/46309,
author="Lee, David
and Jiang, Tao
and Crocker, Jennifer
and Way, Baldwin",
title="Social Media Use and Its Concurrent and Subsequent Relation to a Biological Marker of Inflammation: Short-Term Longitudinal Study",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="8",
volume="25",
pages="e46309",
keywords="social media use",
keywords="inflammation",
keywords="physical health",
keywords="well-being",
keywords="screen time",
keywords="mental health",
keywords="social media",
keywords="biomarker",
keywords="chronic disease",
abstract="Background: Although many studies have examined the impact of social media use (SMU) on mental health, very few studies have examined the association of SMU with health-relevant biomarkers. Objective: Addressing this gap, we conducted a short-term longitudinal study examining the link between SMU and C-reactive protein (CRP), a biological marker of systemic inflammation predictive of major depression, chronic diseases, and mortality. Methods: We measured college students' weekly amount of SMU for 5 consecutive weeks objectively via the Screen Time app and collected blood samples at baseline and 5 weeks later. Results: In separate cross-sectional analyses conducted at phase 1 (baseline) and at phase 2 (5 weeks after baseline), objective SMU had a positive, concurrent association with CRP at both time points. Critically, in a longitudinal analysis, more SMU between phase 1 and phase 2 predicted increased CRP between these time points, suggesting that increased SMU led to heightened inflammation during that period. Conclusions: Although more research is needed to understand why SMU led to higher inflammation, the association between objective SMU and a marker of a biological process critical to physical health presents an intriguing opportunity for future research on social media effects. ",
doi="10.2196/46309",
url="https://www.jmir.org/2023/1/e46309",
url="http://www.ncbi.nlm.nih.gov/pubmed/38064253"
}


@Article{info:doi/10.2196/39310,
author="Dulin, J. Akilah
and Dunsiger, Shira
and Benitez, Tanya
and Larsen, Britta
and Marcus, H. Bess
and Champion, Gregory
and Gans, M. Kim",
title="The Hombres Saludables Physical Activity Web-Based and Mobile Phone Intervention: Pilot Randomized Controlled Trial With Latino Men",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="7",
volume="25",
pages="e39310",
keywords="physical activity",
keywords="Latino",
keywords="Hispanic",
keywords="men",
keywords="eHealth",
keywords="expert system",
keywords="internet",
keywords="SMS text messaging",
keywords="mobile phone",
keywords="social media",
keywords="mobile health",
keywords="mHealth",
abstract="Background: Owing to structural-level, interpersonal-level, and individual-level barriers, Latino men have disproportionately high rates of physical inactivity and experience related chronic diseases. Despite these disparities, few physical activity (PA) interventions are culturally targeted for Latino men. Objective: This study reported the feasibility and acceptability of Hombres Saludables PA intervention for Latino men. We also reported the preliminary efficacy of the intervention on PA change and provided the results of the exploratory moderator and mediator analysis. Methods: We completed a 6-month, single-blind, pilot randomized controlled trial of Hombres Saludables with Latino men aged between 18 and 65 years. Men were randomized to either (1) a theory-driven, individually tailored, internet-based and SMS text message--based, Spanish-language PA intervention arm or (2) a nutrition and wellness attention contact control arm that was also delivered via the web and SMS text message. We assessed the primary study outcomes of feasibility using participant retention and acceptability using postintervention survey and open-ended interview questions. We measured the preliminary efficacy via change in minutes of moderate to vigorous PA per week using ActiGraph wGT3X-BT accelerometry (primary measure) and self-reported minutes per week using 7-day Physical Activity Recall. Participants completed the assessments at study enrollment and after 6 months. Results: The 38 participants were predominantly Dominican (n=8, 21\%) or Guatemalan (n=5, 13\%), and the mean age was 38.6 (SD 12.43) years. Retention rates were 91\% (21/23) for the PA intervention arm and 100\% (15/15) for the control arm. Overall, 95\% (19/20) of the intervention arm participants reported that the Hombres study was somewhat to very helpful in getting them to be more physically active. Accelerometry results indicated that participants in the intervention group increased their PA from a median of 13 minutes per week at study enrollment to 34 minutes per week at 6 months, whereas the control group participants showed no increases. On the basis of self-reports, the intervention group was more likely to meet the US PA guidelines of 150 minutes per week of moderate to vigorous PA at 6-month follow-up, with 42\% (8/19) of the intervention participants meeting the PA guidelines versus 27\% (4/15) of the control participants (odds ratio 3.22, 95\% CI 0.95-13.69). Exploratory analyses suggested conditional effects on PA outcomes based on baseline stage of motivational readiness, employment, and neighborhood safety. Conclusions: The PA intervention demonstrated feasibility and acceptability. Results of this pilot study indicate that the Hombres Saludables intervention is promising for increasing PA in Latino men and suggest that a fully powered trial is warranted. Our technology-based PA intervention provides a potentially scalable approach that can improve health in a population that is disproportionately affected by low PA and related chronic disease. Trial Registration: ClinicalTrials.gov NCT03196570; https://classic.clinicaltrials.gov/ct2/show/NCT03196570 International Registered Report Identifier (IRRID): RR2-10.2196/23690 ",
doi="10.2196/39310",
url="https://www.jmir.org/2023/1/e39310",
url="http://www.ncbi.nlm.nih.gov/pubmed/38060285"
}


@Article{info:doi/10.2196/44569,
author="Shim, Young Sun
and Lee, Hyeonkyeong",
title="Sex and Age Differences in the Association Between Social Determinants of Health and Cardiovascular Health According to Household Income Among Mongolian Adults: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Dec",
day="1",
volume="9",
pages="e44569",
keywords="social determinants of health",
keywords="cardiovascular health",
keywords="education",
keywords="household income",
keywords="health insurance",
keywords="association",
keywords="risk factors",
keywords="cardiovascular",
keywords="cardiovascular disease",
keywords="cross-sectional study",
abstract="Background: Although social determinants of health (SDH) are an underlying cause of poor cardiovascular health (CVH), there is insufficient evidence for the association between SDH and CVH, which varies by sex and age among Mongolian adults. Objective: We aimed to explore whether education, household income, and health insurance were associated with CVH according to sex and age among Mongolian adults. Methods: The final sample included data on 5691 participants (male: n=2521. 44.3\% and female: n=3170, 55.7\%) aged 18-69 years from the 2019 World Health Organization STEPwise approach to noncommunicable disease risk-factor surveillance. CVH was measured using a modified version of Life's Simple 7 with 4 health behaviors (cigarette smoking, BMI, physical activity, and a healthy diet) and 3 biological factors (blood pressure, fasting glucose, and total cholesterol blood levels) and classified into poor, intermediate, and ideal levels as recommended by the American Heart Association. Multinomial logistic regression analyses examined the associations between SDH and CVH by monthly equivalized household income after adjusting for age, sex, work status, area, history of myocardial infarction or stroke, use of aspirin, and use of statin. Subgroup analyses were conducted to examine the associations between SDH and CVH based on sex and age, considering monthly equivalized household income as a key variable. Results: Using the ideal level of CVH as a reference, among those with the lowest household income, having less than 12 years of education, and not having health insurance were associated with poor CVH (education level: odds ratio [OR] 2.42, 95\% CI 1.30-4.51; P=.006; health insurance: OR 2.17, 95\% CI 1.13-4.18; P=.02). These associations were more profound among female individuals (education level: OR 2.99, 95\% CI 1.35-6.63; P=.007; health insurance: OR 2.54, 95\% CI 1.09-5.90; P=.03) and those aged 18-44 years (education level: OR 3.22, 95\% CI 1.54-6.72; P=.002; health insurance: OR 2.03, 95\% CI 0.98-4.18; P=.06). Conclusions: Participants in the lowest household income group with lower educational levels and without health insurance were more likely to have poor CVH, and these results were more pronounced in female individuals and young adults. These findings suggest the need to develop strategies for CVH equity in Mongolian female individuals and young adults that consider income levels, education levels, and health insurance. ",
doi="10.2196/44569",
url="https://publichealth.jmir.org/2023/1/e44569",
url="http://www.ncbi.nlm.nih.gov/pubmed/38039072"
}


@Article{info:doi/10.2196/50867,
author="Ajayi, Toluwalase
and Pawelek, Jeff
and Bhargava, Hansa
and Faksh, Arij
and Radin, Jennifer",
title="Self-Reported Medication Use Across Racial and Rural or Urban Subgroups of People Who Are Pregnant in the United States: Decentralized App-Based Cohort Study",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="28",
volume="7",
pages="e50867",
keywords="prenatal care",
keywords="maternal health",
keywords="digital study",
keywords="underrepresented in biomedical research",
keywords="pregnant",
keywords="pregnancy",
keywords="medications",
keywords="vaccinations",
keywords="vitamins",
abstract="Background: Maternal health outcomes have been underresearched due to people who are pregnant being underrepresented or excluded from studies based on their status as a vulnerable study population. Based on the available evidence, Black people who are pregnant have dramatically higher maternal morbidity and mortality rates compared to other racial and ethnic groups. However, insights into prenatal care---including the use of medications, immunizations, and prenatal vitamins---are not well understood for pregnant populations, particularly those that are underrepresented in biomedical research. Medication use has been particularly understudied in people who are pregnant; even though it has been shown that up to 95\% of people who are pregnant take at least 1 or more medications. Understanding gaps in use could help identify ways to reduce maternal disparities and optimize maternal health outcomes. Objective: We aimed to characterize and compare the use of prenatal vitamins, immunizations, and commonly used over-the-counter and prescription medications among people who are pregnant, those self-identifying as Black versus non-Black, and those living in rural versus urban regions in the United States. Methods: We conducted a prospective, decentralized study of 4130 pregnant study participants who answered survey questionnaires using a mobile research app that was only available on iOS (Apple Inc) devices. All people who were pregnant, living in the United States, and comfortable with reading and writing in English were eligible. The study was conducted in a decentralized fashion with the use of a research app to facilitate enrollment using an eConsent and self-reported data collection. Results: Within the study population, the use of prenatal vitamins, antiemetics, antidepressants, and pain medication varied significantly among different subpopulations underrepresented in biomedical research. Black participants reported significantly lower frequencies of prenatal vitamin use compared to non-Black participants (P<.001). The frequency of participants who were currently receiving treatment for anxiety and depression was also lower among Black and rural groups compared to their non-Black and urban counterparts, respectively. There was significantly lower use of antidepressants (P=.002) and antiemetics (P=.02) among Black compared to non-Black participants. While prenatal vitamin use was lower among participants in rural areas, the difference between rural and urban groups did not reach statistical significance (P=.08). There were no significant differences in vaccine uptake for influenza or tetanus-diphtheria-pertussis (TDaP) across race, ethnicity, rural, or urban status. Conclusions: A prospective, decentralized app-based study demonstrated significantly lower use of prenatal vitamins, antiemetics, and antidepressants among Black pregnant participants. Additionally, significantly fewer Black and rural participants reported receiving treatment for anxiety and depression during pregnancy. Future research dedicated to identifying the root mechanisms of these differences can help improve maternal health outcomes, specifically for diverse communities. ",
doi="10.2196/50867",
url="https://formative.jmir.org/2023/1/e50867",
url="http://www.ncbi.nlm.nih.gov/pubmed/38015604"
}


@Article{info:doi/10.2196/47729,
author="Balki, Eric
and Hayes, Niall
and Holland, Carol",
title="The Indirect Impact of Educational Attainment as a Distal Resource for Older Adults on Loneliness, Social Isolation, Psychological Resilience, and Technology Use During the COVID-19 Pandemic: Cross-Sectional Quantitative Study",
journal="JMIR Aging",
year="2023",
month="Nov",
day="24",
volume="6",
pages="e47729",
keywords="pandemic",
keywords="educational attainment",
keywords="isolation",
keywords="loneliness",
keywords="socioemotional needs",
keywords="social engagement",
keywords="technology use",
keywords="older adults",
keywords="psychological resilience",
abstract="Background: During the COVID-19 pandemic, government-mandated social distancing prevented the spread of the disease but potentially exacerbated social isolation and loneliness for older people, especially those already vulnerable to isolation. Older adults may have been able to draw from their personal resources such as psychological resilience (PR) and technology use (TU) to combat such effects. Educational attainment (EA) or early-life EA may potentially shape later-life personal resources and their impact on the effects of the pandemic lockdown on outcomes such as loneliness. The developmental adaptation model allows for the supposition that social isolation, TU, and PR may be affected by early EA in older adults. Objective: This study examined the indirect impact of EA on pandemic-linked loneliness in a sample of older adults. The developmental adaptation model was used as the conceptual framework to view EA as a distal influence on loneliness, social isolation, PR, and TU. We hypothesized that EA would predict TU and PR and have a moderating impact on social isolation and loneliness. We also hypothesized that PR and TU would mediate the effect of EA on loneliness. Methods: This was a cross-sectional observational study, in which data were gathered from 92 older adults aged ?65 years in the United Kingdom from March 2020 to June 2021, when the country was under various pandemic-linked social mobility restrictions. The data captured demographic information including age, gender, ethnicity, and the highest degree of education achieved. The University of California Los Angeles Loneliness Scale, Connor--Davidson Resilience Scale, Lubben Social Network Index, and Technology Experience Questionnaire were used as standardized measures. Pearson correlation, moderation, and mediation regression analyses were conducted to investigate the hypotheses. Results: We found a higher prevalence of loneliness in older adults than in prepandemic norms. EA was correlated with greater TU and PR and moderated the impact of social isolation on loneliness. PR mediated and TU partially mediated the relationship between EA and loneliness. Conclusions: Early-life EA was confirmed as a distal resource for older adults and played an indirect role in affecting loneliness levels during the pandemic. It has an impact on present-day personal resources, such as PR and TU, which affect loneliness and also moderate the impact of social isolation on loneliness. Policymakers should be aware that older adults with low levels of EA may be more vulnerable to the harmful impacts of loneliness when isolated by choice. ",
doi="10.2196/47729",
url="https://aging.jmir.org/2023/1/e47729",
url="http://www.ncbi.nlm.nih.gov/pubmed/37999938"
}


@Article{info:doi/10.2196/45215,
author="Braund, Heather
and Dalgarno, Nancy
and Chan-Nguyen, Sophy
and Digby, Genevi{\`e}ve
and Haji, Faizal
and O'Riordan, Anne
and Appireddy, Ramana",
title="Exploring Patient Advisors' Perceptions of Virtual Care Across Canada: Qualitative Phenomenological Study",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="23",
volume="25",
pages="e45215",
keywords="virtual care",
keywords="patient-oriented research",
keywords="patient advisor",
keywords="remote care",
keywords="telehealth",
keywords="telemedicine",
keywords="phenomenology",
keywords="phenomenological",
keywords="perception",
keywords="qualitative",
abstract="Background: While virtual care services existed prior to the emergence of COVID-19, the pandemic catalyzed a rapid transition from in-person to virtual care service delivery across the Canadian health care system. Virtual care includes synchronous or asynchronous delivery of health care services through video visits, telephone visits, or secure messaging. Patient advisors are people with patient and caregiving experiences who collaborate within the health care system to share insights and experiences in order to improve health care. Objective: This study aimed to understand patient advisors' perceptions related to virtual care and potential impacts on health care quality. Methods: We adopted a phenomenological approach, whereby we interviewed 20 participants who were patient advisors across Canada using a semistructured interview protocol. The protocol was developed by content experts and medical education researchers. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Data collection stopped once thematic saturation was reached. The study was conducted at Queen's University, Kingston, Ontario. We recruited 20 participants from 5 Canadian provinces (17 female participants and 3 male participants). Results: Six themes were identified: (1) characteristics of effective health care, (2) experiences with virtual care, (3) modality preferences, (4) involvement of others, (5) risks associated with virtual care encounters, and (6) vulnerable populations. Participants reported that high-quality health care included building relationships and treating patients holistically. In general, participants described positive experiences with virtual care during the pandemic, including greater efficiency, increased accessibility, and that virtual care was less stressful and more patient centered. Participants comparing virtual care with in-person care reported that time, scheduling, and content of interactions were similar across modalities. However, participants also shared the perception that certain modalities were more appropriate for specific clinical encounters (eg, prescription renewals and follow-up appointments). Perspectives related to the involvement of family members and medical trainees were positive. Potential risks included miscommunication, privacy concerns, and inaccurate patient assessments. All participants agreed that stakeholders should be proactive in applying strategies to support vulnerable patients. Participants also recommended education for patients and providers to improve virtual care delivery. Conclusions: Participant-reported experiences of virtual care encounters were relatively positive. Future work could focus on delivering training and resources for providers and patients. While initial experiences are positive, there is a need for ongoing stakeholder engagement and evaluation to improve patient and caregiver experiences with virtual care. ",
doi="10.2196/45215",
url="https://www.jmir.org/2023/1/e45215",
url="http://www.ncbi.nlm.nih.gov/pubmed/37995127"
}


@Article{info:doi/10.2196/47510,
author="Ferreira, Moraes P{\^a}mela
and Gomes, Cunha Mateus
and de Araujo, Nascimento Lucianne
and Oliveira, de Tain{\'a} Sayuri Onuma
and Ferreira, Glenda
and Aben-Athar, Cintia
and da Silva, Dias Silvio Eder
and Cruz Ramos, P. Aline M.
and Rodrigues, Pereira Diego
and Sousa, Fabianne",
title="Sociodemographic Profile, Health Conditions, and Burden of Informal Caregivers of Older Adults in Brazil During the COVID-19 Pandemic: Cross-Sectional, Exploratory, Noninterventional, Descriptive Study",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="23",
volume="7",
pages="e47510",
keywords="informal caregivers",
keywords="older adult",
keywords="caregiver",
keywords="caregivers",
keywords="caregiving",
keywords="burden",
keywords="informal care",
keywords="cross-sectional",
keywords="gerontology",
keywords="older adults",
keywords="hospitalized",
keywords="overload",
keywords="burnout",
abstract="Background: Demographic changes in the world population have resulted in an increasingly aging society, with a progressive increase in the number of people in situations of dependence, who require assistance from family members to meet their basic needs. Caring for older adults involves performing diverse activities, resulting in reduced free time and tiredness, and fulfilling the demands and expectations related to personal, family, physical, and social life, consequently compromising the quality of life of the caregiver. In this context, the informal caregiver of hospitalized older adults emerges as the focus of attention. Objective: The aim of this study was to describe the sociodemographic profile, health conditions, and burden of informal caregivers of older adults admitted to a university hospital in Brazil during the COVID-19 pandemic period. Methods: This is a cross-sectional, descriptive, and analytical study that was conducted with 25 informal caregivers of hospitalized older adults in a university hospital in Brazil between August and September 2022. Three instruments were applied: Caregiver Burden Inventory, sociodemographic questionnaire, and health conditions questionnaire. The data were analyzed using SPSS version 28.0. Descriptive (frequency and percentage) and inferential analyses were performed using 2-sided Student t test with 95\% CIs. Results: Of the 25 interviewees, 18 (72\%) were females, 17 (46\%) were married or in a stable union, 14 (56\%) completed secondary education, and 11 (44\%) lived with the older adults who needed care. The average age of the participants was 44 (SD 12.8) years. Regarding their health conditions, most caregivers self-reported it as good (12/25, 48\%). They provided care to their father or mother older than 70 years (14/25, 56\%). The Caregiver Burden Inventory analysis showed that the caregivers were the most negatively impacted in the domains of personal life overload (mean 10.8, SD 3.46; P=.047) and physical overload (mean 10.6, SD 2.32; P=.02). Conclusions: In recent years, there has been an increase in the burden on informal caregivers of hospitalized older adults in Brazil, thereby impacting their personal and physical lives. The findings of our study show that health care professionals should be trained to promote health guidelines and actions to improve the personal and physical lives of the caregiver population in Brazil. ",
doi="10.2196/47510",
url="https://formative.jmir.org/2023/1/e47510",
url="http://www.ncbi.nlm.nih.gov/pubmed/37995120"
}


@Article{info:doi/10.2196/50814,
author="Herrera-Espejel, Sofia Paula
and Rach, Stefan",
title="The Use of Machine Translation for Outreach and Health Communication in Epidemiology and Public Health: Scoping Review",
journal="JMIR Public Health Surveill",
year="2023",
month="Nov",
day="20",
volume="9",
pages="e50814",
keywords="machine translation",
keywords="public health",
keywords="epidemiology",
keywords="population-based",
keywords="recruitment",
keywords="outreach",
keywords="multilingual",
keywords="culturally and linguistically diverse communities",
abstract="Background: Culturally and linguistically diverse groups are often underrepresented in population-based research and surveillance efforts, leading to biased study results and limited generalizability. These groups, often termed ``hard-to-reach,'' commonly encounter language barriers in the public health (PH) outreach material and information campaigns, reducing their involvement with the information. As a result, these groups are challenged by 2 effects: the medical and health knowledge is less tailored to their needs, and at the same time, it is less accessible for to them. Modern machine translation (MT) tools might offer a cost-effective solution to PH material language accessibility problems. Objective: This scoping review aims to systematically investigate current use cases of MT specific to the fields of PH and epidemiology, with a particular interest in its use for population-based recruitment methods. Methods: PubMed, PubMed Central, Scopus, ACM Digital Library, and IEEE Xplore were searched to identify articles reporting on the use of MT in PH and epidemiological research for this PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews)--compliant scoping review. Information on communication scenarios, study designs and the principal findings of each article were mapped according to a settings approach, the World Health Organization monitoring and evaluation framework and the service readiness level framework, respectively. Results: Of the 7186 articles identified, 46 (0.64\%) were included in this review, with the earliest study dating from 2009. Most of the studies (17/46, 37\%) discussed the application of MT to existing PH materials, limited to one-way communication between PH officials and addressed audiences. No specific article investigated the use of MT for recruiting linguistically diverse participants to population-based studies. Regarding study designs, nearly three-quarters (34/46, 74\%) of the articles provided technical assessments of MT from 1 language (mainly English) to a few others (eg, Spanish, Chinese, or French). Only a few (12/46, 26\%) explored end-user attitudes (mainly of PH employees), whereas none examined the legal or ethical implications of using MT. The experiments primarily involved PH experts with language proficiencies. Overall, more than half (38/70, 54\% statements) of the summarizing results presented mixed and inconclusive views on the technical readiness of MT for PH information. Conclusions: Using MT in epidemiology and PH can enhance outreach to linguistically diverse populations. The translation quality of current commercial MT solutions (eg, Google Translate and DeepL Translator) is sufficient if postediting is a mandatory step in the translation workflow. Postediting of legally or ethically sensitive material requires staff with adequate content knowledge in addition to sufficient language skills. Unsupervised MT is generally not recommended. Research on whether machine-translated texts are received differently by addressees is lacking, as well as research on MT in communication scenarios that warrant a response from the addressees. ",
doi="10.2196/50814",
url="https://publichealth.jmir.org/2023/1/e50814",
url="http://www.ncbi.nlm.nih.gov/pubmed/37983078"
}


@Article{info:doi/10.2196/42517,
author="Shiroma, Kristina
and Zimmerman, Tara
and Xie, Bo
and Fleischmann, R. Kenneth
and Rich, Kate
and Lee, Kyung Min
and Verma, Nitin
and Jia, Chenyan",
title="Older Adults' Trust and Distrust in COVID-19 Public Health Information: Qualitative Critical Incident Study",
journal="JMIR Aging",
year="2023",
month="Nov",
day="9",
volume="6",
pages="e42517",
keywords="health information",
keywords="information-seeking behavior",
keywords="COVID-19",
keywords="qualitative research methods",
keywords="communication",
keywords="media and networks",
keywords="aging",
keywords="older adults",
keywords="elderly population",
keywords="mass media",
keywords="public health information",
keywords="trust",
abstract="Background: The COVID-19 infodemic has imposed a disproportionate burden on older adults who face increased challenges in accessing and assessing public health information, but little is known about factors influencing older adults' trust in public health information during COVID-19. Objective: This study aims to identify sources that older adults turn to for trusted COVID-19 public health information and factors that influence their trust. In addition, we explore the relationship between public health information sources and trust factors. Methods: Adults aged 65 years or older (N=30; mean age 71.6, SD 5.57; range 65-84 years) were recruited using Prime Panels. Semistructured phone interviews, guided by critical incident technique, were conducted in October and November 2020. Participants were asked about their sources of COVID-19 public health information, the trustworthiness of that information, and factors influencing their trust. Interview data were examined with thematic analysis. Results: Mass media, known individuals, and the internet were the older adults' main sources for COVID-19 public health information. Although they used social media for entertainment and personal communication, the older adults actively avoided accessing or sharing COVID-19 information on social media. Factors influencing their trust in COVID-19 public health information included confirmation bias, personal research, resigned acceptance, and personal relevance. Conclusions: These findings shed light on older adults' use of information sources and their criteria for evaluating the trustworthiness of public health information during a pandemic. They have implications for the future development of effective public health communication, policies, and interventions for older adults during health crises. ",
doi="10.2196/42517",
url="https://aging.jmir.org/2023/1/e42517",
url="http://www.ncbi.nlm.nih.gov/pubmed/37856774"
}


@Article{info:doi/10.2196/49068,
author="Banala, Manisha
and Mamidipaka, Anusha
and Ogunleye, Temitayo",
title="Skin-Lightening Product Use Among South Asian Americans: Cross-Sectional Survey Study",
journal="JMIR Dermatol",
year="2023",
month="Nov",
day="2",
volume="6",
pages="e49068",
keywords="colorism",
keywords="skin-lightening products",
keywords="skin bleaching",
keywords="South Asian Americans",
keywords="South Asian immigrants",
abstract="Background: Despite their potential for adverse health effects, skin-lightening products remain popular among South Asian Americans. Objective: This study investigates attitudes toward skin tone and the prevalence and adverse effects of skin-lightening product use among South Asian Americans. Methods: We conducted a cross-sectional study, recruiting and surveying 175 women or nonbinary individuals meeting the following inclusion criteria: (1) lived in the United States, (2) identified as South Asian, and (3) were raised by parents born in South Asian countries. Results: Of the 175 participants, 55 (31\%) respondents used a skin-lightening product before. Parental pressure to use skin-lightening products and decreased time spent in the United States were significantly associated with skin-lightening product use (odds ratio [OR] 8.51, 95\% CI 3.33-21.78, P<.001, and OR 0.70, 95\% CI 0.52-0.96, P=.03, respectively). Although only 6 of the 55 (11\%) users reported being aware of the potential side effects of skin-lightening products, 33 (60\%) reported adverse effects, with acne, skin sensitivity, and dry skin being the most common. Users and nonusers equally endorsed statements associating lighter skin with increased attractiveness (P=.31), marriageability (P=.94), social status (P=.98), self-esteem (P=.73), and respect received from others (P=.74). Conclusions: The use of skin-lightening products among South Asian Americans is common and linked to social and psychological factors. Parental pressure and cultural beauty standards may play a significant role in perpetuating this practice. This study highlights the need for educational campaigns about the potential health risks associated with skin-lightening and increased efforts to challenge harmful beauty standards. ",
doi="10.2196/49068",
url="https://derma.jmir.org/2023/1/e49068",
url="http://www.ncbi.nlm.nih.gov/pubmed/37917151"
}


@Article{info:doi/10.2196/47595,
author="Jiao, Wen
and Chang, Angela
and Ho, Mary
and Lu, Qianfeng
and Liu, Tingchi Matthew
and Schulz, Johannes Peter",
title="Predicting and Empowering Health for Generation Z by Comparing Health Information Seeking and Digital Health Literacy: Cross-Sectional Questionnaire Study",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="30",
volume="25",
pages="e47595",
keywords="health information seeking",
keywords="digital health literacy",
keywords="health empowerment",
keywords="Generation Z",
keywords="digitally savvy",
abstract="Background: Generation Z (born 1995-2010) members are digital residents who use technology and the internet more frequently than any previous generation to learn about their health. They are increasingly moving away from conventional methods of seeking health information as technology advances quickly and becomes more widely available, resulting in a more digitalized health care system. Similar to all groups, Generation Z has specific health care requirements and preferences, and their use of technology influences how they look for health information. However, they have often been overlooked in scholarly research. Objective: First, we aimed to identify the information-seeking preferences of older individuals and Generation Z (those between the ages of 18 and 26 years); second, we aimed to predict the effects of digital health literacy and health empowerment in both groups. We also aimed to identify factors that impact how both groups engage in digital health and remain in control of their own health. Methods: The Health Information National Trends Survey was adopted for further use in 2022. We analyzed 1862 valid data points by conducting a survey among Chinese respondents to address the research gap. A descriptive analysis, 2-tailed t test, and multiple linear regression were applied to the results. Results: When compared with previous generations, Generation Z respondents (995/1862, 53.44\%) were more likely to use the internet to find out about health-related topics, whereas earlier generations relied more on traditional media and interpersonal contact. Web-based information-seeking behavior is predicted by digital health literacy (Generation Z: $\beta$=.192, P<.001; older population: $\beta$=.337, P<.001). While this was happening, only seeking health information from physicians positively predicted health empowerment (Generation Z: $\beta$=.070, P=.002; older population: $\beta$=.089, P<.001). Despite more frequent use of the internet to learn about their health, Generation Z showed lower levels of health empowerment and less desire to look for health information, overall. Conclusions: This study examined and compared the health information--seeking behaviors of Generation Z and older individuals to improve their digital health literacy and health empowerment. The 2 groups demonstrated distinct preferences regarding their choice of information sources. Health empowerment and digital health literacy were both significantly related to information-seeking behaviors. ",
doi="10.2196/47595",
url="https://www.jmir.org/2023/1/e47595",
url="http://www.ncbi.nlm.nih.gov/pubmed/37902832"
}


@Article{info:doi/10.2196/44777,
author="Zaidi, Maryum
and Gazarian, Priscilla
and Mattie, Heather
and Sheldon, Kennedy Lisa
and Gakumo, Ann C.",
title="Examining the Impact of Selected Sociodemographic Factors and Cancer-Related Fatalistic Beliefs on Patient Engagement via Health Information Technology Among Older Adults: Cross-Sectional Analysis",
journal="JMIR Aging",
year="2023",
month="Oct",
day="20",
volume="6",
pages="e44777",
keywords="health information technology",
keywords="patient portals",
keywords="older adults",
keywords="digital health",
keywords="self-management",
keywords="mobile phone",
abstract="Background: Despite the role of health information technology (HIT) in patient engagement processes and government incentives for HIT development, research regarding HIT is lacking among older adults with a high burden of chronic diseases such as cancer. This study examines the role of selected sociodemographic factors and cancer-related fatalistic beliefs on patient engagement expressed through HIT use for patient engagement in adults aged ?65 years. We controlled for cancer diagnosis to account for its potential influence on patient engagement. Objective: This study has 2 aims: to investigate the role of sociodemographic factors such as race, education, poverty index, and psychosocial factors of cancer fatalistic beliefs in accessing and using HIT in older adults and to examine the association between access and use of HIT in the self-management domain of patient activation that serves as a precursor to patient engagement. Methods: This is a secondary data analysis of a subset of the Health Information National Trend Survey (Health Information National Trend Survey 4, cycle 3). The subset included individuals aged ?65 years with and without a cancer diagnosis. The relationships between access to and use of HIT to several sociodemographic variables and psychosocial factors of fatalistic beliefs were analyzed. Logistic and linear regression models were fit to study these associations. Results: This study included 180 individuals aged ?65 years with a cancer diagnosis and 398 without a diagnosis. This analysis indicated that having less than a college education level (P=<.001), being an individual from an ethnic and minority group (P=<.001), and living in poverty (P=.001) were significantly associated with decreased access to HIT. Reduced HIT use was associated with less than a college education (P=.001) and poverty(P=.02). This analysis also indicated that fatalistic beliefs about cancer were significantly associated with lower HIT use (P=.03). Specifically, a 1-point increase in the cancer fatalistic belief score was associated with a 36\% decrease in HIT use. We found that controlling for cancer diagnosis did not affect the outcomes for sociodemographic variables or fatalistic beliefs about cancer. However, patients with access to HIT had a self-management domain of patient activation (SMD) score of 0.21 points higher (P=.003) compared with patients who did not have access. SMD score was higher by 0.28 points (P=.002) for individuals who used HIT and 0.14 points higher (P=.04) who had a prior diagnosis of cancer. Conclusions: Sociodemographic factors (education, race, poverty, and cancer fatalistic beliefs) impact HIT access and use in older adults, regardless of prior cancer diagnosis. Among older adults, HIT users report higher self-management, which is essential for patient activation and engagement. ",
doi="10.2196/44777",
url="https://aging.jmir.org/2023/1/e44777",
url="http://www.ncbi.nlm.nih.gov/pubmed/37655786"
}


@Article{info:doi/10.2196/51702,
author="Gordon, D. Jacob
and Whitfield, L. Darren
and Mammadli, Tural
and Escobar-Viera, G. C{\'e}sar",
title="Social Support--Seeking Strategies on Social Media at the Intersection of Lesbian, Gay, Bisexual, Transgender, and Queer Identity, Race, and Ethnicity: Insights for Intervention From a Qualitative Study",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="20",
volume="7",
pages="e51702",
keywords="intersectionality",
keywords="LGBTQ+",
keywords="minority stress",
keywords="sexual and gender minorities",
keywords="social media",
keywords="social support",
keywords="lesbian, gay, bisexual, transgender, and queer",
abstract="Background: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals experience a disproportionately higher prevalence of mental health challenges when compared to their heterosexual and cisgender counterparts. Moreover, they exhibit increased engagement with social media platforms relative to their peers. Understanding the intersectional dynamics of their identities is crucial in elucidating effective and safe approaches to garnering social support through social media channels. This exploration holds significance for informing future research endeavors and shaping targeted interventions to address the unique mental health needs of LGBTQ+ individuals. Objective: The purpose of this study was to explore the strategies used by Black, Hispanic, and non-Hispanic White LGBTQ+ young adults to acquire social support from social media. The study aimed to examine how these strategies may differ by race and ethnicity. Methods: We conducted semistructured interviews with LGBTQ+ young adults aged between 18 and 30 years recruited in the United States from social media. Of 52 participants, 12 (23\%) were Black, 12 (23\%) were Hispanic, and 28 (54\%) were non-Hispanic White. Thematic analysis was used to analyze the collected data. Results: The analysis uncovered both divergent and convergent strategies among participants of different races and ethnicities. Black and Hispanic young adults exhibited a preference for connecting with individuals who shared similar identities, seeking safety and tailored advice. Conversely, non-Hispanic White participants demonstrated minimal preference for identity-based advice. Seeking support from anonymous sources emerged as a strategy to avoid unwanted disclosure among Hispanic participants. Furthermore, all participants emphasized the importance of content filtering with family members to cultivate positive and supportive social media experiences. Conclusions: This study sheds light on the strategies used by LGBTQ+ individuals of different racial and ethnic backgrounds to seek social support from social media platforms. The findings underscore the importance of considering race and ethnicity when examining social support--seeking behaviors on social media in LGBTQ+ populations. The identified strategies provide valuable insights for the development of interventions that aim to leverage social support from social media to benefit the mental health of Black, Hispanic, and non-Hispanic White LGBTQ+ young adults. ",
doi="10.2196/51702",
url="https://formative.jmir.org/2023/1/e51702",
url="http://www.ncbi.nlm.nih.gov/pubmed/37862069"
}


@Article{info:doi/10.2196/48249,
author="Chen, Yanhua
and Wu, Ziye
and Wang, Peicheng
and Xie, Linbo
and Yan, Mengsha
and Jiang, Maoqing
and Yang, Zhenghan
and Zheng, Jianjun
and Zhang, Jingfeng
and Zhu, Jiming",
title="Radiology Residents' Perceptions of Artificial Intelligence: Nationwide Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="19",
volume="25",
pages="e48249",
keywords="artificial intelligence",
keywords="technology acceptance",
keywords="radiology",
keywords="residency",
keywords="perceptions",
keywords="health care services",
keywords="resident",
keywords="residents",
keywords="perception",
keywords="adoption",
keywords="readiness",
keywords="acceptance",
keywords="cross sectional",
keywords="survey",
abstract="Background: Artificial intelligence (AI) is transforming various fields, with health care, especially diagnostic specialties such as radiology, being a key but controversial battleground. However, there is limited research systematically examining the response of ``human intelligence'' to AI. Objective: This study aims to comprehend radiologists' perceptions regarding AI, including their views on its potential to replace them, its usefulness, and their willingness to accept it. We examine the influence of various factors, encompassing demographic characteristics, working status, psychosocial aspects, personal experience, and contextual factors. Methods: Between December 1, 2020, and April 30, 2021, a cross-sectional survey was completed by 3666 radiology residents in China. We used multivariable logistic regression models to examine factors and associations, reporting odds ratios (ORs) and 95\% CIs. Results: In summary, radiology residents generally hold a positive attitude toward AI, with 29.90\% (1096/3666) agreeing that AI may reduce the demand for radiologists, 72.80\% (2669/3666) believing AI improves disease diagnosis, and 78.18\% (2866/3666) feeling that radiologists should embrace AI. Several associated factors, including age, gender, education, region, eye strain, working hours, time spent on medical images, resilience, burnout, AI experience, and perceptions of residency support and stress, significantly influence AI attitudes. For instance, burnout symptoms were associated with greater concerns about AI replacement (OR 1.89; P<.001), less favorable views on AI usefulness (OR 0.77; P=.005), and reduced willingness to use AI (OR 0.71; P<.001). Moreover, after adjusting for all other factors, perceived AI replacement (OR 0.81; P<.001) and AI usefulness (OR 5.97; P<.001) were shown to significantly impact the intention to use AI. Conclusions: This study profiles radiology residents who are accepting of AI. Our comprehensive findings provide insights for a multidimensional approach to help physicians adapt to AI. Targeted policies, such as digital health care initiatives and medical education, can be developed accordingly. ",
doi="10.2196/48249",
url="https://www.jmir.org/2023/1/e48249",
url="http://www.ncbi.nlm.nih.gov/pubmed/37856181"
}


@Article{info:doi/10.2196/43038,
author="Auener, L. Stefan
and van Dulmen, A. Simone
and Atsma, Femke
and van der Gali{\"e}n, Onno
and Bellersen, Louise
and van Kimmenade, Roland
and Westert, P. Gert
and Jeurissen, T. Patrick P.",
title="Characteristics Associated With Telemonitoring Use Among Patients With Chronic Heart Failure: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="18",
volume="25",
pages="e43038",
keywords="heart failure",
keywords="telemonitoring",
keywords="remote monitoring",
keywords="eHealth",
keywords="chronic heart failure",
keywords="heart",
keywords="disease",
keywords="patient",
keywords="self-management",
keywords="prevention",
keywords="utilization",
keywords="Netherlands",
keywords="hospital",
keywords="treatment",
abstract="Background: Chronic heart failure (HF) is a chronic disease affecting more than 64 million people worldwide, with an increasing prevalence and a high burden on individual patients and society. Telemonitoring may be able to mitigate some of this burden by increasing self-management and preventing use of the health care system. However, it is unknown to what degree telemonitoring has been adopted by hospitals and if the use of telemonitoring is associated with certain patient characteristics. Insight into the dissemination of this technology among hospitals and patients may inform strategies for further adoption. Objective: We aimed to explore the use of telemonitoring among hospitals in the Netherlands and to identify patient characteristics associated with the use of telemonitoring for HF. Methods: We performed a retrospective cohort study based on routinely collected health care claim data in the Netherlands. Descriptive analyses were used to gain insight in the adoption of telemonitoring for HF among hospitals in 2019. We used logistic multiple regression analyses to explore the associations between patient characteristics and telemonitoring use. Results: Less than half (31/84, 37\%) of all included hospitals had claims for telemonitoring, and 20\% (17/84) of hospitals had more than 10 patients with telemonitoring claims. Within these 17 hospitals, a total of 7040 patients were treated for HF in 2019, of whom 5.8\% (409/7040) incurred a telemonitoring claim. Odds ratios (ORs) for using telemonitoring were higher for male patients (adjusted OR 1.90, 95\% CI 1.50-2.41) and patients with previous hospital treatment for HF (adjusted OR 1.76, 95\% CI 1.39-2.24). ORs were lower for higher age categories and were lowest for the highest age category, that is, patients older than 80 years (OR 0.30, 95\% CI 0.21-0.44) compared to the reference age category (18-59 years). Socioeconomic status, degree of multimorbidity, and excessive polypharmacy were not associated with the use of telemonitoring. Conclusions: The use of reimbursed telemonitoring for HF was limited up to 2019, and our results suggest that large variation exists among hospitals. A lack of adoption is therefore not only due to a lack of diffusion among hospitals but also due to a lack of scaling up within hospitals that already deploy telemonitoring. Future studies should therefore focus on both kinds of adoption and how to facilitate these processes. Older patients, female patients, and patients with no previous hospital treatment for HF were less likely to use telemonitoring for HF. This shows that some patient groups are not served as much by telemonitoring as other patient groups. The underlying mechanism of the reported associations should be identified in order to gain a deeper understanding of telemonitoring use among different patient groups. ",
doi="10.2196/43038",
url="https://www.jmir.org/2023/1/e43038",
url="http://www.ncbi.nlm.nih.gov/pubmed/37851505"
}


@Article{info:doi/10.2196/50584,
author="Henson, Connie
and Chapman, Felicity
and Shepherd, Gina
and Carlson, Bronwyn
and Rambaldini, Boe
and Gwynne, Kylie",
title="Amplifying Older Aboriginal and Torres Strait Islander Women's Perspectives to Promote Digital Health Equity: Co-Designed Qualitative Study",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="17",
volume="25",
pages="e50584",
keywords="digital health",
keywords="Aboriginal and Torres Strait Islander",
keywords="Indigenous",
keywords="health technology",
keywords="co-design",
keywords="cultural safety",
keywords="older Indigenous women",
keywords="social media",
keywords="wearables",
keywords="mobile phone",
abstract="Background: Digital health is becoming ubiquitous, and we must ensure equity in access. Indigenous people across most high-income countries typically have not benefited as much as other citizens from usual health care systems and technologies. Despite Aboriginal and Torres Strait Islander people's clear interest in, and enthusiastic use of, new technologies, little research has examined the needs or interests of older Aboriginal and Torres Strait Islander women. Objective: This study prioritizes the perspectives of older Aboriginal and Torres Strait Islander women, tapping into their expertise associated with Indigenous ways of knowing, being, and doing, as well as their unique position within their families and communities, to design a model for using digital technologies to improve health for themselves and their families as well as their communities. Methods: Older Aboriginal and Torres Strait Islander women from 4 partner organizations were recruited for this study. This co-designed qualitative research included citizen scientists in shaping the protocol as well as collecting, analyzing, and interpreting data. We used yarning, an Indigenous research method validated for use in health research with Indigenous people and seen as respectful and culturally safe, as a primary research tool. The use of Indigenous methodologies and our iterative process enabled us to deeply explore and incorporate perspectives from all participants and ensure that the perspectives of Indigenous citizen scientists with lived experience were privileged. The data-checking methods also used a yarning methodology, which ensured that the findings and translational model derived from the findings were validated by the participants. Results: Participants comprised 24 Aboriginal and Torres Strait Islander women aged ?41 years and including 3 generations that did not grow up with the internet: seniors, baby boomers, and Generation X. The key findings in this research were that older women use various digital technologies to improve health and well-being for themselves and their families as well as their communities. Older Aboriginal women want a culturally sensitive cyberspace that caters specifically to their needs and includes relevant content and functionality that are accessible and efficient. Our translational model highlights the conditions necessary for anyone to use digital health technologies, summarizes the essential elements needed to promote equity in digital health, and illuminates the unmet needs and requirements for older Aboriginal and Torres Strait Islander women to fully benefit from digital health technologies. Conclusions: Health is a fundamental right. As we move toward greater reliance on digital health solutions, we must recognize and address the concerns of the smaller populations of people who differ in their needs. We must urgently address the financial, connectivity, and other limiting factors highlighted by older Aboriginal and Torres Strait Islander women in this study that limit equitable access to digital health tools. International Registered Report Identifier (IRRID): RR2-10.1177/20552076221084469 ",
doi="10.2196/50584",
url="https://www.jmir.org/2023/1/e50584",
url="http://www.ncbi.nlm.nih.gov/pubmed/37847550"
}


@Article{info:doi/10.2196/49804,
author="Buis, R. Lorraine
and Brown, K. Lindsay
and Plegue, A. Melissa
and Kadri, Reema
and Laurie, R. Anna
and Guetterman, C. Timothy
and Vydiswaran, Vinod V. G.
and Li, Jiazhao
and Veinot, C. Tiffany",
title="Identifying Inequities in Video and Audio Telehealth Services for Primary Care Encounters During COVID-19: Repeated Cross-Sectional, Observational Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="29",
volume="25",
pages="e49804",
keywords="COVID-19",
keywords="telemedicine",
keywords="health equity",
keywords="clinical encounters",
keywords="electronic health records",
abstract="Background: The COVID-19 pandemic resulted in rapid changes in how patient care was provided, particularly through the expansion of telehealth and audio-only phone-based care. Objective: The goal of this study was to evaluate inequities in video and audio-only care during various time points including the initial wave of the COVID-19 pandemic, later stages of the pandemic, and a historical control. We sought to understand the characteristics of care during this time for a variety of different groups of patients that may experience health care inequities. Methods: We conducted a retrospective analysis of electronic health record (EHR) data from encounters from 34 family medicine and internal medicine primary care clinics in a large, Midwestern health system, using a repeated cross-sectional, observational study design. These data included patient demographic data, as well as encounter, diagnosis, and procedure records. Data were obtained for all in-person and telehealth encounters (including audio-only phone-based care) that occurred during 3 separate time periods: an initial COVID-19 period (T2: March 16, 2020, to May 3, 2020), a later COVID-19 period (T3: May 4, 2020, to September 30, 2020), and a historical control period from the previous year (T1: March 16, 2019, to September 30, 2019). Primary analysis focused on the status of each encounter in terms of whether it was completed as scheduled, it was canceled, or the patient missed the appointment. A secondary analysis was performed to evaluate the likelihood of an encounter being completed based on visit modality (phone, video, in-person). Results: In total, there were 938,040 scheduled encounters during the 3 time periods, with 178,747 unique patients, that were included for analysis. Patients with completed encounters were more likely to be younger than 65 years old (71.8\%-74.1\%), be female (58.8\%-61.8\%), be White (75.6\%-76.7\%), and have no significant comorbidities (63.2\%-66.8\%) or disabilities (53.2\%-61.1\%) in all time periods than those who had only canceled or missed encounters. Effects on different subpopulations are discussed herein. Conclusions: Findings from this study demonstrate that primary care utilization across delivery modalities (in person, video, and phone) was not equivalent across all groups before and during the COVID-19 pandemic and different groups were differentially impacted at different points. Understanding how different groups of patients responded to these rapid changes and how health care inequities may have been affected is an important step in better understanding implementation strategies for digital solutions in the future. ",
doi="10.2196/49804",
url="https://www.jmir.org/2023/1/e49804",
url="http://www.ncbi.nlm.nih.gov/pubmed/37773609"
}


@Article{info:doi/10.2196/45343,
author="Liu, Jing
and Peng, Junwei
and Chen, Minyan
and Zhang, Tao",
title="Mediating and Moderating Effects of Internet Use on Urban-Rural Disparities in Health Among Older Adults: Nationally Representative Cross-Sectional Survey in China",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="28",
volume="25",
pages="e45343",
keywords="internet use",
keywords="cognitive function",
keywords="depressive symptoms",
keywords="functional disability",
keywords="mediation analysis",
keywords="mobile phone",
abstract="Background: The urban-rural disparities in health outcomes in China are remarkable. The internet has shown the potential to reduce the likelihood of contracting a disease by increasing disease knowledge. However, little is known about the effects of internet use in alleviating health inequities between urban and rural areas. Objective: This study aimed to examine the mediation and moderation of health disparities between urban and rural older adults through internet use. Methods: A total of 8223 respondents were selected from the China Health and Retirement Longitudinal Study 2018 data set. Basic activities of daily living, a brief Community Screening Instrument for Dementia, and the Centre for Epidemiologic Studies Depression Scale were used to measure functional disability, cognitive function, and depressive symptoms, respectively. Logistic regressions testing ``internet use{\texttimes}urban-rural status'' interactions for moderation and Karlson-Holm-Breen decomposition for mediation were performed. Results: Internet use moderated the urban-rural disparities in cognitive function (odds ratio 7.327, 95\% CI 3.011-17.832) and depressive symptoms (odds ratio 1.070, 95\% CI 1.037-1.787), but the moderating effects were significant only for those using the internet daily. Karlson-Holm-Breen results showed the suppression effects of using the internet daily ($\beta$=.012, 95\% CI .002-.021) on the association between urban-rural status and cognitive function. The urban-rural inequality in depressive symptoms was partially attributed to the disparity in internet use ($\beta$=?.027, 95\% CI ?.043 to ?.009). Conclusions: The urban-rural inequalities in mental health are partially attributable to disparities in the prevalence of internet use between the 2 groups. However, using the internet is more beneficial for the psychological health of rural users, thereby alleviating the urban-rural disparities in health. Providing convenient channels for rural older adults to use the internet, improving the ability of rural users to effectively use the internet, and promoting internet popularity in rural areas are effective approaches to reducing urban-rural health inequalities. ",
doi="10.2196/45343",
url="https://www.jmir.org/2023/1/e45343",
url="http://www.ncbi.nlm.nih.gov/pubmed/37768721"
}


@Article{info:doi/10.2196/41715,
author="Marshall, Jaclyn
and Yurkovic, Alexandra
and Thames, Todd
and Parekh, Ami",
title="A Narrow Definition of Clinical Robustness",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="21",
volume="25",
pages="e41715",
keywords="digital health",
keywords="research",
keywords="virtual care",
doi="10.2196/41715",
url="https://www.jmir.org/2023/1/e41715",
url="http://www.ncbi.nlm.nih.gov/pubmed/37733417"
}


@Article{info:doi/10.2196/50232,
author="Rush, L. Kathy
and Burton, Lindsay
and Seaton, L. Cherisse
and Loewen, Peter
and O'Connor, P. Brian
and Moroz, Lana
and Corman, Kendra
and Smith, A. Mindy
and Andrade, G. Jason",
title="Telehealth Satisfaction in Patients Receiving Virtual Atrial Fibrillation Care: Quantitative Exploratory Study",
journal="JMIR Hum Factors",
year="2023",
month="Sep",
day="14",
volume="10",
pages="e50232",
keywords="atrial fibrillation",
keywords="telehealth",
keywords="telehealth satisfaction",
keywords="self-efficacy",
keywords="attitudes toward technology",
keywords="attitude",
keywords="attitudes",
keywords="satisfaction",
keywords="telemedicine",
keywords="cardiology",
keywords="heart",
keywords="adoption",
keywords="eHealth",
keywords="perception",
keywords="perceptions",
abstract="Background: Telehealth can optimize access to specialty care for patients with atrial fibrillation (AF). Virtual AF care, however, may not fit with the complex needs of patients with AF. Objective: This study aims to explore the correlation among attitudes toward health care technologies, self-efficacy, and telehealth satisfaction as part of the future planning of virtual AF clinic care. Methods: Patients with AF older than 18 years from an urban-based, highly specialized AF clinic who had an upcoming telehealth visit were invited to participate in a web-based survey. The survey asked about demographic characteristics; use of technology; general, computer, and health care technology self-efficacy (HTSE) and health care technology attitudes, using a validated 30-item tool; and telehealth satisfaction questionnaire using a validated 14-item questionnaire. Data were analyzed with descriptive statistics, correlational analyses, and linear regression modeling. Results: Participants (n=195 of 579 invited, for a 34\% response rate) were primarily older, male, and White, had postsecondary schooling or more, and had high self-reported overall and mental health ratings. A variety of technologies were used in their daily lives and for health care, with the majority of technologies comprising desktop and laptop computers, smartphones, and tablets. Self-efficacy and telehealth satisfaction questionnaire scores were high overall, with male participants having higher general self-efficacy, computer self-efficacy, HTSE, and technology attitude scores. After controlling for age and sex, only HTSE was significantly related to individuals' attitudes toward health care technology. Both general self-efficacy and attitude toward health care technology were positively related to telehealth satisfaction. Conclusions: Consistent with a previous study, only HTSE significantly influenced attitudes toward health care technology. This finding confirms that, in this regard, self-efficacy is not a general perception but is domain specific. Considering participants' predominant use of the telephone for virtual care, it follows that general self-efficacy and attitude toward health care technology were significant contributors to telehealth satisfaction. Given our patients' frequent use of technology and high computer self-efficacy and HTSE scores, the use of video for telehealth appointments could be supported. ",
doi="10.2196/50232",
url="https://humanfactors.jmir.org/2023/1/e50232",
url="http://www.ncbi.nlm.nih.gov/pubmed/37707881"
}


@Article{info:doi/10.2196/47566,
author="Chen, Yuling
and Kruahong, Suratsawadee
and Elias, Sabrina
and Turkson-Ocran, Ruth-Alma
and Commodore-Mensah, Yvonne
and Koirala, Binu
and Himmelfarb, Dennison Cheryl R.",
title="Racial Disparities in Shared Decision-Making and the Use of mHealth Technology Among Adults With Hypertension in the 2017-2020 Health Information National Trends Survey: Cross-Sectional Study in the United States",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="13",
volume="25",
pages="e47566",
keywords="mobile health",
keywords="disparities",
keywords="shared decision-making",
keywords="hypertension",
keywords="association",
keywords="decision-making",
keywords="mHealth",
keywords="technology",
keywords="health disparity",
keywords="adult",
keywords="smartphone",
keywords="racial",
keywords="ethnic",
keywords="health literacy",
keywords="digital literacy",
abstract="Background: Mobile health (mHealth) technology has the potential to support shared decision-making (SDM) and improve hypertension control. However, our understanding of the variations in individuals' involvement in SDM and mHealth usage across different racial and ethnic groups in the United States is still limited. Objective: This study aimed to investigate the extent of involvement in SDM and the usage of mHealth technology in health-related activities among US adults with hypertension from diverse racial and ethnic backgrounds and to examine whether the mHealth usage differed by individuals' level of engagement in SDM. Methods: This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey, which was conducted on US adults with self-reported hypertension, and race and ethnicity data were included. The exposure of interest was race and ethnicity. The outcomes were SDM and mHealth usage. SDM was assessed using an item: ``In the past 12 months, how often did your health professional: involve you in decisions about your healthcare as much as you wanted?'' mHealth usage was defined as using a smartphone or tablet to engage in (1) making health decisions, (2) discussing health decisions with health providers, (3) tracking health progress, and (4) sharing health information. Weighted multivariable logistic regression models were used to examine the association between race and ethnicity and SDM or mHealth usage adjusted for covariates and stratified by the level of engagement in SDM. Results: This study included 4893 adults with hypertension, and the mean age was 61 (SD 13) years. The sample was 53\% female, 61\% (n=3006) non-Hispanic White, 19\% (n=907) non-Hispanic Black or African American, 12\% (n=605) Hispanic, 4\% (n=193) non-Hispanic Asian, and 4\% (n=182) non-Hispanic other. Compared to the non-Hispanic White adults, non-Hispanic Black adults were more likely to use mHealth to make health decisions (adjusted odds ratio [aOR] 1.70, 95\% CI 1.23-2.34), share health information (aOR 1.46, 95\% CI 1.02-2.08), and discuss health decisions with health providers (aOR 1.38, 95\% CI 1.02-1.87). Significant associations were observed specifically among those who were always involved in SDM. Asian adults were less likely to be involved in SDM (aOR 0.51, 95\% CI 0.26-0.99) and were more likely to use mHealth to track progress on a health-related goal (aOR 2.07, 95\% CI 1.28-3.34) than non-Hispanic White adults. Hispanic adults were less likely to use mHealth to share health information (aOR 0.47, 95\% CI 0.33-0.67) and discuss health decisions with health providers (aOR 0.65, 95\% CI 0.46-0.94) compared to non-Hispanic White adults. Conclusions: This study observed racial and ethnic disparities in SDM and mHealth usage among US adults with hypertension. These findings emphasize the significance of comprehending the involvement of SDM and the usage of mHealth technology within racially and ethnically diverse populations. ",
doi="10.2196/47566",
url="https://www.jmir.org/2023/1/e47566",
url="http://www.ncbi.nlm.nih.gov/pubmed/37703088"
}


@Article{info:doi/10.2196/46002,
author="Tewary, Sweta
and Cook, Nicole
and Dezine, Marie
and Shnayder, Oksana
and Pandya, Naushira",
title="Supporting Vulnerable Older Adults With Telehealth Through Wellness Calls and Tablet Distribution During COVID-19: Quality Improvement Project",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="11",
volume="7",
pages="e46002",
keywords="COVID-19",
keywords="telehealth",
keywords="older adults",
keywords="isolation",
keywords="health education",
keywords="mental wellness",
keywords="telemedicine",
keywords="health literacy",
keywords="digital health",
keywords="mental health",
keywords="social isolation",
abstract="Background: Loneliness, social isolation, and lack of technical literacy are associated with poorer health outcomes. To help improve social connection during the COVID-19 pandemic, Nova Southeastern University's South Florida Geriatric Workforce Enhancement Program partnered with a community-based organization to provide educational resources to promote telehealth services. Objective: This study aimed to provide educational resources to older adults with limited resources and promote the use of telehealth services in this population. Methods: Through this pilot project, we contacted 66 vulnerable older adults who expressed interest in telehealth support through wellness calls, with 44 participants moving on to participate in tablet usage. All tablets were preloaded with educational information on using the device, COVID-19 resources, and accessing telehealth services for patients, caregivers, and families. Results: Feedback from wellness assessments suggested a significant need for telehealth support. Participants used the tablets mainly for telehealth (n=6, 15\%), to connect with friends and family (n=10, 26\%), and to connect with faith communities (n=3, 8\%). Conclusions: The findings from the pilot project suggest that wellness calls and telehealth education are beneficial to support telehealth usage among older adults. ",
doi="10.2196/46002",
url="https://formative.jmir.org/2023/1/e46002",
url="http://www.ncbi.nlm.nih.gov/pubmed/37695647"
}


@Article{info:doi/10.2196/47577,
author="Fan, Qiping
and DuBose, Logan
and Ory, G. Marcia
and Lee, Shinduk
and Hoang, Minh-Nguyet
and Vennatt, Jeswin
and Kew, Lin Chung
and Doyle, David
and Falohun, Tokunbo",
title="Financial, Legal, and Functional Challenges of Providing Care for People Living With Dementia and Needs for a Digital Platform: Interview Study Among Family Caregivers",
journal="JMIR Aging",
year="2023",
month="Sep",
day="5",
volume="6",
pages="e47577",
keywords="family caregiver",
keywords="Alzheimer disease",
keywords="dementia",
keywords="caregiving challenges",
keywords="digital health",
keywords="community-based participatory research",
keywords="mobile phone",
abstract="Background: Alzheimer disease and Alzheimer disease--related dementia represent complex neuropathologies directly challenging individuals, their families, and communities in the United States. To support persons living with dementia, family or informal caregivers often encounter complex financial, psychological, and physical challenges. A widely used solution such as a consolidated web-based assistance or guidance platform is missing, compounding care challenges. Objective: In preparation for designing an internet-based artificial intelligence--driven digital resource platform, a qualitative interview study was conducted to characterize the challenges and needs of family caregivers in the United States. Methods: A semistructured interview topic guide in English was developed by engaging community partners and research partnerships. Family caregiver participants were purposefully recruited via various means, such as word of mouth, local dementia community service providers, digital recruitment emails, flyers, and social media. Interested individuals were first invited to complete an eligibility screening survey, and eligible individuals were then contacted to arrange a web-based in-depth interview via Zoom (Zoom Video Communications) from January 1, 2022, to May 31, 2022. A follow-up survey was administered in May 2022 to provide an overview of the participants' demographics, socioeconomic characteristics, and caregiving information. Thematic analysis in a framework approach was used to identify and organize themes and the study findings. Results: Following the prescreening of 150 eligible respondents, 20\% (30/150) individuals completed both the interviews and follow-up survey, allowing for an in-depth look into the challenges, experiences, and expectations of primary caregivers of people living with dementia. Most participants (20/30, 67\%) were primary caregivers of persons with dementia, and 93\% (28/30) had provided care for at least a year. Most participants were aged >50 years (25/30, 83\%), female (23/30, 77\%), White (25/30, 83\%), and non-Hispanic (27/30, 90\%) and held a bachelor's or graduate degree (22/30, 73\%). Collectively, all participants acknowledged challenges in caring for people living with dementia. Thematic analyses elicited the challenges of caregiving related to functional care needs and financial and legal challenges. In addition, participants identified the need for an integrative digital platform where information could be supplied to foster education, share resources, and provide community support, enabling family caregivers to improve the quality of care and reducing caregiver burden. Conclusions: This study emphasized the difficulties associated with the family caregiver role and the expectations and potential for a supportive web-based platform to mitigate current challenges within the caregiving role. ",
doi="10.2196/47577",
url="https://aging.jmir.org/2023/1/e47577",
url="http://www.ncbi.nlm.nih.gov/pubmed/37526513"
}


@Article{info:doi/10.2196/44514,
author="Du, Xiwang
and Liao, Jiazhi
and Ye, Qing
and Wu, Hong",
title="Multidimensional Internet Use, Social Participation, and Depression Among Middle-Aged and Elderly Chinese Individuals: Nationwide Cross-Sectional Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="30",
volume="25",
pages="e44514",
keywords="internet use",
keywords="depression",
keywords="social participation",
keywords="middle-aged and elderly Chinese",
keywords="RIDL",
abstract="Background: There is growing evidence that the internet has beneficial effects on the mental health of middle-aged and older people (?45 years), but the evidence is inconclusive, and the underlying mechanisms are less known. Objective: This study aims to explore the relationship between multidimensional (devices, frequency, and purpose) internet use and depression in middle-aged and elderly Chinese, as well as the mediating effect of social participation. Moreover, this study will explore the moderating effect of the regional informatization development level (RIDL) on the relationships between individual internet use, social participation, and depression. Methods: Data on 17,676 participants aged 45 years or older were obtained from the China Health and Retirement Longitudinal Study (CHARLS) 2018 data set. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to identify the presence of depression. Logistic regression was used to explore the relationship between each dimension of internet use and depression. Multiple linear regression was used to explore the mediating effect of social participation and the moderating effect of the RIDL. Results: The results showed that 28.33\% (5008/17,676) of the total population had depression. In terms of regional subgroups, respondents living in the western region exhibited the highest proportion of depression (2041/5884, 34.69\%). Internet use was negatively associated with depression (odds ratio 0.613, 95\% CI 0.542-0.692; P<.001). Various dimensions of internet use positively contributed to individual social participation and reduced individual depression (devices: $\beta$=--.170, 95\% CI --0.209 to --0.127; frequency: $\beta$=--.065, 95\% CI --0.081 to --0.047; and purpose: $\beta$=--.043, 95\% CI --0.053 to --0.031). In addition, the RIDL weakened the relationship between individual-level internet use and social participation (internet use: F74.12,9.82=7.55, P<.001; devices: F51.65/9.88=5.23, P=.005; frequency: F66.74/10.08=6.62, P=.001; and purpose: F66.52/9.78=6.80, P=.001), and negatively moderated the relationship between the frequency of internet use and depression (frequency: F662.67/188.79=3.51, P=.03). Conclusions: This study found that different dimensions of internet use are associated with lower levels of depression. Social participation partially mediates the association between multidimensional internet use and depression in the eastern, central, and western regions, respectively. Additionally, the RIDL helps individuals further their internet use and social participation, reducing the impact of depression. However, this effect weakens sequentially from the western region to the central region and then to the eastern region. ",
doi="10.2196/44514",
url="https://www.jmir.org/2023/1/e44514",
url="http://www.ncbi.nlm.nih.gov/pubmed/37647119"
}


@Article{info:doi/10.2196/51799,
author="Berger, Mitchell",
title="Digital Health Tools Can Support Patient Access to Culturally and Linguistically Competent Behavioral Health Treatment",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="25",
volume="25",
pages="e51799",
keywords="African American",
keywords="women",
keywords="depression",
keywords="telemedicine",
keywords="mobile health",
keywords="mHealth",
keywords="mobile apps",
keywords="digital health",
keywords="mental health",
keywords="gender minority",
keywords="mobile technology",
keywords="mobile phone",
doi="10.2196/51799",
url="https://www.jmir.org/2023/1/e51799",
url="http://www.ncbi.nlm.nih.gov/pubmed/37624636"
}


@Article{info:doi/10.2196/45016,
author="Thomas, Elizabeth
and Lee, Ying Crystal Man
and Norman, Richard
and Wells, Leanne
and Shaw, Tim
and Nesbitt, Julia
and Frean, Isobel
and Baxby, Luke
and Bennett, Sabine
and Robinson, Suzanne",
title="Patient Use, Experience, and Satisfaction With Telehealth in an Australian Population (Reimagining Health Care): Web-Based Survey Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="17",
volume="25",
pages="e45016",
keywords="telehealth",
keywords="consumer experience",
keywords="demographic influence",
keywords="population survey",
keywords="health care survey",
keywords="telemedicine",
keywords="Australia",
keywords="participant recruitment",
abstract="Background: The COVID-19 pandemic triggered a rapid scale-up of telehealth services in Australia as a means to provide continued care through periods of physical restrictions. The factors that influence engagement in telehealth remain unclear. Objective: The purpose of this study is to understand the experience of Australian people who engaged in a telehealth consultation during the pandemic period (2020-2021) and the demographic factors that influence engagement. Methods: A web-based survey was distributed to Australians aged over 18 years that included 4 questions on frequency and type of clinical consultation, including with a general practitioner (GP), specialist, allied health, or nurse; 1 question on the experience of telehealth; and 2 questions on the quality of and satisfaction with telehealth. Statistical analysis included proportion of responses (of positive responses where a Likert scale was used) and regression analyses to determine the effect of demographic variables. Results: Of the 1820 participants who completed the survey, 88.3\% (1607/1820) had engaged in a health care consultation of some type in the previous 12 months, and 69.3\% (1114/1607) of those had used telehealth. The most common type of consultation was with a GP (959/1114, 86.1\%). Older people were more likely to have had a health care consultation but less likely to have had a telehealth consultation. There was no difference in use of telehealth between metropolitan and nonmetropolitan regions; however, people with a bachelor's degree or above were more likely to have used telehealth and to report a positive experience. A total of 87\% (977/1114) of participants agreed or strongly agreed that they had received the information they required from their consultation, 71\% (797/1114) agreed or strongly agreed that the outcome of their consultation was the same as it would have been face-to-face, 84\% (931/1114) agreed or strongly agreed that the doctor or health care provider made them feel comfortable, 83\% (924/1114) agreed or strongly agreed that the doctor or health care provider was equally as knowledgeable as providers they have seen in person; 57\% (629/1114) of respondents reported that they would not have been able to access their health consultation if it were not for telehealth; 69\% (765/1114) of respondents reported that they were satisfied with their telehealth consultation, and 60\% (671/1114) reported that they would choose to continue to use telehealth in the future. Conclusions: There was a relatively high level of engagement with telehealth over the 12 months leading up to the study period, and the majority of participants reported a positive experience and satisfaction with their telehealth consultation. While there was no indication that remoteness influenced telehealth usage, there remains work to be done to improve access to older people and those with less than a bachelor's degree. ",
doi="10.2196/45016",
url="https://www.jmir.org/2023/1/e45016",
url="http://www.ncbi.nlm.nih.gov/pubmed/37590037"
}


@Article{info:doi/10.2196/45717,
author="Lee, Frank
and Jain, Payaal Jennifer
and Duthely, M. Lunthita
and Ikeda, Janet
and Santos, Glenn-Milo",
title="Stimulant Use Associated With Psychosocial Factors, HIV Risk, and Concurrent Hazardous Alcohol Use Among US Adults: Exploratory Cross-Sectional Questionnaire Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="17",
volume="7",
pages="e45717",
keywords="Amazon Mechanical Turk",
keywords="stimulant use",
keywords="alcohol use",
keywords="craving",
keywords="men who have sex with men",
keywords="MSM",
keywords="depression",
keywords="affect",
keywords="HIV",
keywords="public health",
keywords="gender minority",
keywords="psychosocial",
keywords="addiction",
abstract="Background: Stimulant use is a major public health problem that contributes to morbidity and mortality among men who have sex with men (MSM) in the United States. To reduce the harms associated with stimulant use, there is a need to identify the factors associated with stimulant use to inform interventions. Additionally, there is a need to use large crowdsourcing platforms like Amazon Mechanical Turk (MTurk) to engage more individuals who use substances across the United States. Objective: We identified the correlates of stimulant use among people who use alcohol or stimulants in the United States recruited using MTurk. Methods: Participants who were aged ?18 years in the United States and reported alcohol or stimulant (ie, cocaine, crack cocaine, and methamphetamine) use were deemed eligible and recruited via the web platform MTurk. Participants completed a baseline survey, which assessed sociodemographics, psychosocial (ie, depression, affect, self-esteem, and stress) factors, substance use, and sexual behaviors. Data were collected and analyzed with STATA (version 17; StataCorp). Stratifying by MSM status, bivariate and multivariable logistic regression models were built in STATA to examine the correlates of stimulant use. Multivariable models controlled for age, race, health insurance, and relationship status. Results: Of 272 participants, 201 (73.9\%) identified as male, 134 (49.2\%) were MSM, 52 (19.1\%) were from racial and ethnic minoritized communities, and 158 (58\%) were in a relationship. The mean age was 36.10 (SD 10.3) years. A total of 40 (14.7\%) participants reported stimulant use in the past 6 months. Factors significantly associated with stimulant use were being MSM (adjusted odds ratio [aOR]\thinspace4.61, 95\% CI 1.97-10.81), a higher Alcohol Use Disorders Identification Test-Concise score (aOR 1.24, 95\% CI 1.08-1.42), more intense cravings for alcohol in the past 24 hours (aOR 1.03, 95\% CI 1.01-1.04), a higher depression score (aOR 1.06, 95\% CI 1.01-1.12), a greater number of male partners in the last 6 months (aOR 1.32, 95\% CI 1.08-1.61), a greater number of female partners in the last 6 months (aOR 1.42, 95\% CI 1.04-1.92), and being diagnosed with a sexually transmitted infection (eg, syphilis, gonorrhea, chlamydia, herpes simplex virus, human papillomavirus, and other) in the last 6 months (aOR 14.61, 95\% CI 3.45-61.87). Additionally, there was a significant additive interaction between MSM status and negative affect, such that the impact of negative affect on stimulant use was significantly greater among MSM compared with non-MSM (relative excess risk due to interaction 0.085, 95\% CI 0.037-0.13). Conclusions: Interventions that address stimulant use should use evidence-based approaches that reduce negative affect, depression, and cravings for alcohol. Additionally, interventions should be customized for MSM populations. ",
doi="10.2196/45717",
url="https://formative.jmir.org/2023/1/e45717",
url="http://www.ncbi.nlm.nih.gov/pubmed/37590045"
}


@Article{info:doi/10.2196/45952,
author="Boskey, R. Elizabeth
and Quint, Meg
and Xu, Rena
and Kremen, Jessica
and Estrada, Carlos
and Tham, Regina
and Kane, Kaiden
and Reisner, L. Sari",
title="Gender Affirmation--Related Information-Seeking Behaviors in a Diverse Sample of Transgender and Gender-Diverse Young Adults: Survey Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="15",
volume="7",
pages="e45952",
keywords="web-based health",
keywords="information seeking",
keywords="transgender youth",
keywords="health communication",
keywords="survey",
keywords="gender diverse",
keywords="youth",
keywords="United States",
keywords="support",
keywords="gender identity",
keywords="accessibility",
keywords="transgender community",
keywords="web-based information",
abstract="Background: Of the 1.6 million transgender and gender-diverse (TGD) people in the United States, approximately 700,000 are youth aged 13-24 years. Many factors make it difficult for TGD young people to identify resources for support and information related to gender identity and medical transition. These range from lack of knowledge to concerns about personal safety in the setting of increased antitransgender violence and legislative limitations on transgender rights. Web-based resources may be able to address some of the barriers to finding information and support, but youth may have difficulty finding relevant content or have concerns about the quality and content of information they find on the internet. Objective: We aim to understand ways TGD young adults look for web-based information about gender and health. Methods: In August 2022, 102 young adults completed a 1-time survey including closed- and open-ended responses. Individuals were recruited through the Prolific platform. Eligibility was restricted to people between the ages of 18-25 years who identified as transgender and were residents of the United States. The initial goal was to recruit 50 White individuals and 50 individuals who identified as Black, indigenous, or people of color. In total, 102 people were eventually enrolled. Results: Young adults reported looking on the internet for information about a broad range of topics related to both medical- and social-gender affirmation. Most participants preferred to obtain information via personal stories. Participants expressed a strong preference for obtaining information from other trans people. Conclusions: There is a need for accessible, expert-informed information for TGD youth, particularly more information generated for the transgender community by members of the community. ",
doi="10.2196/45952",
url="https://formative.jmir.org/2023/1/e45952",
url="http://www.ncbi.nlm.nih.gov/pubmed/37581925"
}


@Article{info:doi/10.2196/43612,
author="Wang, Jing
and Kwan, Patrick
and Zhang, Gong
and Shen, Mingwang
and Piccenna, Loretta
and O'Brien, J. Terence
and Zhang, Lei",
title="A Multidimensional Assessment of Activities of Daily Living, Mental Status, Communication, and Social Abilities Among Older Adults in Shenzhen, China: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Aug",
day="10",
volume="9",
pages="e43612",
keywords="older adults",
keywords="ability assessment",
keywords="activities of daily living",
keywords="mental status",
keywords="sensory and communication",
keywords="social participation",
abstract="Background: China is facing a rapidly expanding aging population. Insights into the health status of older adults are of great significance for health resource allocation and health care provision to this population. Objective: With the goal of providing a comprehensive understanding of the health status of older adults and to inform potential interventions, we investigated the level of disability and identified risk factors associated with disability among the older population (aged ?60 years) living in China. Methods: A total of 8467 older adults living in the Chinese city of Shenzhen were enrolled in this cross-sectional study. We used a multidimensional ability assessment survey, which assessed their activities of daily living (ADL; including eating, bathing, grooming, dressing, defecation control, urination control, using a toilet unaided, transfer, flat-ground walking, stair activity), mental status (including cognitive function, aggressive behavior, depression symptoms), sensory and communication (including consciousness level, vision, hearing, communication), and social participation (including living, working, time/space orientation, distinguish persons, social communication) abilities. The impact of demographic risk factors on ability levels was analyzed using ordinal logistic regression. The correlations between the four dimensions of ability mentioned above were analyzed using Spearman correlation analysis. Results: A total of 7766 participants were effectively assessed. The participants' average age was 70.64 (SD 8.46) years comprising 56.53\% females. The overall ability level was classified as mildly, moderately, and severely impaired for 27.57\% (n=2141), 2.83\% (n=220), and 4.28\% (n=332) of the 7766 participants, respectively. With increasing age, the proportion of impaired participants increased from 17.62\% (365/2071) in the age group 60-64 years to 91.3\% (253/277) in the age group above 90 years (P<.001), corresponding to an approximate 10\% rise for every 5-year age increment. The odds of having more severe overall ability impairment in females was 1.15 times that in males (odds ratio [OR] 1.15, 95\% CI 1.04-1.28). Participants who were divorced or widowed had a higher risk of more severe overall ability impairment than those currently married (OR 1.98, 95\% CI 1.68-2.33). Participants living with nonrelatives had an increased risk of more severe overall ability impairment than those living alone (OR 2.38, 95\% CI 1.46-3.91). Higher education level was a protective factor of overall ability impairment (college degree or above: OR 0.32, 95\% CI 0.24-0.42). The four dimensions of ability assessed were significantly correlated; a low score for ADL was significantly correlated with poorer mental status, sensory and communication, and social participation (all P<.001). Conclusions: The proportion of disability among Chinese older adults increases with age, being female, having lower education levels, being divorced or widowed, and living with nonrelatives. Impairment in ADL ability is significantly correlated with poor mental status, social participation, and sensory and communication abilities. A holistic approach to improving the health of the older population is recommended in China. ",
doi="10.2196/43612",
url="https://publichealth.jmir.org/2023/1/e43612",
url="http://www.ncbi.nlm.nih.gov/pubmed/37561566"
}


@Article{info:doi/10.2196/44981,
author="Mai, Feng
and Ko, Dong-Gil
and Shan, Zhe
and Zhang, Dawei",
title="The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="9",
volume="25",
pages="e44981",
keywords="digital divide",
keywords="race",
keywords="health care",
keywords="patient portal",
keywords="mobile health",
keywords="accelerated digitization",
keywords="COVID-19",
keywords="mobile phone",
abstract="Background: Prior research on the digital divide has documented substantial racial inequality in using web-based health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minority groups are left further behind. However, it is unclear to what extent the use of health information and communications technology by underprivileged racial minority groups is affected. Objective: We have considered the COVID-19 disruption as a rare exogenous shock and estimated the impact of the accelerated digitization on the quantity and variety of patient portal use. In this study, we aimed to answer the following 2 key research questions. Did patients alter their use of health information and communications technology owing to COVID-19--induced digital acceleration? Does the effect differ across racial lines? Methods: We used a longitudinal patient portal use data set gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in health care. We limited the sample period of our study to 2 same periods (March 11 to August 30) in 2019 and 2020. Our final sample consisted of 25,612 patients belonging to 1 of the 3 racial groups: Black or African American (n=5157, 20.13\%), Hispanic (n=253, 0.99\%), and White (n=20,202, 78.88\%) patients. We estimated the panel data regression using 3 different models: pooled ordinary least squares (OLS), random effect (RE), and fixed effect (FE). Results: Our study yielded 4 findings. First, we confirmed that the racial digital divide remains a significant issue for telehealth; underprivileged racial minority group patients had lower patient portal use than White patients before the pandemic (Minority: OLS, $\beta$=?.158; P<.001; RE, $\beta$=?.168; P<.001). Second, we found that the digital gap regarding patient portal use frequency between underprivileged racial minority groups and White patients is shrinking rather than widening after the COVID-19 pandemic started (COVID\_Period{\texttimes}Minority: OLS, $\beta$=.028; P=.002; RE, $\beta$=.037; P<.001; FE, $\beta$=.043; P<.001). Third, the shrinking gap is foremost driven by access through mobile (vs desktop) devices (COVID\_Period{\texttimes}Minority: web, $\beta$=?.020; P=.02; mobile, $\beta$=.037; P<.001). Finally, underprivileged racial minority groups expanded their use of a variety of portal functionalities faster than White patients during the pandemic (COVID\_Period{\texttimes}Minority [for functionality]: OLS, $\beta$=?.004; P<.001; RE, $\beta$=?.004; P<.001; FE, $\beta$=?.003; P=.001). Conclusions: Using the COVID-19 pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among underprivileged racial minority groups during accelerated digitization. They also offer policy makers an opportunity to identify new strategies to help close the racial digital gap in the postpandemic world. ",
doi="10.2196/44981",
url="https://www.jmir.org/2023/1/e44981",
url="http://www.ncbi.nlm.nih.gov/pubmed/37384810"
}


@Article{info:doi/10.2196/45063,
author="Ketelhut, Sascha
and Bodman, Alex
and Ries, Thomas
and Nigg, R. Claudio",
title="Challenging the Portrait of the Unhealthy Gamer---The Fitness and Health Status of Esports Players and Their Peers: Comparative Cross-Sectional Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="3",
volume="25",
pages="e45063",
keywords="blood pressure",
keywords="gamers",
keywords="health status",
keywords="physical activity behavior",
keywords="physical fitness",
keywords="esports",
keywords="health burden",
keywords="sedentary athlete",
keywords="health",
keywords="fitness",
abstract="Background: Esports players are often referred to as sedentary athletes, as gaming requires prolonged sedentary screen exposure. As sedentary behavior and physical inactivity are major causes of noncommunicable diseases and premature death, esports players may be at an increased risk for health implications. Prior research has established esports players as having higher levels of body fat and lower levels of lean body mass versus age-matched controls, suggesting the need to assess further health and fitness outcomes of this demographic. However, while research interest is undoubtedly increasing, the majority of studies has focused on subjective self-report data and has lacked relevant objective health and fitness measurements. Objective: This study aimed to assess the health and fitness status of a group of competitive esports players in relation to an age- and sex-matched comparison group. Methods: In total, 51 competitive esports players (mean 23, SD 3 years, 2 female) and 51 nonesports players (mean 24, SD 3 years, 2 female) were enrolled in this cross-sectional laboratory study. The esports players and the nonesports players completed a questionnaire assessing demographic data and self-reported physical activity levels. Furthermore, physical parameters including BMI, waist-to-height ratio, body fat percentage, systolic blood pressure, diastolic blood pressure, pulse wave velocity, maximal grip strength, and maximal oxygen consumption were assessed. Results: There were no significant differences in BMI (t100=1.54; P=.13; d=0.30), waist-to-height ratio (t100=1.44; P=.16; d=0.28), body fat percentage (t100=?0.48; P=.63; d=?0.09), systolic blood pressure (t100=?0.06; P=.93; d=?0.01), diastolic blood pressure (t100=0.37; P=.71; d=0.07), pulse wave velocity (t93=?2.08; P=.15; d=?0.43), maximal grip strength (t100=?.08; P=.94; d=?0.02), maximal oxygen consumption (t100=?0.11; P=.92; d=?0.02), and physical activity (PA) levels (t86=2.17; P=.08; d=0.46) between the groups. Conclusions: While the health narrative directed toward esports players has been mainly negative, this laboratory-based study indicated that esports players are not less healthy or fit compared to their peers. However, it seems that esports players are very heterogeneous and seem to span across the whole range of the fitness and health spectrum. Thus, the generalized statements of the esports athlete as an obese and unhealthy individual may need to be reconsidered. ",
doi="10.2196/45063",
url="https://www.jmir.org/2023/1/e45063",
url="http://www.ncbi.nlm.nih.gov/pubmed/37535408"
}


@Article{info:doi/10.2196/37447,
author="Adu-Brimpong, Joel
and Pugh, Jennifer
and Darko, Agyen David
and Shieh, Lisa",
title="Examining Diversity in Digital Therapeutics Clinical Trials: Descriptive Analysis",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="2",
volume="25",
pages="e37447",
keywords="digital therapeutics, DTx",
keywords="clinical trials, health informatics",
keywords="digital health",
keywords="digital medicine",
keywords="DTx clinical trials",
keywords="health equity",
keywords="digital therapy",
keywords="demographic",
keywords="sociodemographic",
keywords="representation",
keywords="software",
keywords="telehealth",
keywords="telemedicine",
abstract="Background: Digital therapeutics (DTx) are an emerging class of software-based medical therapies helping to improve care access and delivery. As we leverage these digital health therapies broadly in clinical care, it is important to consider sociodemographic representation underlying clinical trials data to ensure broad application to all groups. Objective: We review current sociodemographic representation in DTx clinical trials using data from the Digital Therapeutics Alliance Product Library database. Methods: We conducted a descriptive analysis of DTx products. We analyzed 15 manuscripts associated with 13 DTx products. Sociodemographic information was retrieved and compared with the US population's demographic distribution. Results: The median study size and age of participants were 252 and 43.3 years, respectively. Of the 15 studies applicable to this study, 10 (67\%) reported that females made up 65\% or greater of the study cohort. A total of 14 studies reported race data with Black or African American and Asian American individuals underrepresented in 9 and 11 studies, respectively. In 7 studies that reported ethnicity, Hispanics were underrepresented in all 7 studies. Furthermore, 8 studies reported education levels, with 5 studies reporting populations in which 70\% or greater had at least some college education. Only 3 studies reported health insurance information, each reporting a study cohort in which 100\% of members were privately insured. Conclusions: Our findings indicate opportunities for improved sociodemographic representation in DTx clinical trials, especially for underserved populations typically underrepresented in clinical trials. This review is a step in examining sociodemographic representation in DTx clinical trials to help inform the path forward for DTx development and testing. ",
doi="10.2196/37447",
url="https://www.jmir.org/2023/1/e37447",
url="http://www.ncbi.nlm.nih.gov/pubmed/37531157"
}


@Article{info:doi/10.2196/44399,
author="Chivela, L. Fernando
and Burch, E. Ashley
and Asagbra, Oghale",
title="An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="1",
volume="25",
pages="e44399",
keywords="patient portal",
keywords="multimorbidity",
keywords="chronic disease",
keywords="patient messaging",
keywords="rural",
keywords="mobile phone",
abstract="Background: Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited. Objective: This study aimed to explore the factors associated with portal messaging use by rural patients. Methods: We assessed patient portal use among patients with ?1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient's number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient's home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density. Results: A total of 65,178 patients (n=38,587, 59.2\% female and n=21,454, 32.92\% Black) were included in the final data set, of which 38,380 (58.88\%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ?7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income. Conclusions: Patients' use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity. ",
doi="10.2196/44399",
url="https://www.jmir.org/2023/1/e44399",
url="http://www.ncbi.nlm.nih.gov/pubmed/37526967"
}


@Article{info:doi/10.2196/47670,
author="Rome, Danielle
and Sales, Alyssa
and Cornelius, Talea
and Malhotra, Sujata
and Singer, Jessica
and Ye, Siqin
and Moise, Nathalie",
title="Impact of Telemedicine Modality on Quality Metrics in Diverse Settings: Implementation Science--Informed Retrospective Cohort Study",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="26",
volume="25",
pages="e47670",
keywords="telemedicine",
keywords="telehealth",
keywords="implementation science",
keywords="quality metrics",
keywords="screening",
keywords="adoption",
keywords="diverse",
keywords="socioeconomic",
keywords="audio based",
keywords="video based",
keywords="video consultation",
abstract="Background: Video-based telemedicine (vs audio only) is less frequently used in diverse, low socioeconomic status settings. Few prior studies have evaluated the impact of telemedicine modality (ie, video vs audio-only visits) on clinical quality metrics. Objective: The aim of this study was to assess telemedicine uptake and impact of visit modality (in-person vs video and phone visits) on primary care quality metrics in diverse, low socioeconomic status settings through an implementation science lens. Methods: Informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we evaluated telemedicine uptake, assessed targeted primary care quality metrics by visit modality, and described provider-level qualitative feedback on barriers and facilitators to telemedicine implementation. Results: We found marginally better quality metrics (ie, blood pressure and depression screening) for in-person care versus video and phone visits; de-adoption of telemedicine was marked within 2 years in our population. Conclusions: Following the widespread implementation of telemedicine during the COVID-19 pandemic, the impact of visit modality on quality outcomes, provider and patient preferences, as well as technological barriers in historically marginalized settings should be considered. ",
doi="10.2196/47670",
url="https://www.jmir.org/2023/1/e47670",
url="http://www.ncbi.nlm.nih.gov/pubmed/37494087"
}


@Article{info:doi/10.2196/42483,
author="Nakayama, Filipe Luis
and Binotti, Warr William
and Link Woite, Naira
and Fernandes, Oliveira Chrystinne
and Alfonso, Gabrielle Pia
and Celi, Anthony Leo
and Regatieri, Vinicius Caio",
title="The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="21",
volume="25",
pages="e42483",
keywords="digital divide",
keywords="digital health",
keywords="health equity",
keywords="internet access",
keywords="medical care",
abstract="Background: The COVID-19 pandemic has increased the use of digital solutions in medical care, especially for patients in remote areas and those requiring regular medical care. However, internet access is essential for the implementation of digital health care. The digital divide is the unequal distribution of access to digital technology, and the first level digital divide encompasses structural barriers. Brazil, a country with economic inequality and uneven population distribution, faces challenges in achieving internet access for all. Objective: This study aims to provide a comprehensive overview of the first-level digital divide in Brazil, estimate the relationship between variables, and identify the challenges and opportunities for digital health care implementation. Methods: Data were retrieved from the Brazilian Institute of Geography and Statistics National Continuous House survey database, including demographic, health, and internet-related variables. Statistical analysis included 2-tailed t tests, chi-square, and multivariate logistic regression to assess associations between variables. Results: Our analysis included 279,382 interviews throughout Brazil. The sample included more houses from the northeast (n=99,553) and fewer houses from the central west (n=30,804). A total of 223,386 (80.13\%) of the interviewed population used the internet, with urban areas having higher internet access (187,671/212,109, 88.48\%) than rural areas (35,715/67,077, 53.24\%). Among the internet users, those interviewed who lived in urban houses, were women, were younger, and had higher income had a statistically higher prevalence (P<.001). Cell phones were the most common device used to access the internet (141,874/143,836, 98.63\%). Reasons for not using the internet included lack of interest, knowledge, availability, and cost, with regional variations. The prevalence of internet access also varied among races, with 84,747 of 98,968 (85.63\%) White respondents having access, compared to 22,234 of 28,272 (78.64\%) Black respondents, 113,518 of 148,191 (76.6\%) multiracial respondents, and 2887 of 3755 (76.88\%) other respondents. In the southeast, central west, and south regions, the numbers of people with internet access were 49,790 of 56,298 (88.44\%), 27,209 of 30,782 (88.39\%), and 27,035 of 31,226 (86.58\%), respectively, and in the north and northeast, 45,038 of 61,404 (73.35\%) and 74,314 of 99,476 (74.7\%). The income of internet users was twice the income of internet nonusers. Among those with diabetes-related limitations in daily activities, 945 of 2377 (39.75\%) did not have internet access, and among those with daily activity restrictions, 1381 of 3644 (37.89\%) did not have access. In a multivariate logistic regression analysis, women (odds ratio [OR] 1.147, 95\% CI 0.118-0.156; P<.001), urban households (OR 6.743, 95\% CI 1.888-1.929; P<.001), and those earning more than the minimum wage (OR 2.087, 95\% CI 0.716-0.756; P<.01) had a positive association with internet access. Conclusions: Brazil's diverse regions have different demographic distributions, house characteristics, and internet access levels, requiring targeted measures to address the first-level digital divide in rural areas and reduce inequalities in digital health solutions. Older people, poor, and rural populations face the greatest challenges in the first level digital divide in Brazil, highlighting the need to tackle the digital divide in order to promote equitable access to digital health care. ",
doi="10.2196/42483",
url="https://www.jmir.org/2023/1/e42483",
url="http://www.ncbi.nlm.nih.gov/pubmed/37477958"
}


@Article{info:doi/10.2196/45766,
author="McCall, Terika
and Foster, Meagan
and Schwartz, A. Todd",
title="Attitudes Toward Seeking Mental Health Services and Mobile Technology to Support the Management of Depression Among Black American Women: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="19",
volume="25",
pages="e45766",
keywords="African American",
keywords="women",
keywords="depression",
keywords="telemedicine",
keywords="mobile health",
keywords="mHealth",
keywords="mobile apps",
keywords="digital health",
keywords="mental health",
keywords="gender minority",
keywords="mobile technology",
keywords="mobile phone",
abstract="Background: Depression is a common mental health condition among Black American women. Many factors may contribute to the development of depressive symptoms, such as gender and racial discrimination, financial strain, chronic health conditions, and caregiving responsibilities. Barriers such as the stigmatization of mental illness, less access to treatment, the lack of or inadequate health insurance, mistrust of providers, and limited health literacy prevent marginalized populations from seeking care. Previous literature has shown that mobile health interventions are effective and can increase access to mental health services and resources. Objective: We aimed to understand the attitudes and perceptions of Black women toward using mental health services and determine the acceptability and concerns of using mobile technology (ie, voice call, video call, SMS text messaging, and mobile app) to support the management of depression. Methods: We launched a self-administered web-based questionnaire in October 2019 and closed it in January 2020. Women (aged ?18 years) who identify as Black or African American or multiracial (defined as Black or African American and another race) were eligible to participate. The survey consisted of approximately 70 questions and included topics such as attitudes toward seeking professional psychological help, the acceptability of using a mobile phone to receive mental health care, and screening for depression. Results: The findings (n=395) showed that younger Black women were more likely to have greater severity of depression than their older counterparts. The results also revealed that Black women have favorable views toward seeking mental health services. Respondents were the most comfortable with the use of voice calls or video calls to communicate with a professional to receive support for managing depression in comparison with SMS text messaging or mobile apps. The results revealed that higher help-seeking propensity increased the odds of indicating agreement with the use of voice calls and video calls to communicate with a professional to receive support for managing depression by 27\% and 38\%, respectively. However, no statistically significant odds ratios (all P>.05) were found between help-seeking propensity and respondents' agreement to use mobile apps or SMS text messaging. Moderate to severe depression severity increased the odds of using mobile apps to communicate with a professional to receive support for managing depression by 43\%; however, no statistically significant odds ratios existed for the other modalities. Privacy and confidentiality, communication issues (eg, misinterpreting text), and the impersonal feeling of communicating by mobile phone (eg, SMS text messaging) were the primary concerns. Conclusions: Black American women, in general, have favorable views toward seeking mental health services and are comfortable with the use of mobile technology to receive support for managing depression. Future work should address the issues of access and consider the preferences and cultural appropriateness of the resources provided. ",
doi="10.2196/45766",
url="https://www.jmir.org/2023/1/e45766",
url="http://www.ncbi.nlm.nih.gov/pubmed/37467027"
}


@Article{info:doi/10.2196/46298,
author="Li, Peiyi
and Zhang, Chenyang
and Gao, Shuanliang
and Zhang, Yanbo
and Liang, Xiaolong
and Wang, Chengdi
and Zhu, Tao
and Li, Weimin",
title="Association Between Daily Internet Use and Incidence of Chronic Diseases Among Older Adults: Prospective Cohort Study",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="17",
volume="25",
pages="e46298",
keywords="daily internet use",
keywords="chronic disease",
keywords="disease prevention",
keywords="middle-aged and older adult",
keywords="usage",
keywords="internet use",
keywords="technology use",
keywords="chronic illness",
keywords="association",
keywords="incidence",
keywords="middle age",
keywords="older adult",
keywords="gerontology",
keywords="geriatric",
keywords="aging",
keywords="elder",
keywords="national survey",
abstract="Background: Chronic disease incidence among the elderly is increasing, which is correlated with the acceleration of population aging. Evolving internet technologies may help prevent and provide interventions for chronic diseases in an accelerating aging process. However, the impact of daily internet use on the incidence of chronic diseases is not well understood. Objective: This study aims to investigate whether daily internet use by middle-aged and older adults may inhibit or promote the occurrence of chronic diseases. Methods: We included participants from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal survey of Chinese residents aged ?45 years. We assessed 8-year data from wave 1 (June 2011-March 2012) to wave 4 (July-September 2018) in CHARLS. Data from wave 4 were used for a cross-sectional study, and data from all 4 waves were used for a longitudinal study. Self-reported data were used to track variables, including internet use, use frequency, and the incidence of different chronic diseases. Cox proportional hazards modeling was applied in the longitudinal study to examine the relationship between daily internet use and chronic diseases among middle-aged and older adults, while adjusting for sociodemographic characteristics and health behaviors. In addition, longitudinal data were used to analyze internet usage trends, and cross-sectional data were used to analyze the factors influencing internet use. Results: Among the 20,113 participants included in the longitudinal analyses, internet use increased significantly, from 2\% to 12.3\%, between 2011 and 2018. The adjusted model found statistically significant relationships between daily internet use and a lower incidence of the following chronic diseases: hypertension (hazard ratio [HR] 0.78, 95\% CI 0.65-0.95, P=.01), chronic lung disease (HR 0.74, 95\% CI 0.57-0.97, P=.03), stroke (HR 0.69, 95\% CI 0.50-0.94, P=.02), digestive disease (HR 0.73, 95\% CI 0.58-0.91, P=.005), memory-related disorders (HR 0.58, 95\% CI 0.37-0.91, P=.02), arthritis or rheumatism (HR 0.60, 95\% CI 0.48-0.76, P<.001), asthma (HR 0.52, 95\% CI 0.33-0.84, P=.007), depression (HR 0.80, 95\% CI 0.71-0.89, P<.001), and vision impairment (HR 0.83, 95\% CI 0.74-0.93, P=.004). Moreover, our study also showed that with increasing frequency of internet use, the risk of some chronic diseases decreases. Conclusions: This study found that middle-aged and older adults who use the internet have a reduced risk of developing chronic diseases versus those who do not use the internet. The increasing prevalence of daily internet use among middle-aged and older adults may stimulate contemplation of the potential role of internet platforms in future research on chronic disease prevention. ",
doi="10.2196/46298",
url="https://www.jmir.org/2023/1/e46298",
url="http://www.ncbi.nlm.nih.gov/pubmed/37459155"
}


@Article{info:doi/10.2196/46489,
author="Torres, Silva Thiago
and Silva, Torres Mayara Secco
and Coutinho, Carolina
and Hoagland, Brenda
and Jalil, Moreira Emilia
and Cardoso, Wagner Sandra
and Moreira, Julio
and Magalhaes, Avelar Monica
and Luz, Mendes Paula
and Veloso, G. Valdilea
and Grinsztejn, Beatriz",
title="Evaluation of Mpox Knowledge, Stigma, and Willingness to Vaccinate for Mpox: Cross-Sectional Web-Based Survey Among Sexual and Gender Minorities",
journal="JMIR Public Health Surveill",
year="2023",
month="Jul",
day="17",
volume="9",
pages="e46489",
keywords="sexual and gender minorities",
keywords="mpox",
keywords="Brazil",
keywords="Latin America and Caribbean",
keywords="community",
keywords="LGBT",
keywords="gay",
keywords="lesbian",
keywords="minority",
keywords="minorities",
keywords="survey",
keywords="emergency",
keywords="stigma",
keywords="discrimination",
keywords="Latin America",
keywords="sociodemographic",
keywords="behavioral",
keywords="diagnosis",
keywords="application",
keywords="social media",
keywords="infection",
keywords="gender",
keywords="MSM",
keywords="monkeypox",
keywords="infectious disease",
keywords="awareness",
keywords="patient education",
keywords="health knowledge",
keywords="patient knowledge",
keywords="knowledge translation",
keywords="access to care",
keywords="viral",
abstract="Background: The 2022 multicountry mpox outbreak positioned the condition as a public health emergency of international concern. By May 2023, Brazil ranked second globally in the cumulative number of mpox cases and deaths. The higher incidence of mpox among gay and other men who have sex with men in the current mpox outbreak deepens the stigma and discrimination against sexual and gender minorities (SGM). This might worsen the structural barriers impacting access to health services, which ultimately leads to undertesting and underreporting of cases. There are no data available on mpox knowledge and stigma in Latin America. Objective: We aimed to evaluate mpox knowledge, stigma, and willingness to vaccinate for mpox among SGM, and to describe sociodemographic and behavioral characteristics according to self-reported mpox diagnosis. Methods: A cross-sectional, internet-based survey was conducted in a convenience sample of adults (aged >18 years) living in Brazil recruited through advertisements on dating apps, social media, referral institutions for infectious diseases websites, and mass media (October-November 2022). We compared participants' characteristics according to self-reported mpox diagnosis using chi-square test or Fisher exact test for qualitative variables and Kruskal-Wallis test for quantitative variables. Results: We enrolled 6236 participants: 5685 (91.2\%) were cisgender men; 6032 (96.7\%) were gay, bisexual, or pansexual; 3877 (62.2\%) were White; 4902 (78.7\%) had tertiary education; and 4070 (65.2\%) reported low or middle income. Most participants (n=5258, 84.4\%) agreed or strongly agreed that ``LGBTQIA+ individuals are being discriminated and stigmatized due to mpox.'' Mpox awareness was 96.9\% (n=6044), and 5008 (95.1\%) were willing to get vaccinated for mpox. Overall, 324 (5.2\%) reported an mpox diagnosis. Among these, 318 (98.1\%) reported lesions, 178 (56\%) local pain, and 316 (99.4\%) sought health care. Among participants not reporting a diagnosis, 288 (4.9\%) had a suspicious lesion, but only 158 (54.9\%) of these had sought health care. Compared to participants with no diagnosis, those reporting an mpox diagnosis were younger (P<.001), reported more sex partners (P<.001), and changes in sexual behavior after mpox onset (P=.002). Moreover, participants diagnosed with mpox reported more frequently being tested for HIV in the prior 3 months (P<.001), living with HIV (P<.001), currently using HIV pre-exposure prophylaxis (P<.001), and previous sexually transmitted infection diagnosis (P<.001). Conclusions: Our results point to high mpox knowledge and willingness to vaccinate among SGM in Brazil. Participants self-reporting mpox diagnosis more frequently reported to be living with HIV, STI diagnosis, and current pre-exposure prophylaxis use, highlighting the importance of an mpox assessment that includes comprehensive sexual health screenings. Efforts to decrease stigma related to mpox among SGM are necessary to avoid mpox underdiagnosis. ",
doi="10.2196/46489",
url="https://publichealth.jmir.org/2023/1/e46489",
url="http://www.ncbi.nlm.nih.gov/pubmed/37459174"
}


@Article{info:doi/10.2196/44024,
author="Grimm, Michael
and Link, Elena
and Albrecht, Martina
and Czerwinski, Fabian
and Baumann, Eva
and Suhr, Ralf",
title="Exploring Functions and Predictors of Digital Health Engagement Among German Internet Users: Survey Study",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="28",
volume="25",
pages="e44024",
keywords="eHealth",
keywords="mobile health",
keywords="digital health engagement",
keywords="health information seeking",
keywords="self-monitoring",
keywords="digital health care",
keywords="mobile phone",
abstract="Background: Digital health engagement may serve many support functions, such as providing access to information; checking or evaluating one's state of health; and tracking, monitoring, or sharing health data. Many digital health engagement behaviors are associated with the potential to reduce inequalities in information and communication. However, initial studies suggest that health inequalities may persist in the digital realm. Objective: This study aimed to explore the functions of digital health engagement by describing how frequently respective services are used for a range of purposes and how these purposes can be categorized from the users' perspective. This study also aimed to identify the prerequisites for successfully implementing and using digital health services; therefore, we shed light on the predisposing, enabling, and need factors that may predict digital health engagement for different functions. Methods: Data were gathered via computer-assisted telephone interviews during the second wave of the German adaption of the Health Information National Trends Survey in 2020 (N=2602). The weighted data set allowed for nationally representative estimates. Our analysis focused on internet users (n=2001). Engagement with digital health services was measured by their reported use for 19 different purposes. Descriptive statistics showed the frequency with which digital health services were used for these purposes. Using a principal component analysis, we identified the underlying functions of these purposes. Using binary logistic regression models, we analyzed which predisposing factors (age and sex), enabling factors (socioeconomic status, health- and information-related self-efficacy, and perceived target efficacy), and need factors (general health status and chronic health condition) can predict the use of the distinguished functions. Results: Digital health engagement was most commonly linked to acquiring information and less frequently to more active or interactive purposes such as sharing health information with other patients or health professionals. Across all purposes, the principal component analysis identified 2 functions. Information-related empowerment comprised items on acquiring health information in various forms, critically assessing one's state of health, and preventing health problems. In total, 66.62\% (1333/2001) of internet users engaged in this behavior. Health care--related organization and communication included items on patient-provider communication and organizing health care. It was applied by 52.67\% (1054/2001) of internet users. Binary logistic regression models showed that the use of both functions was determined by predisposing factors (female and younger age) and certain enabling factors (higher socioeconomic status) and need factors (having a chronic condition). Conclusions: Although a large share of German internet users engage with digital health services, predictors show that existing health-related disparities prevail in the digital realm. To make use of the potential of digital health services, fostering digital health literacy at different levels, especially in vulnerable groups, is key. ",
doi="10.2196/44024",
url="https://www.jmir.org/2023/1/e44024",
url="http://www.ncbi.nlm.nih.gov/pubmed/37379058"
}


@Article{info:doi/10.2196/44486,
author="Li, Haomiao
and Wu, Yibo
and Bai, Zhongliang
and Xu, Xiwu
and Su, Dai
and Chen, Jiangyun
and He, Ruibo
and Sun, Ju",
title="The Association Between Family Health and Frailty With the Mediation Role of Health Literacy and Health Behavior Among Older Adults in China: Nationwide Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Jun",
day="27",
volume="9",
pages="e44486",
keywords="family health",
keywords="frailty",
keywords="health literacy",
keywords="health behavior",
keywords="healthy aging",
abstract="Background: Family health develops from the intersection of the health of each family member and their interactions and capacities as well as the family's internal and external resources. Frailty is the most prominent and typical clinical manifestation during population aging. Family health may be effective in addressing frailty, and this association may be mediated by health literacy and health behaviors. Until now, it is unclear whether and how family health affects frailty in older adults. Objective: This study aimed to examine the associations between family health and frailty and the mediation roles of health literacy and health behaviors. Methods: A total of 3758 participants aged ?60 years were recruited from a national survey conducted in 2022 in China for this cross-sectional study. Family health was measured using the Short Form of the Family Health Scale. Frailty was measured using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale. Potential mediators included health literacy and health behaviors (not smoking, not having alcohol intake, physical exercise for ?150 minutes per week, longer sleep duration, and having breakfast every day). Ordered logistic regression was applied to explore the association between family health and frailty status. Mediation analysis based on Sobel tests was used to analyze the indirect effects mediated by health literacy and behaviors, and the Karlson-Holm-Breen method was used to composite the indirect effects. Results: Ordered logistic regression showed that family health is negatively associated with frailty (odds ratio 0.94, 95\% CI 0.93-0.96) with covariates and potential mediators controlled. This association was mediated by health literacy (8.04\%), not smoking (1.96\%), longer sleep duration (5.74\%), and having breakfast every day (10.98\%) through the Karlson-Holm-Breen composition. Conclusions: Family health can be an important intervention target that appears to be negatively linked to frailty in Chinese older adults. Improving family health can be effective in promoting healthier lifestyles; improving health literacy; and delaying, managing, and reversing frailty. ",
doi="10.2196/44486",
url="https://publichealth.jmir.org/2023/1/e44486",
url="http://www.ncbi.nlm.nih.gov/pubmed/37368463"
}


@Article{info:doi/10.2196/46604,
author="Tao, Xiangyu
and Fisher, Celia",
title="Associations Among Web-Based Civic Engagement and Discrimination, Web-Based Social Support, and Mental Health and Substance Use Risk Among LGBT Youth: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="26",
volume="25",
pages="e46604",
keywords="lesbian, gay, bisexual, and transgender or nonbinary",
keywords="LGBT adolescents",
keywords="social media",
keywords="discrimination",
keywords="social support",
keywords="mental health",
keywords="substance use",
abstract="Background: Social media use is ubiquitous among lesbian, gay, bisexual, and transgender or nonbinary (LGBT) adolescents. The time spent on LGBT sites and involvement in social justice--oriented web-based civic activities can increase exposure to heterosexist and transphobic posts, resulting in increases in depression, anxiety, and substance use. Collaborative social justice civic engagement may also increase LGBT adolescents' social support on the web, which may buffer the mental health and substance use risks associated with web-based discrimination. Objective: Drawing on the minority stress and stress-buffering hypotheses, this study aimed to test time spent on LGBT sites, involvement in web-based social justice activities, the mediating effect of web-based discrimination, and the moderating effect of web-based social support on mental health and substance use. Methods: An anonymous web-based survey conducted from October 20 to November 18, 2022, analyzed data from 571 respondents (mean age 16.4, SD 1.1 years): 125 cisgender lesbian girls, 186 cisgender gay boys, 111 cisgender bisexual adolescents, and 149 transgender or nonbinary adolescents. Measures included demographics, web-based LGBT identity disclosure, hours per week spent on LGBT social media sites, engagement in web-based social justice activities (Online Civic Engagement Behavior Construct), exposure to web-based discrimination (Online Victimization Scale), web-based social support (adapted from scales examining web-based interactions), depressive and anxiety symptoms, and substance use (the Patient Health Questionnaire modified for Adolescents; Generalized Anxiety Disorder 7-item; and Car, Relax, Alone, Forget, Friends, Trouble Screening Test). Results: The time spent on LGBT social media sites was unrelated to web-based discrimination after civic engagement was accounted for (90\% CI ?0.007 to 0.004). Web-based social justice civic engagement was positively associated with social support ($\beta$=.4, 90\% CI 0.2-0.4), exposure to discrimination ($\beta$=.6, 90\% CI 0.5-0.7), and higher substance use risk ($\beta$=.2, 90\% CI 0.2-0.6). Consistent with minority stress theory, exposure to web-based discrimination fully mediated the positive association between LGBT justice civic engagement and depressive ($\beta$=.3, 90\% CI 0.2-0.4) and anxiety symptoms ($\beta$=.3, 90\% CI 0.2-0.4). Web-based social support did not moderate the association between exposure to discrimination with depressive (90\% CI ?0.07 to 0.1) and anxiety symptoms (90\% CI ?0.06 to 0.1) and substance use (90\% CI ?0.04 to 0.01). Conclusions: This study highlights the importance of examining LGBT youth's specific web-based activities and the need for future research to focus on the intersectional experiences of LGBT adolescents from racial and ethnic minoritized groups through culturally sensitive questions. This study also calls for social media platforms to implement policies that mitigate the effects of algorithms that expose youth to heterosexist and transphobic messaging, such as adopting machine learning algorithms that can efficiently recognize and remove harmful content. ",
doi="10.2196/46604",
url="https://www.jmir.org/2023/1/e46604",
url="http://www.ncbi.nlm.nih.gov/pubmed/37358882"
}


@Article{info:doi/10.2196/45162,
author="Goodman, Andrew
and Mahoney, Ray
and Spurling, Geoffrey
and Lawler, Sheleigh",
title="Influencing Factors to mHealth Uptake With Indigenous Populations: Qualitative Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jun",
day="23",
volume="11",
pages="e45162",
keywords="mHealth",
keywords="Indigenous",
keywords="Canada",
keywords="Australia",
keywords="New Zealand",
keywords="United States",
keywords="Papua New Guinea",
keywords="Samoa",
keywords="qualitative",
keywords="systematic review",
keywords="feasibility",
keywords="acceptability",
keywords="users",
keywords="design",
keywords="workflow",
abstract="Background: The advancements and abundance of mobile phones and portable health devices have created an opportunity to use mobile health (mHealth) for population health systems. There is increasing evidence for the feasibility and acceptance of mHealth with Indigenous populations. Providing a synthesis of qualitative findings of mHealth with Indigenous populations will gain insights into the strengths and challenges to mHealth use in Indigenous populations. Objective: This review aimed to identify and synthesize qualitative data pertaining to the experiences and perceptions of mHealth from the perspectives of end users (patients and service providers) living in the colonial settler democracies of Canada, Australia, New Zealand, the United States, the Pacific Islands, and the S{\'a}pmi region of northern Europe. Methods: In May 2021, systematic searches of peer-reviewed, scientific papers were conducted across the 5 databases of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Qualitative or mixed method studies were included where a mHealth intervention was the primary focus for responding to health challenges with Indigenous populations. Two authors independently screened papers for eligibility and assessed the risk of bias using a modified version of the Critical Appraisal Skills Programme. A meta-aggregative approach was used to analyze the findings of included studies. Results: Seventeen papers met the eligibility criteria, 8 studies with patients, 7 studies with service providers, and 2 studies that included both patients and service providers. Studies were conducted in Australia (n=10), Canada (n=2), New Zealand (n=2), Papua New Guinea (n=1), the United States (n=1), and Samoa (n=1). Our interpretation of these qualitative findings shows commonalities between Indigenous patients' and service providers' perceptions of mHealth. We summarize our findings in six themes: (1) mHealth literacy, (2) mHealth as a facilitator for connection and support, (3) mHealth content needed to be culturally relevant, (4) mHealth security and confidentiality, (5) mHealth supporting rather than replacing service providers, and (6) workplace and organizational capacity. Conclusions: This research suggests that mHealth can meet the needs of both patients and service providers when the mHealth intervention is culturally relevant, accounts for digital and health literacy, incorporates interactive components, is supported by workplaces, fits into health provider workflows, and meets security and confidentiality standards. Future mHealth research with Indigenous populations should partner with key representatives (eg, patients, service providers, and executive leaders) in the mHealth design appropriate to the purpose, people, setting, and delivery. ",
doi="10.2196/45162",
url="https://mhealth.jmir.org/2023/1/e45162",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351947"
}


@Article{info:doi/10.2196/46231,
author="Kopka, Marvin
and Scatturin, Lennart
and Napierala, Hendrik
and F{\"u}rstenau, Daniel
and Feufel, A. Markus
and Balzer, Felix
and Schmieding, L. Malte",
title="Characteristics of Users and Nonusers of Symptom Checkers in Germany: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="20",
volume="25",
pages="e46231",
keywords="symptom checker",
keywords="cross-sectional study",
keywords="user characteristic",
keywords="digital public health",
keywords="health information seeking",
keywords="decision support",
keywords="eHealth",
keywords="mHealth",
keywords="Germany",
keywords="mobile health",
keywords="health app",
keywords="information seeking",
keywords="technology use",
keywords="usage",
keywords="demographic",
keywords="perception",
keywords="awareness",
keywords="adoption",
abstract="Background: Previous studies have revealed that users of symptom checkers (SCs, apps that support self-diagnosis and self-triage) are predominantly female, are younger than average, and have higher levels of formal education. Little data are available for Germany, and no study has so far compared usage patterns with people's awareness of SCs and the perception of usefulness. Objective: We explored the sociodemographic and individual characteristics that are associated with the awareness, usage, and perceived usefulness of SCs in the German population. Methods: We conducted a cross-sectional online survey among 1084 German residents in July 2022 regarding personal characteristics and people's awareness and usage of SCs. Using random sampling from a commercial panel, we collected participant responses stratified by gender, state of residence, income, and age to reflect the German population. We analyzed the collected data exploratively. Results: Of all respondents, 16.3\% (177/1084) were aware of SCs and 6.5\% (71/1084) had used them before. Those aware of SCs were younger (mean 38.8, SD 14.6 years, vs mean 48.3, SD 15.7 years), were more often female (107/177, 60.5\%, vs 453/907, 49.9\%), and had higher formal education levels (eg, 72/177, 40.7\%, vs 238/907, 26.2\%, with a university/college degree) than those unaware. The same observation applied to users compared to nonusers. It disappeared, however, when comparing users to nonusers who were aware of SCs. Among users, 40.8\% (29/71) considered these tools useful. Those considering them useful reported higher self-efficacy (mean 4.21, SD 0.66, vs mean 3.63, SD 0.81, on a scale of 1-5) and a higher net household income (mean EUR 2591.63, SD EUR 1103.96 [mean US \$2798.96, SD US \$1192.28], vs mean EUR 1626.60, SD EUR 649.05 [mean US \$1756.73, SD US \$700.97]) than those who considered them not useful. More women considered SCs unhelpful (13/44, 29.5\%) compared to men (4/26, 15.4\%). Conclusions: Concurring with studies from other countries, our findings show associations between sociodemographic characteristics and SC usage in a German sample: users were on average younger, of higher socioeconomic status, and more commonly female compared to nonusers. However, usage cannot be explained by sociodemographic differences alone. It rather seems that sociodemographics explain who is or is not aware of the technology, but those who are aware of SCs are equally likely to use them, independently of sociodemographic differences. Although in some groups (eg, people with anxiety disorder), more participants reported to know and use SCs, they tended to perceive them as less useful. In other groups (eg, male participants), fewer respondents were aware of SCs, but those who used them perceived them to be more useful. Thus, SCs should be designed to fit specific user needs, and strategies should be developed to help reach individuals who could benefit but are not aware of SCs yet. ",
doi="10.2196/46231",
url="https://www.jmir.org/2023/1/e46231",
url="http://www.ncbi.nlm.nih.gov/pubmed/37338970"
}


@Article{info:doi/10.2196/43672,
author="Montiel Ishino, Alejandro Francisco
and Villalobos, Kevin
and Williams, Faustine",
title="COVID-19 Vaccination Among US-Born and Non--US-Born Residents of the United States From a Nationally Distributed Survey: Cross-sectional Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="20",
volume="7",
pages="e43672",
keywords="COVID-19",
keywords="vaccination",
keywords="nativity",
keywords="health disparity",
keywords="survey",
keywords="sociodemographics",
keywords="socioeconomics",
keywords="pandemic",
keywords="vaccine",
keywords="US",
keywords="USA",
keywords="United States",
keywords="birth",
keywords="country",
abstract="Background: Extended literature has demonstrated that COVID-19 vaccination is crucial for the health of all individuals, regardless of age. Research on vaccination status in the United States (US) among US-born and non--US-born residents is limited. Objective: The objective of our study was to examine COVID-19 vaccination during the pandemic among US-born and non--US-born people, while accounting for sociodemographic and socioeconomic factors gathered through a nationally distributed survey. Methods: A descriptive analysis was conducted on a comprehensive 116-item survey distributed between May 2021 and January 2022 across the US by self-reported COVID-19 vaccination and US/non-US birth status. For participants that responded that they were not vaccinated, we asked if they were ``not at all likely,'' ``slightly to moderately likely,'' or ``very to extremely likely'' to be vaccinated. Race and ethnicity were categorized as White, Black or African American, Asian, American Indian or Alaskan Native, Hawaiian or Pacific Islander, African, Middle Eastern, and multiracial or multiethnic. Additional sociodemographic and socioeconomic variables included gender, sexual orientation, age group, annual household income, educational attainment, and employment status. Results: The majority of the sample, regardless of whether they were US-born or non--US-born, reported being vaccinated (3639/5404, 67.34\%). The US-born participants with the highest proportion of COVID-19 vaccination self-identified as White (1431/2753, 51.98\%), while the highest proportion of vaccination among non--US-born participants was found among participants who self-identified as Hispanic/Latino (310/886, 34.99\%). Comparing US-born and non--US-born participants showed that among those who were not vaccinated, the highest self-reported sociodemographic characteristics by proportion were similar between the groups, and included identifying as a woman, being straight or heterosexual, being aged 18 to 35 years, having an annual household income <\$25,000, and being unemployed or taking part in nontraditional work. Among the 32.66\% (1765/5404) of participants that reported not being vaccinated, 45.16\% (797/1765) stated that they were not at all likely to seek vaccination. Examining US/non--US birth status and the likelihood to be vaccinated for COVID-19 among nonvaccinated participants revealed that the highest proportions of both US-born and non--US-born participants reported being not at all likely to seek vaccination. Non--US-born participants, however, were almost proportionally distributed in their likelihood to seek vaccination; they reported to be ``very to extremely likely'' to vaccinate (112/356, 31.46\%); compared to 19.45\% (274/1409) of US-born individuals reporting the same. Conclusions: Our study highlights the need to further explore factors that can increase the likelihood of seeking vaccination among underrepresented and hard-to-reach populations, with a particular focus on tailoring interventions for US-born individuals. For instance, non--US-born individuals were most likely to vaccinate when reporting COVID-19 nonvaccination than US-born individuals. These findings will aid in identifying points of intervention for vaccine hesitancy and promoting vaccine adoption during current and future pandemics. ",
doi="10.2196/43672",
url="https://formative.jmir.org/2023/1/e43672",
url="http://www.ncbi.nlm.nih.gov/pubmed/37097810"
}


@Article{info:doi/10.2196/45822,
author="Touzani, Rajae
and Dembele, Elodie
and Schultz, Emilien
and Rouquette, Alexandra
and Seguin, Lor{\`e}ne
and Dufour, Jean-Charles
and Bannier, Marie
and Mancini, Julien",
title="The French General Population's Perception of New Information and Communication Technologies for Medical Consultations: National Survey",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="16",
volume="25",
pages="e45822",
keywords="new ICT",
keywords="video recording",
keywords="mHealth apps",
keywords="video broadcasting",
keywords="health literacy",
keywords="telehealth",
keywords="teleconsultation",
keywords="HLS19",
keywords="COVID-19",
keywords="France",
abstract="Background: The development of telehealth and telemedicine, in the form of increased teleconsultation and medical telemonitoring, accelerated during the COVID-19 health crisis in France to ensure continued access to care for the population. Since these new information and communication technologies (ICTs) are diverse and likely to transform how the health care system is organized, there is a need better to understand public attitudes toward them and their relationship with peoples' current experience of health care. Objective: This study aimed to determine the French general population's perception of the usefulness of video recording/broadcasting (VRB) and mobile Health (mHealth) apps for medical consultations in France during the COVID-19 health crisis and the factors associated with this perception. Methods: Data were collected for 2003 people in 2 waves of an online survey alongside the Health Literacy Survey 2019 (1003 in May 2020 and 1000 in January 2021) based on quota sampling. The survey collected sociodemographic characteristics, health literacy levels, trust in political representatives, and perceived health status. The perceived usefulness of VRB in medical consultations was measured by combining 2 responses concerning this technology for consultations. The perceived usefulness of mHealth apps was measured by combining 2 responses concerning their usefulness for booking doctor appointments and for communicating patient-reported outcomes to doctors. Results: The majority (1239/2003, 62\%) of respondents considered the use of mHealth apps useful, while only 27.6\% (551/2003) declared VRB useful. The factors associated with the perceived usefulness of both technologies were younger age (? 55 years), trust in political representatives (VRB: adjusted odds ratio [aOR] 1.68, 95\% CI 1.31-2.17; mHealth apps: aOR 1.88, 95\% CI 1.42-2.48), and higher (sufficient and excellent) health literacy. The period of the beginning of the COVID-19 epidemic, living in an urban area, and being limited in daily activities were also associated with perceiving VRB positively. The perceived usefulness of mHealth apps increased with the level of education. It was also higher in people who had 3 or more consultations with a medical specialist. Conclusions: There are important differences in attitudes toward new ICTs. Perceived usefulness was lower for VRB than for mHealth apps. Moreover, it decreased after the initial months of the COVID-19 pandemic. There is also the possibility of new inequalities. Hence, despite the potential benefits of VRB and mHealth apps, people with low health literacy considered them to be of little use for their health care, possibly increasing their difficulties in accessing health care in the future. As such, health care providers and policy makers need to consider those perceptions to guarantee that new ICTs are accessible and beneficial to all. ",
doi="10.2196/45822",
url="https://www.jmir.org/2023/1/e45822",
url="http://www.ncbi.nlm.nih.gov/pubmed/37327032"
}


@Article{info:doi/10.2196/46031,
author="Shah, Asghar
and Saliba, Elie",
title="Gender and Ethnic Disparities in Teledermatology Clinical Trial Participants: Cross-Sectional Analysis of ClinicalTrials.gov-Registered Trials",
journal="JMIR Dermatol",
year="2023",
month="Jun",
day="13",
volume="6",
pages="e46031",
keywords="teledermatology",
keywords="tele",
keywords="gender disparities",
keywords="clinical trial",
keywords="ClinicalTrials.gov",
keywords="gender",
keywords="disparity",
keywords="disparities",
keywords="ethnic",
keywords="dermatology",
keywords="research subject",
keywords="participant",
keywords="skin",
keywords="derma",
keywords="derm",
keywords="dermatologist",
keywords="epidermis",
doi="10.2196/46031",
url="https://derma.jmir.org/2023/1/e46031",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632945"
}


@Article{info:doi/10.2196/40425,
author="Aldosari, Nasser
and Ahmed, Saima
and McDermott, Jane
and Stanmore, Emma",
title="The Use of Digital Health by South Asian Communities: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="12",
volume="25",
pages="e40425",
keywords="South Asians",
keywords="Asia",
keywords="digital health",
keywords="eHealth",
keywords="mHealth",
keywords="mobile health",
keywords="aging",
keywords="ethnicity",
keywords="ethnic",
keywords="culturally sensitive",
keywords="cultural sensitivity",
keywords="inequality",
keywords="inequalities",
keywords="disparity",
keywords="disparities",
keywords="physical activity",
keywords="exercise",
keywords="immigrant",
keywords="scoping review",
keywords="experience",
keywords="attitude",
keywords="barrier",
keywords="facilitator",
keywords="opinion",
keywords="adoption",
keywords="digital divide",
keywords="accessibility",
keywords="minority",
keywords="mobile phone",
abstract="Background: South Asian individuals experience a higher burden of chronic diseases and limited access to health care services compared with their Caucasian peers. Digital health interventions can enhance the delivery of health care, minimize health inequities, and consequently improve health status among minority ethnic groups. However, it is unclear how South Asian people view and perceive the use of digital health technologies to support their health needs. Objective: The aim of the review is to identify South Asian individuals' experiences and attitudes of digital health and explore the barriers and facilitators affecting their use of digital health services. Methods: The Arksey and O'Malley methodological framework was used to guide this scoping review. Five electronic databases were examined for pertinent papers, which were augmented by searching bibliographies of the retrieved papers and gray literature. A total of 1328 potentially relevant papers were retrieved from the initial search, and the supplemental search added 7 papers to the final list of potentially included papers. Each paper on the initial inclusion list was independently reviewed, leaving 15 papers to be included in the review. Results: Data were analyzed thematically leading to the development of two overarching themes: (1) barriers to uptake of digital health and (2) facilitators of use of digital health services. There was a general consensus that South Asian communities still struggle with inadequate access to digital health technologies. Some studies suggest multiple initiatives to improve accessibility and acceptability of digital health services within South Asian communities in order to mitigate health disparities and develop a more inclusive health care system. These include the development of multiple-language and culturally sensitive interventions and digital skill development sessions. Most studies were conducted in South Asian countries, focusing on measurable outcomes of digital health interventions. Few explored the experiences and views of South Asian community members residing in the West as a minority ethnic group, for example, British South Asians. Conclusions: Literature mapping proposes that South Asian people frequently struggle with a health care system that may limit their access to digital health services, and sometimes fails to consider social and cultural needs. There is growing evidence that digital health interventions have the potential to facilitate supported self-management, which is part of the plans to adopt person-centered care. These interventions are particularly important for overcoming some of the challenges, for example, time constraints, safety, and gender sensitivity, associated with the delivery of health care interventions in minority ethnic groups such as South Asians in the United Kingdom, and thus to improve minority ethnic groups' access to health care services to support individual health needs, and consequently enhance health status. ",
doi="10.2196/40425",
url="https://www.jmir.org/2023/1/e40425",
url="http://www.ncbi.nlm.nih.gov/pubmed/37307045"
}


@Article{info:doi/10.2196/45890,
author="Loomba, Lindsey
and Bonanno, Shaila
and Arellano, Diana
and Crossen, Stephanie
and Glaser, Nicole",
title="Disparities in Insulin Pump Use Among Spanish-Speaking Children With Type 1 Diabetes Compared to Their Non-Hispanic White Peers: Mixed Methods Study",
journal="JMIR Diabetes",
year="2023",
month="Jun",
day="9",
volume="8",
pages="e45890",
keywords="disparities",
keywords="type 1 diabetes",
keywords="Spanish-speaking",
keywords="insulin pump",
keywords="children",
keywords="diabetes",
keywords="diabetes mellitus",
keywords="insulin",
keywords="glucose monitoring",
abstract="Background: Disparities in Insulin Pump Use Among Spanish-Speaking Children With Type 1 Diabetes Compared to Their Non-Hispanic White Peers: Mixed Methods Study Objective: We aimed to investigate the use of insulin pumps and continuous glucose monitoring (CGM) devices among Spanish-language--preferring children in our clinic population and to identify specific barriers to technology use. Methods: First, we assessed rates and patterns of diabetes technology use (eg, insulin pumps and CGM devices) in a sample of 76 children (38 Spanish-language preferring and 38 non-Hispanic White). We compared rates of technology use, average length of time between diabetes diagnosis and initiation of insulin pump or CGM device, and rates of discontinuation of these devices between the Spanish-language--preferring and non-Hispanic White children. Second, to understand specific barriers to technology use, we compared responses to a questionnaire assessing decision-making about insulin pumps. Results: Spanish-language--preferring patients had lower rates of insulin pump use, even after controlling for age, gender, age at diagnosis, and type of health insurance. Spanish-language--preferring participants were more likely to report concerns over learning to use an insulin pump and were more likely to discontinue using an insulin pump after starting one. Conclusions: These data confirm demographic disparities in insulin pump use among children with T1D and provide new insights about insulin pump discontinuation among Spanish-language--preferring children. Our findings suggest a need for improved patient education about insulin pump technology in general and improved support for Spanish-language--preferring families with T1D after initiation of pump therapy. ",
doi="10.2196/45890",
url="https://diabetes.jmir.org/2023/1/e45890",
url="http://www.ncbi.nlm.nih.gov/pubmed/37294607"
}


@Article{info:doi/10.2196/42205,
author="Nontarak, Jiraluck
and Bundhamcharoen, Kanitta
and Prasitsiriphon, Orawan
and Aekplakorn, Wichai",
title="The Association of Sociodemographic Variables and Unhealthy Behaviors With Limitations in Activities of Daily Living Among Thai Older Adults: Cross-sectional Study and Projected Trends Over the Next 20 Years",
journal="Asian Pac Isl Nurs J",
year="2023",
month="Jun",
day="6",
volume="7",
pages="e42205",
keywords="ADL limitation",
keywords="National Health Examination Survey",
keywords="older adults",
keywords="activities of daily living",
keywords="physical activity",
keywords="disability",
abstract="Background: Extended life spans have led to an increase in the number of older people and an increase in the prevalence of disability among people older than 60\thinspaceyears of age. Objective: This study aims to investigate the association of sociodemographic variables and unhealthy behaviors with limitations in activities of daily living (ADL) among Thai older adults. The study also projects the number of older individuals likely to experience ADL limitations in the next 20 years. Methods: We performed sex-specific multinomial logistic regression analysis based on the 5th Thai National Health Examination Survey in 2014 to investigate the association between sociodemographic variables and health behaviors with ADL limitations among Thai older adults. Age- and sex-specific prevalence estimates of ADL limitations were obtained by applying the same models. These estimates were combined with population projections up to 2040 from the Office of the National Economic and Social Development Board, Thailand, to generate projections of older individuals with ADL limitations. Results: Age and physical activity were significant factors for both sexes, with age positively associated with the level of ADL limitations and low physical activity associated with an increased relative probability of mild or moderate to severe ADL limitations compared to individuals with no ADL limitation (1.2-2.2 times). Other variables such as education, marital status, diabetes, hypertension, smoking, alcohol consumption, and having a fruit- and vegetable-based diet showed significant associations, but the results varied regarding sex and levels of ADL limitations. This study also projected the number of older adults with mild and moderate to severe ADL limitations over the next 20 years from 2020 to 2040, revealing an increase of 3.2 and 3.1 times, respectively, along with a significant increase in men compared to that in women. Conclusions: This study identified age and physical activity as significant factors associated with ADL limitations in older adults, while other factors showed varying associations. Over the next 2 decades, projections suggest a significant increase in the number of older adults with ADL limitations, particularly men. Our findings emphasize the importance of interventions to reduce ADL limitations, and health care providers should consider various factors impacting them. ",
doi="10.2196/42205",
url="https://apinj.jmir.org/2023/1/e42205",
url="http://www.ncbi.nlm.nih.gov/pubmed/37279055"
}


@Article{info:doi/10.2196/46721,
author="Zhou, Weijiao
and Cho, Youmin
and Shang, Shaomei
and Jiang, Yun",
title="Use of Digital Health Technology Among Older Adults With Cancer in the United States: Findings From a National Longitudinal Cohort Study (2015-2021)",
journal="J Med Internet Res",
year="2023",
month="May",
day="31",
volume="25",
pages="e46721",
keywords="digital health",
keywords="technology",
keywords="older adults",
keywords="cancer",
keywords="survivorship",
keywords="cancer survivor",
keywords="older cancer survivors",
keywords="digital health technology",
abstract="Background: Despite the benefits of digital health technology use, older adults with cancer (ie, aged 65 years) have reported challenges to technology adoption. However, there has been a lack of a good understanding of their digital health technology use patterns and the associated influential factors in the past few years. Objective: This study aimed to examine the trends in and factors associated with digital health technology use among older adults with cancer. Methods: The National Health and Aging Trends Study (NHATS) data set is a national longitudinal cohort study with annual survey waves of Medicare beneficiaries 65 years and older. Participants were community-dwelling older adults who self-reported previous or current cancer diagnoses in each round. The study sample size of each round ranged from 1996 (2015) to 1131 (2021). Digital health technology use was defined as using the internet or online in the last month to order or refill prescriptions, contact medical providers, handle Medicare or other insurance matters, or get information about their health conditions. The association of sociodemographics, clinical factors (self-rated health, chronic conditions, difficulties in activities of daily living, dementia, anxiety, and depression), and physical function (Short Physical Performance Battery and grip strength) with digital health technology use was examined using design-based logistic regression. All statistical analyses accounted for the complex sample design. Results: The prevalence of any digital health technology use increased from 36\% in 2015 to 45\% in 2019. In 2020-2021, which was amid the COVID-19 pandemic, it ranged from 51\% to 52\%. In terms of each digital health technology use behavior, in 2015, overall, 28\% of older cancer survivors used digital health technology to obtain health information, followed by contacting clinicians (19\%), filling prescriptions (14\%), and handling insurance (11\%). Greater use of digital health technology was associated with younger age, being White, having a college or higher education, having a higher income, having more comorbidities, nondementia, and having a higher gait speed. Conclusions: Digital health technology use in older adults with cancer has gradually increased, particularly during the COVID-19 pandemic. However, socioeconomic and racial disparities have remained in older cancer survivors. Additionally, older adults with cancer may have some unique features associated with digital health technology use; for example, their use of digital health may be increased by their comorbidities (ie, health care needs) and reduced by their frailty. ",
doi="10.2196/46721",
url="https://www.jmir.org/2023/1/e46721",
url="http://www.ncbi.nlm.nih.gov/pubmed/37256672"
}


@Article{info:doi/10.2196/43132,
author="Rocha, Paulo
and Pinheiro, Diego
and de Paula Monteiro, Rodrigo
and Tubert, Ela
and Romero, Erick
and Bastos-Filho, Carmelo
and Nuno, Miriam
and Cadeiras, Martin",
title="Adaptive Content Tuning of Social Network Digital Health Interventions Using Control Systems Engineering for Precision Public Health: Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="May",
day="31",
volume="25",
pages="e43132",
keywords="psychosocial intervention",
keywords="social network",
keywords="SNI",
keywords="social network intervention",
keywords="precision medicine",
keywords="precision public health",
keywords="organ donation",
keywords="organ procurement",
keywords="public awareness",
keywords="social media",
keywords="systems analysis",
keywords="tissue and organ procurement",
keywords="adaptive clinical trial",
keywords="proportional integral derivative",
keywords="patient education",
keywords="digital health",
abstract="Background: Social media has emerged as an effective tool to mitigate preventable and costly health issues with social network interventions (SNIs), but a precision public health approach is still lacking to improve health equity and account for population disparities. Objective: This study aimed to (1) develop an SNI framework for precision public health using control systems engineering to improve the delivery of digital educational interventions for health behavior change and (2) validate the SNI framework to increase organ donation awareness in California, taking into account underlying population disparities. Methods: This study developed and tested an SNI framework that uses publicly available data at the ZIP Code Tabulation Area (ZCTA) level to uncover demographic environments using clustering analysis, which is then used to guide digital health interventions using the Meta business platform. The SNI delivered 5 tailored organ donation--related educational contents through Facebook to 4 distinct demographic environments uncovered in California with and without an Adaptive Content Tuning (ACT) mechanism, a novel application of the Proportional Integral Derivative (PID) method, in a cluster randomized trial (CRT) over a 3-month period. The daily number of impressions (ie, exposure to educational content) and clicks (ie, engagement) were measured as a surrogate marker of awareness. A stratified analysis per demographic environment was conducted. Results: Four main clusters with distinctive sociodemographic characteristics were identified for the state of California. The ACT mechanism significantly increased the overall click rate per 1000 impressions ($\beta$=.2187; P<.001), with the highest effect on cluster 1 ($\beta$=.3683; P<.001) and the lowest effect on cluster 4 ($\beta$=.0936; P=.053). Cluster 1 is mainly composed of a population that is more likely to be rural, White, and have a higher rate of Medicare beneficiaries, while cluster 4 is more likely to be urban, Hispanic, and African American, with a high employment rate without high income and a higher proportion of Medicaid beneficiaries. Conclusions: The proposed SNI framework, with its ACT mechanism, learns and delivers, in real time, for each distinct subpopulation, the most tailored educational content and establishes a new standard for precision public health to design novel health interventions with the use of social media, automation, and machine learning in a form that is efficient and equitable. Trial Registration: ClinicalTrials.gov NTC04850287; https://clinicaltrials.gov/ct2/show/NCT04850287 ",
doi="10.2196/43132",
url="https://www.jmir.org/2023/1/e43132",
url="http://www.ncbi.nlm.nih.gov/pubmed/37256680"
}


@Article{info:doi/10.2196/40709,
author="Fridman, Ilona
and Smalls, Ahmaya
and Fleming, Patrice
and Elston Lafata, Jennifer",
title="Preferences for Electronic Modes of Communication Among Older Primary Care Patients: Cross-sectional Survey",
journal="JMIR Form Res",
year="2023",
month="May",
day="24",
volume="7",
pages="e40709",
keywords="electronic communication",
keywords="patient preferences",
keywords="digital health",
keywords="patient portals",
keywords="physician-patient communication",
keywords="communication",
keywords="text",
keywords="phone",
keywords="test",
keywords="treatment",
keywords="clinical",
keywords="vaccination",
keywords="survey",
keywords="intervention",
keywords="screening",
keywords="social media",
keywords="information",
abstract="Background: Health information delivered via daily modes of communication such as email, text, or telephone reportedly supports improved health behavior and outcomes. While different modes of communication beyond clinical visits have proven successful for patient outcomes, preferences for communication modes have not been comprehensively studied among older primary care patients. We addressed this gap by assessing patient preferences for receiving cancer screening and other information from their doctors' offices. Objective: We explored stated preferences by communication modes through the lens of social determinants of health (SDOH) to gauge acceptability and equity implications for future interventions. Methods: A cross-sectional survey was mailed to primary care patients aged 45-75 years, in 2020-2021, which assessed respondents' use of telephones, computers, or tablets in daily life and their preferred modes of communication for different types of health information, including educational materials about cancer screening, tips for taking prescription medication, and protection from respiratory diseases from their doctors' offices. Respondents indicated their willingness to receive messages from their doctors' offices via each of the provided modes of communication, including telephone, text, email, patient portals, websites, and social media, on a 5-point Likert scale ranging from ``unwilling'' to ``willing.'' We present the percentage of respondents who indicated that they were ``willing'' to receive information via specific electronic mode. Chi-square tests were used to compare participants' willingness by social characteristics. Results: In total, 133 people completed the survey (response rate 27\%). The average respondent age was 64 years, 82 (63\%) respondents were female, 106 (83\%) were White, 20 (16\%) were Black, and 1 (1\%) was Asian. In total, 75 (58\%) respondents had a bachelor's degree or higher; 26 (20\%) resided in rural areas, 37 (29\%) in suburban areas, 50 (39\%) in a town, and 15 (12\%) in a city. The majority, 73 (57\%), reported being comfortable with their income. Preferences of respondents for electronic communication about cancer screening were distributed as follows: 100 (75\%) respondents were willing to receive information from their doctor's office via their patient portal, 98 (74\%) via email, 75 (56\%) via text, 60 (45\%) via the hospital website, 50 (38\%) via telephone, and 14 (11\%) via social media. About 6 (5\%) respondents were unwilling to receive any communication via electronic modes. Preferences were distributed similarly for other types of information. Respondents reporting lesser income and education consistently preferred receiving telephone calls relative to other communication modes. Conclusions: To optimize health communication and reach a socioeconomically diverse population, telephone calls should be added to electronic communication, especially for people with less income and education. Further research needs to identify the underlying reasons for the observed differences and how best to ensure that socioeconomically diverse groups of older adults can access reliable health information and health care services. ",
doi="10.2196/40709",
url="https://formative.jmir.org/2023/1/e40709",
url="http://www.ncbi.nlm.nih.gov/pubmed/37223979"
}


@Article{info:doi/10.2196/40103,
author="Gupta, C. Juhi
and Arora, M. Vineet
and Vollbrecht, Hanna
and Kappel, Nicole
and Meltzer, O. David
and Press, G. Valerie",
title="The Relationship Between Insufficient Vision and Technology Access and Use Among Hospitalized Adults at an Urban Academic Hospital: Observational Study",
journal="JMIR Form Res",
year="2023",
month="May",
day="24",
volume="7",
pages="e40103",
keywords="vision",
keywords="health technology",
keywords="chronic disease",
keywords="ownership",
keywords="internet",
keywords="eHealth",
keywords="digital health",
keywords="eye",
keywords="optometry",
keywords="myopia",
keywords="ophthalmology",
keywords="myopic",
keywords="digital device",
keywords="observational study",
keywords="use",
keywords="visual impairment",
keywords="visually impaired",
abstract="Background: The role of sufficient vision in self-management is salient with respect to the growing prevalence of eHealth-based interventions for chronic diseases. However, the relationship between insufficient vision and self-management has been understudied. Objective: We aimed to assess differences in access to and use of technology among adults with and without insufficient vision at an academic urban hospital. Methods: This is an observational study of hospitalized adult general medicine patients that is part of a larger quality improvement study called the hospitalist study. The hospitalist study provided demographic and health literacy data (Brief Health Literacy Screen). Our substudy included several measures. Validated surveys assessed technology access and use, and included benchmarked questions from the National Pew Survey to determine access to, willingness to use, and self-described ability to use technology at home, particularly for self-management, and eHealth-specific questions assessing future willingness to access eHealth post discharge. The eHealth Literacy Scale (eHEALS) was used to assess eHealth literacy. Visual acuity was assessed using the Snellen pocket eye chart with low vision defined as visual acuity ?20/50 in at least one eye. Descriptive statistics, bivariate chi-square analyses, and multivariate logistic regressions (adjusted for age, race, gender, education level, and eHealth literacy) were performed using Stata. Results: A total of 59 participants completed our substudy. The mean age was 54 (SD 16.4) years. Demographic data from the hospitalist study was missing for several participants. Among those who responded, most identified as Black (n=34, 79\%) and female (n=26, 57\%), and most reported at least some college education (n=30, 67\%). Most participants owned technology devices (n=57, 97\%) and had previously used the internet (n=52, 86\%), with no significant differences between those with insufficient and sufficient vision (n=34 vs n=25). Though there was a 2x effect size for laptop ownership, with those with sufficient vision more likely to own a laptop, those with insufficient vision versus sufficient vision were less likely to report an ability to perform online tasks without assistance, including using a search engine (n=22, 65\% vs n=23, 92\%; P=.02), opening an attachment (n=17, 50\% vs n=22, 88\%; P=.002), and using an online video (n=20, 59\% vs n=22, 88\%; P=.01). In multivariate analysis, the ability to independently open an online attachment did not remain statistically significant (P=.01). Conclusions: Technology device ownership and internet use rates are high in this population, yet participants with insufficient vision (vs sufficient vision) reported a reduced ability to independently perform online tasks. To ensure the effective use of eHealth technologies by at-risk populations, the relationship between vision and technology use needs to be further studied. ",
doi="10.2196/40103",
url="https://formative.jmir.org/2023/1/e40103",
url="http://www.ncbi.nlm.nih.gov/pubmed/37223969"
}


@Article{info:doi/10.2196/40818,
author="Gajewski, D. Patrick
and Rieker, A. Jennifer
and Athanassiou, Georgios
and Br{\"o}de, Peter
and Claus, Maren
and Golka, Klaus
and Hengstler, G. Jan
and Kleinsorge, Thomas
and Nitsche, A. Michael
and Reinders, J{\"o}rg
and Tisch, Anita
and Watzl, Carsten
and Wascher, Edmund
and Getzmann, Stephan",
title="A Systematic Analysis of Biological, Sociodemographic, Psychosocial, and Lifestyle Factors Contributing to Work Ability Across the Working Life Span: Cross-sectional Study",
journal="JMIR Form Res",
year="2023",
month="May",
day="19",
volume="7",
pages="e40818",
keywords="aging",
keywords="cognitive aging",
keywords="cardiovascular system",
keywords="immunology",
keywords="lifestyle",
keywords="metabolism",
keywords="occupational safety and health",
keywords="public health",
keywords="psychosocial stress",
keywords="work ability",
keywords="mobile phone",
abstract="Background: As employees age, their physical and mental abilities decline and work ability decreases, enhancing the risk for long-term sick leave or even premature retirement. However, the relative impact of biological and environmental determinants on work ability with increasing age is poorly understood in terms of their complexity. Objective: Previous research has shown relationships between work ability and job and individual resources, as well as specific demographic and lifestyle-related variables. However, other potentially important predictors of work ability remain unexplored, such as personality traits and biological determinants, including cardiovascular, metabolic, immunological, and cognitive abilities or psychosocial factors. Our aim was to systematically evaluate a wide range of factors to extract the most crucial predictors of low and high work ability across the working life span. Methods: As part of the Dortmund Vital Study, 494 participants from different occupational sectors, aged between 20 and 69 years, completed the Work Ability Index (WAI) assessing employee's mental and physical resources. A total of 30 sociodemographic variables were grouped into 4 categories (social relationships, nutrition and stimulants, education and lifestyle, and work related), and 80 biological and environmental variables were grouped into 8 domains (anthropometric, cardiovascular, metabolic, immunologic, personality, cognitive, stress related, and quality of life) and have been related to the WAI. Results: Using the analyses, we extracted important sociodemographic factors influencing work ability, such as education, social activities, or sleep quality, and identified age-dependent and age-independent determinants of work ability. Regression models explained up to 52\% of the WAI variance. Negative predictors of work ability were chronological and immunological age, immunological inefficiency, BMI, neuroticism, psychosocial stress, emotional exhaustion, demands from work, daily cognitive failures, subclinical depression, and burnout symptoms. Positive predictors were maximum heart rate during ergometry, normal blood pressure, hemoglobin and monocyte concentration, weekly physical activity, commitment to the company, pressure to succeed, and good quality of life. Conclusions: The identified biological and environmental risk factors allowed us to evaluate work ability in its complexity. Policy makers, employers, and occupational safety and health personnel should consider the modifiable risk factors we identified to promote healthy aging at work through focused physical, dietary, cognitive, and stress-reduced preventive programs, in addition to well-balanced working conditions. This may also increase the quality of life, commitment to the job, and motivation to succeed, which are important factors to maintain or even enhance work ability in the aging workforce and to prevent early retirement. Trial Registration: ClinicalTrials.gov NCT05155397; https://clinicaltrials.gov/ct2/show/NCT05155397 International Registered Report Identifier (IRRID): RR2-10.2196/32352 ",
doi="10.2196/40818",
url="https://formative.jmir.org/2023/1/e40818",
url="http://www.ncbi.nlm.nih.gov/pubmed/37204831"
}


@Article{info:doi/10.2196/42707,
author="Braz, Rodrigues Patricia
and Moreira, Ricardo Tiago
and Ribeiro, Queiroz Andr{\'e}ia
and de Faria, Ribeiro Luciane
and Carbogim, Costa Fabio da
and P{\"u}schel, Ara{\'u}jo Vilanice Alves de
and Fhon, Silva Jack Roberto
and Freitas, Rezende Eduarda
and Pinto, Carvalho Ione
and Zacharias, Machado Fabiana Costa
and Cruz, Panitz Gylce Eloisa Cabreira
and Machado, Miranda Richardson
and Santana, Ferreira Rosimere
and de Souza, Alfradique Priscilla
and Bitencourt, Ribeiro Graziele
and Bulgarelli, Favero Alexandre
and Cavalcante, Bezerra Ricardo",
title="COVID-19 Infodemic and Impacts on the Mental Health of Older People: Cross-sectional Multicenter Survey Study",
journal="JMIR Aging",
year="2023",
month="May",
day="17",
volume="6",
pages="e42707",
keywords="information dissemination",
keywords="health communication",
keywords="COVID-19",
keywords="COVID-19 pandemic",
keywords="public health",
keywords="health of older people",
keywords="mental health",
abstract="Background: The COVID-19 pandemic received widespread media coverage due to its novelty, an early lack of data, and the rapid rise in deaths and cases. This excessive coverage created a secondary ``infodemic'' that was considered to be a serious public and mental health problem by the World Health Organization and the international scientific community. The infodemic particularly affected older individuals, specifically those who are vulnerable to misinformation due to political positions, low interpretive and critical analysis capacity, and limited technical-scientific knowledge. Thus, it is important to understand older people's reaction to COVID-19 information disseminated by the media and the effect on their lives and mental health. Objective: We aimed to describe the profile of exposure to COVID-19 information among older Brazilian individuals and the impact on their mental health, perceived stress, and the presence of generalized anxiety disorder (GAD). Methods: This cross-sectional, exploratory study surveyed 3307 older Brazilians via the web, social networks, and email between July 2020 and March 2021. Descriptive analysis and bivariate analysis were performed to estimate associations of interest. Results: Major proportions of the 3307 participants were aged 60 to 64 years (n=1285, 38.9\%), female (n=2250, 68.4\%), and married (n=1835, 55.5\%) and self-identified as White (n=2364, 71.5\%). Only 295 (8.9\%) had never started or completed a basic education. COVID-19 information was mainly accessed on television (n=2680, 81.1\%) and social networks (n=1943, 58.8\%). Television exposure was ?3 hours in 1301 (39.3\%) participants, social network use was 2 to 5 hours in 1084 (32.8\%) participants, and radio exposure was ?1 hour in 1223 (37\%) participants. Frequency of exposure to social networks was significantly associated with perceived stress (P=.04) and GAD (P=.01). A Bonferroni post hoc test revealed significantly different perceived stress in participants who were exposed to social networks for 1 hour (P=.04) and those who had no exposure (P=.04). A crude linear regression showed that ``some'' social media use (P=.02) and 1 hour of exposure to social media (P<.001) were associated with perceived stress. Adjusting for sociodemographic variables revealed no associations with this outcome variable. In a crude logistic regression, some social media use (P<.001) and 2 to 5 hours of exposure to social media (P=.03) were associated with GAD. Adjusting for the indicated variables showed that some social network use (P<.001) and 1 hour (P=.04) and 2 to 5 hours (P=.03) of exposure to social media were associated with GAD. Conclusions: Older people, especially women, were often exposed to COVID-19--related information through television and social networks; this affected their mental health, specifically GAD and stress. Thus, the impact of the infodemic should be considered during anamnesis for older people, so that they can share their feelings about it and receive appropriate psychosocial care. ",
doi="10.2196/42707",
url="https://aging.jmir.org/2023/1/e42707",
url="http://www.ncbi.nlm.nih.gov/pubmed/37195762"
}


@Article{info:doi/10.2196/44564,
author="Schroeder, Tanja
and Dodds, Laura
and Georgiou, Andrew
and Gewald, Heiko
and Siette, Joyce",
title="Older Adults and New Technology: Mapping Review of the Factors Associated With Older Adults' Intention to Adopt Digital Technologies",
journal="JMIR Aging",
year="2023",
month="May",
day="16",
volume="6",
pages="e44564",
keywords="technology adoption",
keywords="digital technology",
keywords="older adults",
keywords="seniors",
keywords="intention to use digital technologies",
abstract="Background: Ongoing advancements in digital solutions support older adults' healthy aging and well-being. However, a unified synthesis of sociodemographic, cognitive, attitudinal, emotional, and environmental factors that influence older adults' intention to use these new digital technologies is still lacking. Understanding the salient factors that influence older adults' intention to use digital technologies will help to ensure that technology is developed appropriately and contextually. This understanding is also likely to contribute to developing technology acceptance models specifically for the aging generation, by reorganizing principles and constructing objectivity criteria for future research studies. Objective: This review aims to identify the key factors associated with older adults' intention to use digital technologies and to provide a comprehensive conceptual framework to describe the relationships between these key factors and older adults' intention to use digital technologies. Methods: A mapping review was conducted using 9 databases from inception to November 2022. Articles were selected for review if they had an evaluative component of older adults' intention to use digital technologies. Three researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review and quality appraisal was measured using 3 different tools based on each article's study design. Results: We identified a total of 59 articles investigating older adults' intention to use digital technologies. The majority (40/59, 68\%) of articles did not use an existing framework or model for technology acceptance. Studies mostly adopted a quantitative research design (27/59, 46\%). We found 119 unique factors reported to influence older adults' intention to use digital technologies. These were categorized into 6 distinct themes: Demographics and Health Status, Emotional Awareness and Needs, Knowledge and Perception, Motivation, Social Influencers, and Technology Functional Features. Conclusions: Given the importance of global demographic change toward an aging society, there is surprisingly limited research on the factors that influence older adults' intention to use digital technologies. Our identification of the key factors across different types of digital technology and models supports the future integration of a comprehensive perspective encompassing environmental, psychological, and social determinants for older adults' intention to use digital technologies. ",
doi="10.2196/44564",
url="https://aging.jmir.org/2023/1/e44564",
url="http://www.ncbi.nlm.nih.gov/pubmed/37191976"
}


@Article{info:doi/10.2196/43604,
author="Williams, Cynthia
and Shang, Di",
title="Telehealth Usage Among Low-Income Racial and Ethnic Minority Populations During the COVID-19 Pandemic: Retrospective Observational Study",
journal="J Med Internet Res",
year="2023",
month="May",
day="12",
volume="25",
pages="e43604",
keywords="COVID-19",
keywords="telehealth",
keywords="health equity",
keywords="minority health",
keywords="low income",
keywords="healthcare access",
keywords="pandemic",
keywords="USA",
keywords="United States",
keywords="healthcare system",
keywords="health care",
keywords="risk",
keywords="minority",
keywords="database",
keywords="utilization",
keywords="education",
abstract="Background: Despite considerable efforts to encourage telehealth use during the COVID-19 pandemic, we witnessed a potential widening of health inequities that may continue to plague the US health care system unless we mitigate modifiable risk factors. Objective: This study aimed to examine the hypothesis that there are systemic differences in telehealth usage among people who live at or below 200\% of the federal poverty level. Factors that we consider are age, gender, race, ethnicity, education, employment status, household size, and income. Methods: A retrospective observational study was performed using the COVID-19 Research Database to analyze factors contributing to telehealth inequities. The study period ranged from March 2020 to April 2021. The Office Ally database provided US claims data from 100 million unique patients and 3.4 billion claims. The Analytics IQ PeopleCore Consumer database is nationally representative of 242.5 million US adults aged 19 years and older. We analyzed medical claims to investigate the influence of demographic and socioeconomic factors on telehealth usage among the low-income racial and ethnic minority populations. We conducted a multiple logistic regression analysis to determine the odds of patients in diverse groups using telehealth during the study period. Results: Among 2,850,831 unique patients, nearly 60\% of them were female, 75\% of them had a high school education or less, 49\% of them were unemployed, and 62\% of them identified as non-Hispanic White. Our results suggest that 9.84\% of the patients had ?1 telehealth claims during the study period. Asian (odds ratio [OR] 1.569, 95\% CI 1.528-1.611, P<.001) and Hispanic (OR 1.612, 95\% CI 1.596-1.628, P<.001) patients were more likely to use telehealth than non-Hispanic White and -Black patients. Patients who were employed full-time were 15\% (OR 1.148, 95\% CI 1.133-1.164, P<.001) more likely to use telehealth than unemployed patients. Patients who identified as male were 12\% (OR 0.875, 95\% CI 0.867-0.883, P<.001) less likely to use telehealth than those who identified as female. Patients with high school education or less were 5\% (OR 0.953, 95\% CI 0.944-0.962, P<.001) less likely to use telehealth than those with a bachelor's degree or higher. Patients in the 18-44--year age group were 32\% (OR 1.324, 95\% CI 1.304-1.345, P<.001) more likely to use telehealth than those in the ?65-year age group. Conclusions: Factors that impact telehealth usage include age, gender, race, education, employment status, and income. While low-income racial and ethnic minority communities are at greater risk for health inequities among this group, Hispanic communities are more likely to use telehealth, and non-Hispanic Black patients continue to demonstrate telehealth inequity. Gender, age, and household income contribute to health inequities across gradients of poverty. Strategies to improve health use should consider characteristics of subgroups, as people do not experience poverty equally. ",
doi="10.2196/43604",
url="https://www.jmir.org/2023/1/e43604",
url="http://www.ncbi.nlm.nih.gov/pubmed/37171848"
}


@Article{info:doi/10.2196/44501,
author="Cheng, Jessica
and Arora, M. Vineet
and Kappel, Nicole
and Vollbrecht, Hanna
and Meltzer, O. David
and Press, Valerie",
title="Assessing Disparities in Video-Telehealth Use and eHealth Literacy Among Hospitalized Patients: Cross-sectional Observational Study",
journal="JMIR Form Res",
year="2023",
month="May",
day="12",
volume="7",
pages="e44501",
keywords="health literacy",
keywords="eHealth literacy",
keywords="telehealth",
keywords="transitions of care, digital divide",
keywords="telemedicine",
keywords="technology use",
keywords="video consultation",
keywords="urban population",
keywords="digital health literacy",
keywords="patient care",
abstract="Background: Medicare coverage for audio-only telehealth is slated to end this year after the public health emergency concludes. When the time comes, many patients may be unable to make the transition from audio-only to video telehealth due to digital inexperience. This study explores the second digital divide within video telehealth use, which is primarily characterized by skills and capabilities rather than access, by measuring eHealth literacy (eHL) and video capabilities in hospitalized patients. Objective: The aim of this study is to evaluate video capabilities, eHealth literacy, and engagement with video telehealth among hospitalized patients. Methods: The study design is a cross-sectional observational study of adult inpatients at the University of Chicago Medical Center. We assessed self-reported rates of audio versus video telehealth usage as well as the participants' self-reported willingness to use video telehealth for future health care visits. We used a multivariable binary logistic regression to determine the odds ratio for being unwilling to use video telehealth, adjusted for age, sex, race or ethnicity, educational level, eHL literacy scale (eHEALS), health literacy (brief health literacy screen), technology access, internet access, and video capability. Results: Of the 297 enrolled participants, median age was 58 years, most (n=185, 62\%) identified as Black, half (n=149, 50\%) were female, one-quarter (n=66, 22\%) lacked home internet access, and one-third (n=102, 34\%) had inadequate eHL. Conclusions: Patients with low eHL reported greater participation in audio-only telehealth over video telehealth, of which the former may lose its flexible pandemic reimbursement policy. This may widen the existing health disparities as older adults and patients with low eHL face challenges in accessing video telehealth services. Low eHL is associated with lack of web-based skills, lower rates of video telehealth usage, and lower willingness to use video technology. The study results raise the question of how to improve video capability among patients who, despite having access to smartphones and laptops, face challenges in using telehealth optimally. ",
doi="10.2196/44501",
url="https://formative.jmir.org/2023/1/e44501",
url="http://www.ncbi.nlm.nih.gov/pubmed/37171854"
}


@Article{info:doi/10.2196/43961,
author="Alatorre, Selenne
and Schwarz, G. Aviva
and Egan, A. Kelsey
and Feldman, R. Amanda
and Rosa, Marielis
and Wang, L. Monica",
title="Exploring Social Media Preferences for Healthy Weight Management Interventions Among Adolescents of Color: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2023",
month="May",
day="8",
volume="6",
pages="e43961",
keywords="social media",
keywords="adolescents of color",
keywords="obesity disparities",
keywords="disparity",
keywords="disparities",
keywords="healthy weight management",
keywords="health education",
keywords="child health",
keywords="mHealth",
keywords="mobile health",
keywords="weight",
keywords="obese",
keywords="obesity",
keywords="child",
keywords="pediatric",
keywords="adolescent",
keywords="adolescence",
keywords="preference",
keywords="health behavior",
keywords="mobile phone",
abstract="Background: Social media holds promise as an intervention platform to engage youths in healthy weight management and target racial inequities in obesity. Objective: This mixed methods study aimed to examine social media habits, preferences, and obesity-related behaviors (eg, diet and physical activity) among adolescents of color and understand preferences for healthy weight management interventions delivered via social media. Methods: This mixed methods study is comprised of a cross-sectional web-based survey and a series of digital focus groups. Study participants (English-speaking youths of color ages 14-18 years) were recruited from high schools and youth-based community settings in Massachusetts and California. For surveys, participants were invited to complete an anonymous web-based survey assessing self-reported sociodemographics, social media habits and preferences, health behaviors (diet, physical activity, sleep, and screen time), and height and weight. For focus groups, participants were invited to participate in 45- to 60-minute web-based group discussions assessing social media habits, preferred social media platforms, and preferences for physical activity and nutrition intervention content and delivery. Survey data were analyzed descriptively; focus group transcripts were analyzed using a directed content analysis approach. Results: A total of 101 adolescents completed the survey and 20 adolescents participated in a total of 3 focus groups. Participants reported most frequently using TikTok, followed by Instagram, Snapchat, and Twitter; preference for platform varied by purpose of use (eg, content consumption, connection, or communication). TikTok emerged as the platform of choice as an engaging way to learn about various topics, including desired health information on physical fitness and diet. Conclusions: Findings from this study suggest that social media platforms can be an engaging way to reach adolescents of color. Data will inform future social media--based interventions to engage adolescents of color in healthy weight management content. ",
doi="10.2196/43961",
url="https://pediatrics.jmir.org/2023/1/e43961",
url="http://www.ncbi.nlm.nih.gov/pubmed/37155230"
}


@Article{info:doi/10.2196/42287,
author="Heponiemi, Tarja
and Kainiemi, Emma
and Virtanen, Lotta
and Saukkonen, Petra
and Sainio, P{\"a}ivi
and Koponen, P{\"a}ivikki
and Koskinen, Seppo",
title="Predicting Internet Use and Digital Competence Among Older Adults Using Performance Tests of Visual, Physical, and Cognitive Functioning: Longitudinal Population-Based Study",
journal="J Med Internet Res",
year="2023",
month="May",
day="5",
volume="25",
pages="e42287",
keywords="internet services",
keywords="digital exclusion",
keywords="digital skills",
keywords="older adults",
keywords="physical and cognitive decline",
keywords="mobile phone",
abstract="Background: The rapidly increasing role of the internet in obtaining basic services poses challenges, especially for older adults' capabilities of getting the services they need. Research on the predictors of older adults' internet use and digital competence is especially relevant given that people are living longer than before, and the age profile of many societies is changing rapidly. Objective: We aimed to examine the associations of objective measures of physical and cognitive impairment with the nonuse of the internet for services and low digital competence among older adults. Methods: A longitudinal population-based design was used that combined data from performance tests and self-rated questionnaires. Data were gathered in 2017 and 2020 among 1426 older adults aged between 70 and 100 years in Finland. Logistic regression analyses were used to examine the associations. Results: Those who had poor near (odds ratio [OR] 1.90, 95\% CI 1.36-2.66) or distant vision (OR 1.81, 95\% CI 1.21-2.71), restricted or failed abduction of upper arms (OR 1.81, 95\% CI 1.28-2.85), and poor results from the word list memory (OR 3.77, 95\% CI 2.65-5.36) or word list delayed recall (OR 2.12, 95\% CI 1.48-3.02) tests had greater odds for nonuse of the internet for services than their counterparts. Moreover, those who had poor near (OR 2.18, 95\% CI 1.57-3.02) or distant vision (OR 2.14, 95\% CI 1.43-3.19), poor results from the chair stand test (OR 1.57, 95\% CI 1.06-2.31), restricted or failed abduction of upper arms (OR 1.74, 95\% CI 1.10-2.76), and poor results from the word list memory (OR 3.41, 95\% CI 2.32-5.03) or word list delayed recall (OR 2.05, 95\% CI 1.39-3.04) tests had greater odds of low digital competence than their counterparts. Conclusions: According to our results, older adults' impaired physical and cognitive functioning may hamper their possibilities of accessing internet services such as digital health care services. Our results should be considered when planning digital health care services intended to be used by older adults; that is, digital solutions should also be suitable for older adults with impairments. Furthermore, face-to-face services should be provided for those who cannot use digital services, even if they are assisted properly. ",
doi="10.2196/42287",
url="https://www.jmir.org/2023/1/e42287",
url="http://www.ncbi.nlm.nih.gov/pubmed/37145836"
}


@Article{info:doi/10.2196/43917,
author="Lee, W. Jarrett G.
and Lee, Kyungyeon
and Lee, Bongshin
and Choi, Soyoung
and Seo, JooYoung
and Choe, Kyoung Eun",
title="Personal Health Data Tracking by Blind and Low-Vision People: Survey Study",
journal="J Med Internet Res",
year="2023",
month="May",
day="4",
volume="25",
pages="e43917",
keywords="personal health data",
keywords="self-tracking",
keywords="blind and low vision",
keywords="survey",
keywords="consumer health information",
keywords="mobile phone",
abstract="Background: Personal health technologies, including wearable tracking devices and mobile apps, have great potential to equip the general population with the ability to monitor and manage their health. However, being designed for sighted people, much of their functionality is largely inaccessible to the blind and low-vision (BLV) population, threatening the equitable access to personal health data (PHD) and health care services. Objective: This study aims to understand why and how BLV people collect and use their PHD and the obstacles they face in doing so. Such knowledge can inform accessibility researchers and technology companies of the unique self-tracking needs and accessibility challenges that BLV people experience. Methods: We conducted a web-based and phone survey with 156 BLV people. We reported on quantitative and qualitative findings regarding their PHD tracking practices, needs, accessibility barriers, and work-arounds. Results: BLV respondents had strong desires and needs to track PHD, and many of them were already tracking their data despite many hurdles. Popular tracking items (ie, exercise, weight, sleep, and food) and the reasons for tracking were similar to those of sighted people. BLV people, however, face many accessibility challenges throughout all phases of self-tracking, from identifying tracking tools to reviewing data. The main barriers our respondents experienced included suboptimal tracking experiences and insufficient benefits against the extended burden for BLV people. Conclusions: We reported the findings that contribute to an in-depth understanding of BLV people's motivations for PHD tracking, tracking practices, challenges, and work-arounds. Our findings suggest that various accessibility challenges hinder BLV individuals from effectively gaining the benefits of self-tracking technologies. On the basis of the findings, we discussed design opportunities and research areas to focus on making PHD tracking technologies accessible for all, including BLV people. ",
doi="10.2196/43917",
url="https://www.jmir.org/2023/1/e43917",
url="http://www.ncbi.nlm.nih.gov/pubmed/37140967"
}


@Article{info:doi/10.2196/43709,
author="Zhang, Yichi
and Lee, J. Edmund W.
and Teo, Wei-Peng",
title="Health-Seeking Behavior and Its Associated Technology Use: Interview Study Among Community-Dwelling Older Adults",
journal="JMIR Aging",
year="2023",
month="May",
day="4",
volume="6",
pages="e43709",
keywords="health",
keywords="health-seeking behavior",
keywords="aging",
keywords="technology",
keywords="telehealth",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="health access",
keywords="qualitative study",
keywords="mobile phone",
abstract="Background: Understanding older people's health-seeking behavior (HSB) is crucial for uncovering their health needs and priorities and developing appropriate policies to address them and avert their disease progression. Technologies play an active role in our daily lives and have been incorporated into health activities to support the older population and facilitate their HSB. However, previous studies of HSB have mainly focused on behaviors during illness, and there are limited studies on how technologies have been used in older people's health-seeking activities. Objective: This study aimed to investigate HSB and the associated technology use among the older population, ultimately proposing implications for practice to address their unmet health needs. Methods: This paper presents partial data from a large qualitative study, which has been approved by the institutional review board and used a phenomenological approach. Semistructured interviews were conducted between April 2022 and July 2022, either via Zoom (Zoom Video Communications Inc) or face-to-face sessions. Inclusion criteria were being aged ?50 years, long-term residence in Singapore, and being able to speak English or Mandarin. The interviews were manually transcribed verbatim, and thematic analysis was performed, with the individual as the unit of analysis to understand the patterns of behaviors. Results: In total, 15 interviews were conducted to reach thematic saturation. We identified 5 main consequences of HSB, which were aligned with the original HSB model. Regarding technology use in health seeking, 4 themes were extracted: the most widely used digital technologies are the mobile health apps and wearable devices with the associated wellness programs launched by the government and local companies, and they have the potential to enhance health communication, promote health maintenance, and increase access to health services; information communication technologies and social media, though not primarily designed for health purposes, play a substantial role in easing the process of seeking health information and managing symptoms. Although the outbreak of the COVID-19 pandemic has resulted in some alterations to older adults' well-being, it has catalyzed the adoption of telehealth as a complement to access health care services, and older adults have different considerations when selecting technologies to facilitate their health seeking and fulfill their health needs. Moreover, 4 archetypes were proposed based on our findings and the insights gained from our participants' observations in their social networks. These findings led to several implications for practice regarding health communication and promotion, health education, technology design and improvement, telemonitoring service implementation, and solutions to address the needs of each proposed archetype. Conclusions: Unlike the commonly held belief that older adults resist technologies and lack technological proficiency, our findings showed that technologies could play a promising role in facilitating older adults' health seeking. Our findings have implications for the design and implementation of health services and policies. ",
doi="10.2196/43709",
url="https://aging.jmir.org/2023/1/e43709",
url="http://www.ncbi.nlm.nih.gov/pubmed/36996003"
}


@Article{info:doi/10.2196/44990,
author="Nguyen, T. Thu
and Merchant, S. Junaid
and Criss, Shaniece
and Makres, Katrina
and Gowda, N. Krishik
and Mane, Heran
and Yue, Xiaohe
and Hswen, Yulin
and Glymour, Maria M.
and Nguyen, C. Quynh
and Allen, M. Amani",
title="Examining Twitter-Derived Negative Racial Sentiment as Indicators of Cultural Racism: Observational Associations With Preterm Birth and Low Birth Weight Among a Multiracial Sample of Mothers, 2011-2021",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="28",
volume="25",
pages="e44990",
keywords="birth outcomes",
keywords="health disparities",
keywords="machine learning, racial sentiment",
keywords="social media",
abstract="Background: Large racial and ethnic disparities in adverse birth outcomes persist. Increasing evidence points to the potential role of racism in creating and perpetuating these disparities. Valid measures of area-level racial attitudes and bias remain elusive, but capture an important and underexplored form of racism that may help explain these disparities. Cultural values and attitudes expressed through social media reflect and shape public norms and subsequent behaviors. Few studies have quantified attitudes toward different racial groups using social media with the aim of examining associations with birth outcomes. Objective: We used Twitter data to measure state-level racial sentiments and investigate associations with preterm birth (PTB) and low birth weight (LBW) in a multiracial or ethnic sample of mothers in the United States. Methods: A random 1\% sample of publicly available tweets from January 1, 2011, to December 31, 2021, was collected using Twitter's Academic Application Programming Interface (N=56,400,097). Analyses were on English-language tweets from the United States that used one or more race-related keywords. We assessed the sentiment of each tweet using support vector machine, a supervised machine learning model. We used 5-fold cross-validation to assess model performance and achieved high accuracy for negative sentiment classification (91\%) and a high F1 score (84\%). For each year, the state-level racial sentiment was merged with birth data during that year ({\textasciitilde}3 million births per year). We estimated incidence ratios for LBW and PTB using log binomial regression models, among all mothers, Black mothers, racially minoritized mothers (Asian, Black, or Latina mothers), and White mothers. Models were controlled for individual-level maternal characteristics and state-level demographics. Results: Mothers living in states in the highest tertile of negative racial sentiment for tweets referencing racial and ethnic minoritized groups had an 8\% higher (95\% CI 3\%-13\%) incidence of LBW and 5\% higher (95\% CI 0\%-11\%) incidence of PTB compared to mothers living in the lowest tertile. Negative racial sentiment referencing racially minoritized groups was associated with adverse birth outcomes in the total population, among minoritized mothers, and White mothers. Black mothers living in states in the highest tertile of negative Black sentiment had 6\% (95\% CI 1\%-11\%) and 7\% (95\% CI 2\%-13\%) higher incidence of LBW and PTB, respectively, compared to mothers living in the lowest tertile. Negative Latinx sentiment was associated with a 6\% (95\% CI 1\%-11\%) and 3\% (95\% CI 0\%-6\%) higher incidence of LBW and PTB among Latina mothers, respectively. Conclusions: Twitter-derived negative state-level racial sentiment toward racially minoritized groups was associated with a higher risk of adverse birth outcomes among the total population and racially minoritized groups. Policies and supports establishing an inclusive environment accepting of all races and cultures may decrease the overall risk of adverse birth outcomes and reduce racial birth outcome disparities. ",
doi="10.2196/44990",
url="https://www.jmir.org/2023/1/e44990",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115602"
}


@Article{info:doi/10.2196/44181,
author="Woolley, E. Katherine
and Bright, Diana
and Ayres, Toby
and Morgan, Fiona
and Little, Kirsty
and Davies, R. Alisha",
title="Mapping Inequities in Digital Health Technology Within the World Health Organization's European Region Using PROGRESS PLUS: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="28",
volume="25",
pages="e44181",
keywords="digital health",
keywords="health inequities",
keywords="PROGRESS PLUS",
keywords="health services accessibility",
keywords="health care disparities",
keywords="mobile phone",
abstract="Background: The use of digital technologies within health care rapidly increased as services transferred to web-based platforms during the COVID-19 pandemic. Inequalities in digital health across the domains of equity are not routinely examined; yet, the long-term integration of digitally delivered services needs to consider such inequalities to ensure equitable benefits. Objective: This scoping review aimed to map inequities in access, use, and engagement with digital health technologies across equity domains. Methods: We searched 4 electronic databases (MEDLINE, ASSIA, PsycINFO, and Scopus) for quantitative and mixed methods reviews and meta-analyses published between January 2016 and May 2022. Reviews were limited to those that included studies from the World Health Organization's European region. Extracted data were mapped against Cochrane's PROGRESS PLUS (place of residence, race, ethnicity, culture, and language, occupation, gender and sex, religion, education, socioeconomic status, social capital, and other characteristics) dimensions of equity. Results: In total, 404 unique citations were identified from the searches, and 2 citations were identified from other sources. After eligibility assessment, 22 reviews were included. Consistent evidence was found showing higher access to digital health technologies among patients who were of White ethnicity, were English speaking, and had no disability. There were no reviews that explored differences in access to digital health care by age, gender and sex, occupation, education, or homeless or substance misuse. Higher use of digital health technologies was observed among populations that were White, English speaking, younger, with a higher level of education, of higher economic status, and residents in urban areas. No clear evidence of differences in the use of digital technologies by occupation, gender and sex, disability, or homeless or substance misuse was found, nor was clear evidence found in the included reviews on inequalities in the engagement with digital technologies. Finally, no reviews were identified that explored differences by place of residence. Conclusions: Despite awareness of the potential impact of inequalities in digital health, there are important evidence gaps across multiple equity domains. The development of a common framework for evaluating digital health equity in new health initiatives and consistency in reporting findings is needed. ",
doi="10.2196/44181",
url="https://www.jmir.org/2023/1/e44181",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115613"
}


@Article{info:doi/10.2196/38169,
author="Cinalioglu, Karin
and Elbaz, Sasha
and Sekhon, Kerman
and Su, Chien-Lin
and Rej, Soham
and Sekhon, Harmehr",
title="Exploring Differential Perceptions of Artificial Intelligence in Health Care Among Younger Versus Older Canadians: Results From the 2021 Canadian Digital Health Survey",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="28",
volume="25",
pages="e38169",
keywords="artificial intelligence",
keywords="telehealth",
keywords="telemedicine",
keywords="older adult",
keywords="perception",
keywords="technology",
keywords="public opinion",
keywords="national survey",
keywords="Canada",
keywords="Canadian",
keywords="attitude",
keywords="adoption",
keywords="trust",
keywords="satisfaction",
abstract="Background: The changing landscape of health care has led to the incorporation of powerful new technologies like artificial intelligence (AI) to assist with various services across a hospital. However, despite the potential outcomes that this tool may provide, little work has examined public opinion regarding their use. Objective: In this study, we aim to explore differences between younger versus older Canadians with regard to the level of comfort and perceptions around the adoption and use of AI in health care settings. Methods: Using data from the 2021 Canadian Digital Health Survey (n=12,052), items related to perceptions about the use of AI as well as previous experience and satisfaction with health care were identified. We conducted Mann-Whitney U tests to compare the level of comfort of younger versus older Canadians regarding the use of AI in health care for a variety of purposes. Multinomial logistic regression was used to predict the comfort ratings based on categorical indicators. Results: Younger Canadians had greater knowledge of AI, but older Canadians were more comfortable with AI applied to monitoring and predicting health conditions, decision support, diagnostic imaging, precision medicine, drug and vaccine development, disease monitoring at home, tracking epidemics, and optimizing workflow to save time. Additionally, for older respondents, higher satisfaction led to higher comfort ratings. Only 1 interaction effect was identified between previous experience, satisfaction, and comfort with AI for drug and vaccine development. Conclusions: Older Canadians may be more open to various applications of AI within health care than younger Canadians. High satisfaction may be a critical criterion for comfort with AI, especially for older Canadians. Additionally, in the case of drug and vaccine development, previous experience may be an important moderating factor. We conclude that gaining a greater understanding of the perceptions of all health care users is integral to the implementation and sustainability of new and cutting-edge technologies in health care settings. ",
doi="10.2196/38169",
url="https://www.jmir.org/2023/1/e38169",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115588"
}


@Article{info:doi/10.2196/43348,
author="Dong, Zhaogang
and Ji, Meng
and Shan, Yi
and Xu, Xiaofei
and Xing, Zhaoquan",
title="Functional Health Literacy Among Chinese Populations and Associated Factors: Latent Class Analysis",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="28",
volume="7",
pages="e43348",
keywords="functional health literacy",
keywords="associated factors",
keywords="Chinese populations",
keywords="latent class analysis",
abstract="Background: Poor functional health literacy has been found to be independently associated with poor self-assessed health, poor understanding of one's health condition and its management, and higher use of health services. Given the importance of functional health literacy, it is necessary to assess the overall status of functional health literacy in the general public. However, the literature review shows that no studies of functional health literacy have been conducted among the Chinese population in China. Objective: This study aimed to classify Chinese populations into different functional health literacy clusters and ascertain significant factors closely associated with low functional health literacy to provide some implications for health education, medical research, and public health policy making. Methods: We hypothesized that the participants' functional health literacy levels were associated with various demographic characteristics. Therefore, we designed a four-section questionnaire including the following information: (1) age, gender, and education; (2) self-assessed disease knowledge; (3) 3 validated health literacy assessment tools (ie, the All Aspects of Health Literacy Scale, the eHealth Literacy Scale, and the 6-item General Health Numeracy Test); and (4) health beliefs and self-confidence measured by the Multidimensional Health Locus of Control Scales Form B. Using randomized sampling, we recruited survey participants from Qilu Hospital affiliated to Shandong University, China. The questionnaire was administered via wenjuanxing. A returned questionnaire was valid only when all question items included were answered, according to our predefined validation criterion. All valid data were coded according to the predefined coding schemes of Likert scales with different point (score) ranges. Finally, we used latent class analysis to classify Chinese populations into clusters of different functional health literacy and identify significant factors closely associated with low functional health literacy. Results: All data in the 800 returned questionnaires proved valid according to the predefined validation criterion. Applying latent class analysis, we classified Chinese populations into low (n=292, 36.5\%), moderate-to-adequate (n=286, 35.7\%), and low-to-moderate (n=222, 27.8\%) functional health literacy groups and identified five factors associated with low communicative health literacy: (1) male gender (aged 40-49 years), (2) lower educational attainment (below diploma), (3) age between 38 and 68 years, (4) lower self-efficacy, and (5) belief that staying healthy was a matter of luck. Conclusions: We classified Chinese populations into 3 functional health literacy groups and identified 5 factors associated with low functional health literacy. These associated factors can provide some implications for health education, medical research, and health policy making. ",
doi="10.2196/43348",
url="https://formative.jmir.org/2023/1/e43348",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115594"
}


@Article{info:doi/10.2196/46123,
author="Park, Sooyeol
and Walker, Brigham
and Anderson, Andrew
and Shao, Yixue
and Callison, Kevin",
title="Telemedicine Use by Age in Louisiana Medicaid During COVID-19: Claims-Based Longitudinal Analysis",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="26",
volume="25",
pages="e46123",
keywords="telemedicine",
keywords="age",
keywords="disparities",
keywords="COVID-19",
keywords="availability",
keywords="health care services",
keywords="infection",
keywords="pandemic",
keywords="usage",
keywords="users",
keywords="reliance",
keywords="digital literacy",
keywords="internet",
keywords="trends",
abstract="Background: Limited availability of in-person health care services and fear of contracting COVID-19 during the pandemic promoted an increased reliance on telemedicine. However, long-standing inequities in telemedicine due to unequal levels of digital literacy and internet connectivity among different age groups raise concerns about whether the uptake of telemedicine has exacerbated or alleviated those inequities. Objective: The aim of this study is to examine changes in telemedicine and in-person health service use during the COVID-19 pandemic across age groups for Medicaid beneficiaries in the state of Louisiana. Methods: Interrupted time series models were used on Louisiana Medicaid claims data to estimate trends in total, in-person, and telemedicine monthly office visit claims per 1000 Medicaid beneficiaries between January 2018 and December 2020. Changes in care pattern trends and levels were estimated around the infection peaks (April 2020 and July 2020) and for an end-of-year infection leveling off period (December 2020). Four mutually exclusive age categories (0 to 17, 18 to 34, 35 to 49, and 50 to 64 years) were used to compare the differences. Results: Prior to the COVID-19 pandemic, telemedicine services accounted for less than 1\% of total office visit claim volume across the age groups. Each age group followed similar patterns of sharp increases in April 2020, downward trends until sharp increases again in July 2020, followed by flat trends thereafter until December 2020. These sharp increases were most pronounced for older patients, with those aged 50 to 64 years seeing increases of 184.09 telemedicine claims per 1000 Medicaid beneficiaries in April 2020 (95\% CI 172.19 to 195.99) and 120.81 in July 2020 (95\% CI 101.32 to 140.31) compared with those aged 18 to 34 years, seeing increases of 84.47 (95\% CI 78.64 to 90.31) and 57.00 (95\% CI 48.21 to 65.79), respectively. This resulted in overall changes from baseline to December 2020 levels of 123.65 (95\% CI 112.79 to 134.51) for those aged 50 to 64 years compared with 59.07 (95\% CI 53.89 to 64.24) for those aged 18 to 34 years. Conclusions: Older Medicaid beneficiaries in Louisiana had higher rates of telemedicine claim volume during the COVID-19 pandemic compared with younger beneficiaries. ",
doi="10.2196/46123",
url="https://www.jmir.org/2023/1/e46123",
url="http://www.ncbi.nlm.nih.gov/pubmed/37099371"
}


@Article{info:doi/10.2196/40004,
author="Brainin, Esther
and Neter, Efrat",
title="Refined Analysis of Older eHealth Users From an Agency Perspective: Quantitative Telephone Interview Study",
journal="JMIR Aging",
year="2023",
month="Apr",
day="26",
volume="6",
pages="e40004",
keywords="eHealth",
keywords="health",
keywords="internet",
keywords="structuration theory",
keywords="agency",
keywords="digital divide",
keywords="age",
keywords="gender",
keywords="education",
keywords="information",
keywords="health condition",
keywords="self-rated health",
keywords="SRH",
keywords="health care services",
keywords="surrogate",
keywords="older adults",
keywords="users",
keywords="patient",
keywords="Giddens",
keywords="Archer",
keywords="Bourdieu",
keywords="capital",
abstract="Background: Most studies on the eHealth divide among older people have compared users to nonusers and found that age, gender, and education were associated with eHealth misuse. They assumed that these characteristics were structural barriers to eHealth adoption. Furthermore, eHealth practices have been examined in a narrow and incomplete way, and the studies disagree about the association between health conditions and eHealth use. Using a more dynamic theoretical lens, we investigated the potential motivations driving older adults' agential adoption of eHealth practices despite their advanced age. Objective: This study aimed to obtain a complete and detailed description of eHealth uses among older adults; examine whether demographic characteristics such as age, gender, and education (previously related to eHealth misuse) are still associated with the various eHealth clusters; and determine whether contextual factors such as changes in the health condition of older eHealth users or their loved ones are associated with older adult eHealth use. Methods: We conducted a 30-minute telephone interview with a representative sample of 442 Israeli adults (aged ?50 years) with a sampling error of 2.04\%. The interviews were conducted in Hebrew, Arabic, and Russian. Using factor analysis with 21 eHealth use questions, we identified 4 eHealth clusters: instrumental and administrative information seeking, information sharing, seeking information from peers, and web-based self-tracking. In addition to age, gender, education, internet experience, frequency of internet use, perceived eHealth literacy, and self-rated health, we asked respondents to indicate how much they had used offline health services because of a health crisis in the past year. Results: We found differences in the number of older eHealth users in the various clusters. They used instrumental and administrative information (420/442, 95\%) and obtained information from peers (348/442, 78.7\%) the most; followed by web-based self-tracking related to health issues (305/442, 69\%), and only a few (52/442, 11.3\%) uploaded and shared health information on the web. When controlling for personal attributes, age, gender, and education were no longer predictors of eHealth use, nor was a chronic ailment. Instead, internet experience, frequency of internet use, and perceived eHealth literacy were associated with 3 eHealth clusters. Looking for health information for family and friends predicted all 4 eHealth clusters. Conclusions: Many older adults can overcome structural barriers such as age, gender, and education. The change in their or their loved ones' circumstances encouraged them to make deliberate efforts to embrace the new practices expected from today's patients. Seeking health information for family and friends and dealing with unexpected health crises motivates them to use eHealth. We suggest that health professionals ignore their tendency to label older people as nonusers and encourage them to benefit from using eHealth and overcome stereotypical ways of perceiving these patients. ",
doi="10.2196/40004",
url="https://aging.jmir.org/2023/1/e40004",
url="http://www.ncbi.nlm.nih.gov/pubmed/37121572"
}


@Article{info:doi/10.2196/42868,
author="Xing, Zhaoquan
and Ji, Meng
and Dong, Zhaogang
and Xu, Xiaofei
and Shan, Yi",
title="Factors Associated With Limited Digital Health Literacy Among Chinese Male Populations: Cross-sectional Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="19",
volume="7",
pages="e42868",
keywords="factor",
keywords="older age",
keywords="lower education attainment",
keywords="lower functional, communicative, and critical health literacy",
keywords="weaker belief and self-confidence",
keywords="limited eHealth literacy",
keywords="Chinese population",
keywords="logistic regression",
abstract="Background: eHealth resources and interventions promise to promote favorable behavior change, self-efficacy, and knowledge acquisition, thereby improving health literacy. However, individuals with limited eHealth literacy may find it difficult to identify, understand, and benefit from eHealth use. It is necessary to identify the self-assessed eHealth literacy of those who use eHealth resources to classify their eHealth literacy levels and to determine the demographic characteristics associated with higher and lower eHealth literacy skills. Objective: This study aimed to identify notable factors closely associated with limited eHealth literacy among Chinese male populations to provide some implications for clinical practice, health education, medical research, and public health policy making. Methods: We hypothesized that participants' eHealth literacy status was associated with various demographic characteristics. Therefore, we elicited the following information in the questionnaire: age and education, self-assessed disease knowledge, 3 well-developed health literacy assessment tools (ie, the All Aspects of Health Literacy Scale, eHealth Literacy Scale, and General Health Numeracy Test), and the 6 Internal items on health beliefs and self-confidence in the Multidimensional Health Locus of Control Scales. Using randomized sampling, we recruited survey participants from Qilu Hospital of Shandong University, China. After validating the data collected through a web-based questionnaire survey via wenjuanxing, we coded all valid data according to predefined coding schemes of Likert scales with different point (score) ranges. We then calculated the total scores of the subsections of the scales or the entire scale. Finally, we used logistic regression modeling to associate the scores of the eHealth Literacy Scale with the scores of the All Aspects of Health Literacy Scale, the General Health Numeracy Test-6, and age and education to ascertain factors considerably associated with limited eHealth literacy among Chinese male populations. Results: All data from the 543 returned questionnaires were valid according to the validation criteria. By interpreting these descriptive statistics, we found that 4 factors were significantly correlated with participants' limited eHealth literacy: older age, lower education attainment, lower levels of all aspects of health literacy (functional, communicative, and critical), and weaker beliefs and self-confidence in internal drivers and strengths to stay healthy. Conclusions: By applying logistic regression modeling, we ascertained 4 factors that were significantly correlated with limited eHealth literacy among Chinese male populations. These relevant factors identified can inform stakeholders engaging in clinical practice, health education, medical research, and health policy making. ",
doi="10.2196/42868",
url="https://formative.jmir.org/2023/1/e42868",
url="http://www.ncbi.nlm.nih.gov/pubmed/37074760"
}


@Article{info:doi/10.2196/41984,
author="Henson, Connie
and Chapman, Felicity
and Shepherd, Gina
and Carlson, Bronwyn
and Rambaldini, Boe
and Gwynne, Kylie",
title="How Older Indigenous Women Living in High-Income Countries Use Digital Health Technology: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="18",
volume="25",
pages="e41984",
keywords="digital health",
keywords="Aboriginal and Torres Strait Islander",
keywords="Indigenous",
keywords="Aboriginal",
keywords="health technology",
keywords="engagement",
keywords="co-design",
keywords="cultural safety",
keywords="older Ingenuous women",
keywords="older women",
keywords="older adult",
keywords="gerontology",
keywords="lived experience",
keywords="patient experience",
keywords="ethic",
keywords="minority",
keywords="minorities",
keywords="elder",
keywords="usability",
keywords="acceptability",
keywords="preference",
keywords="PRISMA",
keywords="systematic review",
keywords="review methodology",
keywords="social media",
keywords="wearable",
abstract="Background: Research associated with digital health technologies similar to the technologies themselves has proliferated in the last 2 decades. There are calls for these technologies to provide cost-effective health care for underserved populations. However, the research community has also underserved many of these populations. Older Indigenous women are one such segment of the population. Objective: Our objective is to systematically review the literature to consolidate and document what we know about how older Indigenous women living in high-income countries use digital health technology to enhance their health. Methods: We analyzed the peer-reviewed literature by systematically searching 8 databases in March 2022. We included studies published between January 2006 and March 2022 with original data specific to older Indigenous women from high-income countries that reported on the effectiveness, acceptability, and usability of some user-focused digital health technology. We incorporated 2 measures of quality for each study. We also conducted a thematic analysis and a lived experience analysis, which examined each paper from the perspectives of older Indigenous women. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in this study. Results: Three papers met the inclusion criteria. The key findings were that older Indigenous women do not see themselves reflected in mainstream health messaging or other digital health offerings. They prefer an approach that considers their uniqueness and diversity. We also identified 2 significant gaps in the literature. First, research reporting on older Indigenous women from high-income countries' experiences with digital health technology is minimal. Second, the limited research related to older Indigenous women has not consistently engaged Indigenous people in the research process or governance. Conclusions: Older Indigenous women want digital health technologies to respond to their needs and preferences. Research is needed to understand their requirements and preferences to ensure equity as we move toward greater adoption of digital health technology. Engaging older Indigenous women throughout the research is essential to ensuring that digital health products and services are safe, usable, effective, and acceptable for older Indigenous women. ",
doi="10.2196/41984",
url="https://www.jmir.org/2023/1/e41984",
url="http://www.ncbi.nlm.nih.gov/pubmed/37071466"
}


@Article{info:doi/10.2196/41915,
author="Kim, Seungmo
and Chow, Chu Bik
and Park, Sanghyun
and Liu, Huaxuan",
title="The Usage of Digital Health Technology Among Older Adults in Hong Kong and the Role of Technology Readiness and eHealth Literacy: Path Analysis",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="12",
volume="25",
pages="e41915",
keywords="older adults",
keywords="elderly",
keywords="digital health technology",
keywords="health technology",
keywords="digital health",
keywords="technology readiness",
keywords="eHealth literacy",
keywords="continuous usage intention",
keywords="usage intention",
keywords="intention-to-use",
keywords="attitude",
keywords="technology use",
keywords="elder",
keywords="digital literacy",
keywords="adoption",
keywords="acceptance",
keywords="readiness",
keywords="gerontology",
keywords="aging",
abstract="Background: Although digital health technologies (DHTs) help many people maintain a healthy life, including those of advanced age, these technologies are of little use to older adult populations if they are not being adopted in daily life. Thus, it is critical to identify ways to help older adults recognize and try new technologies and maintain their use of them to maximize the benefits of these technologies in a digital-based society. Objective: Our study aimed (1) to assess the current usage of DHT among older adults in Hong Kong and (2) to examine how high and low levels of eHealth literacy in this group affects the relationship between the Technology Readiness and Acceptance Model (TRAM) and attitudes and intention toward DHT. Methods: A total of 306 adults over 60 years of age in Hong Kong participated in this study. After conducting confirmatory factor analysis to validate the measurement model, the hypothesized model was tested using structural equation modeling. Results: Optimism was significantly related to perceived usefulness, while optimism, innovativeness, and discomfort were significantly associated with perceived ease of use. Both perceived usefulness and perceived ease of use were significantly linked to attitude toward the use of DHTs. Meanwhile, attitude significantly predicted usage intention. Additionally, the results revealed the differences in the relationships of the TRAM between participants with high and low levels of eHealth literacy. The influence of optimism and innovativeness on perceived ease of use was stronger for the higher-level group than for the lower-level group, and the influence of discomfort for the higher-level group was much weaker. Conclusions: The findings provided partial support for the impact of eHealth literacy on encouraging older adults to use DHT and obtain health benefits from it. This study also suggests providing assistance and guidelines for older adults to narrow the aging-related technology gap and to further explore the associations of eHealth literacy, the TRAM, and actual behaviors. ",
doi="10.2196/41915",
url="https://www.jmir.org/2023/1/e41915",
url="http://www.ncbi.nlm.nih.gov/pubmed/37043274"
}


@Article{info:doi/10.2196/39891,
author="Van Heel, Lou Kasi
and Nelson, Anna
and Handysides, Daniel
and Shah, Huma",
title="The Factors Associated With Confidence in Using the Internet to Access Health Information: Cross-sectional Data Analysis",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="11",
volume="7",
pages="e39891",
keywords="confidence",
keywords="health information access",
keywords="health information seeking",
keywords="health information sources",
keywords="internet",
keywords="health information",
abstract="Background: Confidence in health information access is a measure of the perceived ability to obtain health information. One's beliefs or perceived ability to access health information is particularly important in understanding trends in health care access. Previous literature has found that access to health information is lowest among society's most vulnerable population groups. These groups include older, less educated, and low-income populations. While health confidence has previously been used as a scale to measure health outcomes, additional research is needed describing the demographic factors associated with users' confidence in health information access. This may be a key component of health information seeking that affects beneficial health outcomes such as prevention and treatment. Objective: This study examines the demographic factors associated with the levels of confidence in using the internet to access health information for adults 18 years and older in the United States. Methods: Using a cross-sectional design, secondary data from the Health Information National Trends Survey (HINTS) 5, Cycle 3 (2019) were analyzed (N=5374). An ordinal regression stratified by internet use was used to determine the association between demographic characteristics and level of confidence in health information access. Results: When the internet is the primary source for health information, high school graduates (adjusted odds ratio [AOR] 0.58, 95\% CI 0.37-0.89) compared to those with a college degree or more had significantly lower odds of being confident in obtaining health information. In addition, non-Hispanic Asian participants (AOR 0.44, 95\% CI 0.24-0.82) compared to non-Hispanic White participants, male participants (AOR 0.72, 95\% CI 0.54-0.97) compared to female participants, and those who made between US \$20,000-\$35,000 annually (AOR 0.55, 95\% CI 0.31-0.98) compared to those who made US \$75,000 or more annually had significantly lower odds of being confident in obtaining health information via the internet. Moreover, when the internet is the primary source for health information, those with health insurance had significantly higher odds of being confident in obtaining health information (AOR 2.91, 95\% CI 1.58-5.34) compared to those who do not have health insurance. Lastly, a significant association was observed between confidence in health information access and primary health information source and frequency of visiting a health care provider. Conclusions: Confidence in accessing health information can differ by individual demographics. Accessing health-related information from the internet has become increasingly more common and can provide insight into health information-seeking behaviors. Further exploration of these factors can inform the science of health education by providing deeper insight into improving access to health information for vulnerable populations. ",
doi="10.2196/39891",
url="https://formative.jmir.org/2023/1/e39891",
url="http://www.ncbi.nlm.nih.gov/pubmed/37040161"
}


@Article{info:doi/10.2196/41935,
author="Shin, Ri Hye
and Um, Rang Sa
and Yoon, Jeong Hee
and Choi, Young Eun
and Shin, Chul Won
and Lee, Yun Hee
and Kim, Sun Young",
title="Comprehensive Senior Technology Acceptance Model of Daily Living Assistive Technology for Older Adults With Frailty: Cross-sectional Study",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="10",
volume="25",
pages="e41935",
keywords="senior technology acceptance model",
keywords="daily living assistive technologies",
keywords="frailty",
keywords="older adults",
abstract="Background: There are considerable gaps between the need for assistive technologies and the actual adoption of these technologies among older adults, although older adults are among the groups that most need assistive technologies. Consequently, research is needed in this area because older adults' technology acceptance and influencing factors may differ depending on their level of frailty. Objective: The objective of this study was to compare frail, prefrail, and robust groups of South Korean adults regarding their behavioral intention to use daily living assistive technologies and the affecting factors---namely, technological context factors, health contexts and abilities, and attitudinal factors---based on a comprehensive senior technology acceptance model. Methods: A nationwide sample of 500 older South Korean adults (aged 55-92 years) was analyzed, and multivariate linear regression analyses of the robust, prefrail, and frail groups were performed. The independent and dependent variables consisted of 3 factors based on previous studies. First, technological context factors consisted of gerontechnology self-efficacy, gerontechnology anxiety, and facilitating conditions. Second, health contexts and abilities consisted of self-reported health conditions, cognitive ability, social relationships, psychological function, and physical function. Third and last, attitudinal factors consisted of behavioral intention to use assistive technologies, attitude toward use, perceived usefulness (PU), and perceived ease of use (PEOU). Results: The results of the analyses showed that technological context factors such as gerontechnology self-efficacy, health contexts and abilities such as self-reported health conditions and psychological function, and attitudinal factors such as attitude toward use, PU, and PEOU had significant effects on behavioral intention to use daily living assistive technologies. In particular, gerontechnology self-efficacy had a significant relationship with behavioral intention to use these technologies in the robust (r=0.120; P=.03) and prefrail (r=0.331; P<.001) groups. Psychological function (life satisfaction) had a significant relationship with behavioral intention to use these technologies in the robust group (r=--0.040; P=.02). Self-reported health conditions had a significant relationship with behavioral intention to use these technologies in the prefrail group (r=--0.169; P=.01). Although each group had a different significant relationship with the variables, attitudinal factors such as attitude toward use affected all groups (robust group: r=0.190; P=.03; prefrail group: r=0.235; P=.006; and frail group: r=0.526; P=.002). In addition, PU and PEOU in the attitudinal factors had a significant relationship with behavioral intention to use assistive technologies in the robust (PU: r=0.160; P=.01; and PEOU: r=0.350; P<.001) and prefrail (PU: r=0.265; P<.001; and PEOU: r=0.120; P=.04) groups. Conclusions: This study found that the comprehensive senior technology acceptance model of daily living assistive technologies had different associations according to the frailty group. These findings provided insights into the consideration of interventions with daily living assistive technologies for older adults with varying levels of frailty. ",
doi="10.2196/41935",
url="https://www.jmir.org/2023/1/e41935",
url="http://www.ncbi.nlm.nih.gov/pubmed/37036760"
}


@Article{info:doi/10.2196/43342,
author="Shan, Yi
and Ji, Meng
and Dong, Zhaogang
and Xing, Zhaoquan
and Xu, Xiaofei",
title="Assessing Patients' Critical Health Literacy and Identifying Associated Factors: Cross-sectional Study",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="5",
volume="25",
pages="e43342",
keywords="critical health literacy",
keywords="Chinese patients",
keywords="latent class modeling",
keywords="limited critical health literacy",
keywords="associated factors",
abstract="Background: Previous studies have revealed that functional health literacy plays a less important role than communicative and critical health literacy (CRHL) and that communicative literacy and CRHL contribute more to better patient self-management. Although improving health literacy has been identified as an approach to fostering community involvement and empowerment, CRHL may be regarded as the neglected domain of health literacy, rarely achieving any focus or interventions that claim to be working toward this outcome. Considering this research background, close scholarly attention needs to be paid to CRHL and its associated factors. Objective: This study aimed to assess CRHL and identify essential factors closely associated with the status of CRHL among Chinese patients and to provide some implications for clinical practice, health education, medical research, and public health policy making. Methods: We conducted this cross-sectional study, which lasted from April 8, 2022, to September 23, 2022, following the steps below. We first designed a 4-section survey questionnaire and then recruited Mandarin Chinese--speaking patients from Qilu Hospital of Shandong University, China, using randomized sampling. Subsequently, we administered the questionnaire via wenjuanxing, the most popular web-based survey platform in China, between July 20, 2022, and August 19, 2022. Finally, we used latent class modeling to analyze the valid data collected to classify the patient participants and identify the factors potentially associated with different CRHL levels. Results: All data in the 588 returned questionnaires were valid. On the basis of the collected data, we classified the patient participants into 3 latent classes of limited, moderate, and adequate CRHL and identified 4 factors associated with limited CRHL, including middle and old age, male sex, lower educational attainment, and low internal drive to maintain one's health. Conclusions: Using latent class modeling, we identified 3 classes of CRHL and 4 factors associated with limited CRHL among the Chinese study participants. These literacy classes and the predicting factors ascertained in this study can provide some implications for clinical practice, health education, medical research, and health policy making. ",
doi="10.2196/43342",
url="https://www.jmir.org/2023/1/e43342",
url="http://www.ncbi.nlm.nih.gov/pubmed/37018027"
}


@Article{info:doi/10.2196/44086,
author="Jackson, Malia Alexandra
and Woo, Juhee
and Olson, Marley
and Dalisay, Francis
and Pokhrel, Pallav
and Muller, J. Clemma
and Okamoto, K. Scott",
title="Methodological Challenges in Web-Based Qualitative Research With Medically Underserved Populations",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="30",
volume="25",
pages="e44086",
keywords="data collection",
keywords="internet",
keywords="mischievous responders",
keywords="recruitment",
keywords="qualitative",
keywords="technology",
doi="10.2196/44086",
url="https://www.jmir.org/2023/1/e44086",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995748"
}


@Article{info:doi/10.2196/40834,
author="Lee, Junbok
and Oh, Yumi
and Kim, Meelim
and Cho, Belong
and Shin, Jaeyong",
title="Willingness to Use and Pay for Digital Health Care Services According to 4 Scenarios: Results from a National Survey",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Mar",
day="29",
volume="11",
pages="e40834",
keywords="digital health intervention",
keywords="service experience",
keywords="willingness to pay",
keywords="willingness to use",
keywords="digital health",
keywords="health technology",
abstract="Background: Smartphones and their associated technology have evolved to an extent where these devices can be used to provide digital health interventions. However, few studies have been conducted on the willingness to use (WTU) and willingness to pay (WTP) for digital health interventions. Objective: The purpose of this study was to investigate how previous service experience, the content of the services, and individuals' health status affect WTU and WTP. Methods: We conducted a nationwide web-based survey in 3 groups: nonusers (n=506), public service users (n=368), and private service users (n=266). Participants read scenarios about an imagined health status (such as having a chronic illness) and the use of digital health intervention models (self-management, expert management, and medical management). They were then asked to respond to questions on WTU and WTP. Results: Public service users had a greater intention to use digital health intervention services than nonusers and private service users: scenario A (health-risk situation and self-management), nonusers=odd ratio [OR] .239 (SE .076; P<.001) and private service users=OR .138 (SE .044; P<.001); scenario B (health-risk situation and expert management), nonusers=OR .175 (SE .040; P<.001) and private service users=OR .219 (SE .053; P<.001); scenario C (chronic disease situation and expert management), nonusers=OR .413 (SE .094; P<.001) and private service users=OR .401 (SE .098; P<.001); and scenario D (chronic disease situation and medical management), nonusers=OR .480 (SE .120; P=.003) and private service users=OR .345 (SE .089; P<.001). In terms of WTP, in scenarios A and B, those who used the public and private services had a higher WTP than those who did not (scenario A: $\beta$=--.397, SE .091; P<.001; scenario B: $\beta$=--.486, SE .098; P<.001). In scenario C, private service users had greater WTP than public service users ($\beta$=.264, SE .114; P=.02), whereas public service users had greater WTP than nonusers ($\beta$=--.336, SE .096; P<.001). In scenario D, private service users were more WTP for the service than nonusers ($\beta$=--.286, SE .092; P=.002). Conclusions: We confirmed that the WTU and WTP for digital health interventions differed based on individuals' prior experience with health care services, health status, and demographics. Recently, many discussions have been made to expand digital health care beyond the early adapters and fully into people's daily lives. Thus, more understanding of people's awareness and acceptance of digital health care is needed. ",
doi="10.2196/40834",
url="https://mhealth.jmir.org/2023/1/e40834",
url="http://www.ncbi.nlm.nih.gov/pubmed/36989025"
}


@Article{info:doi/10.2196/41692,
author="Drazich, F. Brittany
and Lee, Won Ji
and Bowles, H. Kathryn
and Taylor, L. Janiece
and Shah, Shivani
and Resnick, Barbara
and Kim, Nayeon
and Szanton, L. Sarah",
title="Pandemic-Related Changes in Technology Use Among a Sample of Previously Hospitalized Older Adult New Yorkers: Observational Study",
journal="JMIR Aging",
year="2023",
month="Mar",
day="29",
volume="6",
pages="e41692",
keywords="older adults",
keywords="technology",
keywords="COVID-19",
keywords="well-being",
keywords="elderly population",
keywords="technology use",
keywords="physical disability",
keywords="virtual health",
keywords="social interaction",
keywords="digital gaming",
keywords="digital learning",
abstract="Background: The COVID-19 pandemic increased the importance of technology for all Americans, including older adults. Although a few studies have indicated that older adults might have increased their technology use during the COVID-19 pandemic, further research is needed to confirm these findings, especially among different populations, and using validated surveys. In particular, research on changes in technology use among previously hospitalized community-dwelling older adults, especially those with physical disability, is needed because older adults with multimorbidity and hospital associated deconditioning were a population greatly impacted by COVID-19 and related distancing measures. Obtaining knowledge regarding previously hospitalized older adults' technology use, before and during the pandemic, could inform the appropriateness of technology-based interventions for vulnerable older adults. Objective: In this paper, we 1) described changes in older adult technology-based communication, technology-based phone use, and technology-based gaming during the COVID-19 pandemic, compared to before the COVID-19 pandemic and 2) tested whether technology use moderated the association between changes in in-person visits and well-being, controlling for covariates. Methods: Between December 2020 and January 2021 we conducted a telephone-based objective survey with 60 previously hospitalized older New Yorkers with physical disability. We measured technology-based communication through three questions pulled from the National Health and Aging Trends Study COVID-19 Questionnaire. We measured technology-based smart phone use and technology-based video gaming through the Media Technology Usage and Attitudes Scale. We used paired t tests and interaction models to analyze survey data. Results: This sample of previously hospitalized older adults with physical disability consisted of 60 participants, 63.3\% of whom identified as female, 50.0\% of whom identified as White, and 63.8\% of whom reported an annual income of \$25,000 or less. This sample had not had physical contact (such as friendly hug or kiss) for a median of 60 days and had not left their home for a median of 2 days. The majority of older adults from this study reported using the internet, owning smart phones, and nearly half learned a new technology during the pandemic. During the pandemic, this sample of older adults significantly increased their technology-based communication (mean difference=.74, P=.003), smart phone use (mean difference=2.9, P=.016), and technology-based gaming (mean difference=.52, P=.030). However, this technology use during the pandemic did not moderate the association between changes in in-person visits and well-being, controlling for covariates. Conclusions: These study findings suggest that previously hospitalized older adults with physical disability are open to using or learning technology, but that technology use might not be able to replace in-person social interactions. Future research might explore the specific components of in-person visits that are missing in virtual interactions, and if they could be replicated in the virtual environment, or through other means. ",
doi="10.2196/41692",
url="https://aging.jmir.org/2023/1/e41692",
url="http://www.ncbi.nlm.nih.gov/pubmed/36881528"
}


@Article{info:doi/10.2196/40956,
author="Wen, Wen
and Zhang, Yaru
and Shi, Wenjie
and Li, Jiajia",
title="Association Between Internet Use and Physical Health, Mental Health, and Subjective Health in Middle-aged and Older Adults: Nationally Representative Cross-sectional Survey in China",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="21",
volume="25",
pages="e40956",
keywords="internet use",
keywords="health status",
keywords="middle-aged and older adults",
keywords="China",
abstract="Background: Internet use is an important means of accessing health-related information. Identifying the associations between internet use and health outcomes could provide insight into strategies for improving public health among middle-aged and older adults (45 years and up). Objective: This study aimed to examine the relationship between internet use and health outcomes in middle-aged and older adults. Methods: Data were obtained from the 2018 China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) Scale, the 10-item Center for Epidemiologic Studies Depression Scale, and the 3-level Self-Rated Health Scale, respectively. The chi-square test and rank sum test were used to explore whether internet use was associated with health status. A multivariate logistic regression model was used to determine this association further after controlling for the confounding factors. Results: Overall, 13\% (1752/13,474) of the participants used the internet. Regression analyses revealed that the prevalence of depression (odds ratio [OR] 0.59, 95\% CI 0.52-0.68; P<.001), negative self-rated health (OR 0.68, 95\% CI 0.61-0.76; P<.001), and difficulty with ADL (OR 0.48, 95\% CI 0.39-0.60; P<.001) in the participating middle-aged and older adult was lower in those using the internet than nonusers. After controlling for confounding factors, internet use was found to be negatively associated with difficulty with ADL (urban: OR 0.44, 95\% CI 0.32-0.61; P<.001 vs rural: OR 0.55, 95\% CI 0.41-0.75; P<.001), depression (urban: OR 0.69, 95\% CI 0.57-0.84; P<.001 vs rural: OR 0.52, 95\% CI: 0.43-0.63; P<.001), and self-rated health status (urban: OR 0.70, 95\% CI 0.61-0.81; P<.001 vs rural: OR 0.67, 95\% CI 0.57-0.78; P<.001) among middle-aged and older adults in both urban and rural areas. Conclusions: Internet use had a positive effect on the physical and mental health of middle-aged and older adults who participated in this study. However, the internet usage rate remains low among older Chinese people. Therefore, the internet penetration rate should be a priority. ",
doi="10.2196/40956",
url="https://www.jmir.org/2023/1/e40956",
url="http://www.ncbi.nlm.nih.gov/pubmed/36943368"
}


@Article{info:doi/10.2196/41615,
author="Scherrenberg, Martijn
and Falter, Maarten
and Kaihara, Toshiki
and Xu, Linqi
and van Leunen, Mayke
and Kemps, Hareld
and Kindermans, Hanne
and Dendale, Paul",
title="Development and Internal Validation of the Digital Health Readiness Questionnaire: Prospective Single-Center Survey Study",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="10",
volume="25",
pages="e41615",
keywords="adherence",
keywords="assessment",
keywords="digital access",
keywords="digital divide",
keywords="digital health intervention",
keywords="digital health",
keywords="digital literacy",
keywords="digital skills",
keywords="health literacy",
keywords="participation",
keywords="telemedicine",
abstract="Background: While questionnaires for assessing digital literacy exist, there is still a need for an easy-to-use and implementable questionnaire for assessing digital readiness in a broader sense. Additionally, learnability should be assessed to identify those patients who need additional training to use digital tools in a health care setting. Objective: The aim of the development of the Digital Health Readiness Questionnaire (DHRQ) was to create a short, usable, and freely accessible questionnaire that was designed from a clinical practice perspective. Methods: It was a prospective single-center survey study conducted in Jessa Hospital Hasselt in Belgium. The questionnaire was developed with a panel of field experts with questions in following 5 categories: digital usage, digital skills, digital literacy, digital health literacy, and digital learnability. All participants who were visiting the cardiology department as patients between February 1, 2022, and June 1, 2022, were eligible for participation. Cronbach $\alpha$ and confirmatory factor analysis were performed. Results: A total number of 315 participants were included in this survey study, of which 118 (37.5\%) were female. The mean age of the participants was 62.6 (SD 15.1) years. Cronbach $\alpha$ analysis yielded a score of >.7 in all domains of the DHRQ, which indicates acceptable internal consistency. The fit indices of the confirmatory factor analysis showed a reasonably good fit: standardized root-mean-square residual=0.065, root-mean-square error of approximation=0.098 (95\% CI 0.09-0.106), Tucker-Lewis fit index=0.895, and comparative fit index=0.912. Conclusions: The DHRQ was developed as an easy-to-use, short questionnaire to assess the digital readiness of patients in a routine clinical setting. Initial validation demonstrates good internal consistency, and future research will be needed to externally validate the questionnaire. The DHRQ has the potential to be implemented as a useful tool to gain insight into the patients who are treated in a care pathway, tailor digital care pathways to different patient populations, and offer those with low digital readiness but high learnability appropriate education programs in order to let them take part in the digital pathways. ",
doi="10.2196/41615",
url="https://www.jmir.org/2023/1/e41615",
url="http://www.ncbi.nlm.nih.gov/pubmed/36897627"
}


@Article{info:doi/10.2196/41768,
author="Mathijssen, Elke
and de Lange, Wendela
and Bleijenberg, Nienke
and van Houwelingen, Thijs
and Jaarsma, Tiny
and Trappenburg, Jaap
and Westland, Heleen",
title="Factors That Influence the Use of eHealth in Home Care: Scoping Review and Cross-sectional Survey",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="9",
volume="25",
pages="e41768",
keywords="eHealth",
keywords="digital health",
keywords="mHealth",
keywords="mobile applications",
keywords="telehealth",
keywords="telemedicine",
keywords="telecare",
keywords="implementation",
keywords="influencing factors",
keywords="home care",
abstract="Background: In home care, eHealth implementation requires health care professionals and home care clients to change their behavior because they have to incorporate the use of eHealth into their daily routines. Knowledge of factors that influence the use of eHealth in home care is needed to optimize implementation strategies. However, a comprehensive overview of such factors is lacking. Objective: The aims of this study were to (1) provide insight into the types of eHealth that are used and preferred in home care and (2) identify factors that influence the use of eHealth in home care according to health care professionals and home care clients. Methods: A scoping review and online, cross-sectional survey were conducted sequentially. The survey was conducted among Dutch health care professionals with a nursing background who were working for a home care organization at the time. The capability, opportunity, motivation, behavior (COM-B) model, which posits that for any behavior (B) to occur, a person must have the capability (C), opportunity (O), and motivation (M) to perform the behavior, was used to identify influencing factors. The use of a theoretical model may contribute to a better understanding of how to achieve and sustain behavior change in clinical practice. Results: We included 30 studies in the scoping review. The most frequently studied type of eHealth was a telecommunication/telemonitoring system. The survey was completed by 102 participants. The most frequently used types of eHealth were electronic health records, social alarms, and online client portals. A health app was the most frequently preferred type of eHealth. We identified 22 factors that influence the use of eHealth in home care according to health care professionals and home care clients. Influencing factors were organized into the components of the COM-B model, namely capability (n=6), opportunity (n=10), and motivation (n=6). We found that there is no single influencing factor that is key to the complexity of eHealth implementation. Conclusions: Different types of eHealth are used, and many types of eHealth are preferred by health care professionals. The identified factors that influence the use of eHealth in home care relate to all components of the COM-B model. These factors need to be addressed and embedded in implementation strategies of eHealth to optimize the use of eHealth in home care. ",
doi="10.2196/41768",
url="https://www.jmir.org/2023/1/e41768",
url="http://www.ncbi.nlm.nih.gov/pubmed/36892935"
}


@Article{info:doi/10.2196/42660,
author="Perkes, Jane Sarah
and Bonevski, Billie
and Hall, Kerry
and Mattes, Joerg
and Chamberlain, Catherine
and Bennett, Jessica
and Whittaker, Robyn
and Palazzi, Kerrin
and Lambkin, David
and Kennedy, Michelle",
title="Aboriginal and Torres Strait Islander Women's Access to and Interest in mHealth: National Web-based Cross-sectional Survey",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="6",
volume="25",
pages="e42660",
keywords="mHealth",
keywords="Aboriginal",
keywords="Torres Strait Islander",
keywords="public health",
keywords="health literacy",
keywords="digital literacy",
keywords="Australia",
keywords="native",
keywords="cross-sectional",
keywords="national survey",
keywords="technology use",
keywords="technology ownership",
keywords="digital device",
keywords="mobile device",
keywords="usage",
keywords="adoption",
keywords="acceptance",
keywords="digital divide",
abstract="Background: Health programs delivered through digital devices such as mobile phones (mobile health [mHealth]) have become an increasingly important component of the health care tool kit. Aboriginal and Torres Strait Islander women of reproductive age are likely to be caring for children and family members and needing health care, but little is known about their access to and interest in mHealth. Objective: The objectives of this study were to investigate Aboriginal and Torres Strait Islander women's ownership of digital devices, access to the internet, current mHealth use, and interest and preferences for future mHealth. We examined the factors (age, remoteness, caring for a child younger than 5 years, and level of education) associated with the ownership of digital devices, use of internet, and interest in using a mobile phone to improve health. This study also examines if women are more likely to use mHealth for topics that they are less confident to talk about face-to-face with a health professional. Methods: A national web-based cross-sectional survey targeting Aboriginal and Torres Strait Islander women of reproductive age (16-49 years) was performed. Descriptive statistics were reported, and logistic regressions were used to examine the associations. Results: In total, 379 women completed the survey; 89.2\% (338/379) owned a smartphone, 53.5\% (203/379) a laptop or home computer, 35.6\% (135/379) a tablet, and 93.1\% (353/379) had access to the internet at home. Most women used social media (337/379, 88.9\%) or the internet (285/379, 75.2\%) everyday. The most common modality used on the mobile phone for health was Google (232/379, 61.2\%), followed by social media (195/379, 51.5\%). The most preferred modality for future programs was SMS text messaging (211/379, 55.7\%) and social media (195/379, 51.4\%). The most preferred topics for future mHealth programs were healthy eating (210/379, 55.4\%) and cultural engagement (205/379, 54.1\%). Women who were younger had greater odds of owning a smartphone, and women with tertiary education were more likely to own a tablet or laptop. Older age was associated with interest to use telehealth, and higher educational attainment was associated with interest for videoconferencing. Most women (269/379, 70.9\%) used an Aboriginal medical service and overall reported high rates of confidence to discuss health topics with a health professional. Overall, women showed a similar likelihood of selecting a topic in mHealth whether they were or were not confident to talk to a health professional about that. Conclusions: Our study found that Aboriginal and Torres Strait Islander women were avid users of the internet and had strong interest in mHealth. Future mHealth programs for these women should consider utilizing SMS text messaging and social media modalities and including content on nutrition and culture. A noteworthy limitation of this study was that participant recruitment was web-based (due to COVID-19 restrictions). ",
doi="10.2196/42660",
url="https://www.jmir.org/2023/1/e42660",
url="http://www.ncbi.nlm.nih.gov/pubmed/36877565"
}


@Article{info:doi/10.2196/43541,
author="He, Siyi
and Li, He
and Cao, Maomao
and Sun, Dianqin
and Yang, Fan
and Yan, Xinxin
and Zhang, Shaoli
and Xia, Changfa
and Yu, Yiwen
and Zhao, Liang
and Shi, Jufang
and Li, Ni
and Yu, Qin Xue
and Chen, Wanqing
and He, Jie",
title="Geographic, Demographic, and Socioeconomic Disparities and Factors Associated With Cancer Literacy in China: National Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Feb",
day="17",
volume="9",
pages="e43541",
keywords="health literacy",
keywords="cancer literacy",
keywords="cross-sectional study",
keywords="Healthy China Initiative",
keywords="cancer control",
abstract="Background: Cancer literacy is associated with several health-related behaviors and outcomes. However, there is still a lack of nationwide surveys for cancer literacy in China. Objective: This study aims to evaluate cancer literacy in China, explore disparities, and provide scientific evidence for policy makers. Methods: A cross-sectional survey was conducted in mainland China in 2021 using the multistage probability proportional to the size sampling method. Both the reliability and validity of the questionnaire were evaluated. The awareness levels were adjusted by sampling weights and nonrepresentativeness weights to match the actual population distributions. The Rao-Scott adjusted chi-square test was applied to test geographic, demographic, and socioeconomic disparities. A generalized linear model was used to explore potential factors. Results: A total of 80,281 participants aged 15-74 years were finally enrolled from 21 provinces, with an overall response rate of 89.32\%. The national rate of cancer literacy was 70.05\% (95\% CI 69.52\%-70.58\%). The rates were highest regarding knowledge of cancer management (74.96\%, 95\% CI 74.36\%-75.56\%) but were lowest regarding basic knowledge of cancer (66.77\%, 95\% CI 66.22\%-67.33\%). Cancer literacy was highest in East China (72.65\%, 95\% CI 71.82\%-73.49\%), Central China (71.73\%, 95\% CI 70.65\%-72.81\%), and North China (70.73\%, 95\% CI 68.68\%-72.78\%), followed by Northeast (65.38\%, 95\% CI 64.54\%-66.22\%) and South China (63.21\%, 95\% CI 61.84\%-64.58\%), whereas Southwest (59.00\%, 95\% CI 58.11\%-59.89\%) and Northwest China (57.09\%, 95\% CI 55.79\%-58.38\%) showed a need for improvement. Demographic and socioeconomic disparities were also observed. Urban dwellers, the Han ethnic group, and population with higher education level or household income were associated with prior knowledge. The questionnaire showed generally good internal and external reliability and validity. Conclusions: It remains important for China to regularly monitor levels of cancer literacy, narrow disparities, and strengthen health education for dimensions with poor performance and for individuals with limited knowledge to move closer to the goal of Healthy China 2030. ",
doi="10.2196/43541",
url="https://publichealth.jmir.org/2023/1/e43541",
url="http://www.ncbi.nlm.nih.gov/pubmed/36800218"
}


@Article{info:doi/10.2196/41809,
author="Vazquez, Elias Christian
and Xie, Bo
and Shiroma, Kristina
and Charness, Neil",
title="Individualistic Versus Collaborative Learning in an eHealth Literacy Intervention for Older Adults: Quasi-Experimental Study",
journal="JMIR Aging",
year="2023",
month="Feb",
day="9",
volume="6",
pages="e41809",
keywords="eHealth literacy",
keywords="digital literacy",
keywords="older adults",
keywords="eHealth",
keywords="aging",
keywords="web-based information",
keywords="health information",
abstract="Background: Older adults tend to have insufficient health literacy, which includes eHealth literacy---the ability to access, assess, and use digital health information. Interventions using methods such as collaborative learning (CL) and individualistic learning (IL) may be effective in addressing older adults' low eHealth literacy, but little is known about the short- and long-term effects of CL versus IL on older adults' eHealth literacy. Objective: The objective of this study was to use a 3 {\texttimes} 2 {\texttimes} 3 mixed factorial design to examine older adults' learning with CL versus IL for eHealth literacy. Methods: Older adults (N=466; mean age 70.5, SD 7.2; range 60-96 years) from diverse racial and ethnic groups were randomly assigned to either the CL or IL group (233/466, 50\% in each). The intervention consisted of 4 weeks of training in 2-hour sessions held twice a week. Using ANOVA and multiple regression, we focused on the main effects of learning condition and interaction between learning condition and previous computer experience. Learning method (CL or IL) and previous computer experience (experienced, new, or mixed) were between-subject variables, and time of measurement (pretest measurement, posttest measurement, and 6-month follow-up) was the within-subject variable. Primary outcome variables were eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills. Control variables were age, sex, education, health status, race and ethnicity, income, primary language, and previous health literacy. Results: eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills improved significantly (P<.001 in all cases) from before to after the intervention. From postintervention measurement to 6-month follow-up, there was a significant interaction between learning condition and previous computer experience based on 1 outcome measure, computer and web operation skills (F2,55=3.69; P=.03). To maintain computer and web operation skills 6 months after the intervention, it was more effective for people with little to no previous computer experience to learn individually, whereas for people with more previous computer experience, it was more effective to learn collaboratively. From postintervention measurement to 6-month follow-up, statistically significant decreases were found in 3 of the 5 outcome measures: eHealth literacy efficacy, computer and web knowledge, and basic computer and web operation skills (P<.001 for all 3 cases). Conclusions: Older adults' eHealth literacy can be improved through effective intervention, and the IL or CL condition may have little effect on short-term outcomes. However, to maintain long-term benefits, it may be best to learn collaboratively with others who have similar previous computer experience. eHealth literacy is multidimensional, with some components retained better over time. Findings suggest a need for resources to provide continuous training or periodic boosting to maintain intervention gains. ",
doi="10.2196/41809",
url="https://aging.jmir.org/2023/1/e41809",
url="http://www.ncbi.nlm.nih.gov/pubmed/36757773"
}


@Article{info:doi/10.2196/42563,
author="Dhanani, Zainub
and Ferguson, M. Jacqueline
and Van Campen, James
and Slightam, Cindie
and Jacobs, C. Josephine
and Heyworth, Leonie
and Zulman, Donna",
title="Overcoming Access Barriers for Veterans: Cohort Study of the Distribution and Use of Veterans Affairs' Video-Enabled Tablets Before and During the COVID-19 Pandemic",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="26",
volume="25",
pages="e42563",
keywords="COVID-19",
keywords="veterans",
keywords="health care access",
keywords="video-based care",
keywords="telehealth",
keywords="barriers to care",
keywords="telemedicine",
keywords="veteran's association",
keywords="health disparity",
keywords="sociodemographic",
keywords="virtual health",
abstract="Background: During the COVID-19 pandemic, as health care services shifted to video- and phone-based modalities for patient and provider safety, the Veterans Affairs (VA) Office of Connected Care widely expanded its video-enabled tablet program to bridge digital divides for veterans with limited video care access. Objective: This study aimed to characterize veterans who received and used US Department of VA--issued video-enabled tablets before versus during the COVID-19 pandemic. Methods: We compared sociodemographic and clinical characteristics of veterans who received VA-issued tablets during 6-month prepandemic and pandemic periods (ie, from March 11, 2019, to September 10, 2019, and from March 11, 2020, to September 10, 2020). Then, we examined characteristics associated with video visit use for primary and mental health care within 6 months after tablet shipment, stratifying models by timing of tablet receipt. Results: There was a nearly 6-fold increase in the number of veterans who received tablets in the pandemic versus prepandemic study periods (n=36,107 vs n=6784, respectively). Compared to the prepandemic period, tablet recipients during the pandemic were more likely to be older (mean age 64 vs 59 years), urban-dwelling (24,504/36,107, 67.9\% vs 3766/6784, 55.5\%), and have a history of housing instability (8633/36,107, 23.9\% vs 1022/6784, 15.1\%). Pandemic recipients were more likely to use video care (21,090/36,107, 58.4\% vs 2995/6784, 44.2\%) and did so more frequently (5.6 vs 2.3 average encounters) within 6 months of tablet receipt. In adjusted models, pandemic and prepandemic video care users were significantly more likely to be younger, stably housed, and have a mental health condition than nonusers. Conclusions: Although the COVID-19 pandemic led to increased distribution of VA-issued tablets to veterans with complex clinical and social needs, tablet recipients who were older or unstably housed remained less likely to have a video visit. The VA's tablet distribution program expanded access to video-enabled devices, but interventions are needed to bridge disparities in video visit use among device recipients. ",
doi="10.2196/42563",
url="https://www.jmir.org/2023/1/e42563",
url="http://www.ncbi.nlm.nih.gov/pubmed/36630650"
}


@Article{info:doi/10.2196/40121,
author="Dieris-Hirche, Jan
and Bottel, Laura
and Herpertz, Stephan
and Timmesfeld, Nina
and te Wildt, Theodor Bert
and W{\"o}lfling, Klaus
and Henningsen, Peter
and Neumann, Anja
and Beckers, Rainer
and Pape, Magdalena",
title="Internet-Based Self-Assessment for Symptoms of Internet Use Disorder---Impact of Gender, Social Aspects, and Symptom Severity: German Cross-sectional Study",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="12",
volume="25",
pages="e40121",
keywords="internet use disorder",
keywords="eHealth",
keywords="telemedicine",
keywords="internet addiction",
keywords="gaming disorder",
keywords="OMPRIS",
keywords="internet use",
keywords="online self-assessment",
keywords="self-assessment",
keywords="eHealth services",
abstract="Background: Internet use disorder (IUD) is a new type of behavioral addiction in the digital age. At the same time, internet applications and eHealth can also provide useful support in medical treatment. Objective: The purpose of this study is to examine if an internet-based eHealth service can reach individuals with IUD. In particular, it should be investigated whether both male and female individuals with more severe IUDs can be reached. Methods: Data were retrieved from the OMPRIS (online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder) project (DRKS00019925), an internet-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and IUD. During the recruitment process (August 2020-March 2022), a total of 3007 individuals filled out the standardized scale for the assessment of internet and computer game addiction (AICA-S). The assessment was accessible via the project homepage. There was no preselection of participants at this stage of the study; however, the offer was addressed to people with hazardous internet use and IUDs. The web-based assessment was free and could be found via search engines, but attention was also drawn to the service via newspaper articles, radio reports, and podcasts. Results: Out of 3007 who participated in the web-based self-assessment, 1033 (34.4\%) are female, 1740 (57.9\%) are male, 67 (2.2\%) are diverse individuals, and 167 (5.5\%) did not disclose their gender. The IUD symptom severity score showed a wide range between the AICA-S extreme values of 0 and 27 points. On average, the total sample (mean 8.19, SD 5.47) was in the range of hazardous IUD behavior (AICA-S cutoff>7.0). Furthermore, 561 individuals (18.7\% of the total sample; mean 17.42, SD 3.38) presented severe IUD (AICA-S cutoff>13.5). Focusing on female and male participants, 20.9\% (363/1740) of the men and 14.9\% (151/1033) of the women scored above 13.5 points, which can be considered pathological IUD behavior ($\chi$22,2773=16.73, P<.001, effect size: Cram{\'e}r V=0.078). Unemployment, being in vocational training or studying at a university, and being male were significantly associated with high IUD symptoms. Conclusions: Using a large sample, the study showed that both mildly and severely IUD-affected individuals can be reached via the internet. An internet-based eHealth offer can thus be a good way to reach patients with IUD where they are addicted---on the internet. In addition, eHealth services increase the likelihood of reaching female patients, who hardly ever come to specialized outpatient clinics and hospitals. Since social problems, especially unemployment, have a strong association with disease severity, the integration of social counseling into treatment seems advisable in terms of a multidisciplinary approach. Trial Registration: German Clinical Trials Register (DRKS) DRKS00019925; https://drks.de/search/de/trial/DRKS00019925 ",
doi="10.2196/40121",
url="https://www.jmir.org/2023/1/e40121",
url="http://www.ncbi.nlm.nih.gov/pubmed/36633897"
}


@Article{info:doi/10.2196/39155,
author="Kwan, Heng Yu
and Phang, Kie Jie
and Woon, Hui Ting
and Liew, W. Jean
and Dubreuil, Maureen
and Proft, Fabian
and Ramiro, Sofia
and Molto, Anna
and Navarro-Comp{\'a}n, Victoria
and de Hooge, Manouk
and Meghnathi, Bhowmik
and Ziade, Nelly
and Zhao, Steven Sizheng
and Llop, Maria
and Baraliakos, Xenofon
and Fong, Warren",
title="Social Media Use Among Members of the Assessment of Spondyloarthritis International Society: Results of a Web-Based Survey",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="10",
volume="25",
pages="e39155",
keywords="social media",
keywords="spondyloarthritis",
keywords="cross-sectional survey",
abstract="Background: The use of social media in health care may serve as a beneficial tool for education, information dissemination, telemedicine, research, networking, and communications. To better leverage the benefits of social media, it is imperative to understand the patterns of its use and potential barriers to its implementation in health care. A previous study in 2016 that investigated social media use among young clinical rheumatologists (?45 years) and basic scientists showed that there was substantial social media use among them for social and professional reasons. However, there is a limited inquiry into social media use in different areas of rheumatology, such as spondyloarthritis. Objective: We aimed to explore the motivations, barriers, and patterns of social media use among an international group of experts in spondyloarthritis. Methods: We distributed a web-based survey via email from March 2021 to June 2021 to 198 members of the Assessment of Spondyloarthritis International Society. It contained 24 questions about demographic characteristics, patterns of current social media use, and perceptions of utility. Univariable and multivariable logistic regression analyses were performed to identify the characteristics associated with use trends. Results: The response rate was 78.8\% (156/198). Of these, 93.6\% (146/156) of participants used at least one social media platform. Apart from internet-based shopping and entertainment, the use of social media for clinical updates (odds ratio [OR] 6.25, 95\% CI 2.43-16.03) and research updates (OR 3.45, 95\% CI 1.35-8.78) were associated with higher social media consumption. Among the respondents, 66\% (103/156) used social media in a work-related manner. The use of social media for new web-based resources (OR 6.55, 95\% CI 2.01-21.37), interaction with international colleagues (OR 4.66, 95\% CI 1.21-17.90), and establishing a web-based presence (OR 4.05, 95\% CI 1.25-13.13) were associated with higher levels of consumption for work-related purposes. Time investment, confidentiality concerns, and security concerns were the top 3 challenges to a wider adoption of social media. Conclusions: Most respondents (103/156, 66\%) use social media in a work-related manner. Professional development, establishing a web-based presence, and international collaboration were associated with higher use. Challenges to social media adoption should be addressed to maximize its benefits. ",
doi="10.2196/39155",
url="https://www.jmir.org/2023/1/e39155",
url="http://www.ncbi.nlm.nih.gov/pubmed/36626201"
}


@Article{info:doi/10.2196/40630,
author="Goswami, Aumeya
and Poole, Lydia
and Thorlu-Bangura, Zareen
and Khan, Nushrat
and Hanif, Wasim
and Khunti, Kamlesh
and Gill, Paramjit
and Sajid, Madiha
and Blandford, Ann
and Stevenson, Fiona
and Banerjee, Amitava
and Ramasawmy, Mel",
title="The Use of Digital Health Interventions for Cardiometabolic Diseases Among South Asian and Black Minority Ethnic Groups: Realist Review",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="6",
volume="25",
pages="e40630",
keywords="digital health",
keywords="health inequality",
keywords="cardiometabolic disease",
keywords="cardiometabolic",
keywords="ethnic",
keywords="minority",
keywords="cardiology",
keywords="heart",
keywords="eHealth",
keywords="review",
keywords="realist",
keywords="context-mechanism-outcome",
keywords="South Asia",
keywords="Black",
keywords="migrant",
keywords="systematic search",
keywords="literature search",
keywords="African American",
keywords="CVD",
keywords="cardiovascular",
keywords="diabetes",
keywords="diabetic",
keywords="type 2",
keywords="mobile phone",
abstract="Background: Digital health interventions (DHIs) for the prevention and management of cardiometabolic diseases have become increasingly common. However, there is limited evidence for the suitability of these approaches in minority ethnic populations, who are at an increased risk of these diseases. Objective: This study aimed to investigate the use of DHIs for cardiovascular disease and type 2 diabetes among minority ethnic populations in countries with a majority of White, English-speaking populations, focusing on people who identified as South Asian, Black, or African American. Methods: A realist methodology framework was followed. A literature search was conducted to develop context-mechanism-outcome configurations, including the contexts in which DHIs work for the target minority ethnic groups, mechanisms that these contexts trigger, and resulting health outcomes. After systematic searches, a qualitative analysis of the included studies was conducted using deductive and inductive coding. Results: A total of 15 studies on the uptake of DHIs for cardiovascular disease or diabetes were identified, of which 13 (87\%) focused on people with an African-American background. The review found evidence supporting the use of DHIs in minority ethnic populations when specific factors are considered in implementation and design, including patients' beliefs, health needs, education and literacy levels, material circumstances, culture, social networks, and wider community and the supporting health care systems. Conclusions: Our context-mechanism-outcome configurations provide a useful guide for the future development of DHIs targeted at South Asian and Black minority ethnic populations, with specific recommendations for improving cultural competency and promoting accessibility and inclusivity of design. ",
doi="10.2196/40630",
url="https://www.jmir.org/2023/1/e40630",
url="http://www.ncbi.nlm.nih.gov/pubmed/36607732"
}


@Article{info:doi/10.2196/40062,
author="Horn, Bade Deborah
and Pash, Elizabeth
and Zhou, S. Megan
and Broffman, Lauren
and Bialonczyk, Damian
and Doron, Tzvi
and Chiquette, Elaine",
title="Characteristics and Weight Loss Practices From a Cohort of 20,000 Patients Using Direct-to-Consumer Telehealth: Observational Cross-sectional Study",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="5",
volume="7",
pages="e40062",
keywords="obesity",
keywords="preobesity",
keywords="overweight",
keywords="weight management",
keywords="direct-to-consumer telehealth",
keywords="oral superabsorbent hydrogel",
abstract="Background: Despite the increasing prevalence of obesity, the use of pharmacotherapy treatment remains low. Telehealth platforms have the potential to facilitate access to pharmacotherapy interventions, but little is known about telehealth patients. Objective: This study describes a large patient population taking Plenity, an oral superabsorbent hydrogel (OSH) used in the treatment of excess weight or obesity (BMI 25-40 kg/m2). The analysis compared differences in weight loss practices and in-person access to obesity care among telehealth patients with preobesity and obesity. Methods: This was a cross-sectional assessment of a random sample of 20,000 telehealth patients who completed a structured, web-based visit and received at least one prescription of OSH. Patients were eligible to receive care via telehealth if they were adults, were not pregnant, and had a BMI ?25 kg/m2. During the visit, patients provided baseline health information including comorbidities, diet, and exercise habits. Their zip code of residence was used to determine their proximity to an obesity medicine provider. Descriptive statistical analysis and tests of differences (chi-square and 2-tailed t tests) were used to compare patients with preobesity (BMI 25-29.9 kg/m2) and obesity (BMI 30-40 kg/m2). Results: Most (15,576/20,000, 77.88\%) of the cohort were female, with a mean age of 44 (SD 11) years and a mean BMI of 32.4 (SD 4.1) kg/m2. Among the cohort, 32.13\% (6426/20,000) had preobesity, and 40.18\% (8036/20,000) of all patients had ?1 weight-related comorbidity. Almost all (19,732/20,000, 98.66\%) patients attempted 1 weight loss method before OSH and half (10,067/20,000, 50.34\%) tried ?4 different methods. Exercise and low-calorie diets were the most attempted weight loss methods, and 28.76\% (5752/20,000) of patients reported a prior prescription of weight loss medication. Patients with obesity were more likely than patients with preobesity to have previously tried commercial weight loss plans (7294/13,574, 53.74\% vs 2791/6426, 43.43\%; P<.001), specialized diets (8493/13,574, 62.57\% vs 3799/6426, 59.12\%; P<.001), over-the-counter supplements (6807/13,574, 50.15\% vs 2876/6426, 44.76\%; P<.001), and prescription weight loss medications (4407/13,574, 32.47\% vs 1345/6426, 20.93\%; P<.001). Females were more likely to seek treatment for preobesity (5332/15,576, 34.23\% vs 1094/4424, 24.73\% male; P<.001) and reported fewer comorbidities (5992/15,576, 38.47\% vs 2044/4424, 46.2\% male; P<.001), despite >90\% of both sexes reporting the belief that excess weight negatively affected their health (14,247/15,576, 91.47\% female participants, 4116/4424, 93.04\% male participants). Moreover, 29.25\% (5850/20,000) of patients lived in the same zip code and 85.15\% (17,030/20,000) lived in the same county as an obesity medicine provider. Conclusions: Data from this large patient cohort supports the potential for telehealth to provide prescriptive weight management treatment to a population seeking care. Patients with preobesity are an undertreated population who actively seek new weight management options. Female participants sought weight management treatment earlier in the disease continuum than males, despite reporting fewer comorbidities. ",
doi="10.2196/40062",
url="https://formative.jmir.org/2023/1/e40062",
url="http://www.ncbi.nlm.nih.gov/pubmed/36602855"
}


@Article{info:doi/10.2196/41972,
author="Ndabu, Theophile
and Agrawal, Lavlin
and Sharman, Raj",
title="The Role of Access Type and Age Group in the Breadth of Use of Patient Portals: Observational Study",
journal="J Med Internet Res",
year="2022",
month="Dec",
day="27",
volume="24",
number="12",
pages="e41972",
keywords="patient portal",
keywords="mobile health apps",
keywords="electronic medical records",
keywords="personal health record functionalities",
keywords="patient satisfaction",
keywords="health information",
keywords="Health Information National Trends Survey",
keywords="healthcare delivery",
keywords="app use",
keywords="electronic medical record",
abstract="Background: Health care delivery and patient satisfaction are improved when patients engage with their medical information through patient portals. Despite their wide availability and multiple functionalities, patient portals and their functionalities are still underused. Objective: We seek to understand factors that lead to patient engagement through multiple portal functionalities. We provide recommendations that could lead to higher patients' usage of their portals. Methods: Using data from the Health Information National Trends Survey 5, Cycle 3 (N=2093), we performed descriptive statistics and used a chi-square test to analyze the association between the demographic variables and the use of mobile health apps for accessing medical records. We further fitted a generalized linear model to examine the association between access type and the use of portal functionalities. We further examined the moderation effects of age groups on the impact of access type on portal usage. Results: Our results show that accessing personal health records using a mobile health app is positively associated with greater patient usage of access capabilities ($\beta$=.52; P<.001), patient-provider interaction capabilities ($\beta$=.24, P=.006), and patient--personal health information interaction capabilities ($\beta$=.23, P=.009). Patients are more likely to interact with their records and their providers when accessing their electronic medical records using a mobile health app. The impacts of mobile health app usage fade with age for tasks consisting of viewing, downloading, and transmitting medical results to a third party ($\beta$=--.43, P=.005), but not for those involving patient-provider interaction ($\beta$=.05, P=.76) or patient--personal health information interaction ($\beta$=--.15, P=.19). Conclusions: These findings provide insights on how to increase engagement with diverse portal functionalities for different age groups and thus improve health care delivery and patient satisfaction. ",
doi="10.2196/41972",
url="https://www.jmir.org/2022/12/e41972",
url="http://www.ncbi.nlm.nih.gov/pubmed/36574284"
}


@Article{info:doi/10.2196/40771,
author="Du, Yumeng
and Zhou, Qiru
and Cheng, Weibin
and Zhang, Zhang
and Hoelzer, Samantha
and Liang, Yizhi
and Xue, Hao
and Ma, Xiaochen
and Sylvia, Sean
and Tian, Junzhang
and Tang, Weiming",
title="Factors Influencing Adoption and Use of Telemedicine Services in Rural Areas of China: Mixed Methods Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Dec",
day="23",
volume="8",
number="12",
pages="e40771",
keywords="telemedicine",
keywords="telehealth",
keywords="rural residents",
keywords="mixed methods",
keywords="China",
keywords="mobile phone",
abstract="Background: The shortage of medical resources in rural China reflects the health inequity in resource-limited settings, whereas telemedicine could provide opportunities to fill this gap. However, evidence of patient acceptance of telemedicine services from low- and middle-income countries is still lacking. Objective: We aimed to understand the profile of patient end-user telemedicine use and identify factors influencing telemedicine service use in rural China. Methods: Our study followed a mixed methods approach, with a quantitative cross-sectional survey followed by in-depth semistructured interviews to describe telemedicine use and its associated factors among rural residents in Guangdong Province, China. In the quantitative analysis, explanatory variables included environmental and context factors, household-level factors, individual sociodemographic factors, access to digital health care, and health needs and demand factors. We conducted univariate and multivariate analyses using Firth logistic regression to examine the correlations of telemedicine uptake. A thematic approach was used, guided by the Social Cognitive Theory for the qualitative analysis. Results: A total of 2101 households were recruited for the quantitative survey. With a mean age of 61.4 (SD 14.41) years, >70\% (1364/2101, 72.94\%) of the household respondents were male. Less than 1\% (14/2101, 0.67\%) of the respondents reported experience of using telemedicine. The quantitative results supported that villagers living with family members who had a fever in the past 2 weeks (adjusted odds ratio 6.96, 95\% CI 2.20-21.98; P=.001) or having smartphones or computers (adjusted odds ratio 3.71, 95\% CI 0.64-21.32; P=.14) had marginally higher telemedicine uptake, whereas the qualitative results endorse these findings. The results of qualitative interviews (n=27) also supplemented the potential barriers to telemedicine use from the lack of knowledge, trust, demand, low self-efficacy, and sufficient physical and social support. Conclusions: This study found extremely low use of telemedicine in rural China and identified potential factors affecting telemedicine uptake. The main barriers to telemedicine adoption among rural residents were found, including lack of knowledge, trust, demand as well as low self-efficacy, and insufficient physical and social support. Our study also suggests strategies to facilitate telemedicine engagement in low-resource settings: improving digital literacy and self-efficacy, building trust, and strengthening telemedicine infrastructure support. ",
doi="10.2196/40771",
url="https://publichealth.jmir.org/2022/12/e40771",
url="http://www.ncbi.nlm.nih.gov/pubmed/36563026"
}


@Article{info:doi/10.2196/38878,
author="Sahashi, Kentaro
and Hashizume, Atsushi
and Kuwatsuka, Yachiyo
and Chinen, Madoka
and Saotome-Nakamura, Ai
and Ando, Masahiko
and Katsuno, Masahisa",
title="The Japan Registry for Adult Subjects of Spinal Muscular Atrophy (jREACT-SMA): Protocol for a Longitudinal Observational Study",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="15",
volume="11",
number="12",
pages="e38878",
keywords="adult",
keywords="disease-modifying therapy",
keywords="Japan",
keywords="nusinersen",
keywords="observational study",
keywords="registry",
keywords="spinal muscular atrophy",
abstract="Background: Spinal muscular atrophy (SMA) is an autosomal recessive genetic neuromuscular disorder with progressive muscle weakness and atrophy, mainly caused by lower motor neuron degeneration resulting from decreased levels of the survival motor neuron protein. Recently, 3 disease-modifying therapies for SMA (nusinersen, onasemnogene abeparvovec, and risdiplam) were approved in Japan that are expected to improve the prognosis of patients with SMA. Long-term clinical follow-up of adult patients treated with disease-modifying therapies and the natural history of SMA are essential to assess the real-world effectiveness of available treatments. Until recently, nusinersen was the only treatment option for patients with SMA in Japan; however, because Japanese approval of nusinersen was based on global clinical trials in infants and children aged 0-15 years with SMA, the effectiveness of nusinersen in adult patients has not been fully assessed in Japan. In addition, longitudinal clinical data of adult patients have not been systematically collected in Japan. Objective: This longitudinal observational study of adult patients with SMA who have been diagnosed with 5q-SMA in Japan aims to gain a better understanding of the natural history of SMA, as well as the long-term effectiveness of disease-modifying therapies. Here, we describe the protocol for the study. Methods: The Japan Registry for Adult Subjects of Spinal Muscular Atrophy (jREACT-SMA) study is a longitudinal (prospective and retrospective) observational study with a 60-month prospective follow-up being conducted at 19 investigational sites using the newly established jREACT-SMA registry. Patients aged ?18 years with genetically confirmed 5q-SMA were planned to be enrolled in the registry from December 2020 to May 2022. The planned enrollment was 100 patients. The protocol was approved on September 28, 2020 (approval 2020-0289) by the ethical review committee of Nagoya University. Registration, demographics, genetic diagnosis, motor functions, patient-reported outcomes/quality-of-life outcomes, and other clinical data have been or will be collected. Results: As of May 2022, 113 patients had been enrolled, and the completion of patient registration has been extended from May 2022 to December 2022. Data at registration and during the follow-up period were and will be prospectively collected at least once a year until November 2025 (maximum 60 months). Data analyses will be conducted when all data have been collected. Results are expected to be available in 2026 and the study is expected to be completed by March 2027. Conclusions: This jREACT-SMA study will provide longitudinal prospective follow-up data in adult patients with SMA in Japan, including data on the natural history of the disease and data on the long-term effectiveness of disease-modifying therapies. Trial Registration: University Hospital Medical Information Network Center Clinical Trials Registry UMIN000042015; https://rctportal.niph.go.jp/en/detail?trial\_id=UMIN000042015 International Registered Report Identifier (IRRID): DERR1-10.2196/38878 ",
doi="10.2196/38878",
url="https://www.researchprotocols.org/2022/12/e38878",
url="http://www.ncbi.nlm.nih.gov/pubmed/36520510"
}


@Article{info:doi/10.2196/39220,
author="Montagni, Ilaria
and Pouymayou, Aude
and Pereira, Edwige
and Tzourio, Christophe
and Sch{\"u}ck, St{\'e}phane
and Texier, Nathalie
and Gonz{\'a}lez-Caballero, Luis Juan
and ",
title="Measuring Digital Vaccine Literacy: Development and Psychometric Assessment of the Digital Vaccine Literacy Scale",
journal="J Med Internet Res",
year="2022",
month="Dec",
day="14",
volume="24",
number="12",
pages="e39220",
keywords="Internet",
keywords="literacy",
keywords="measurement",
keywords="vaccination",
keywords="vaccine",
keywords="health information",
keywords="health literacy",
keywords="online",
keywords="content",
keywords="validity",
keywords="reliability",
keywords="digital literacy",
abstract="Background: The use of the internet to look for information about vaccines has skyrocketed in the last years, especially with the COVID-19 pandemic. Digital vaccine literacy (DVL) refers to understanding, trust, appraisal, and application of vaccine-related information online. Objective: This study aims to develop a tool measuring DVL and assess its psychometric properties. Methods: A 7-item online questionnaire was administered to 848 French adults. Different psychometric analyses were performed, including descriptive statistics, exploratory factor analysis, confirmatory factor analysis, and convergent and discriminant validity. Results: We developed the 7-item DVL scale composed of 3 factors (understanding and trust official information; understanding and trust information in social media; and appraisal of vaccine information online in terms of evaluation of the information and its application for decision making). The mean DVL score of the baseline sample of 848 participants was 19.5 (SD 2.8) with a range of 7-28. The median score was 20. Scores were significantly different by gender (P=.24), age (P=.03), studying or working in the field of health (P=.01), and receiving regular seasonal flu shots (P=.01). Conclusions: The DVL tool showed good psychometric proprieties, resulting in a promising measure of DVL. ",
doi="10.2196/39220",
url="https://www.jmir.org/2022/12/e39220",
url="http://www.ncbi.nlm.nih.gov/pubmed/36515982"
}


@Article{info:doi/10.2196/40068,
author="Turin, C. Tanvir
and Subroto, Sujoy
and Raihan, H. Mohammad M.
and Koch, Katharina
and Wiles, Robert
and Ruttan, Erin
and Nesset, Monique
and Chowdhury, Nashit",
title="Identifying Challenges, Enabling Practices, and Reviewing Existing Policies Regarding Digital Equity and Digital Divide Toward Smart and Healthy Cities: Protocol for an Integrative Review",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="8",
volume="11",
number="12",
pages="e40068",
keywords="healthy city",
keywords="smart city",
keywords="digital equity",
keywords="digital divide",
keywords="digital literacy",
keywords="equity",
keywords="urban community",
keywords="inequality",
keywords="urban area",
keywords="challenges",
keywords="barriers",
keywords="participation",
keywords="social interaction",
keywords="structural inequality",
abstract="Background: Digital equity denotes that all individuals and communities have equitable access to the information technology required to participate in digital life and can fully capitalize on this technology for their individual and community gain and benefits. Recent research highlighted that COVID-19 heightened the existing structural inequities and further exacerbated the technology-related social divide, especially for racialized communities, including new immigrants, refugees, and ethnic minorities. The intersection of challenges associated with racial identity (eg, racial discrimination and cultural differences), socioeconomic marginalization, and age- and gender-related barriers affects their access to health and social services, education, economic activity, and social life owing to digital inequity. Objective: Our aim is to understand the current state of knowledge on digital equity and the digital divide (which is often considered a complex social-political challenge) among racialized communities in urban cities of high-income countries and how they impact the social interactions, economic activities, and mental well-being of racialized city dwellers. Methods: We will conduct an integrative review adapting the Whittemore and Knafl methodology to summarize past empirical or theoretical literature describing digital equity issues pertaining to urban racialized communities. The context will be limited to studies on multicultural cities in high-income countries (eg, Calgary, Alberta) in the last 10 years. We will use a comprehensive search of 8 major databases across multiple disciplines and gray literature (eg, Google Scholar), using appropriate search terms related to digital ``in/equity'' and ``divide.'' A 2-stage screening will be conducted, including single citation tracking and a hand search of reference lists. Results will be synthesized using thematic analysis guidelines. Results: As of August 25, 2022, we have completed a systematic search of 8 major academic databases from multiple disciplines, gray literature, and citation or hand searching. After duplicate removal, we identified 8647 articles from all sources. Two independent reviewers are expected to complete the 2-step screening (title, abstract, and full-text screening) using Covidence followed by data extraction and analysis in 4 months (by December 2022). Data will be extracted regarding digital equity--related initiatives, programs, activities, research findings, issues, barriers, policies, recommendations, etc. Thematic analysis will reveal how barriers and facilitators of digital equity affect or benefit racialized population groups and what social, material, and systemic issues need to be addressed to establish digital equity for racialized communities in the context of a multicultural city. Conclusions: This project will inform public policy about digital inequity alongside conventional systemic inequities (eg, education and income levels); promote digital equity by exploring and examining the pattern, extent, and determinants and barriers of digital inequity across sociodemographic variables and groups; and analyze its interconnectedness with spatial dimensions and variations of the urban sphere (geographic differences). International Registered Report Identifier (IRRID): DERR1-10.2196/40068 ",
doi="10.2196/40068",
url="https://www.researchprotocols.org/2022/12/e40068",
url="http://www.ncbi.nlm.nih.gov/pubmed/36480264"
}


@Article{info:doi/10.2196/42358,
author="Husain, Laiba
and Greenhalgh, Trisha
and Hughes, Gemma
and Finlay, Teresa
and Wherton, Joseph",
title="Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage",
journal="J Med Internet Res",
year="2022",
month="Dec",
day="7",
volume="24",
number="12",
pages="e42358",
keywords="digital health disparities",
keywords="video consultations",
keywords="intersectionality",
keywords="health inequity",
keywords="narrative review",
keywords="digital capital",
keywords="fundamental cause theory",
keywords="mobile phone",
abstract="Background: Digital consultations between patients and clinicians increased markedly during the COVID-19 pandemic, raising questions about equity. Objective: This study aimed to review the literature on how multiple disadvantage---specifically, older age, lower socioeconomic status, and limited English proficiency---has been conceptualized, theorized, and studied empirically in relation to digital consultations. We focused mainly on video consultations as they have wider disparities than telephone consultations and relevant data on e-consultations are sparse. Methods: Using keyword and snowball searching, we identified relevant papers published between 2012 and 2022 using Ovid MEDLINE, Web of Science, Google Scholar, and PubMed. The first search was completed in July 2022. Papers meeting the inclusion criteria were analyzed thematically and summarized, and their key findings were tabulated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research criteria. Explanations for digital disparities were critically examined, and a search was undertaken in October 2022 to identify theoretical lenses on multiple disadvantage. Results: Of 663 articles from the initial search, 27 (4.1\%) met our inclusion criteria. In total, 37\% (10/27) were commentaries, and 63\% (17/27) were peer-reviewed empirical studies (11/27, 41\% quantitative; 5/27, 19\% qualitative; 1/27, 4\% mixed methods; 1/27, 4\% systematic reviews; and 1/27, 4\% narrative reviews). Empirical studies were mostly small, rapidly conducted, and briefly reported. Most studies (25/27, 93\%) identified marked digital disparities but lacked a strong theoretical lens. Proposed solutions focused on identifying and removing barriers, but the authors generally overlooked the pervasive impact of multiple layers of disadvantage. The data set included no theoretically informed studies that examined how different dimensions of disadvantage combined to affect digital health disparities. In our subsequent search, we identified 3 theoretical approaches that might help account for these digital disparities. Fundamental cause theory by Link and Phelan addresses why the association between socioeconomic status and health is pervasive and persists over time. Digital capital theory by Ragnedda and Ruiu explains how people mobilize resources to participate in digitally mediated activities and services. Intersectionality theory by Crenshaw states that systems of oppression are inherently bound together, creating singular social experiences for people who bear the force of multiple adverse social structures. Conclusions: A limitation of our initial sample was the sparse and undertheorized nature of the primary literature. The lack of attention to how digital health disparities emerge and play out both within and across categories of disadvantage means that solutions proposed to date may be oversimplistic and insufficient. Theories of multiple disadvantage have bearing on digital health, and there may be others of relevance besides those discussed in this paper. We call for greater interdisciplinary dialogue between theoretical research on multiple disadvantage and empirical studies on digital health disparities. ",
doi="10.2196/42358",
url="https://www.jmir.org/2022/12/e42358",
url="http://www.ncbi.nlm.nih.gov/pubmed/36383632"
}


@Article{info:doi/10.2196/40404,
author="Wong, Eiin Jyh
and Yamaguchi, Miwa
and Nishi, Nobuo
and Araki, Michihiro
and Wee, Hum Lei",
title="Predicting Overweight and Obesity Status Among Malaysian Working Adults With Machine Learning or Logistic Regression: Retrospective Comparison Study",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="7",
volume="6",
number="12",
pages="e40404",
keywords="overweight",
keywords="obesity",
keywords="prediction",
keywords="machine learning",
keywords="logistic regression",
keywords="etiology",
keywords="algorithms",
keywords="Malaysia",
keywords="adults",
keywords="predictive models",
keywords="accuracy",
keywords="working adults",
keywords="surveillance",
abstract="Background: Overweight or obesity is a primary health concern that leads to a significant burden of noncommunicable disease and threatens national productivity and economic growth. Given the complexity of the etiology of overweight or obesity, machine learning (ML) algorithms offer a promising alternative approach in disentangling interdependent factors for predicting overweight or obesity status. Objective: This study examined the performance of 3 ML algorithms in comparison with logistic regression (LR) to predict overweight or obesity status among working adults in Malaysia. Methods: Using data from 16,860 participants (mean age 34.2, SD 9.0 years; n=6904, 41\% male; n=7048, 41.8\% with overweight or obesity) in the Malaysia's Healthiest Workplace by AIA Vitality 2019 survey, predictor variables, including sociodemographic characteristics, job characteristics, health and weight perceptions, and lifestyle-related factors, were modeled using the extreme gradient boosting (XGBoost), random forest (RF), and support vector machine (SVM) algorithms, as well as LR, to predict overweight or obesity status based on a BMI cutoff of 25 kg/m2. Results: The area under the receiver operating characteristic curve was 0.81 (95\% CI 0.79-0.82), 0.80 (95\% CI 0.79-0.81), 0.80 (95\% CI 0.78-0.81), and 0.78 (95\% CI 0.77-0.80) for the XGBoost, RF, SVM, and LR models, respectively. Weight satisfaction was the top predictor, and ethnicity, age, and gender were also consistent predictor variables of overweight or obesity status in all models. Conclusions: Based on multi-domain online workplace survey data, this study produced predictive models that identified overweight or obesity status with moderate to high accuracy. The performance of both ML-based and logistic regression models were comparable when predicting obesity among working adults in Malaysia. ",
doi="10.2196/40404",
url="https://formative.jmir.org/2022/12/e40404",
url="http://www.ncbi.nlm.nih.gov/pubmed/36476813"
}


@Article{info:doi/10.2196/39647,
author="Patel, Piyush Sharvil
and Sun, Elizabeth
and Reinhardt, Alec
and Geevarghese, Sanjaly
and He, Simon
and Gazmararian, A. Julie",
title="Social Determinants of Digital Health Adoption: Pilot Cross-sectional Survey",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="6",
volume="6",
number="12",
pages="e39647",
keywords="digital health",
keywords="health accessibility",
keywords="utilization",
keywords="mobile health",
keywords="mHealth",
keywords="telemedicine",
abstract="Background: Interest in and funding for digital health interventions have rapidly grown in recent years. Despite the increasing familiarity with mobile health from regulatory bodies, providers, and patients, overarching research on digital health adoption has been primarily limited to morbidity-specific and non-US samples. Consequently, there is a limited understanding of what personal factors hold statistically significant relationships with digital health uptake. Moreover, this limits digital health communities' knowledge of equity along digital health use patterns. Objective: This study aims to identify the social determinants of digital health tool adoption in Georgia. Methods: Web-based survey respondents in Georgia 18 years or older were recruited from mTurk to answer primarily closed-ended questions within the following domains: participant demographics and health consumption background, telehealth, digital health education, prescription management tools, digital mental health services, and doctor finder tools. Participants spent around 15 to 20 minutes on a survey to provide demographic and personal health care consumption data. This data was analyzed with multivariate linear and logistic regressions to identify which of these determinants, if any, held statistically significant relationships with the total number of digital health tool categories adopted and which of these determinants had absolute relationships with specific categories. Results: A total of 362 respondents completed the survey. Private insurance, residence in an urban area, having a primary care provider, fewer urgent emergency room (ER) visits, more ER visits leading to inpatient stays, and chronic condition presence were significantly associated with the number of digital health tool categories adopted. The separate logistic regressions exhibited substantial variability, with 3.5 statistically significant predictors per model, on average. Age, federal poverty level, number of primary care provider visits in the past 12 months, number of nonurgent ER visits in the past 12 months, number of urgent ER visits in the past 12 months, number of ER visits leading to inpatient stays in the past 12 months, race, gender, ethnicity, insurance, education, residential area, access to the internet, difficulty accessing health care, usual source of care, status of primary care provider, and status of chronic condition all had at least one statistically significant relationship with the use of a specific digital health category. Conclusions: The results demonstrate that persons who are socioeconomically disadvantaged may not adopt digital health tools at disproportionately higher rates. Instead, digital health tools may be adopted along social determinants of health, providing strong evidence for the digital health divide. The variability of digital health adoption necessitates investing in and building a common framework to increase mobile health access. With a common framework and a paradigm shift in the design, evaluation, and implementation strategies around digital health, disparities can be further mitigated and addressed. This likely will begin with a coordinated effort to determine barriers to adopting digital health solutions. ",
doi="10.2196/39647",
url="https://formative.jmir.org/2022/12/e39647",
url="http://www.ncbi.nlm.nih.gov/pubmed/36472905"
}


@Article{info:doi/10.2196/40123,
author="Hermsen, Sander
and van Kraaij, Alex
and Camps, Guido",
title="Low-- and Medium--Socioeconomic-Status Group Members' Perceived Challenges and Solutions for Healthy Nutrition: Qualitative Focus Group Study",
journal="JMIR Hum Factors",
year="2022",
month="Dec",
day="2",
volume="9",
number="4",
pages="e40123",
keywords="nutrition",
keywords="citizen science",
keywords="socioeconomic status",
keywords="digital technology",
abstract="Background: Although digital tools for healthy nutrition have shown great potential, their actual impact remains variable as digital solutions often do not fit users' needs and barriers. This is especially poignant for priority communities in society. Involving these groups in citizen science may have great benefits even beyond the increase in knowledge of the lives and experiences of these groups. However, this requires specialized skills. Participants from priority groups could benefit from an approach that offers sensitization and discussion to help them voice their needs regarding healthy nutrition and technology to support healthy eating. Objective: This study aimed to gather insights into people's thoughts on everyday eating practices, self-regulation in healthy eating, and skill acquisition and on applying technological innovations to these domains. Methods: Participants answered 3 daily questionnaires to garner their current practices regarding habits, self-regulation, skills, and technology use surrounding healthy eating and make it easier for them to collect their thoughts and experiences (sensitization). Within a week of filling out the 3 questionnaires, participants took part in a web-based focus group discussion session. All sessions were transcribed and analyzed using a thematic qualitative approach. Results: A total of 42 people took part in 7 focus group interviews of 6 people each. The analysis showed that participants would like to receive support from technology for a broad range of aspects of nutrition, such as measuring the effect their personal nutrition has on their individual health, providing them with reliable product information, giving them practical guidance for healthy eating and snacking, and reducing the burden of registering food intake. Technology should be easy to use, reduce burdens, and be tailored to personal situations. Privacy and cost were major concerns for the participants. Conclusions: This study shows that people from low-- and medium--socioeconomic-status groups have a need for specific support in tailoring their knowledge of healthy nutrition to their own situation and see technology as a means to achieve this. ",
doi="10.2196/40123",
url="https://humanfactors.jmir.org/2022/4/e40123",
url="http://www.ncbi.nlm.nih.gov/pubmed/36459403"
}


@Article{info:doi/10.2196/40304,
author="Muehlensiepen, Felix
and Petit, Pascal
and Knitza, Johannes
and Welcker, Martin
and Vuillerme, Nicolas",
title="Factors Associated With Telemedicine Use Among German General Practitioners and Rheumatologists: Secondary Analysis of Data From a Nationwide Survey",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="30",
volume="24",
number="11",
pages="e40304",
keywords="telemedicine",
keywords="rheumatology",
keywords="primary care",
keywords="secondary analysis",
keywords="health services research",
abstract="Background: Previous studies have demonstrated telemedicine (TM) to be an effective tool to complement rheumatology care and address workforce shortage. With the outbreak of the SARS-CoV-2 pandemic, TM experienced a massive upswing. However, in rheumatology care, the use of TM stagnated again shortly thereafter. Consequently, the factors associated with physicians' willingness to use TM (TM willingness) and actual use of TM (TM use) need to be thoroughly investigated. Objective: This study aimed to identify the factors that determine TM use and TM willingness among German general practitioners and rheumatologists. Methods: We conducted a secondary analysis of data from a German nationwide cross-sectional survey with general practitioners and rheumatologists. Bayesian univariate and multivariate logistic regression analyses were applied to the data to determine which factors were associated with TM use and TM willingness. The predictor variables (covariates) that were studied individually included sociodemographic factors (eg, age and sex), work characteristics (eg, practice location and medical specialty), and self-assessed knowledge of TM. All the variables positively and negatively associated with TM use and TM willingness in the univariate analysis were then considered for Bayesian model averaging analysis after a selection based on the variance inflation factor (?2.5). All analyses were stratified by sex. Results: Univariate analysis revealed that out of 83 variables, 36 (43\%) and 34 (41\%) variables were positively or negatively associated (region of practical equivalence?5\%) with TM use and TM willingness, respectively. The Bayesian model averaging analysis allowed us to identify 13 and 17 factors of TM use and TM willingness, respectively. Among these factors, being female, having very poor knowledge of TM, treating <500 patients per quarter, and not being willing to use TM were negatively associated with TM use, whereas having good knowledge of TM and treating >1000 patients per quarter were positively associated with TM use. In addition, being aged 51 to 60 years, thinking that TM is not important for current and future work, and not currently using TM were negatively associated with TM willingness, whereas owning a smart device and working in an urban area were positively associated with TM willingness. Conclusions: The results point to the close connection between health care professionals' knowledge of TM and actual TM use. These results lend support to the integration of digital competencies into medical education as well as hands-on training for health care professionals. Incentive programs for physicians aged >50 years and practicing in rural areas could further encourage TM willingness. ",
doi="10.2196/40304",
url="https://www.jmir.org/2022/11/e40304",
url="http://www.ncbi.nlm.nih.gov/pubmed/36449333"
}


@Article{info:doi/10.2196/37455,
author="McCall, P. Madison
and Hineline, T. Megan
and Anton, T. Margaret
and Highlander, April
and Jones, J. Deborah",
title="The Socioeconomic Indicators Linked to Parent Health-Related Technology Use: Cross-sectional Survey",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="30",
volume="24",
number="11",
pages="e37455",
keywords="parenting",
keywords="child",
keywords="health behavior",
keywords="information seeking",
keywords="health-related technology use",
keywords="health information",
keywords="digital health",
keywords="mobile health",
keywords="socioeconomic status",
keywords="accessibility",
abstract="Background: Despite the prevalence of parent health information seeking on the internet and its impact on parenting behavior, there is a paucity of research on parents of young children (ages 3 to 8 years). Given the importance of this developmental period, exploring how family socioeconomic indicators linked to the digital divide and health inequities affect parent proxy- and self-seeking is critical to further understanding variability in health information seeking and associated outcomes. Objective: This study aimed to explore parental health-related technology use (HTU), the process by which parents engage in support, advice, and information-seeking behavior related to their (self-seeking) and their children's (proxy seeking) health across a range of hardware devices (eg, tablet, wearable, smartphone, laptop, and desktop computer) and sources (eg, search engines, mobile applications, social media, and other digital media). Methods: A cross-sectional study including 313 parents and guardians of children ages 3 to 8 years recruited through Amazon Mechanical Turk (MTurk) was conducted. Parents were asked to complete a self-administered questionnaire on a broad range of parenting and parent-related constructs, including sociodemographic information, technology device ownership, and engagement in and use, features, and perceptions of HTU. Descriptive and bivariate analyses (chi-square tests) were performed to identify patterns and investigate associations between family socioeconomic indicators and parent HTU. Results: The overwhelming majority (301/313, 96\%) of parents of young children reported engaging in HTU, of which 99\% (300/301) reported using search engines (eg, Google), followed by social media (62\%, 188/301), other forms of digital media (eg, podcasts; 145/301, 48\%), and mobile applications (114/301, 38\%). Parents who engaged in HTU reported seeking information about their child's behavior and discipline practices (260/313, 83\%), mental or physical health (181/313, 58\%), and academic performance (142/313, 45\%). Additionally, nearly half (134/313, 43\%) of parents reported searching for advice on managing their stress. Among parents who reported using each source, an overwhelming majority (280/300, 93\%) indicated that search engines were a helpful online source for proxy- and self-seeking, followed by social media (89\%, 167/188), other digital media (120/145, 83\%), and mobile apps (87/114, 76\%). Among parents who reported using any technology source, approximately one-fifth reported that technology sources were most comfortable (61/311, 20\%), most understanding (69/311, 22\%), and most influential toward behavior change (73/312, 23\%) compared to traditional sources of health information--seeking, including mental health professionals, other health care professionals, school professionals, community leaders, friends, and family members. Indicators of family socioeconomic status were differentially associated with frequency and perceptions of and search content associated with parent HTU across technology sources. Conclusions: The findings of this study underscore critical considerations in the design and dissemination of digital resources, programs, and interventions targeting parent and child health, especially for families in traditionally underserved communities. ",
doi="10.2196/37455",
url="https://www.jmir.org/2022/11/e37455",
url="http://www.ncbi.nlm.nih.gov/pubmed/36449346"
}


@Article{info:doi/10.2196/39662,
author="Yu, Ellie
and Xu, Bowen
and Sequeira, Lydia",
title="Determinants of e-Mental Health Use During COVID-19: Cross-sectional Canadian Study",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="16",
volume="24",
number="11",
pages="e39662",
keywords="digital health",
keywords="mental health",
keywords="e-Mental health",
keywords="user profile",
keywords="determinants",
keywords="health service",
keywords="use",
keywords="utilization",
keywords="COVID-19",
keywords="pandemic",
keywords="Canada",
keywords="users",
keywords="factors",
abstract="Background: Access to mental health treatment across Canada remains a challenge, with many reporting unmet care needs. National and provincial e-Mental health (eMH) programs have been developed over the past decade across Canada, with many more emerging during COVID-19 in an attempt to reduce barriers related to geography, isolation, transportation, physical disability, and availability. Objective: The aim of this study was to identify factors associated with the utilization of eMH services across Canada during the COVID-19 pandemic using Andersen and Newman's framework of health service utilization. Methods: This study used data gathered from the 2021 Canadian Digital Health Survey, a cross-sectional, web-based survey of 12,052 Canadians aged 16 years and older with internet access. Bivariate associations between the use of eMH services and health service utilization factors (predisposing, enabling, illness level) of survey respondents were assessed using $\chi$2 tests for categorical variables and t tests for the continuous variable. Logistic regression was used to predict the probability of using eMH services given the respondents' predisposing, enabling, and illness-level factors while adjusting for respondents' age and gender. Results: The proportion of eMH service users among survey respondents was small (883/12,052, 7.33\%). Results from the logistic regression suggest that users of eMH services were likely to be those with regular family physician access (odds ratio [OR] 1.57, P=.02), living in nonrural communities (OR 1.08, P<.001), having undergraduate (OR 1.40, P=.001) or postgraduate (OR 1.48, P=.003) education, and being eHealth literate (OR 1.05, P<.001). Those with lower eMH usage were less likely to speak English at home (OR 0.06, P<.001). Conclusions: Our study provides empirical evidence on the impact of individual health utilization factors on the use of eMH among Canadians during the COVID-19 pandemic. Given the opportunities and promise of eMH services in increasing access to care, future digital interventions should both tailor themselves toward users of these services and consider awareness campaigns to reach nonusers. Future research should also focus on understanding the reasons behind the use and nonuse of eMH services. ",
doi="10.2196/39662",
url="https://www.jmir.org/2022/11/e39662",
url="http://www.ncbi.nlm.nih.gov/pubmed/36191173"
}


@Article{info:doi/10.2196/39728,
author="Safavi, H. Amir
and Lovas, Mike
and Liu, Amy Zhihui
and Melwani, Sheena
and Truong, Tran
and Devonish, Shayla
and Abdelmutti, Nazek
and Sayani, Ambreen
and Rodin, Danielle
and Berlin, Alejandro",
title="Virtual Care and Electronic Patient Communication During COVID-19: Cross-sectional Study of Inequities Across a Canadian Tertiary Cancer Center",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="4",
volume="24",
number="11",
pages="e39728",
keywords="digital health",
keywords="telehealth",
keywords="telemedicine",
keywords="eHealth",
keywords="oncology",
keywords="cancer care",
keywords="virtual care",
keywords="health inequities",
keywords="health inequality",
keywords="digital divide",
keywords="COVID-19",
keywords="electronic mail",
keywords="cross sectional",
keywords="engagement",
keywords="satisfaction",
keywords="patient reported",
keywords="experience",
abstract="Background: Virtual care (VC) visits (telephone or video) and email-based patient communication have been rapidly adopted to facilitate cancer care during the COVID-19 pandemic. Inequities in access and patient experience may arise as these digital health tools become prevalent. Objective: We aimed to characterize inequities in access and patient-reported experience following adoption of digital health tools at a tertiary cancer center during the COVID-19 pandemic. Methods: We designed a cross-sectional study of outpatients with visits from September to December 2020. Patient characteristics and responses to an email-based patient-experience survey were collated. Inequities in access were assessed across three pairs of comparison groups: (1) patients with VC and in-person visits, (2) patients with and without documented email addresses, and (3) responders and nonresponders to the survey. Inequities in patient-reported experience were assessed among survey responders. Demographics were mapped to area-level averages from national census data. Socioeconomic status was mapped to area-level dimensions of the Canadian Index of Multiple Deprivation. Covariate balance between comparison groups was assessed using standardized mean differences (SMDs), with SMD?0.2 indicating differences between groups. Associations between patient experience satisfaction scores and covariates were assessed using multivariable analyses, with P<.05 indicating statistical significance. Results: Among the 42,194 patients who had outpatient visits, 62.65\% (n=26,435) had at least one VC visit and 31.15\% (n=13,144) were emailable. Access to VC and email was similar across demographic and socioeconomic indices (SMD<0.2). Among emailable patients, 21.84\% (2870/13,144) responded to the survey. Survey responsiveness was similar across indices, aside from a small difference by age (SMD=0.24). Among responders, 24.4\% received VC and were similar to in-person responders across indices (SMD<0.2). VC and in-person responders had similar satisfaction levels with all care domains surveyed (all P>.05). Regardless of visit type, patients had variable satisfaction with care domains across demographic and socioeconomic indices. Patients with higher ethnocultural composition scores were less satisfied with the cultural appropriateness of their care (odds ratio [OR] 0.70, 95\% CI 0.57-0.86). Patients with higher situational vulnerability scores were less satisfied with discussion of physical symptoms (OR 0.67, 95\% CI 0.48-0.93). Patients with higher residential instability scores were less satisfied with discussion of both physical (OR 0.81, 95\% CI 0.68-0.97) and emotional (OR 0.86, 95\% CI 0.77-0.96) symptoms, and also with the duration of their visit (OR 0.85, 95\% CI 0.74-0.98; P=.02). Male patients were more satisfied with how their health care provider had listened to them (OR 1.64, 95\% CI 1.11-2.44; P=.01). Conclusions: Adoption of VC and email can equitably maintain access and patient-reported experience in cancer care across demographics and socioeconomic indices. Existing health inequities among structurally marginalized patients must continue to be addressed to improve their care experience. ",
doi="10.2196/39728",
url="https://www.jmir.org/2022/11/e39728",
url="http://www.ncbi.nlm.nih.gov/pubmed/36331536"
}


@Article{info:doi/10.2196/31251,
author="Dawe-Lane, Erin
and Mutepua, Magano
and Morris, Daniel
and Odoi, M. Clarissa
and Wilson, Emma
and Evans, Joanne
and Pinfold, Vanessa
and Wykes, Til
and Jilka, Sagar
and Simblett, Sara",
title="Factors Influencing Increased Use of Technology to Communicate With Others During the COVID-19 Pandemic: Cross-sectional Web-Based Survey Study",
journal="JMIR Ment Health",
year="2022",
month="Oct",
day="25",
volume="9",
number="10",
pages="e31251",
keywords="COVID-19",
keywords="technology use",
keywords="communication",
keywords="demographics",
keywords="digital health",
keywords="mental health",
keywords="pandemic",
keywords="depression",
keywords="health technology",
keywords="psychosocial",
keywords="lockdown",
keywords="United Kingdom",
keywords="cross-sectional",
keywords="survey",
keywords="social interaction",
keywords="social connection",
keywords="social connectivity",
abstract="Background: Communication via technology is regarded as an effective way of maintaining social connection and helping individuals to cope with the psychological impact of social distancing measures during a pandemic. However, there is little information about which factors have influenced increased use of technology to communicate with others during lockdowns and whether this has changed over time. Objective: The aim of this study is to explore which psychosocial factors (eg, mental health and employment) and pandemic-related factors (eg, shielding and time) influenced an increase in communication via technology during the first lockdown in the United Kingdom. Methods: A cross-sectional, web-based survey was conducted between April and July 2020, examining thoughts, feelings, and behaviors associated with the pandemic, including communicating more using technology (eg, via messaging, phone, or video). We collected sociodemographic information, employment status, mental health service user status, and depression symptoms. We used hierarchical logistic regression to test which factors were associated with communicating more using technology during the lockdown. Results: Participants (N=1464) were on average 41.07 (SD 14.61) years old, and mostly women (n=1141; 77.9\%), White (n=1265; 86.4\%), and employed (n=1030; 70.4\%). Participants reported a mild level of depression (mean 9.43, SD 7.02), and were communicating more using technology (n=1164; 79.5\%). The hierarchical regression indicated that people who were employed and experiencing lower levels of depression were more likely to report increased communication using technology during a lockdown period of the COVID-19 pandemic, and over time, men communicated more using technology. Increased use of technology to communicate was related to greater communication and the inability to see others due to the social distancing measures enacted during the lockdown. It was not related to a general increase in technology use during the lockdown. Conclusions: Although most participants reported increased use of technology to communicate during a lockdown period of the COVID-19 pandemic, this was more apparent in the employed and those experiencing low levels of depression. Moving forward, we should continue to monitor groups who may have been excluded from the benefits of support and communication using technology. ",
doi="10.2196/31251",
url="https://mental.jmir.org/2022/10/e31251",
url="http://www.ncbi.nlm.nih.gov/pubmed/35435852"
}


@Article{info:doi/10.2196/39614,
author="Liu, Liping Piper
and Zhao, Xinshu
and Ye, Francis Jizhou",
title="The Effects of the Use of Patient-Accessible Electronic Health Record Portals on Cancer Survivors' Health Outcomes: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="24",
volume="24",
number="10",
pages="e39614",
keywords="electronic health record",
keywords="patient-centered care",
keywords="health self-efficacy",
keywords="cancer survivors",
keywords="physical health",
keywords="psychological health",
abstract="Background: In the past decade, patient-accessible electronic health record (PAEHR) systems have emerged as an important tool for health management both at the hospital level and individual level. However, little is known about the effects of PAEHR portals on the survivorship of patients with chronic health conditions (eg, cancer). Objective: This study aims to investigate the effects of the use of PAEHR portals on cancer survivors' health outcomes and to examine the mediation pathways through patient-centered communication (PCC) and health self-efficacy. Methods: Data for this study were derived from the Health Information National Trends Survey (HINTS 5, Cycle 4) collected from February 2020 to June 2020. This study only involved respondents who reported having been diagnosed with cancer (N=626). Descriptive analyses were performed, and the mediation models were tested using Model 6 from the SPSS macro PROCESS. Statistically significant relationships among PAEHR portal use, PCC, health self-efficacy, and physical and psychological health were examined using bootstrapping procedures. In this study, we referred to the regression coefficients generated by min-max normalization as percentage coefficients (bp). The 95\% bootstrapped CIs were used with 10,000 resamplings. Results: No positive direct associations between PAEHR portal use and cancer survivors' health outcomes were found. The results supported the indirect relationship between PAEHR portal use and cancer survivors' psychological health via (1) PCC (bp=0.029; $\beta$=.023, 95\% CI .009-.054), and (2) PCC and health self-efficacy in sequence (bp=0.006; $\beta$=.005, 95\% CI .002-.014). Besides, the indirect association between PAEHR portal use and cancer survivors' physical health (bp=0.006; $\beta$=.004, 95\% CI .002-.018) via sequential mediators of PCC and health self-efficacy was also statistically acknowledged. Conclusions: This study offers empirical evidence about the significant role of PAEHR portals in delivering PCC, improving health self-efficacy, and ultimately contributing to cancer survivors' physical and psychological health. ",
doi="10.2196/39614",
url="https://www.jmir.org/2022/10/e39614",
url="http://www.ncbi.nlm.nih.gov/pubmed/36279157"
}


@Article{info:doi/10.2196/37845,
author="van Deursen, M. Alexander J. A.",
title="General Health Statuses as Indicators of Digital Inequality and the Moderating Effects of Age and Education: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="21",
volume="24",
number="10",
pages="e37845",
keywords="digital inequality",
keywords="health",
keywords="MOS",
keywords="eHealth",
keywords="digital health",
keywords="online health",
keywords="age",
keywords="education",
keywords="survey",
keywords="digital divide",
keywords="attitude",
keywords="health outcome",
keywords="patient outcome",
keywords="internet access",
keywords="internet skill",
keywords="technology skill",
abstract="Background: Considerable effort has been directed to offering online health information and services aimed at the general population. Such efforts potentially support people to obtain improved health outcomes. However, when health information and services are moved online, issues of equality need to be considered. In this study, we focus on the general population and take as a point of departure how health statuses (physical functioning, social functioning, mental health, perceived health, and physical pain) are linked to internet access (spanning internet attitude, material access, internet skills, and health-related internet use). Objective: This study aims to reveal to what extent (1) internet access is important for online health outcomes, (2) different health statuses are important for obtaining internet access and outcomes, and (3) age and education moderate the contribution of health statuses to internet access. Methods: A sequence of 2 online surveys drawing upon a sample collected in the Netherlands was used, and a data set with 1730 respondents over the age of 18 years was obtained. Results: Internet attitude contributes positively to material access, internet skills, and health outcomes and negatively to health-related internet use. Material access contributes positively to internet skills and health-related internet use and outcomes. Internet skills contribute positively to health-related internet use and outcomes. Physical functioning contributes positively to internet attitude, material access, and internet skills but negatively to internet health use. Social functioning contributes negatively to internet attitude and positively to internet skills and internet health use. Mental health contributes positively to internet attitude and negatively to material access and internet health use. Perceived health positively contributes to material access, internet skills, and internet health use. Physical pain contributes positively to internet attitude and material access and indirectly to internet skills and internet health use. Finally, most contributions are moderated by age (<65 and ?65 years) and education (low and high). Conclusions: To make online health care attainable for the general population, interventions should focus simultaneously on internet attitude, material access, internet skills, and internet health use. However, issues of equality need to be considered. In this respect, digital inequality research benefits from considering health as a predictor of all 4 access stages. Furthermore, studies should go beyond single self-reported measures of health. Physical functioning, social functioning, mental health, perceived health, and physical pain all show unique contributions to the different internet access stages. Further complicating this issue, online health-related interventions for people with different health statuses should also consider age and the educational level of attainment. ",
doi="10.2196/37845",
url="https://www.jmir.org/2022/10/e37845",
url="http://www.ncbi.nlm.nih.gov/pubmed/36269664"
}


@Article{info:doi/10.2196/41536,
author="Balki, Eric
and Hayes, Niall
and Holland, Carol",
title="The Impact of Social Isolation, Loneliness, and Technology Use During the COVID-19 Pandemic on Health-Related Quality of Life: Observational Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="19",
volume="24",
number="10",
pages="e41536",
keywords="health-related quality of life",
keywords="healthy aging",
keywords="older adult",
keywords="elder",
keywords="older person",
keywords="older population",
keywords="geriatric",
keywords="gerontology",
keywords="technology intervention",
keywords="COVID-19",
keywords="pandemic",
keywords="loneliness",
keywords="social isolation",
keywords="isolation",
keywords="isolated",
keywords="lonely",
keywords="cross-sectional",
keywords="technology use",
keywords="digital literacy",
keywords="acceptance",
doi="10.2196/41536",
url="https://www.jmir.org/2022/10/e41536",
url="http://www.ncbi.nlm.nih.gov/pubmed/36260401"
}


@Article{info:doi/10.2196/38729,
author="Rad{\'o}, N{\'o}ra
and Girasek, Edmond
and B{\'e}k{\'a}si, S{\'a}ndor
and Gy?rffy, Zsuzsa",
title="Digital Technology Access and Health-Related Internet Use Among People Experiencing Homelessness in Hungary: Quantitative Survey",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="19",
volume="24",
number="10",
pages="e38729",
keywords="homelessness",
keywords="digital technology",
keywords="internet",
keywords="access",
keywords="internet use",
keywords="homeless shelter",
keywords="digital equity",
keywords="mobile phone",
abstract="Background: In recent years, there has been an increase in the use of digital technology for personal health and well-being. Previous research has revealed that these technologies might provide vulnerable populations, including those who are homeless, better access to health services and thus a greater chance of more personalized care. Objective: However, little is known about the relationship between technology and health among people experiencing homelessness in Central and Eastern Europe. This study is part of a series of studies by the Digital Health Research Group at Semmelweis University (Budapest, Hungary) in cooperation with the Hungarian Charity Service of the Order of Malta; it aims to assess the existing technological resources available for the homeless population and their health-related internet use characteristics to set the ground for potential health policy interventions, enabling better access to health services by strengthening the digital components of the existing health care system. Methods: Between April 19, 2021, and August 11, 2021, a total of 662 people from 28 institutions providing social services for people experiencing homelessness in Budapest, Hungary, were surveyed about their access to digital tools and internet use patterns. For selected questions, the responses of a representative sample of the Hungarian population were used for comparison as the reference group. Chi-square tests and logistic regression analyses were performed to identify variables affecting internet use for health-related reasons. Results: The results demonstrated a considerable level of internet use in the homeless population; 52.9\% (350/662) of the respondents used the internet frequently compared with 81.3\% (1220/1500) of the respondents in the reference group. Among the homeless group, 69.6\% (461/662) of the respondents reported mobile phone ownership, and 39.9\% (264/662) of the respondents added that it had a smartphone function. Moreover, 11.2\% (70/662) of the respondents had already used a health mobile app, and 34.6\% (229/662) of the respondents had used the internet for medical purposes. On the basis of these characteristics, we were able to identify a broadly defined, digitally engaged group among people experiencing homelessness (129/662, 19.5\%). This subpopulation was inclined to benefit from digitalization related to their personal health. Multivariate analysis demonstrated that internet use for health reasons was more significant for younger respondents, women, those with higher levels of education, and those with no chronic conditions. Conclusions: Although compared with the general population, health-related internet use statistics are lower, our results show that the idea of involving homeless populations in the digital health ecosystem is viable, especially if barriers to access are systematically reduced. The results show that digital health services have great promise as another tool in the hands of community shelters for keeping homeless populations well ingrained in the social infrastructure as well as for disease prevention purposes. ",
doi="10.2196/38729",
url="https://www.jmir.org/2022/10/e38729",
url="http://www.ncbi.nlm.nih.gov/pubmed/36260379"
}


@Article{info:doi/10.2196/39584,
author="Fjells{\aa}, Hunsbedt Hilde Marie
and Huseb{\o}, Lunde Anne Marie
and Storm, Marianne",
title="eHealth in Care Coordination for Older Adults Living at Home: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="18",
volume="24",
number="10",
pages="e39584",
keywords="eHealth",
keywords="care coordination",
keywords="older adults",
keywords="primary health care",
keywords="mobile phone",
abstract="Background: The population of older adults is projected to increase, potentially resulting in more older adults living with chronic illnesses or multimorbidity. Living with chronic illnesses increases the need for coordinated health care services. Older adults want to manage their illnesses themselves, and many are positive about using eHealth for care coordination (CC). CC can help older adults navigate the health care system and improve information sharing. Objective: This study aimed to map the research literature on eHealth used in CC for older adults living at home. This study assessed CC activities, outcomes, and factors influencing the use of eHealth in CC reported by older adults and health care professionals. Methods: We used a scoping review methodology. We searched four databases---MEDLINE, CINAHL, Academic Scoping Premier, and Scopus---from 2009 to 2021 for research articles. We screened 630 records using the inclusion criteria (older adults aged >65 years, primary health care setting, description of an eHealth program or intervention or measure or experiences with the use of eHealth, and inclusion of CC or relevant activities as described in the Care Coordination Atlas). The analysis of the included articles consisted of both a descriptive and thematic analysis. Results: A total of 16 studies were included in this scoping review. Of these 16 studies, 12 (75\%) had a quantitative design, and the samples of the included studies varied in size. The categories of eHealth used for CC among older adults living at home were electronic health records and patient portals, telehealth monitoring solutions, and telephone only. The CC activity communication was evident in all studies (16/16, 100\%). The results on patient- and system-level outcomes were mixed; however, most studies (7/16, 44\%) reported improved mental and physical health and reduced rehospitalization and hospital admission rates. Observing changes in patients' health was a facilitator for health care professionals using eHealth in CC. When using eHealth in CC, available support to the patient, personal continuity, and a sense of security and safety were facilitators for older adults. Individual characteristics and lack of experience, confidence, and knowledge were barriers to older adults' use of eHealth. Health care professionals reported barriers such as increased workload and hampered communication. Conclusions: We mapped the research literature on eHealth-enabled CC for older adults living at home. We did not map the gray literature as we aimed to map the research literature (peer-reviewed research articles published in academic journals). The study results showed that using eHealth to coordinate care for older adults who live at home is promising. To ensure the successful use of eHealth in CC, we recommend customized eHealth-enabled health care services for older adults, including individualized education and support. ",
doi="10.2196/39584",
url="https://www.jmir.org/2022/10/e39584",
url="http://www.ncbi.nlm.nih.gov/pubmed/36256831"
}


@Article{info:doi/10.2196/37687,
author="Chavarria, A. Enmanuel
and Christy, M. Shannon
and Feng, Han
and Miao, Hongyu
and Abdulla, Rania
and Gutierrez, Liliana
and Lopez, Diana
and Sanchez, Julian
and Gwede, K. Clement
and Meade, D. Cathy",
title="Online Health Information Seeking and eHealth Literacy Among Spanish Language--Dominant Latino Adults Receiving Care in a Community Clinic: Secondary Analysis of Pilot Randomized Controlled Trial Data",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="13",
volume="6",
number="10",
pages="e37687",
keywords="eHealth literacy",
keywords="online health information seeking",
keywords="medically underserved",
keywords="Hispanic",
keywords="Latino",
keywords="Spanish language--dominant",
keywords="health communications",
keywords="colorectal cancer screening",
abstract="Background: eHealth literacy is the ability to seek, obtain, and decipher online health information (OHI) for health and disease management. Rapid developments in eHealth (eg, health care services and online information) place increased demands on patients to have high eHealth literacy levels. Yet, greater emphasis on eHealth may disproportionately affect groups with limited eHealth literacy. Cultural background, language, and eHealth literacy are influential considerations affecting health care and information access, health care use, and successful eHealth resource use, and they may influence OHI seeking for behavioral change toward cancer prevention. Objective: This study aimed to characterize the extent of OHI seeking and eHealth literacy among Spanish-dominant (SD) Latino adults aged 50 to 75 years. Further, we aimed to examine potential associations between sociodemographic characteristics, Preventive Health Model (PHM) constructs, OHI-seeking behaviors, and eHealth literacy, separately. Methods: Participants (N=76) self-identified as Latino, were enrolled in a colorectal cancer (CRC) screening intervention, were aged 50 to 75 years, were at average risk for CRC, were not up to date with CRC screening, and preferred receiving health information in Spanish. We describe participants' sociodemographic characteristics, PHM constructs, OHI-seeking behaviors, and eHealth literacy---among those seeking OHI---assessed at enrollment. Descriptive analyses were first performed for all variables. Next, primary univariate logistic analyses explored possible associations with OHI seeking. Finally, using data from those seeking OHI, exploratory univariate analyses sought possible associations with eHealth literacy. Results: A majority (51/76, 67\%) of the participants were female, 62\% (47/76) reported not having graduated high school, and 41\% (31/76) reported being unemployed or having an annual income of less than US \$10,000. Additionally, 75\% (57/76) of the participants reported not having health insurance. In total, 71\% (54/76) of the participants reported not having sought OHI for themselves or others. Univariate logistic regression suggested that higher educational attainment was significantly associated with an increased likelihood of having sought OHI (odds ratio 17.4, 95\% CI 2.0-150.7; P=.009). Among those seeking OHI (22/76, 29\%), 27\% (6/22) were at risk of having low eHealth literacy based on an eHealth Literacy Scale score of less than 26. Among OHI seekers (22/76, 29\%), an examination of associations found that higher eHealth literacy was associated with greater self-efficacy for screening with the fecal immunochemical test ($\beta$=1.20, 95\% CI 0.14-2.26; P=.02). Conclusions: Most SD Latino participants had not sought OHI for themselves or others (eg, family or friends), thus potentially limiting access to beneficial online resources. Preliminary findings convey that higher eHealth literacy occurs among those with higher self-efficacy for CRC screening. Findings inform areas of focus for future larger-scale investigations, including further exploration of reasons for not seeking OHI among SD Latino adults and an in-depth look at eHealth literacy and cancer screening behaviors. Trial Registration: ClinicalTrials.gov NCT03078361; https://clinicaltrials.gov/ct2/show/NCT03078361 ",
doi="10.2196/37687",
url="https://formative.jmir.org/2022/10/e37687",
url="http://www.ncbi.nlm.nih.gov/pubmed/35238785"
}


@Article{info:doi/10.2196/39017,
author="Gurtner, Marcus
and Smith, Moira
and Gage, Ryan
and Howey-Brown, Anna
and Wang, Xinyi
and Latavao, Tevita
and D Deng, Jeremiah
and P Zwanenburg, Sander
and Stanley, James
and Signal, Louise",
title="Objective Assessment of the Nature and Extent of Children's Internet-Based World: Protocol for the Kids Online Aotearoa Study",
journal="JMIR Res Protoc",
year="2022",
month="Oct",
day="11",
volume="11",
number="10",
pages="e39017",
keywords="public health",
keywords="child health",
keywords="internet",
keywords="policy",
keywords="methods",
keywords="child",
keywords="youth",
keywords="methodology",
keywords="student",
keywords="human-computer interaction",
keywords="digital health",
keywords="eHealth",
keywords="technology use",
keywords="computer use",
keywords="user experience",
keywords="perception",
keywords="attitude",
keywords="internet use",
keywords="screen time",
keywords="perceived behavior",
keywords="phone use",
keywords="social media",
abstract="Background: Children under 18 years of age account for approximately 1 in 3 internet users worldwide. Largely unregulated, the internet-based world is evolving rapidly and becoming increasingly intrusive. There is a dearth of objective research globally on children's real-time experiences of the internet-based world. Objective: This paper reports an objective methodology to study the nature and extent of children's internet-based world, their engagement with it, and how this impacts their health and well-being. Methods: A total of 180 year 8 students from 12 schools will be recruited into the study within the Wellington region of Aotearoa, New Zealand. Children use Zoom video teleconferencing software to record real-time, screen-shared internet-based content, for 4 consecutive days. Data on demographics, health and well-being, and attitudes and perceived behaviors in relation to the internet-based world are collected. Phone screen-time balances are retrieved. Data collection commenced in June 2021 and is anticipated to be completed in 2023. Results: Recordings show children exploring diverse web-based settings and content, including personalized content curated by algorithms on platforms such as TikTok, YouTube, and Instagram. Preliminary analysis shows that the data can be used to study a wide range of topics. Behavioral Observation Research Interaction Software is being used to manually code recordings. Artificial Intelligence techniques are also being applied, including hashtag extraction, optical character recognition, as well as object, pattern, speech, and lyric recognition. Conclusions: This novel methodology reveals the unique internet-based experiences of children. It is underpinned by a commitment to ensuring that their rights are protected. It seeks to provide concrete evidence on internet usage in this group and to facilitate appropriate political and societal action to effectively regulate the internet-based world to prevent harm to children. International Registered Report Identifier (IRRID): DERR1-10.2196/39017 ",
doi="10.2196/39017",
url="https://www.researchprotocols.org/2022/10/e39017",
url="http://www.ncbi.nlm.nih.gov/pubmed/36129809"
}


@Article{info:doi/10.2196/37316,
author="Lian, Tyler
and Reid, Hadley
and Rader, Abigail
and Dewitt-Feldman, Sarah
and Hezarkhani, Elmira
and Gu, Elizabeth
and Scott, Malik
and Kutzer, Kate
and Sandhu, Sahil
and Crowder, Carolyn
and Ito, Kristin
and Eisenson, Howard
and Bettger, Prvu Janet
and Shaw, J. Ryan
and Lewinski, A. Allison
and Ming, Y. David
and Bosworth, B. Hayden
and Zullig, L. Leah
and Batch, C. Bryan
and Drake, Connor",
title="A Tailored SMS Text Message--Based Intervention to Facilitate Patient Access to Referred Community-Based Social Needs Resources: Protocol for a Pilot Feasibility and Acceptability Study",
journal="JMIR Res Protoc",
year="2022",
month="Oct",
day="11",
volume="11",
number="10",
pages="e37316",
keywords="text messaging",
keywords="primary health care",
keywords="social determinants of health",
keywords="needs assessment",
keywords="community health centers",
keywords="vulnerable populations",
abstract="Background: Health care providers are increasingly screening patients for unmet social needs (eg, food, housing, transportation, and social isolation) and referring patients to relevant community-based resources and social services. Patients' connection to referred services is often low, however, suggesting the need for additional support to facilitate engagement with resources. SMS text messaging presents an opportunity to address barriers related to contacting resources in an accessible, scalable, and low-cost manner. Objective: In this multi-methods pilot study, we aim to develop an automated SMS text message--based intervention to promote patient connection to referred social needs resources within 2 weeks of the initial referral and to evaluate its feasibility and patient acceptability. This protocol describes the intervention, conceptual underpinnings, study design, and evaluation plan to provide a detailed illustration of how SMS technology can complement current social needs screening and referral practice patterns without disrupting care. Methods: For this pilot prospective cohort study, this SMS text message--based intervention augments an existing social needs screening, referral, and navigation program at a federally qualified health center. Patients who received at least one referral for any identified unmet social need are sent 2 rounds of SMS messages over 2 weeks. The first round consists of 5-10 messages that deliver descriptions of and contact information for the referred resources. The second round consists of 2 messages that offer a brief reminder to contact the resources. Participants will evaluate the intervention via a survey and a semistructured interview, informed by an adapted technology acceptance model. Rapid qualitative and thematic analysis will be used to extract themes from the responses. Primary outcomes are implementation feasibility and patient acceptability. Secondary outcomes relate to intervention effectiveness: self-reported attempt to connect and successful connection to referred resources 2 weeks after the initial referral encounter. Results: The study received regulatory approval in May 2021, and we anticipate enrolling 15-20 participants for this initial pilot. Conclusions: This protocol presents detailed implementation methods about a novel automated SMS intervention for social care integration within primary care. By sharing the study protocol early, we intend to facilitate the development and adoption of similar tools across different clinical settings, as more health care providers seek to address the unmet social needs of patients. Study findings will provide practical insights into the design and implementation of SMS text message--based interventions to improve social and medical care coordination. International Registered Report Identifier (IRRID): DERR1-10.2196/37316 ",
doi="10.2196/37316",
url="https://www.researchprotocols.org/2022/10/e37316",
url="http://www.ncbi.nlm.nih.gov/pubmed/36222790"
}


@Article{info:doi/10.2196/35828,
author="Zeng, Billy
and Rivadeneira, A. Natalie
and Wen, Anita
and Sarkar, Urmimala
and Khoong, C. Elaine",
title="The Impact of the COVID-19 Pandemic on Internet Use and the Use of Digital Health Tools: Secondary Analysis of the 2020 Health Information National Trends Survey",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="19",
volume="24",
number="9",
pages="e35828",
keywords="COVID-19",
keywords="digital divide",
keywords="eHealth",
keywords="telehealth",
abstract="Background: The COVID-19 pandemic increased the use of digital tools in health care (eg, patient portal, telemedicine, and web-based scheduling). Studies have shown that older individuals, racial/ethnic minority groups, or populations with lower educational attainment or income have lower rates of using digital health tools. Digitalization of health care may exacerbate already existing access barriers in these populations. Objective: This study evaluated how use of digital tools to asynchronously communicate with clinicians, schedule appointments, and view medical records changed near the beginning of the pandemic. Methods: Using 2020 Health Information National Trends Survey (HINTS) data, we examined internet use and 7 digital health technology use outcomes (electronic communication with a provider, electronic appointment scheduling, electronic test result viewing, patient portal access, portal use to download health records, portal use for patient-provider communication, and portal use to view test results). The HINTS surveyors designated surveys received after March 11, 2020, as postpandemic responses. Using weighted logistic regression, we investigated the impact of the pandemic after adjusting for sociodemographic traits (age, race/ethnicity, income, education, and gender), digital access (having ever used the internet and smartphone/tablet ownership), and health-related factors (insurance coverage, caregiver status, having a regular provider, and chronic diseases). To explore differences in changes in outcomes among key sociodemographic groups, we tested for significant interaction terms between the pandemic variable and race/ethnicity, age, income, and educational attainment. Results: There were 3865 respondents (1437 prepandemic and 2428 postpandemic). Of the 8 outcomes investigated, the pandemic was only significantly associated with higher odds (adjusted odds ratio 1.99, 95\% CI 1.18-3.35) of using electronic communication with a provider. There were significant interactions between the pandemic variable and 2 key sociodemographic traits. Relative to the lowest income group (<US \$20,000), the highest income group (?US \$75,000) had increased growth in the odds of ever having used the internet in postpandemic responses. Compared to the most educated group (postbaccalaureates), groups with lower educational attainment (high school graduates and bachelor's degree) had lower growth in the odds of using electronic communication with a provider in postpandemic responses. However, individuals with less than a high school degree had similar growth to the postbaccalaureate group in using electronic communication with a provider. Conclusions: Our study did not show a widespread increase in use of digital health tools or increase in disparities in using these tools among less advantaged populations in the early months of the COVID-19 pandemic. Although some advantaged populations reported a greater increase in using the internet or electronic communication with a provider, there were signs that some less advantaged populations also adapted to an increasingly digital health care ecosystem. Future studies are needed to see if these differences remain beyond the initial months of the pandemic. ",
doi="10.2196/35828",
url="https://www.jmir.org/2022/9/e35828",
url="http://www.ncbi.nlm.nih.gov/pubmed/36041005"
}


@Article{info:doi/10.2196/38589,
author="Layug, Alyan
and Krishnamurthy, Samiksha
and McKenzie, Rachel
and Feng, Bo",
title="The Impacts of Social Media Use and Online Racial Discrimination on Asian American Mental Health: Cross-sectional Survey in the United States During COVID-19",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="19",
volume="6",
number="9",
pages="e38589",
keywords="Asian Americans",
keywords="mental health",
keywords="COVID-19 pandemic",
keywords="racial discrimination",
keywords="social media",
keywords="anxiety",
keywords="depression",
keywords="secondary traumatic stress",
keywords="negative affect",
keywords="racial/ethnic identification",
abstract="Background: During the COVID-19 pandemic, increased social media usage has led to worsened mental health outcomes for many people. Moreover, due to the sociopolitical climate during the pandemic, the prevalence of online racial discrimination has contributed to worsening psychological well-being. With increases in anti-Asian hate, Asian and Asian American social media users may experience the negative effects of online racial discrimination in addition to the reduced psychological well-being resulting from exposure to online COVID-19 content. Objective: This study aims to investigate the impact of COVID-19--related social media use and exposure to online racial discrimination during the pandemic on the mental health outcomes (ie, anxiety, depression, and secondary traumatic stress [STS]) of Asian Americans compared with those of non-Asian Americans. In addition, this study explores the mediating role of negative affect and the moderating role of racial/ethnic identification. Methods: An online survey was conducted through Amazon Mechanical Turk and a university-wide research portal from March 3 to March 15, 2021. A total of 1147 participants took the survey. Participants' social media usage related to COVID-19 and exposure to 2 online forms of racial discrimination (individual and vicarious), mental health outcomes (anxiety, depression, and STS), racial/ethnic identification, negative affect, and demographics were assessed. Results: Our results showed that COVID-19--related social media use, individual discrimination, and vicarious discrimination were predictors of negative mental health outcomes (anxiety, depression, and STS). Asian Americans reported higher vicarious discrimination than Latinx and White Americans, but Asian Americans' mental health outcomes did not differ substantially from those of the other racial/ethnic groups. Racial/ethnic identification moderated the relationship between both types of discrimination and STS, and negative affect served as a mediator between both types of discrimination and all 3 mental health outcomes. Conclusions: These results suggest that social media exposure continues to have a dire effect on mental health during the COVID-19 pandemic. This study helps to contextualize the rise of anti-Asian American hate and its impact on mental health outcomes in the United States. ",
doi="10.2196/38589",
url="https://formative.jmir.org/2022/9/e38589",
url="http://www.ncbi.nlm.nih.gov/pubmed/36121698"
}


@Article{info:doi/10.2196/35772,
author="Cheng, Christina
and Gearon, Emma
and Hawkins, Melanie
and McPhee, Crystal
and Hanna, Lisa
and Batterham, Roy
and Osborne, H. Richard",
title="Digital Health Literacy as a Predictor of Awareness, Engagement, and Use of a National Web-Based Personal Health Record: Population-Based Survey Study",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="16",
volume="24",
number="9",
pages="e35772",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="health literacy",
keywords="health equity",
keywords="electronic health records",
keywords="vulnerable populations",
keywords="disadvantaged populations",
abstract="Background: Web-based personal health records (PHRs) have the potential to improve the quality, accuracy, and timeliness of health care. However, the international uptake of web-based PHRs has been slow. Populations experiencing disadvantages are less likely to use web-based PHRs, potentially widening health inequities within and among countries. Objective: With limited understanding of the predictors of community uptake and use of web-based PHR, the aim of this study was to identify the predictors of awareness, engagement, and use of the Australian national web-based PHR, My Health Record (MyHR). Methods: A population-based survey of adult participants residing in regional Victoria, Australia, was conducted in 2018 using telephone interviews. Logistic regression, adjusted for age, was used to assess the relationship among digital health literacy, health literacy, and demographic characteristics, and the 3 dependent variables of MyHR: awareness, engagement, and use. Digital health literacy and health literacy were measured using multidimensional tools, using all 7 scales of the eHealth Literacy Questionnaire and 4 out of the 9 scales of the Health Literacy Questionnaire. Results: A total of 998 responses were analyzed. Many elements of digital health literacy were strongly associated with MyHR awareness, engagement, and use. A 1-unit increase in each of the 7 eHealth Literacy Questionnaire scales was associated with a 2- to 4-fold increase in the odds of using MyHR: using technology to process health information (odds ratio [OR] 4.14, 95\% CI 2.34-7.31), understanding of health concepts and language (OR 2.25, 95\% CI 1.08-4.69), ability to actively engage with digital services (OR 4.44, 95\% CI 2.55-7.75), feel safe and in control (OR 2.36, 95\% CI 1.43-3.88), motivated to engage with digital services (OR 4.24, 95\% CI 2.36-7.61), access to digital services that work (OR 2.49, 95\% CI 1.32-4.69), and digital services that suit individual needs (OR 3.48, 95\% CI 1.97-6.15). The Health Literacy Questionnaire scales of health care support, actively managing health, and social support were also associated with a 1- to 2-fold increase in the odds of using MyHR. Using the internet to search for health information was another strong predictor; however, older people and those with less education were less likely to use MyHR. Conclusions: This study revealed strong and consistent patterns of association between digital health literacy and the use of a web-based PHR. The results indicate potential actions for promoting PHR uptake, including improving digital technology and skill experiences that may improve digital health literacy and willingness to engage in web-based PHR. Uptake may also be improved through more responsive digital services, strengthened health care, and better social support. A holistic approach, including targeted solutions, is needed to ensure that web-based PHR can realize its full potential to help reduce health inequities. ",
doi="10.2196/35772",
url="https://www.jmir.org/2022/9/e35772",
url="http://www.ncbi.nlm.nih.gov/pubmed/36112404"
}


@Article{info:doi/10.2196/31206,
author="Kim, Hyeon Hye
and Lee, JooHyun
and Kim, Heon Ho
and Hwang, Sangho
and Yi, Ilcheong
and Kao, Sambath
and Kim, DooRa
and Sohn, Hyuk-Sang
and Kim, Joohye
and Choi, Yejin
and Yoon, Sangchul
and Park, Rang Yu",
title="Digital Device Exposure and Cognition Levels of Children in Low- and Middle-Income Countries: Cross-sectional Study in Cambodia",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="31",
volume="24",
number="8",
pages="e31206",
keywords="low- and middle-income countries",
keywords="digital device exposure",
keywords="children",
keywords="cognitive function",
keywords="socioeconomic status",
abstract="Background: Policy makers and practitioners in low- and middle-income countries (LMICs) are increasingly focusing on the effectiveness of digital devices in the delivery of medical and educational services to children under resource constraints. It is widely known that digital literacy can be fostered through exposure to and education regarding digital devices, which can improve children's academic performance as well as their search and communication skills in the digital era. However, the correlation between the cognitive function of children and exposure and intensity of the exposure to digital devices has rarely been studied, and the association between digital device exposure and the socioeconomic characteristics and cognitive development of children in LMICs is unknown. Objective: This study examines the association among exposure to digital devices, socioeconomic status, and cognitive function in children aged 3 to 9 years in Cambodia. Methods: We used a survey of 232 children that gathered data on familiarity with digital devices, demographic characteristics, and socioeconomic status, as well as a Cambridge Neuropsychological Test Automated Battery test for cognitive function, to examine the association between possible barriers and factors that may influence the cognitive function of children in 2 Cambodian schools from April 22, 2019, to May 4, 2019. A comparative analysis was performed with and without digital exposure, and an association analysis was performed among the variables from the survey and cognitive function. Results: Significant differences were observed in demographic and socioeconomic characteristics such as school location, family type, and family income according to digital device exposure. The results of the Cambridge Neuropsychological Test Automated Battery tests, except for 1 test related to executive function, indicated no significant differences (P>.05) between group A and group B or among the 4 subgroups. Pretest digital device experience and amount of time spent using digital devices during the test had no significant impacts on the cognitive development of the children. Conversely, the multivariate analyses showed that cognitive function was associated with educational expenses per child, school (location), family type, and family income. Conclusions: These results provide evidence to policy makers and practitioners on the importance of improving socioeconomic conditions, leading to investment in education by implementing programs for children's cognitive development through digital devices in LMICs. ",
doi="10.2196/31206",
url="https://www.jmir.org/2022/8/e31206",
url="http://www.ncbi.nlm.nih.gov/pubmed/36044246"
}


@Article{info:doi/10.2196/38802,
author="Sun, Y. Enid
and Alvarez, Carolina
and Callahan, F. Leigh
and Sheikh, Z. Saira",
title="The Disparities in Patient Portal Use Among Patients With Rheumatic and Musculoskeletal Diseases: Retrospective Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="31",
volume="24",
number="8",
pages="e38802",
keywords="COVID-19",
keywords="telemedicine",
keywords="telehealth",
keywords="health technology",
keywords="health care disparities",
keywords="patient portal",
keywords="rheumatology",
keywords="musculoskeletal diseases",
keywords="chronic disease",
keywords="digital health",
keywords="MyChart",
keywords="rural area",
keywords="minority population",
keywords="virtual care",
abstract="Background: During the COVID-19 pandemic, the shift to virtual care became essential for the continued care of patients. Individuals with rheumatic and musculoskeletal diseases (RMDs) especially require frequent provider visits and close monitoring. To date, there have been limited studies examining inequities in health technology use among patients with RMDs. Objective: Our goal was to identify characteristics associated with patient portal use before and after the COVID-19 pandemic in a convenience sample of patients with RMDs from a large academic medical center. Methods: In this cross-sectional study, Epic electronic medical record data were queried to identify established patients of the University of North Carolina Hospitals adult rheumatology clinic between November 1, 2017, through November 30, 2019. Demographic and clinical data were collected to compare MyChart (Epic's patient portal) users with nonusers before and after the COVID-19 pandemic. MyChart activation and use were modeled using logistic regression and adjusted odds ratios, and confidence intervals were estimated. Results: We identified 5075 established patients with RMDs who met the inclusion criteria. Prior to the pandemic, we found that younger age (P<.001), suburban residence (P=.05), commercial/state insurance (P<.001), military insurance (P=.05), and median income >US \$50,000 (P<.001) were associated with significantly higher odds of MyChart activation. Male sex (P<.001), being of Black or African American (P<.001) or ``other'' race (P<.001), Spanish as a primary language (P<.001), rural residence (P=.007), Medicaid insurance (P<.001), and median income of <US \$25,000 (P=.01) were associated with lower odds of MyChart activation. Following COVID-19, younger age (P<.001), commercial insurance (P=.03), state insurance (P=.02), and median income of US \$50,000-75,000 (P=.01) were associated with significantly higher odds of MyChart use. However, being of Black or African American (P<.001) or ``other'' race (P=.01), Spanish as a primary language (P=.002), male sex (P=.004), rural residence (P=.005), and having no insurance (P<.001) or Medicaid (P=.008) were associated with lower odds of MyChart use. Conclusions: Residence in a rural area, being of minority race/ethnicity, older age, male sex, lower median income, Medicaid, being uninsured, and non-English primary language are associated with lower odds of patient portal activation and use. Future health policy and clinical practice measures should focus on reducing barriers to health technology adoption among these groups. ",
doi="10.2196/38802",
url="https://www.jmir.org/2022/8/e38802",
url="http://www.ncbi.nlm.nih.gov/pubmed/36001872"
}


@Article{info:doi/10.2196/38716,
author="Williams, A. Kofoworola D.
and Wijaya, Clarisa
and Stamatis, A. Caitlin
and Abbott, Gabriel
and Lattie, G. Emily",
title="Insights Into Needs and Preferences for Mental Health Support on Social Media and Through Mobile Apps Among Black Male University Students: Exploratory Qualitative Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="31",
volume="6",
number="8",
pages="e38716",
keywords="Black or African American men",
keywords="college",
keywords="mental health",
keywords="social media",
keywords="mobile apps",
keywords="mobile phone",
abstract="Background: Black college-aged men are less likely than their peers to use formal, therapeutic in-person services for mental health concerns. As the use of mobile technologies and social media platforms is steadily increasing, it is important to conduct work that examines the future utility of digital tools and technologies to improve access to and uptake of mental health services for Black men and Black men in college. Objective: The aim of this study was to identify and understand college-attending Black men's needs and preferences for using digital health technologies and social media for stress and mental health symptom management. Methods: Interviews were conducted with Black male students (N=11) from 2 racially diverse universities in the Midwestern United States. Participants were asked questions related to their current mental health needs and interest in using social media platforms and mobile-based apps for their mental health concerns. A thematic analysis was conducted. Results: Four themes emerged from the data: current stress relief strategies, technology-based support needs and preferences (subthemes: mobile-based support and social media--based support), resource information dissemination considerations (subthemes: information-learning expectations and preferences and information-sharing preferences and behaviors), and technology-based mental health support design considerations (subtheme: relatability and representation). Participants were interested in using social media and digital technologies for their mental health concerns and needs, for example, phone notifications and visual-based mental health advertisements that promote awareness. Relatability in the context of representation was emphasized as a key factor for participants interested in using digital mental health tools. Examples of methods for increasing relatability included having tools disseminated by minority-serving organizations and including components explicitly portraying Black men engaging in mental health support strategies. The men also discussed wanting to receive recommendations for stress relief that have been proven successful, particularly for Black men. Conclusions: The findings from this study provide insights into design and dissemination considerations for future work geared toward developing mental health messaging and digital interventions for young Black men. ",
doi="10.2196/38716",
url="https://formative.jmir.org/2022/8/e38716",
url="http://www.ncbi.nlm.nih.gov/pubmed/36044261"
}


@Article{info:doi/10.2196/38443,
author="Park, Ta Van
and Tsoh, Y. Janice
and Dougan, Marcelle
and Nam, Bora
and Tzuang, Marian
and Park, G. Linda
and Vuong, N. Quyen
and Bang, Joon
and Meyer, L. Oanh",
title="Racial Bias Beliefs Related to COVID-19 Among Asian Americans, Native Hawaiians, and Pacific Islanders: Findings From the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS)",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="9",
volume="24",
number="8",
pages="e38443",
keywords="COVID-19",
keywords="racial bias",
keywords="Asian American",
keywords="Native Hawaiian and Pacific Islander",
keywords="mobile phone",
abstract="Background: During the COVID-19 pandemic, there have been increased reports of racial biases against Asian American and Native Hawaiian and Pacific Islander individuals. However, the extent to which different Asian American and Native Hawaiian and Pacific Islander groups perceive and experience (firsthand or as a witness to such experiences) how COVID-19 has negatively affected people of their race has not received much attention. Objective: This study used data from the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS), a nationwide, multilingual survey, to empirically examine COVID-19--related racial bias beliefs among Asian American and Native Hawaiian and Pacific Islander individuals and the factors associated with these beliefs. Methods: COMPASS participants were Asian American and Native Hawaiian and Pacific Islander adults who were able to speak English, Chinese (Cantonese or Mandarin), Korean, Samoan, or Vietnamese and who resided in the United States during the time of the survey (October 2020 to May 2021). Participants completed the survey on the web, via phone, or in person. The Coronavirus Racial Bias Scale (CRBS) was used to assess COVID-19--related racial bias beliefs toward Asian American and Native Hawaiian and Pacific Islander individuals. Participants were asked to rate the degree to which they agreed with 9 statements on a 5-point Likert scale (ie, 1=strongly disagree to 5=strongly agree). Multivariable linear regression was used to examine the associations between demographic, health, and COVID-19--related characteristics and perceived racial bias. Results: A total of 5068 participants completed the survey (mean age 45.4, SD 16.4 years; range 18-97 years). Overall, 73.97\% (3749/5068) agreed or strongly agreed with ?1 COVID-19--related racial bias belief in the past 6 months (during the COVID-19 pandemic). Across the 9 racial bias beliefs, participants scored an average of 2.59 (SD 0.96, range 1-5). Adjusted analyses revealed that compared with Asian Indians, those who were ethnic Chinese, Filipino, Hmong, Japanese, Korean, Vietnamese, and other or multicultural had significantly higher mean CRBS scores, whereas no significant differences were found among Native Hawaiian and Pacific Islander individuals. Nonheterosexual participants had statistically significant and higher mean CRBS scores than heterosexual participants. Compared with participants aged ?60 years, those who were younger (aged <30, 30-39, 40-49, and 50-59 years) had significantly higher mean CRBS scores. US-born participants had significantly higher mean CRBS scores than foreign-born participants, whereas those with limited English proficiency (relative to those reporting no limitation) had lower mean CRBS scores. Conclusions: Many COMPASS participants reported racial bias beliefs because of the COVID-19 pandemic. Relevant sociodemographic contexts and pre-existing and COVID-19--specific factors across individual, community, and society levels were associated with the perceived racial bias of being Asian during the pandemic. The findings underscore the importance of addressing the burden of racial bias on Asian American and Native Hawaiian and Pacific Islander communities among other COVID-19--related sequelae. ",
doi="10.2196/38443",
url="https://www.jmir.org/2022/8/e38443",
url="http://www.ncbi.nlm.nih.gov/pubmed/35658091"
}


@Article{info:doi/10.2196/37039,
author="Brakefield, S. Whitney
and Olusanya, A. Olufunto
and Shaban-Nejad, Arash",
title="Association Between Neighborhood Factors and Adult Obesity in Shelby County, Tennessee: Geospatial Machine Learning Approach",
journal="JMIR Public Health Surveill",
year="2022",
month="Aug",
day="9",
volume="8",
number="8",
pages="e37039",
keywords="obesity",
keywords="obesity surveillance",
keywords="disease surveillance",
keywords="machine learning",
keywords="geographic information systems",
keywords="social determinants of health",
keywords="SDOH",
keywords="disparities",
abstract="Background: Obesity is a global epidemic causing at least 2.8 million deaths per year. This complex disease is associated with significant socioeconomic burden, reduced work productivity, unemployment, and other social determinants of health (SDOH) disparities. Objective: The objective of this study was to investigate the effects of SDOH on obesity prevalence among adults in Shelby County, Tennessee, the United States, using a geospatial machine learning approach. Methods: Obesity prevalence was obtained from the publicly available 500 Cities database of Centers for Disease Control and Prevention, and SDOH indicators were extracted from the US census and the US Department of Agriculture. We examined the geographic distributions of obesity prevalence patterns, using Getis-Ord Gi* statistics and calibrated multiple models to study the association between SDOH and adult obesity. Unsupervised machine learning was used to conduct grouping analysis to investigate the distribution of obesity prevalence and associated SDOH indicators. Results: Results depicted a high percentage of neighborhoods experiencing high adult obesity prevalence within Shelby County. In the census tract, the median household income, as well as the percentage of individuals who were Black, home renters, living below the poverty level, 55 years or older, unmarried, and uninsured, had a significant association with adult obesity prevalence. The grouping analysis revealed disparities in obesity prevalence among disadvantaged neighborhoods. Conclusions: More research is needed to examine links between geographical location, SDOH, and chronic diseases. The findings of this study, which depict a significantly higher prevalence of obesity within disadvantaged neighborhoods, and other geospatial information can be leveraged to offer valuable insights, informing health decision-making and interventions that mitigate risk factors of increasing obesity prevalence. ",
doi="10.2196/37039",
url="https://publichealth.jmir.org/2022/8/e37039",
url="http://www.ncbi.nlm.nih.gov/pubmed/35943795"
}


@Article{info:doi/10.2196/38193,
author="Bonnell, Jarvis Tyler
and Revere, Debra
and Baseman, Janet
and Hills, Rebecca
and Karras, Thomas Bryant",
title="Equity and Accessibility of Washington State's COVID-19 Digital Exposure Notification Tool (WA Notify): Survey and Listening Sessions Among Community Leaders",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="3",
volume="6",
number="8",
pages="e38193",
keywords="COVID-19 exposure notifications",
keywords="digital public health",
keywords="health equity",
keywords="mHealth",
keywords="mobile health",
keywords="mHealth equity",
keywords="digital health tool",
keywords="public health",
keywords="surveillance",
keywords="COVID-19",
keywords="smartphone",
keywords="health inequity",
keywords="sociodemographic factor",
keywords="epidemiology",
abstract="Background: In November 2020, WA Notify, Washington State's COVID-19 digital exposure notification tool, was launched statewide to mitigate ongoing COVID-19 transmission. WA Notify uses the Bluetooth proximity--triggered, Google/Apple Exposure Notification Express framework to distribute notifications to users who have added or activated this tool on their smartphones. This smartphone-based tool relies on sufficient population-level activation to be effective; however, little is known about its adoption among communities disproportionately impacted by the COVID-19 pandemic or what barriers might limit its adoption and use among diverse populations. Objective: We sought to (1) conduct a formative exploration of equity-related issues that may influence the access, adoption, and use of WA Notify, as perceived by community leaders of populations disproportionately impacted by the COVID-19 pandemic; and (2) generate recommendations for promoting the equitable access to and impact of this novel intervention for these communities. Methods: We used a 2-step data collection process to gather the perspectives of community leaders across Washington regarding the launch and implementation of WA Notify in their communities. A web-based, brief, and informational survey measured the perceptions of the community-level familiarity and effectiveness of WA Notify at slowing the spread of COVID-19 and identified potential barriers and concerns to accessing and adopting WA Notify (n=17). Semistructured listening sessions were conducted to expand upon survey findings and explore the community-level awareness, barriers, facilitators, and concerns related to activating WA Notify in greater depth (n=13). Results: Our findings overlap considerably with those from previous mobile health equity studies. Digital literacy, trust, information accessibility, and misinformation were highlighted as key determinants of the adoption and use of WA Notify. Although WA Notify does not track users or share data, community leaders expressed concerns about security, data sharing, and personal privacy, which were cited as outweighing the potential benefits to adoption. Both the survey and informational sessions indicated low community-level awareness of WA Notify. Community leaders recommended the following approaches to improve engagement: tailoring informational materials for low-literacy levels, providing technology navigation, describing more clearly that WA Notify can help the community, and using trusted messengers who are already engaged with the communities to communicate about WA Notify. Conclusions: As digital public health tools, such as WA Notify, emerge to address public health problems, understanding the key determinants of adoption and incorporating equity-focused recommendations into the development, implementation, and communication efforts around these tools will be instrumental to their adoption, use, and retention. ",
doi="10.2196/38193",
url="https://formative.jmir.org/2022/8/e38193",
url="http://www.ncbi.nlm.nih.gov/pubmed/35787520"
}


@Article{info:doi/10.2196/34949,
author="Nishikitani, Mariko
and Ariyoshi, Mie
and Nohara, Yasunobu
and Umihara, Junko",
title="Communications Through Contemporary Tools of Information and Communication Technology: Cross-sectional Study Evaluating Health Among Separated Family Members",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="3",
volume="6",
number="8",
pages="e34949",
keywords="family relations",
keywords="interpersonal communication",
keywords="internet use",
keywords="smartphone",
keywords="home environment",
keywords="psychosocial functioning",
abstract="Background: The number of single-living workers separated from their spouses and families has been increasing due to the need to create a balance between life and work. Workers are assigned everywhere in globalized workplaces while also caring for their family members in the context of Japan's aging society. At the same time, the mental and health status of persons living separately from their families is a matter of concern. The development of interpersonal communication means using information and communications technology (ICT) tools and the internet is remarkable, enabling simultaneous 2-way communication across distances and national borders. The easy accessibility to simultaneous communication is expected to improve the psychosocial status of isolated family members. Objective: This study aims to clarify the health benefits of ICT by using a psychosocial health assessment, the characteristics of ICT tools, and the frequency of communication among the workers and their families who live separately. Methods: This was a cross-sectional study planned and conducted in Japan. Study participants, including adults who live separately from other family members or have separately living family members due to work, were recruited to answer a web response survey about ICT usage status, health status, and life and society evaluation. This study recruited 73 participants divided into 2 groups by their communication tools and frequencies, and their separated life, health, and psychosocial status were statistically compared. Results: Among the 73 study participants, 15 were categorized in the high communication--skilled (HCS) group that used both types of ICT tools to communicate frequently: ``live,'' such as video chat and voice call, and ``nonlive,'' such as SMS text message service and email. A simple comparison between the HCS and reference groups showed significant differences in the cohesion with the neighborhood (P=.03), perceived social position (P=.01), and happiness (P<.001); however, there were no significant differences in the health (psychological distress, P=.08; self-rated health, P=.07), lifestyle (drinking, P>.99; current smoking, P=.37), and dyadic trust in family members living separately (P=.80). Further, in a multivariate regression analysis adjusted for confounding factors, such as educational history, age, gender, and job status, poor subjective health showed a prevalence odds ratio of less than 1 (OR 0.17, 95\% CI 0.03-1.02). The HCS group showed significant positive relationships in the cohesion score with the neighborhood (P=.01; $\beta$=2.40, 95\% CI 0.56-4.24), perceived social position (P=.03; $\beta$=1.17, 95\% CI 0.11-2.23), and happiness score (P=.002; $\beta$=1.46, 95\% CI 0.58-2.34) in the same multivariate regression models. Conclusions: This study suggested that people who frequently communicate with separated family members by taking advantage of various ICT tools can maintain a better mental state and better social relations among those who live alone and are separated from their families. ",
doi="10.2196/34949",
url="https://formative.jmir.org/2022/8/e34949",
url="http://www.ncbi.nlm.nih.gov/pubmed/35921127"
}


@Article{info:doi/10.2196/37666,
author="Holst, Christine
and Stelzle, Dominik
and Diep, My Lien
and Sukums, Felix
and Ngowi, Bernard
and Noll, Josef
and Winkler, Sylvia Andrea",
title="Improving Health Knowledge Through Provision of Free Digital Health Education to Rural Communities in Iringa, Tanzania: Nonrandomized Intervention Study",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="28",
volume="24",
number="7",
pages="e37666",
keywords="digital health",
keywords="digital health promotion",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="Tanzania",
keywords="health education",
keywords="HIV/AIDS",
keywords="tuberculosis",
keywords="cysticercosis",
keywords="tapeworm",
keywords="mobile phone",
abstract="Background: Community health education is one of the most effective measures to increase health literacy worldwide and can contribute to the achievement of specific targets of the Sustainable Development Goal 3. Digitalized health education materials can improve health knowledge as a dimension of health literacy and play an important role in disease prevention in rural sub-Saharan settings. Objective: The objective of this research is to assess the effect of a digital health education intervention on the uptake and retention of knowledge related to HIV/AIDS, tuberculosis (TB), and Taenia solium (neuro)cysticercosis and taeniosis in rural communities in Iringa, Tanzania. Methods: We conducted a nonrandomized intervention study of participants aged 15 to 45 years, randomly selected from 4 villages in Iringa, Tanzania. The intervention consisted of 2 parts. After the baseline assessment, we showed the participants 3 animated health videos on a tablet computer. After a period of 6 months, free access to community information spots (InfoSpots) with an integrated digital health education platform was provided to the intervention villages. Participants in the control group did not receive the intervention. The primary outcome was the difference in disease knowledge between the intervention and control groups, 12 months after baseline. Data were collected using an open-ended questionnaire, with correct or incorrect answers before and after intervention. Results: Between April and May 2019, a total of 600 participants were recruited into the intervention (n=298, 49.7\%) or control (n=302, 50.3\%) groups. At baseline, no statistically significant differences in knowledge of the target diseases were observed. At 12 months after intervention, knowledge about HIV/AIDS, TB, and T. solium (neuro)cysticercosis and taeniosis was 10.2\% (95\% CI 5.0\%-15.4\%), 12\% (95\% CI 7.7\%-16.2\%), and 31.5\% (95\% CI 26.8\%-36.2\%) higher in the intervention group than in the control group, respectively. In all 4 domains (transmission, symptoms, treatment, and prevention), an increase in knowledge was observed in all the 3 diseases, albeit to varying degrees. The results were adjusted for potential confounders, and the significance of the primary results was maintained in the sensitivity analysis to assess dropouts. The participants who reported using the InfoSpots in the 12-month assessment further increased their knowledge about the target diseases by 6.8\% (HIV/AIDS), 7.5\% (TB), and 13.9\% higher mean proportion of correct answers compared with the participants who did not use the InfoSpots. Conclusions: Digital health education based on animated health videos and the use of free InfoSpots has significant potential to improve health knowledge, especially in rural areas of low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT03808597; https://clinicaltrials.gov/ct2/show/NCT03808597 International Registered Report Identifier (IRRID): RR2-10.2196/25128 ",
doi="10.2196/37666",
url="https://www.jmir.org/2022/7/e37666",
url="http://www.ncbi.nlm.nih.gov/pubmed/35900820"
}


@Article{info:doi/10.2196/29056,
author="Florensa, D{\'i}dac
and Mateo-Forn{\'e}s, Jordi
and Solsona, Francesc
and Pedrol Aige, Teresa
and Mesas Juli{\'o}, Miquel
and Pi{\~n}ol, Ramon
and Godoy, Pere",
title="Use of Multiple Correspondence Analysis and K-means to Explore Associations Between Risk Factors and Likelihood of Colorectal Cancer: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="19",
volume="24",
number="7",
pages="e29056",
keywords="colorectal cancer",
keywords="cancer registry",
keywords="multiple correspondence analysis",
keywords="k-means",
keywords="risk factors",
abstract="Background: Previous works have shown that risk factors are associated with an increased likelihood of colorectal cancer. Objective: The purpose of this study was to detect these associations in the region of Lleida (Catalonia) by using multiple correspondence analysis (MCA) and k-means. Methods: This cross-sectional study was made up of 1083 colorectal cancer episodes between 2012 and 2015, extracted from the population-based cancer registry for the province of Lleida (Spain), the Primary Care Centers database, and the Catalan Health Service Register. The data set included risk factors such as smoking and BMI as well as sociodemographic information and tumor details. The relations between the risk factors and patient characteristics were identified using MCA and k-means. Results: The combination of these techniques helps to detect clusters of patients with similar risk factors. Risk of death is associated with being elderly and obesity or being overweight. Stage III cancer is associated with people aged ?65 years and rural/semiurban populations, while younger people were associated with stage 0. Conclusions: MCA and k-means were significantly useful for detecting associations between risk factors and patient characteristics. These techniques have proven to be effective tools for analyzing the incidence of some factors in colorectal cancer. The outcomes obtained help corroborate suspected trends and stimulate the use of these techniques for finding the association of risk factors with the incidence of other cancers. ",
doi="10.2196/29056",
url="https://www.jmir.org/2022/7/e29056",
url="http://www.ncbi.nlm.nih.gov/pubmed/35852835"
}


@Article{info:doi/10.2196/35816,
author="Yang, Keng
and Hu, Yekang
and Qi, Hanying",
title="Digital Health Literacy: Bibliometric Analysis",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="6",
volume="24",
number="7",
pages="e35816",
keywords="digital health literacy",
keywords="eHealth",
keywords="digital divide",
keywords="bibliometrics",
keywords="VOSviewer",
keywords="CiteSpace",
abstract="Background: Digital health is growing at a rapid pace, and digital health literacy has attracted increasing attention from the academic community. Objective: The purposes of this study are to conduct a systematic bibliometric analysis on the field of digital health literacy and to understand the research context and trends in this field. Methods: Methods: A total of 1955 scientific publications were collected from the Web of Science core collection. Institutional co-operation, journal co-citation, theme bursting, keyword co-occurrence, author co-operation, author co-citation, literature co-citation, and references in the field of digital health literacy were analyzed using the VOSviewer and CiteSpace knowledge mapping tools. Results: The results demonstrate that the United States has the highest number of publications and citations in this field. The University of California System was first in terms of institutional contributions. The Journal of Medical Internet Research led in the number of publications, citations, and co-citations. Research areas of highly cited articles in the field of digital health literacy mainly include the definition and scale of health literacy, health literacy and health outcomes, health literacy and the digital divide, and the influencing factors of health literacy. Conclusions: We summarized research progress in the field of digital health literacy and reveal the context, trends, and trending topics of digital health literacy research through statistical analysis and network visualization. We found that digital health literacy has a significant potential to improve health outcomes, bridge the digital divide, and reduce health inequalities. Our work can serve as a fundamental reference and directional guide for future research in this field. ",
doi="10.2196/35816",
url="https://www.jmir.org/2022/7/e35816",
url="http://www.ncbi.nlm.nih.gov/pubmed/35793141"
}


@Article{info:doi/10.2196/29725,
author="Hardy, Amy
and Ward, Thomas
and Emsley, Richard
and Greenwood, Kathryn
and Freeman, Daniel
and Fowler, David
and Kuipers, Elizabeth
and Bebbington, Paul
and Garety, Philippa",
title="Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis",
journal="JMIR Hum Factors",
year="2022",
month="Jul",
day="1",
volume="9",
number="3",
pages="e29725",
keywords="paranoia",
keywords="psychosis",
keywords="digital health",
keywords="apps",
keywords="human-centered design",
keywords="user experience",
keywords="adherence",
keywords="engagement",
keywords="therapy",
abstract="Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the ``digital divide.'' Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the ``digital divide.'' SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the ``digital divide'' and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7\% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75\%, SD 17.1\%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the ``digital divide.'' Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the ``digital divide'' on therapy outcomes. Trial Registration: ISRCTN Registry ISRCTN32448671; https://www.isrctn.com/ISRCTN32448671 ",
doi="10.2196/29725",
url="https://humanfactors.jmir.org/2022/3/e29725",
url="http://www.ncbi.nlm.nih.gov/pubmed/35776506"
}


@Article{info:doi/10.2196/38099,
author="Sokoya, Temiloluwa
and Zhou, Yuchun
and Diaz, Sebastian
and Law, Timothy
and Himawan, Lina
and Lekey, Francisca
and Shi, Lu
and Gimbel, W. Ronald
and Jing, Xia",
title="Health Indicators as Measures of Individual Health Status and Their Public Perspectives: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="21",
volume="24",
number="6",
pages="e38099",
keywords="health status measurement",
keywords="individual health indicators",
keywords="public perspectives",
keywords="surveys and questionnaires",
abstract="Background: Disease status (eg, cancer stage) has been used in routine clinical practice to determine more accurate treatment plans. Health-related indicators, such as mortality, morbidity, and population group life expectancy, have also been used. However, few studies have specifically focused on the comprehensive and objective measures of individual health status. Objective: The aim of this study was to analyze the perspectives of the public toward 29 health indicators obtained from a literature review to provide evidence for further prioritization of the indicators. The difference between health status and disease status should be considered. Methods: This study used a cross-sectional design. Online surveys were administered through Ohio University, ResearchMatch, and Clemson University, resulting in three samples. Participants aged 18 years or older rated the importance of the 29 health indicators. The rating results were aggregated and analyzed as follows (in each case, the dependent variables were the individual survey responses): (1) to determine the agreement among the three samples regarding the importance of each indicator, where the independent variables (IVs) were the three samples; (2) to examine the mean differences between the retained indicators with agreement across the three samples, where the IVs were the identified indicators; and (3) to rank the groups of indicators into various levels after grouping the indicators with no mean differences, where the IVs were the groups of indicators. Results: In total, 1153 valid responses were analyzed. Descriptive statistics revealed that the top five--rated indicators were drug or substance abuse, smoking or tobacco use, alcohol abuse, major depression, and diet and nutrition. Among the 29 health indicators, the three samples agreed upon the importance of 13 indicators. Inferential statistical analysis indicated that some of the 13 indicators held equal importance. Therefore, the 13 indicators were categorized by rank into seven levels: level 1 included blood sugar level and immunization and vaccination; level 2 included LDL cholesterol; level 3 included HDL cholesterol, blood triglycerides, cancer screening detection, and total cholesterol; level 4 included health literacy rate; level 5 included personal care needs and air quality index greater than 100; level 6 included self-rated health status and HIV testing; and level 7 included the supply of dentists. Levels 1 to 3 were rated significantly higher than levels 4 to 7. Conclusions: This study provides a baseline for prioritizing 29 health indicators, which can be used by electronic health record or personal health record system designers or developers to determine what can be included in the systems to capture an individual's health status. Currently, self-rated health status is the predominantly used health indicator. Additionally, this study provides a foundation for tracking and measuring preventive health care services more accurately and for developing an individual health status index. ",
doi="10.2196/38099",
url="https://www.jmir.org/2022/6/e38099",
url="http://www.ncbi.nlm.nih.gov/pubmed/35623051"
}


@Article{info:doi/10.2196/30216,
author="Sehgal, Jay Neil
and Huang, Shuo
and Johnson, Mason Neil
and Dickerson, John
and Jackson, Devlon
and Baur, Cynthia",
title="The Benefits of Crowdsourcing to Seed and Align an Algorithm in an mHealth Intervention for African American and Hispanic Adults: Survey Study",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="21",
volume="24",
number="6",
pages="e30216",
keywords="crowdsourcing",
keywords="health information",
keywords="health promotion",
keywords="prevention",
keywords="public health informatics",
keywords="African American, Black, Latino, and Hispanic populations",
keywords="recommender system",
keywords="RecSys",
keywords="machine learning",
keywords="Mechanical Turk",
keywords="MTurk",
keywords="mobile phone",
abstract="Background: The lack of publicly available and culturally relevant data sets on African American and bilingual/Spanish-speaking Hispanic adults' disease prevention and health promotion priorities presents a major challenge for researchers and developers who want to create and test personalized tools built on and aligned with those priorities. Personalization depends on prediction and performance data. A recommender system (RecSys) could predict the most culturally and personally relevant preventative health information and serve it to African American and Hispanic users via a novel smartphone app. However, early in a user's experience, a RecSys can face the ``cold start problem'' of serving untailored and irrelevant content before it learns user preferences. For underserved African American and Hispanic populations, who are consistently being served health content targeted toward the White majority, the cold start problem can become an example of algorithmic bias. To avoid this, a RecSys needs population-appropriate seed data aligned with the app's purposes. Crowdsourcing provides a means to generate population-appropriate seed data. Objective: Our objective was to identify and test a method to address the lack of culturally specific preventative personal health data and sidestep the type of algorithmic bias inherent in a RecSys not trained in the population of focus. We did this by collecting a large amount of data quickly and at low cost from members of the population of focus, thereby generating a novel data set based on prevention-focused, population-relevant health goals. We seeded our RecSys with data collected anonymously from self-identified Hispanic and self-identified non-Hispanic African American/Black adult respondents, using Amazon Mechanical Turk (MTurk). Methods: MTurk provided the crowdsourcing platform for a web-based survey in which respondents completed a personal profile and a health information--seeking assessment, and provided data on family health history and personal health history. Respondents then selected their top 3 health goals related to preventable health conditions, and for each goal, reviewed and rated the top 3 information returns by importance, personal utility, whether the item should be added to their personal health library, and their satisfaction with the quality of the information returned. This paper reports the article ratings because our intent was to assess the benefits of crowdsourcing to seed a RecSys. The analysis of the data from health goals will be reported in future papers. Results: The MTurk crowdsourcing approach generated 985 valid responses from 485 (49\%) self-identified Hispanic and 500 (51\%) self-identified non-Hispanic African American adults over the course of only 64 days at a cost of US \$6.74 per respondent. Respondents rated 92 unique articles to inform the RecSys. Conclusions: Researchers have options such as MTurk as a quick, low-cost means to avoid the cold start problem for algorithms and to sidestep bias and low relevance for an intended population of app users. Seeding a RecSys with responses from people like the intended users allows for the development of a digital health tool that can recommend information to users based on similar demography, health goals, and health history. This approach minimizes the potential, initial gaps in algorithm performance; allows for quicker algorithm refinement in use; and may deliver a better user experience to individuals seeking preventative health information to improve health and achieve health goals. ",
doi="10.2196/30216",
url="https://www.jmir.org/2022/6/e30216",
url="http://www.ncbi.nlm.nih.gov/pubmed/35727616"
}


@Article{info:doi/10.2196/37677,
author="Day, Sean
and Shah, Veeraj
and Kaganoff, Sari
and Powelson, Shannon
and Mathews, C. Simon",
title="Assessing the Clinical Robustness of Digital Health Startups: Cross-sectional Observational Analysis",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="20",
volume="24",
number="6",
pages="e37677",
keywords="digital health",
keywords="health tech",
keywords="software as a medical device (SaaMD)",
keywords="real-world evidence",
keywords="venture capital",
abstract="Background: The digital health sector has experienced rapid growth over the past decade. However, health care technology stakeholders lack a comprehensive understanding of clinical robustness and claims across the industry. Objective: This analysis aimed to examine the clinical robustness and public claims made by digital health companies. Methods: A cross-sectional observational analysis was conducted using company data from the Rock Health Digital Health Venture Funding Database, the US Food and Drug Administration, and the US National Library of Medicine. Companies were included if they sell products targeting the prevention, diagnosis, or treatment phases of the care continuum. Clinical robustness was defined using regulatory filings and clinical trials completed by each company. Public claims data included clinical, economic, and engagement claims regarding product outcomes made by each company on its website. Results: A total of 224 digital health companies with an average age of 7.7 years were included in our cohort. Average clinical robustness was 2.5 (1.8 clinical trials and 0.8 regulatory filings) with a median score of 1. Ninety-eight (44\%) companies had a clinical robustness score of 0, while 45 (20\%) companies had a clinical robustness score of 5 or more. The average number of public claims was 1.3 (0.5 clinical, 0.4 economic, and 0.4 engagement); the median number of claims was 1. No correlation was observed between clinical robustness and number of clinical claims (r2=0.02), clinical robustness and total funding (r2=0.08), or clinical robustness and company age (r2=0.18). Conclusions: Many digital health companies have a low level of clinical robustness and do not make many claims as measured by regulatory filings, clinical trials, and public data shared online. Companies and customers may benefit from investing in greater clinical validation efforts. ",
doi="10.2196/37677",
url="https://www.jmir.org/2022/6/e37677",
url="http://www.ncbi.nlm.nih.gov/pubmed/35723914"
}


@Article{info:doi/10.2196/34882,
author="Paradis, Sabrina
and Roussel, Jeremy
and Bosson, Jean-Luc
and Kern, Jean-Baptiste",
title="Use of Smartphone Health Apps Among Patients Aged 18 to 69 Years in Primary Care: Population-Based Cross-sectional Survey",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="16",
volume="6",
number="6",
pages="e34882",
keywords="smartphone",
keywords="health applications",
keywords="mHealth",
keywords="apps",
keywords="mobile health",
keywords="digital health",
keywords="well-being",
keywords="epidemiology",
keywords="primary care",
keywords="population survey",
keywords="fitness",
keywords="physical activity",
keywords="health behavior",
keywords="patient",
abstract="Background: The World Health Organization has defined mobile health (mHealth) as the ``use of mobile and wireless technologies to support the achievement of health objectives.'' Smartphones currently represent one of the main media forms for mHealth democratization. Health apps can be an interesting tool for changing health behaviors. However, their use in France is still poorly documented. Objective: The main aim of this study was to evaluate the frequency of use of health apps among patients consulting in the primary care setting in France. The secondary aims were to evaluate the use of health apps according to the sociodemographic and medical characteristics of patients and to determine their use. Methods: A population-based cross-sectional survey was carried out between November 2017 and January 2018 in the Grenoble area of France among patients aged between 18 and 69 years who were consulting at 13 primary care physician offices. Patients were provided with anonymous paper self-questionnaires. The main criterion for participation was the use of a smartphone health app, defined for the purpose of this study as any app supporting patients in efforts to be healthy. Results: The participation rate was 49.27\% (739/1500; 95\% CI 46.7\%-51.8\%). The smartphone use was estimated at 82.6\% (597/723; 95\% CI 79.6\%-85.2\%). Of 597 smartphone owners, 47.7\% (283/595; CI 43.6\%-51.6\%) used at least one smartphone health app. Health apps identified in this study were mainly related to wellness, prevention, and fitness (66.1\%), as well as medication, treatments, and follow-up care (50.0\%). The main factors associated with health app use were: use of social networks (odds ratio [OR] 3.4, 95\% CI 2.1-5.3), age under 30 years (OR 2.7, CI 1.4-4.9), city size between 5001 and 10,000 inhabitants (OR 1.8, CI 1.1-2.8), and city size more than 10,000 inhabitants (OR 2.1, CI 1.4-3.2). Conclusions: In this survey, nearly one out of two patients reported the use of smartphone health apps, which are currently focused on wellness, prevention, and fitness, and are largely used by the younger population. Trial Registration: ClinicalTrials.gov NCT03351491; https://clinicaltrials.gov/ct2/show/NCT03351491 ",
doi="10.2196/34882",
url="https://formative.jmir.org/2022/6/e34882",
url="http://www.ncbi.nlm.nih.gov/pubmed/35708744"
}


@Article{info:doi/10.2196/34793,
author="Savage, D. Rachel
and Di Nicolo, Sophia
and Wu, Wei
and Li, Joyce
and Lawson, Andrea
and Grieve, Jim
and Goel, Vivek
and Rochon, A. Paula",
title="The Factors Associated With Nonuse of Social Media or Video Communications to Connect With Friends and Family During the COVID-19 Pandemic in Older Adults: Web-Based Survey Study",
journal="JMIR Aging",
year="2022",
month="Jun",
day="6",
volume="5",
number="2",
pages="e34793",
keywords="digital technology",
keywords="loneliness",
keywords="older adults",
keywords="COVID-19",
keywords="elderly",
keywords="lonely",
keywords="mental health",
keywords="factor",
keywords="usage",
keywords="social media",
keywords="video",
keywords="communication",
keywords="connection",
keywords="connect",
keywords="family",
keywords="friend",
keywords="age",
keywords="support",
abstract="Background: Digital technologies have enabled social connection during prolonged periods of physical distancing and travel restrictions throughout the COVID-19 pandemic. These solutions may exclude older adults, who are at higher risk for social isolation, loneliness, and severe outcomes if infected with SARS-CoV-2. Objective: This study investigated factors associated with nonuse of social media or video communications to connect with friends and family among older adults during the pandemic's first wave. Methods: A web-based, cross-sectional survey was administered to members of a national retired educators' organization based in Ontario, Canada, between May 6 and 19, 2020. Respondents (N=4879) were asked about their use of social networking websites or apps to communicate with friends and family, their internet connection and smartphone access, loneliness, and sociodemographic characteristics. Factors associated with nonuse were evaluated using multivariable logistic regression. A thematic analysis was performed on open-ended survey responses that described experiences with technology and virtual connection. Results: Overall, 15.4\% (751/4868) of respondents did not use social networking websites or apps. After adjustment, male gender (odds ratio [OR] 1.60, 95\% CI 1.33-1.92), advanced age (OR 1.88, 95\% CI 1.38-2.55), living alone (OR 1.68, 95\% CI 1.39-2.02), poorer health (OR 1.33, 95\% CI 1.04-1.71), and lower social support (OR 1.44, 95\% CI 1.20-1.71) increased the odds of nonuse. The reliability of internet connection and access to a smartphone also predicted nonuse. Many respondents viewed these technologies as beneficial, especially for maintaining pre--COVID-19 social contacts and routines, despite preferences for in-person connection. Conclusions: Several factors including advanced age, living alone, and low social support increased the odds of nonuse of social media in older adults to communicate with friends and family during COVID-19's first wave. Our findings identified socially vulnerable subgroups who may benefit from intervention (eg, improved access, digital literacy, and telephone outreach) to improve social connection. ",
doi="10.2196/34793",
url="https://aging.jmir.org/2022/2/e34793",
url="http://www.ncbi.nlm.nih.gov/pubmed/35344502"
}


@Article{info:doi/10.2196/36799,
author="Rantanen, Teemu
and J{\"a}rvel{\"a}inen, Eeva
and Lepp{\"a}lahti, Teppo",
title="Self-efficacy and Use of Digital Health Care and Social Welfare Services Among Incarcerated People: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2022",
month="May",
day="31",
volume="24",
number="5",
pages="e36799",
keywords="digital inclusion",
keywords="digital exclusion",
keywords="digital divide",
keywords="digitalization in prisons",
keywords="incarcerated people",
abstract="Background: The digitization of health care and social welfare services creates many opportunities for the rehabilitation of incarcerated people and their preparation for release from prison. A range of digital platforms and technology solutions have been developed that offer multiple opportunities to handle private matters either by video conference, email, or some other digital format during imprisonment. However, incarcerated people have limited access to digital health care and social welfare services, and face challenges related to shortcomings in their digital skills and self-efficacy. Objective: This article assessed the significance of incarcerated people's self-efficacy in terms of their sense of control over the use of digital health care and social welfare services. Methods: A cross-sectional study was conducted using a questionnaire. Research data were collected from 11 prisons in different parts of Finland, and a total of 225 incarcerated people responded to the survey. Statistical analyses were conducted using the Pearson product-moment correlation coefficient, 2-tailed t test, linear regression analysis, and Hayes bootstrapping method. Results: The results showed the significance of both general and internet-specific self-efficacy, which appear to be more important for the use of digital health care and social welfare services than factors related to a person's socioeconomic background or sentence. Age was negatively correlated with perceived control over the use of digital health care and social welfare services. Furthermore, the study emphasized the importance of support from family and friends, as well as prison employees. Conclusions: The digitalization of prisons offers many opportunities, but special consideration should be given to how the digitization of health care and social welfare services responds to the needs of incarcerated people in terms of their integration into society and the prevention of recidivism. During imprisonment, attention should be paid to strengthening the digital skills of incarcerated people, with support provided by prison employees. In addition to providing guidance on the use of individual digital services, the study recommends strengthening the general digital skills of incarcerated people, as well as developing their life management skills. ",
doi="10.2196/36799",
url="https://www.jmir.org/2022/5/e36799",
url="http://www.ncbi.nlm.nih.gov/pubmed/35639446"
}


@Article{info:doi/10.2196/32723,
author="Eke, Ransome
and Jannat, Tul Khadiza
and Yang, Thomas Xin
and Parton, M. Jason",
title="Disparity and Factors Associated With Internet Health Information Seeking Among US Adults Living With Diabetes Mellitus: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="May",
day="30",
volume="24",
number="5",
pages="e32723",
keywords="diabetes",
keywords="internet",
keywords="information seeking",
keywords="adults living with diabetes",
keywords="predictors",
keywords="racial disparity",
keywords="Health Information National Trends Survey",
keywords="race",
keywords="ethnicity",
keywords="chronic conditions",
keywords="self-management",
keywords="internet health information",
keywords="mobile phone",
abstract="Background: Many patients with chronic medical conditions search the internet to obtain medical advice and health information to improve their health condition and quality of life. Diabetes is a common chronic disease that disproportionately affects different race and ethnicity groups in the United States. In the existing literature on the popularity of internet health information seeking among persons with a chronic medical condition, there are limited data on US adults living with diabetes. Objective: This study aims to examine the factors associated with internet health information seeking among US adults living with diabetes and whether there is a disparity in internet health information seeking stratified by race and ethnicity. Methods: We conducted a cross-sectional study using the Health Information National Trends Survey data from 2017 to 2020. We selected our study sample based on respondents' reports on whether they were told they had diabetes, and our primary outcome was internet health information--seeking behavior. We used 2 multivariable logistic regression models to examine the effects of sociodemographic factors and other covariates on the internet health information--seeking behavior of adults with diabetes. Jackknife replicate weights were used to provide bias-corrected variance estimates. Results: Our study sample included 2903 adults who self-reported that they had diabetes. In total, 60.08\% (1744/2903) were non-Hispanic White individuals, 46.88\% (1336/2850) were men, and 64\% (1812/2831) had some college or graduate education. The prevalence of internet health information seeking in this population was 64.49\% (1872/2903), and the main factors associated with internet health information seeking included education level (some college vs less than high school: odds ratio [OR] 1.42, 95\% CI 1.44-1.88; and college graduate or higher vs less than high school: OR 2.50, 95\% CI 1.79-3.50), age (age group ?65 years vs age group 18-44 years: OR 0.46, 95\% CI 0.34-0.63), and household income level (P<.001). In addition, we found significant differences in the effects of predictors stratified by race. Conclusions: The findings from this study suggest that internet health information seeking is common among US adults living with diabetes. Internet health information could influence the relationship between health care providers and adults living with diabetes and improve their self-management and quality of life. ",
doi="10.2196/32723",
url="https://www.jmir.org/2022/5/e32723",
url="http://www.ncbi.nlm.nih.gov/pubmed/35635741"
}


@Article{info:doi/10.2196/33291,
author="Clancy, Brigid
and Bonevski, Billie
and English, Coralie
and Baker, L. Amanda
and Turner, Alyna
and Magin, Parker
and Pollack, Michael
and Callister, Robin
and Guillaumier, Ashleigh",
title="Access to and Use of Internet and Social Media by Low-Morbidity Stroke Survivors Participating in a National Web-Based Secondary Stroke Prevention Trial: Cross-sectional Survey",
journal="J Med Internet Res",
year="2022",
month="May",
day="30",
volume="24",
number="5",
pages="e33291",
keywords="stroke",
keywords="stroke survivor",
keywords="recurrent stroke",
keywords="digital health",
keywords="social media",
keywords="internet use",
keywords="eHealth",
keywords="information-seeking behavior",
keywords="web-based",
keywords="mobile phone",
abstract="Background: eHealth applications for stroke are a growing area of research that has yielded promising results. However, little is known about how stroke survivors engage with the internet, social media, and other digital technologies on a day-to-day basis. Objective: This study had three main objectives: to describe the type, frequency, and purpose of technology use among a cohort of low-morbidity stroke survivors; to investigate associations between social media use and participant factors, including sociodemographics, physical function, and independence in activities of daily living; and to investigate associations between stroke-related health risk factors and the use of the internet to search for health and medical information. Methods: This study is a secondary analysis of data obtained during a national randomized controlled trial---Prevent 2nd Stroke. The participants were stroke survivors recruited from 2 Australian stroke registries who completed 2 telephone-administered surveys to collect data on demographics and stroke characteristics; health risk factors (diet quality, physical activity, blood pressure medication, alcohol intake, anxiety and depression, and smoking status); physical functioning; independence in activities of daily living; and questions about what technology they had access to, how often they used it, and for what purposes. Participants were eligible if they had no more than a moderate level of disability (modified Rankin score ?3) and had access to the internet. Multivariable logistic regression was used to assess the associations between social media use and sociodemographics, physical function, and independence in activities of daily living as well as associations between stroke-related health risk factors and the use of the internet to search for health and medical information. Results: Data from 354 participants were included in the analysis. Approximately 79.1\% (280/354) of participants used the internet at least daily, 40.8\% (118/289) accessed social media on their phone or tablet daily, and 46.4\% (134/289) looked up health and medical information at least monthly. Women were 2.7 times more likely to use social media (adjusted odds ratio 2.65, 95\% CI 1.51-4.72), and people aged >75 years were significantly less likely to use social media compared with those aged <55 years (adjusted odds ratio 0.17, 95\% CI 0.07-0.44). Health risk factors were not found to be associated with searching for health- or medical-related information. Conclusions: The internet appears to be a viable platform to engage with stroke survivors who may not be high-morbidity to conduct research and provide information and health interventions. This is important given that they are at high risk of recurrent stroke regardless of their level of disability. Exploring the technology use behaviors and the possibility of eHealth among survivors who experience higher levels of morbidity or disability because of their stroke is an area of research that warrants further study. ",
doi="10.2196/33291",
url="https://www.jmir.org/2022/5/e33291",
url="http://www.ncbi.nlm.nih.gov/pubmed/35635754"
}


@Article{info:doi/10.2196/37534,
author="Li, Shiyu
and Yin, Zenong
and Lesser, Janna
and Li, Chengdong
and Choi, Yeob Byeong
and Parra-Medina, Deborah
and Flores, Belinda
and Dennis, Brittany
and Wang, Jing",
title="Community Health Worker-Led mHealth-Enabled Diabetes Self-management Education and Support Intervention in Rural Latino Adults: Single-Arm Feasibility Trial",
journal="JMIR Diabetes",
year="2022",
month="May",
day="30",
volume="7",
number="2",
pages="e37534",
keywords="health disparity",
keywords="rural health",
keywords="rural",
keywords="community health worker",
keywords="health education",
keywords="digital health",
keywords="diabetes",
keywords="diabetes management",
keywords="mHealth",
keywords="community health",
keywords="self management",
keywords="mobile health",
keywords="technology feasibility",
keywords="underserved",
keywords="Latino",
abstract="Background: Latinos living in rural South Texas have a higher prevalence of diabetes, but their access to diabetes self-management education and support (DSMES) is limited. Objective: We aimed to test the feasibility of a community health worker-led, mobile health (mHealth)-based DSMES intervention to reduce disparities in accessing DSMES in underserved rural Latino residents in South Texas. Methods: This 12-week, single-arm, pre-post trial was delivered by trained community health workers to 15 adults with type 2 diabetes. The intervention consisted of digital diabetes education, self-monitoring, a cloud-based connected platform, and community health worker support. Feasibility was evaluated as retention, actual intervention use, program satisfaction, and barriers to implementation. We also explored the intervention's effect on weight loss and hemoglobin A1c (HbA1c). Results: All 15 participants were Latino (mean age 61.87 years, SD 10.67; 9/15 female, 60\%). The retention rate at posttest was 14 of 15 (93\%). On average, the participants completed 37 of 42 (88\%) digital diabetes education lessons with 8 participants completing all lessons. Participants spent 81/91 days (89\%) step tracking, 71/91 days (78\%) food logging, 43/91 days (47\%) blood glucose self-monitoring, and 74/91 days (81\%) weight self-monitoring. The level of program satisfaction was high. On average, participants lost 3.5 (SD 3.2) kg of body weight (P=.001), while HbA1c level remained unchanged from baseline (6.91\%, SD 1.28\%) to posttest (7.04\%, SD 1.66\%; P=.668). Conclusions: A community health worker-led mHealth-based intervention was feasible and acceptable to improve access to DSMES services for Latino adults living in rural communities. Future randomized controlled trials are needed to test intervention efficacy on weight loss and glycemic control. ",
doi="10.2196/37534",
url="https://diabetes.jmir.org/2022/2/e37534",
url="http://www.ncbi.nlm.nih.gov/pubmed/35635752"
}


@Article{info:doi/10.2196/33985,
author="Korn, Sandra
and B{\"o}ttcher, David Maximilian
and Busse, Sophie Theresa
and Kernebeck, Sven
and Breucha, Michael
and Ehlers, Jan
and Kahlert, Christoph
and Weitz, J{\"u}rgen
and Bork, Ulrich",
title="Use and Perception of Digital Health Technologies by Surgical Patients in Germany in the Pre--COVID-19 Era: Survey Study",
journal="JMIR Form Res",
year="2022",
month="May",
day="20",
volume="6",
number="5",
pages="e33985",
keywords="digital equity",
keywords="eHealth",
keywords="electronic health",
keywords="mobile health",
keywords="health apps",
keywords="mobile health apps",
keywords="eHealth literacy",
keywords="mobile phone",
abstract="Background: This survey study investigates surgical patients' use and perception of digital health technologies in Germany in the pre--COVID-19 era. Objective: The objective of this study was to relate surgical patients' characteristics to the use and perception of several digital health technologies. Methods: In this single-center, cross-sectional survey study in the outpatient department of a university hospital in Germany, 406 patients completed a questionnaire with the following three domains: general information and use of the internet, smartphones, and general digital health aspects. Analyses were stratified by age group and highest education level achieved. Results: We found significant age-based differences in most of the evaluated aspects. Younger patients were more open to using new technologies in private and medical settings but had more security concerns. Although searching for information on illnesses on the web was common, the overall acceptance of and trust in web-based consultations were rather low, with <50\% of patients in each age group reporting acceptance and trust. More people with academic qualifications than without academic qualifications searched for information on the web before visiting physicians (73/121, 60.3\% and 100/240, 41.7\%, respectively). Patients with academic degrees were also more engaged in health-related information and communication technology use. Conclusions: These results support the need for eHealth literacy, health literacy, and available digital devices and internet access to support the active, meaningful use of information and communication technologies in health care. Uncertainties and a lack of knowledge exist, especially regarding telemedicine and the use of medical and health apps. This is especially pronounced among older patients and patients with a low education status. ",
doi="10.2196/33985",
url="https://formative.jmir.org/2022/5/e33985",
url="http://www.ncbi.nlm.nih.gov/pubmed/35594072"
}


@Article{info:doi/10.2196/34508,
author="Hichborn, G. Emily
and Moore, K. Sarah
and Gauthier, R. Phoebe
and Agosti, O. Nico
and Bell, D. Kathleen
and Boggis, S. Jesse
and Lambert-Harris, A. Chantal
and Saunders, C. Elizabeth
and Turner, M. Avery
and McLeman, M. Bethany
and Marsch, A. Lisa",
title="Technology-Based Interventions in Substance Use Treatment to Promote Health Equity Among People Who Identify as African American/Black, Hispanic/Latinx, and American Indian/Alaskan Native: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="17",
volume="11",
number="5",
pages="e34508",
keywords="health disparities",
keywords="scoping review",
keywords="social determinants of health",
keywords="substance use",
keywords="treatment",
keywords="technology-based interventions",
keywords="underrepresented",
abstract="Background: Technology-based interventions (TBIs; ie, web-based and mobile interventions) have the potential to promote health equity in substance use treatment (SUTx) for underrepresented groups (people who identify as African American/Black, Hispanic/Latinx, and American Indian/Alaskan Native) by removing barriers and increasing access to culturally relevant effective treatments. However, technologies (emergent and more long-standing) may have unintended consequences that could perpetuate health care disparities among people who identify as a member of one of the underrepresented groups. Health care research, and SUTx research specifically, is infrequently conducted with people who identify with these groups as the main focus. Therefore, an improved understanding of the literature at the intersection of SUTx, TBIs, and underrepresented groups is warranted to avoid exacerbating inequities and to promote health equity. Objective: This study aims to explore peer-reviewed literature (January 2000-March 2021) that includes people who identify as a member of one of the underrepresented groups in SUTx research using TBIs.  We further seek to explore whether this subset of research is race/ethnicity conscious (does the research consider members of underrepresented groups beyond their inclusion as study participants in the introduction, methods, results, or discussion). Methods: Five electronic databases (MEDLINE, Scopus, Cochrane Library, CINAHL, and PsycInfo) were searched to identify SUTx research using TBIs, and studies were screened for eligibility at the title/abstract and full-text levels.  Studies were included if their sample comprised of people who identify as a member of one of the underrepresented groups at 50\% or more when combined. Results: Title/abstract and full-text reviews were completed in 2021. These efforts netted a sample of 185 studies that appear to meet inclusionary criteria. Due to the uniqueness of tobacco relative to other substances in the SUTx space, as well as the large number of studies netted, we plan to separately publish a scoping review on tobacco-focused studies that meet all other criteria. Filtering for tobacco-focused studies (n=31) netted a final full-text sample for a main scoping review of 154 studies. The tobacco-focused scoping review manuscript is expected to be submitted for peer review in Spring 2022. The main scoping review data extraction and data validation to confirm the accuracy and consistency of data extraction across records was completed in March 2022. We expect to publish the main scoping review findings by the end of 2022. Conclusions: Research is needed to increase our understanding of the range and nature of TBIs being used in SUTx research studies with members of underrepresented groups. The planned scoping review will highlight research at this intersection to promote health equity. International Registered Report Identifier (IRRID): DERR1-10.2196/34508 ",
doi="10.2196/34508",
url="https://www.researchprotocols.org/2022/5/e34508",
url="http://www.ncbi.nlm.nih.gov/pubmed/35579930"
}


@Article{info:doi/10.2196/34013,
author="Evans, Laura
and Evans, Jay
and Pagliari, Claudia
and K{\"a}llander, Karin",
title="Exploring the Equity Impact of Current Digital Health Design Practices: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="17",
volume="11",
number="5",
pages="e34013",
keywords="digital health",
keywords="health equity",
keywords="design",
keywords="human-centered design",
abstract="Background: The field of digital health has grown rapidly in part due to digital health tools' potential to reduce health inequities. However, such potential has not always been realized. The design approaches used in digital health are one of the known aspects that have an impact on health equity. Objective: The aim of our scoping review will be to understand how design approaches in digital health have an impact on health equity. Methods: A scoping review of studies that describe how design practices for digital health have an impact on health equity will be carried out. The scoping review will follow the methodologies laid out by Arksey and O'Malley, the Joanna Briggs Institute, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The PubMed, Embase, Web of Science, and ACM Digital Library databases will be searched for peer-reviewed papers. The ProQuest Dissertations and Theses and Global Index Medicus databases will be searched for gray literature. The results will be screened against our inclusion and exclusion criteria. Subsequently, the data extracted from the included studies will be analyzed. Results: As of March 2022, a preliminary search of the peer-reviewed databases has yielded over 4900 studies, and more are anticipated when gray literature databases are searched. We expect that after duplicates are removed and screening is completed, a much smaller number of studies will meet all of our inclusion criteria. Conclusions: Although there has been much discussion about the importance of design for lowering barriers to digital health participation, the evidence base demonstrating its impacts on health equity is less obvious. We hope that our findings will contribute to a better understanding of the impact that design in digital health has on health equity and that these findings will translate into action that leads to stronger, more equitable health care systems. ",
doi="10.2196/34013",
url="https://www.researchprotocols.org/2022/5/e34013",
url="http://www.ncbi.nlm.nih.gov/pubmed/35579918"
}


@Article{info:doi/10.2196/37523,
author="K{\"o}nig, Lars
and Marbach-Breitr{\"u}ck, Eugenia
and Engler, Anne
and Suhr, Ralf",
title="The Development and Evaluation of an e-Learning Course That Promotes Digital Health Literacy in School-age Children: Pre-Post Measurement Study",
journal="J Med Internet Res",
year="2022",
month="May",
day="16",
volume="24",
number="5",
pages="e37523",
keywords="digital education",
keywords="digital health literacy",
keywords="digital literacy",
keywords="e-learning",
keywords="health education",
keywords="health information",
keywords="health literacy",
keywords="learning material",
keywords="school",
keywords="school-age children",
abstract="Background: Experts agree that the promotion of (digital) health literacy should be an integral part of the school curriculum. However, promoting (digital) health literacy within the German school system is difficult because (digital) health education is not a mandatory school subject in all the German states. Therefore, experts suggest that (digital) health literacy could be addressed as part of the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz). Objective: The goal of this study was to evaluate a newly developed e-learning course that was designed to improve (digital) health literacy in school-age children and concurrently to teach skills specified in the mandatory framework for digital education and digital literacy in schools. It was hypothesized that participants' health literacy and digital health literacy levels would be higher after completing the e-learning course than they were before doing the course. Furthermore, it was hypothesized that after completing the e-learning course, participants' subjective and objective knowledge in the domain of (digital) health literacy would be higher than it was before doing the course. Methods: The pre-post measurement study was conducted online. After participants (N=323) gave their informed consent to participate in the study, they provided demographic information and answered all measures (premeasurement). Following this, participants had 7 days to complete the e-learning course. After finishing the e-learning course, participants answered all the measures again (postmeasurement). Results: To test the hypotheses, Bayesian paired samples t tests (1-sided) were conducted. After completing the e-learning course, participants showed higher health literacy levels. Specifically, they showed higher competency levels in the domains of theoretical knowledge (Bayes factor [BF]--0=676,000; $\delta$=--0.316), practical knowledge (BF--0=92,300; $\delta$=--0.294), critical thinking (BF--0=7.42e+13; $\delta$=--0.482), self-awareness (BF--0=11,500,000; $\delta$=--0.345), and citizenship (BF--0=266,000; $\delta$=--0.306). Furthermore, participants achieved higher digital health literacy levels. Specifically, they achieved higher competency levels in the domains of information searching (BF--0=2.339; $\delta$=--0.135), evaluating reliability (BF--0=2.03e+11; $\delta$=--0.434), and determining relevance (BF--0=316,000; $\delta$=--0.308). Moreover, participants demonstrated higher subjective (BF--0=3.58e+82; $\delta$=--1.515) and objective knowledge (BF--0=3.82e+97; $\delta$=--1.758) in the domain of (digital) health literacy. Conclusions: The newly designed e-learning course provides an easy way for schools and teachers from all German states to integrate (digital) health literacy education into their school curriculums and lessons. The evaluated course is especially attractive because it was designed to improve (digital) health literacy and at the same time to teach skills specified in the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz). ",
doi="10.2196/37523",
url="https://www.jmir.org/2022/5/e37523",
url="http://www.ncbi.nlm.nih.gov/pubmed/35576572"
}


@Article{info:doi/10.2196/35408,
author="Egan, Lyra
and Gardner, Anne Lauren
and Newton, Nicola
and Champion, Katrina",
title="eHealth Interventions Targeting Poor Diet, Alcohol Use, Tobacco Smoking, and Vaping Among Disadvantaged Youth: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="13",
volume="11",
number="5",
pages="e35408",
keywords="eHealth",
keywords="adolescent",
keywords="health promotion",
keywords="diet",
keywords="alcohol",
keywords="smoking",
keywords="vaping",
keywords="socioeconomic status",
keywords="remoteness",
keywords="rural",
keywords="disadvantage",
abstract="Background: Chronic disease burden is higher among disadvantaged populations. Preventing lifestyle risk behaviors such as poor diet, alcohol use, tobacco smoking, and vaping in adolescence is critical for reducing the risk of chronic disease and related harms in adolescence and adulthood. Although eHealth interventions are a promising prevention approach among the general population, it is unclear whether they adequately serve adolescents from disadvantaged backgrounds such as those living in geographically remote or lower socioeconomic areas. Objective: This is the first systematic review to identify, evaluate, and synthesize evidence for the effectiveness of eHealth interventions targeting adolescents living in geographically remote or lower socioeconomic areas in preventing poor diet, alcohol use, tobacco smoking, and vaping. Methods: A systematic search will be conducted in 7 electronic databases: the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PROSPERO, MEDLINE (Ovid), Embase (Ovid), Scopus, and PsycInfo (Ovid). The search will be limited to eHealth-based experimental studies (ie, randomized controlled trials and quasi-experimental studies) targeting diet, alcohol use, tobacco smoking, and vaping among adolescents (aged 10-19 years). Eligible studies will be those reporting on at least one marker of socioeconomic status (eg, social class, household income, parental occupation status, parental education, and family affluence) or geographical remoteness (eg, living in rural, regional, and remote areas, or living outside major metropolitan centers). One reviewer will screen all studies for eligibility, of which 25\% will be double-screened. Data will be extracted and summarized in a narrative synthesis. Risk of bias will be assessed using the Cochrane Revised Risk of Bias Tool. Results: As of December 2021, the title and abstract screening of 3216 articles was completed, and the full-text review was underway. The systematic review is expected to be completed in 2022. Conclusions: This systematic review will provide an in-depth understanding of effective eHealth interventions targeting poor diet, alcohol use, tobacco smoking, and vaping among adolescents living in geographically remote or lower socioeconomic areas and the factors that contribute to their effectiveness. This in turn will provide critical knowledge to improve future interventions delivered to these populations. Trial Registration: PROSPERO CRD42021294119; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=294119 International Registered Report Identifier (IRRID): PRR1-10.2196/35408 ",
doi="10.2196/35408",
url="https://www.researchprotocols.org/2022/5/e35408",
url="http://www.ncbi.nlm.nih.gov/pubmed/35560002"
}


@Article{info:doi/10.2196/37946,
author="Baptist, Alan
and Gibson-Scipio, Wanda
and Carcone, Idalski April
and Ghosh, Samiran
and Jacques-Tiura, J. Angela
and Hall, Amy
and MacDonell, Kolmodin Karen",
title="Asthma and Technology in Emerging African American Adults (The ATHENA Project): Protocol for a Trial Using the Multiphase Optimization Strategy Framework",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="10",
volume="11",
number="5",
pages="e37946",
keywords="African American emerging adults",
keywords="asthma management",
keywords="mHealth",
keywords="mobile health",
keywords="motivational interviewing",
keywords="asthma control",
keywords="physical activity",
abstract="Background: Asthma causes substantial morbidity and mortality in the United States, particularly among African American emerging adults (AAEAs; aged 18-30 years), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be the most effective. However, intensive face-to-face interventions are often difficult to implement in this population. Objective: The purpose of this study is to develop an effective mobile asthma management intervention to improve control among AAEAs. Methods: We will assess the ability of multiple technologic components to assist and improve traditional asthma education. The first component is the Motivational Enhancement System for asthma management. It is a mobile 4-session intervention using supported self-regulation and motivational interviewing. Personalized content is based on each participant's activity level, daily experiences, and goals. The second component is supportive accountability. It is administered by asthma nurses using targeted mobile support (Skype/voice calls) to provide education, promote self-efficacy, and overcome barriers through a motivational interviewing--based framework. The third component is SMS text messaging. It provides reminders for asthma education, medication adherence, and physical activity. The fourth component is physical activity tracking. It uses wearable technology to help meet user-defined physical activity goals. Using a multiphase optimization strategy (MOST) framework, we will test intervention components and combinations of components to identify the most effective mobile intervention. The MOST framework is an innovative, and cost- and time-effective framework that uses engineering principles to produce effective behavioral interventions. We will conduct a component selection experiment using a factorial research design to build an intervention that has been optimized for maximum efficacy, using a clinically significant improvement in asthma. Participants (N=180) will be randomized to 1 of 6 intervention arms. Participants will be recruited from multiple sites of the American Lung Association-Airway Clinical Research Centers network and ambulatory care clinics at the Detroit Medical Center. Data collections will occur at baseline, and 3, 6, and 12 months. Results: At study completion, we will have an empirically supported optimized mobile asthma management intervention to improve asthma control for AAEAs. We hypothesize that postintervention (3, 6, and 12 months), participants with uncontrolled asthma will show a clinically significant improvement in asthma control. We also hypothesize that improvements in asthma management behaviors (including physical activity), quality of life, symptoms, adherence, and exacerbation (secondary outcomes) will be observed. Conclusions: AAEAs are disproportionately impacted by asthma, but have been underrepresented in research. Mobile asthma management interventions may help improve asthma control and allow people to live healthier lives. During this project, we will use an innovative strategy to develop an optimized mobile asthma management intervention using the most effective combination of nurse-delivered asthma education, a smartphone app, and text messaging. International Registered Report Identifier (IRRID): PRR1-10.2196/37946 ",
doi="10.2196/37946",
url="https://www.researchprotocols.org/2022/5/e37946",
url="http://www.ncbi.nlm.nih.gov/pubmed/35536642"
}


@Article{info:doi/10.2196/32006,
author="Coley, Nicola
and Andre, Laurine
and Hoevenaar-Blom, P. Marieke
and Ngandu, Tiia
and Beishuizen, Cathrien
and Barbera, Mariagnese
and van Wanrooij, Lennard
and Kivipelto, Miia
and Soininen, Hilkka
and van Gool, Willem
and Brayne, Carol
and Moll van Charante, Eric
and Richard, Edo
and Andrieu, Sandrine
and ",
title="Factors Predicting Engagement of Older Adults With a Coach-Supported eHealth Intervention Promoting Lifestyle Change and Associations Between Engagement and Changes in Cardiovascular and Dementia Risk: Secondary Analysis of an 18-Month Multinational Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="May",
day="9",
volume="24",
number="5",
pages="e32006",
keywords="aging",
keywords="eHealth",
keywords="disparities",
keywords="engagement",
keywords="prevention",
keywords="cardiovascular",
keywords="lifestyle",
keywords="risk factors",
abstract="Background: Digital health interventions could help to prevent age-related diseases, but little is known about how older adults engage with such interventions, especially in the long term, or whether engagement is associated with changes in clinical, behavioral, or biological outcomes in this population. Disparities in engagement levels with digital health interventions may exist among older people and be associated with health inequalities. Objective: This study aimed to describe older adults' engagement with an eHealth intervention, identify factors associated with engagement, and examine associations between engagement and changes in cardiovascular and dementia risk factors (blood pressure, cholesterol, BMI, physical activity, diet, and cardiovascular and dementia risk scores). Methods: This was a secondary analysis of the 18-month randomized controlled Healthy Ageing Through Internet Counselling in the Elderly trial of a tailored internet-based intervention encouraging behavior changes, with remote support from a lifestyle coach, to reduce cardiovascular and cognitive decline risk in 2724 individuals aged ?65 years, recruited offline in the Netherlands, Finland, and France. Engagement was assessed via log-in frequency, number of lifestyle goals set, measurements entered and messages sent to coaches, and percentage of education materials read. Clinical and biological data were collected during in-person visits at baseline and 18 months. Lifestyle data were self-reported on a web-based platform. Results: Of the 1389 intervention group participants, 1194 (85.96\%) sent at least one message. They logged in a median of 29 times, and set a median of 1 goal. Higher engagement was associated with significantly greater improvement in biological and behavioral risk factors, with evidence of a dose-response effect. Compared with the control group, the adjusted mean difference (95\% CI) in 18-month change in the primary outcome, a composite z-score comprising blood pressure, BMI, and cholesterol, was ?0.08 (?0.12 to ?0.03), ?0.04 (?0.08 to 0.00), and 0.00 (?0.08 to 0.08) in the high, moderate, and low engagement groups, respectively. Low engagers showed no improvement in any outcome measures compared with the control group. Participants not using a computer regularly before the study engaged much less with the intervention than those using a computer up to 7 (adjusted odds ratio 5.39, 95\% CI 2.66-10.95) or ?7 hours per week (adjusted odds ratio 6.58, 95\% CI 3.21-13.49). Those already working on or with short-term plans for lifestyle improvement at baseline, and with better cognition, engaged more. Conclusions: Greater engagement with an eHealth lifestyle intervention was associated with greater improvement in risk factors in older adults. However, those with limited computer experience, who tended to have a lower level of education, or who had poorer cognition engaged less. Additional support or forms of intervention delivery for such individuals could help minimize potential health inequalities associated with the use of digital health interventions in older people. ",
doi="10.2196/32006",
url="https://www.jmir.org/2022/5/e32006",
url="http://www.ncbi.nlm.nih.gov/pubmed/35385395"
}


@Article{info:doi/10.2196/33498,
author="McCloud, Rachel
and Perez, Carly
and Bekalu, Awoke Mesfin
and Viswanath, K.",
title="Using Smart Speaker Technology for Health and Well-being in an Older Adult Population: Pre-Post Feasibility Study",
journal="JMIR Aging",
year="2022",
month="May",
day="9",
volume="5",
number="2",
pages="e33498",
keywords="technology",
keywords="older adults",
keywords="communication inequalities",
keywords="digital health",
keywords="elderly population",
keywords="smart technology",
keywords="smart speaker",
keywords="well-being",
keywords="health technology",
keywords="mobile phone",
abstract="Background: Although smart speaker technology is poised to help improve the health and well-being of older adults by offering services such as music, medication reminders, and connection to others, more research is needed to determine how older adults from lower socioeconomic position (SEP) accept and use this technology. Objective: This study aimed to investigate the feasibility of using smart speakers to improve the health and well-being of low-SEP older adults. Methods: A total of 39 adults aged between 65 and 85 years who lived in a subsidized housing community were recruited to participate in a 3-month study. The participants had a smart speaker at their home and were given a brief orientation on its use. Over the course of the study, participants were given weekly check-in calls to help assist with any problems and newsletters with tips on how to use the speaker. Participants received a pretest and posttest to gauge comfort with technology, well-being, and perceptions and use of the speaker. The study staff also maintained detailed process notes of interactions with the participants over the course of the study, including a log of all issues reported. Results: At the end of the study period, 38\% (15/39) of the participants indicated using the speaker daily, and 38\% (15/39) of the participants reported using it several times per week. In addition, 72\% (28/39) of the participants indicated that they wanted to continue using the speaker after the end of the study. Most participants (24/39, 62\%) indicated that the speaker was useful, and approximately half of the participants felt that the speaker gave them another voice to talk to (19/39, 49\%) and connected them with the outside world (18/39, 46\%). Although common uses were using the speaker for weather, music, and news, fewer participants reported using it for health-related questions. Despite the initial challenges participants experienced with framing questions to the speaker, additional explanations by the study staff addressed these issues in the early weeks of the study. Conclusions: The results of this study indicate that there is promise for smart speaker technology for low-SEP older adults, particularly to connect them to music, news, and reminders. Future studies will need to provide more upfront training on query formation as well as develop and promote more specific options for older adults, particularly in the area of health and well-being. ",
doi="10.2196/33498",
url="https://aging.jmir.org/2022/2/e33498",
url="http://www.ncbi.nlm.nih.gov/pubmed/35532979"
}


@Article{info:doi/10.2196/35540,
author="Moreno, A. Megan
and Binger, Kole
and Zhao, Qianqian
and Eickhoff, Jens
and Minich, Matt
and Uhls, Tehranian Yalda",
title="Digital Technology and Media Use by Adolescents: Latent Class Analysis",
journal="JMIR Pediatr Parent",
year="2022",
month="May",
day="4",
volume="5",
number="2",
pages="e35540",
keywords="digital technology",
keywords="adolescents",
keywords="latent class analysis",
keywords="social media",
keywords="mobile phone",
abstract="Background: Digital technology and media use is integral to adolescents' lives and has been associated with both positive and negative health consequences. Previous studies have largely focused on understanding technology behaviors and outcomes within adolescent populations, which can promote assumptions about adolescent technology use as homogeneous. Furthermore, many studies on adolescent technology use have focused on risks and negative outcomes. To better understand adolescent digital technology use, we need new approaches that can assess distinct profiles within study populations and take a balanced approach to understanding the risks and benefits of digital technology use. Objective: The purpose of this study was to identify profiles of adolescent technology use within a large study population focusing on four evidence-based constructs: technology ownership and use, parental involvement, health outcomes, and well-being indicators. Methods: Adolescent-parent dyads were recruited for a cross-sectional web-based survey using the Qualtrics (Qualtrics International, Inc) platform and panels. Technology use measures included ownership of devices, social media use frequency, and the Adolescents' Digital Technology Interactions and Importance scale. Parent involvement measures included household media rules, technology-related parenting practices, parent social media use frequency, and the parent-child relationship. Health outcome measures included physical activity, sleep, problematic internet use, and mental health assessments. Well-being indicators included mental wellness, communication, and empathy. We used latent class analysis (LCA) to identify distinct profile groups across the aforementioned 4 critical constructs. Results: Among the 3981 adolescent-parent dyads recruited, adolescent participants had a mean age of 15.0 (SD 1.43) years; a total of 46.3\% (1842/3981) were female, 67.8\% (2701/3981) were White, and 75\% (2986/3981) lived in a household with an income above the poverty line. The LCA identified 2 discrete classes. Class 1 was made up of 62.8\% (2501/3981) of the participants. Class 1 participants were more likely than Class 2 participants to report family-owned devices, have lower technology importance scores, have household technology rules often centered on content, have positive parent relationships and lower parent social media use, and report better health outcomes and well-being indicators. Conclusions: Findings from this national cross-sectional survey using LCA led to 2 distinct profile groups of adolescent media use and their association with technology use and parent involvement as well as health and well-being outcomes. The two classes included a larger Class 1 (Family-Engaged Adolescents) and a smaller Class 2 (At-Risk Adolescents). The findings of this study can inform interventions to reinforce positive technology use and family support. ",
doi="10.2196/35540",
url="https://pediatrics.jmir.org/2022/2/e35540",
url="http://www.ncbi.nlm.nih.gov/pubmed/35507401"
}


@Article{info:doi/10.2196/34628,
author="Wolff, L. Jennifer
and Dukhanin, Vadim
and Burgdorf, G. Julia
and DesRoches, M. Catherine",
title="Shared Access to Patient Portals for Older Adults: Implications for Privacy and Digital Health Equity",
journal="JMIR Aging",
year="2022",
month="May",
day="4",
volume="5",
number="2",
pages="e34628",
keywords="patient portal",
keywords="electronic health record",
keywords="care partners",
keywords="proxy",
keywords="health equity",
keywords="health informatics",
keywords="health services",
keywords="elderly",
keywords="older adults",
keywords="aging",
keywords="cognition",
keywords="health system",
keywords="care delivery",
keywords="elderly care",
doi="10.2196/34628",
url="https://aging.jmir.org/2022/2/e34628",
url="http://www.ncbi.nlm.nih.gov/pubmed/35507405"
}


@Article{info:doi/10.2196/34764,
author="Lim, A. Haikel
and Lee, Win Joanne Sze
and Lim, Han Meng
and Teo, Zhen Lynn Pei
and Sin, Wen Natalene Siew
and Lim, Wei Rou
and Chua, Min Si
and Yeo, Qi Jia
and Ngiam, Wen Nerice Heng
and Tey, Jie-Yin Angeline
and Tham, Xin Celine Yi
and Ng, Yi Kennedy Yao
and Low, Leng Lian
and Tang, Aaron Kai Wen",
title="Bridging Connectivity Issues in Digital Access and Literacy: Reflections on Empowering Vulnerable Older Adults in Singapore",
journal="JMIR Aging",
year="2022",
month="May",
day="3",
volume="5",
number="2",
pages="e34764",
keywords="COVID-19",
keywords="digital literacy",
keywords="digital literacy training",
keywords="digital disparities",
keywords="digital divide",
keywords="social construction of health technologies",
keywords="health technology",
keywords="COVID-19 pandemic",
keywords="pandemic",
keywords="COVID",
keywords="social isolation",
keywords="elder",
keywords="older adult",
keywords="Asia",
keywords="access",
keywords="barrier",
keywords="empower",
keywords="volunteer",
keywords="vulnerable",
keywords="digital skill",
keywords="low income",
doi="10.2196/34764",
url="https://aging.jmir.org/2022/2/e34764",
url="http://www.ncbi.nlm.nih.gov/pubmed/35503520"
}


@Article{info:doi/10.2196/35788,
author="Golder, Su
and Stevens, Robin
and O'Connor, Karen
and James, Richard
and Gonzalez-Hernandez, Graciela",
title="Methods to Establish Race or Ethnicity of Twitter Users: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="29",
volume="24",
number="4",
pages="e35788",
keywords="twitter",
keywords="social media",
keywords="race",
keywords="ethnicity",
abstract="Background: A growing amount of health research uses social media data. Those critical of social media research often cite that it may be unrepresentative of the population; however, the suitability of social media data in digital epidemiology is more nuanced. Identifying the demographics of social media users can help establish representativeness. Objective: This study aims to identify the different approaches or combination of approaches to extract race or ethnicity from social media and report on the challenges of using these methods. Methods: We present a scoping review to identify methods used to extract the race or ethnicity of Twitter users from Twitter data sets. We searched 17 electronic databases from the date of inception to May 15, 2021, and carried out reference checking and hand searching to identify relevant studies. Sifting of each record was performed independently by at least two researchers, with any disagreement discussed. Studies were required to extract the race or ethnicity of Twitter users using either manual or computational methods or a combination of both. Results: Of the 1249 records sifted, we identified 67 (5.36\%) that met our inclusion criteria. Most studies (51/67, 76\%) have focused on US-based users and English language tweets (52/67, 78\%). A range of data was used, including Twitter profile metadata, such as names, pictures, information from bios (including self-declarations), or location or content of the tweets. A range of methodologies was used, including manual inference, linkage to census data, commercial software, language or dialect recognition, or machine learning or natural language processing. However, not all studies have evaluated these methods. Those that evaluated these methods found accuracy to vary from 45\% to 93\% with significantly lower accuracy in identifying categories of people of color. The inference of race or ethnicity raises important ethical questions, which can be exacerbated by the data and methods used. The comparative accuracies of the different methods are also largely unknown. Conclusions: There is no standard accepted approach or current guidelines for extracting or inferring the race or ethnicity of Twitter users. Social media researchers must carefully interpret race or ethnicity and not overpromise what can be achieved, as even manual screening is a subjective, imperfect method. Future research should establish the accuracy of methods to inform evidence-based best practice guidelines for social media researchers and be guided by concerns of equity and social justice. ",
doi="10.2196/35788",
url="https://www.jmir.org/2022/4/e35788",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486433"
}


@Article{info:doi/10.2196/30898,
author="Ye, Jiancheng
and Wang, Zidan
and Hai, Jiarui",
title="Social Networking Service, Patient-Generated Health Data, and Population Health Informatics: National Cross-sectional Study of Patterns and Implications of Leveraging Digital Technologies to Support Mental Health and Well-being",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="29",
volume="24",
number="4",
pages="e30898",
keywords="patient-generated health data",
keywords="social network",
keywords="population health informatics",
keywords="mental health",
keywords="social determinants of health",
keywords="health data sharing",
keywords="technology acceptability",
keywords="mobile phone",
keywords="mobile health",
abstract="Background: The emerging health technologies and digital services provide effective ways of collecting health information and gathering patient-generated health data (PGHD), which provide a more holistic view of a patient's health and quality of life over time, increase visibility into a patient's adherence to a treatment plan or study protocol, and enable timely intervention before a costly care episode. Objective: Through a national cross-sectional survey in the United States, we aimed to describe and compare the characteristics of populations with and without mental health issues (depression or anxiety disorders), including physical health, sleep, and alcohol use. We also examined the patterns of social networking service use, PGHD, and attitudes toward health information sharing and activities among the participants, which provided nationally representative estimates. Methods: We drew data from the 2019 Health Information National Trends Survey of the National Cancer Institute. The participants were divided into 2 groups according to mental health status. Then, we described and compared the characteristics of the social determinants of health, health status, sleeping and drinking behaviors, and patterns of social networking service use and health information data sharing between the 2 groups. Multivariable logistic regression models were applied to assess the predictors of mental health. All the analyses were weighted to provide nationally representative estimates. Results: Participants with mental health issues were significantly more likely to be younger, White, female, and lower-income; have a history of chronic diseases; and be less capable of taking care of their own health. Regarding behavioral health, they slept <6 hours on average, had worse sleep quality, and consumed more alcohol. In addition, they were more likely to visit and share health information on social networking sites, write online diary blogs, participate in online forums or support groups, and watch health-related videos. Conclusions: This study illustrates that individuals with mental health issues have inequitable social determinants of health, poor physical health, and poor behavioral health. However, they are more likely to use social networking platforms and services, share their health information, and actively engage with PGHD. Leveraging these digital technologies and services could be beneficial for developing tailored and effective strategies for self-monitoring and self-management. ",
doi="10.2196/30898",
url="https://www.jmir.org/2022/4/e30898",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486428"
}


@Article{info:doi/10.2196/36338,
author="Krishnamurti, Tamar
and Birru Talabi, Mehret
and Callegari, S. Lisa
and Kazmerski, M. Traci
and Borrero, Sonya",
title="A Framework for Femtech:  Guiding Principles for Developing Digital Reproductive Health Tools in the United States",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="28",
volume="24",
number="4",
pages="e36338",
keywords="United States",
keywords="North America",
keywords="femtech",
keywords="mHealth",
keywords="health equity",
keywords="pregnancy",
keywords="women's health",
keywords="preterm birth",
keywords="contraception",
keywords="family planning",
keywords="reproductive care",
keywords="sterilization",
keywords="cystic fibrosis",
keywords="rheumatic disease",
keywords="eHealth",
keywords="mobile health",
keywords="reproductive health",
keywords="digital health",
keywords="health technology",
keywords="health outcomes",
doi="10.2196/36338",
url="https://www.jmir.org/2022/4/e36338",
url="http://www.ncbi.nlm.nih.gov/pubmed/35482371"
}


@Article{info:doi/10.2196/35625,
author="Perales-Puchalt, Jaime
and Acosta-Rull{\'a}n, Mariola
and Ram{\'i}rez-Mantilla, Mariana
and Espinoza-Kissell, Paul
and Vidoni, Eric
and Niedens, Michelle
and Ellerbeck, Edward
and Hinton, Ladson
and Loera, Linda
and Ram{\'i}rez, Susana A.
and Lara, Esther
and Watts, Amber
and Williams, Kristine
and Resendez, Jason
and Burns, Jeffrey",
title="A Text Messaging Intervention to Support Latinx Family Caregivers of Individuals With Dementia (CuidaTEXT): Development and Usability Study",
journal="JMIR Aging",
year="2022",
month="Apr",
day="28",
volume="5",
number="2",
pages="e35625",
keywords="Latinx individuals",
keywords="mHealth",
keywords="dementia",
keywords="caregiving",
abstract="Background: Latinx family caregivers of individuals with dementia face many barriers to caregiver support access. Interventions to alleviate these barriers are urgently needed. Objective: This study aimed to describe the development of CuidaTEXT, a tailored SMS text messaging intervention to support Latinx family caregivers of individuals with dementia. Methods: CuidaTEXT is informed by the stress process framework and social cognitive theory. We developed and refined CuidaTEXT using a mixed methods approach that included thematic analysis and descriptive statistics. We followed 6 user-centered design stages, namely, the selection of design principles, software vendor collaboration, evidence-based foundation, caregiver and research and clinical advisory board guidance, sketching and prototyping, and usability testing of the prototype of CuidaTEXT among 5 Latinx caregivers. Results: CuidaTEXT is a bilingual 6-month-long SMS text messaging--based intervention tailored to caregiver needs that includes 1-3 daily automatic messages (n=244) about logistics, dementia education, self-care, social support, end of life, care of the person with dementia, behavioral symptoms, and problem-solving strategies; 783 keyword-driven text messages for further help with the aforementioned topics; live chat interaction with a coach for further help; and a 19-page reference booklet summarizing the purpose and functions of the intervention. The 5 Latinx caregivers who used the prototype of CuidaTEXT scored an average of 97 out of 100 on the System Usability Scale. Conclusions: CuidaTEXT's prototype demonstrated high usability among Latinx caregivers. CuidaTEXT's feasibility is ready to be tested. ",
doi="10.2196/35625",
url="https://aging.jmir.org/2022/2/e35625",
url="http://www.ncbi.nlm.nih.gov/pubmed/35482366"
}


@Article{info:doi/10.2196/35925,
author="Kokorelias, Marie Kristina
and Nelson, LA Michelle
and Tang, Terence
and Steele Gray, Carolyn
and Ellen, Moriah
and Plett, Donna
and Jarach, Micaela Carlotta
and Xin Nie, Jason
and Thavorn, Kednapa
and Singh, Hardeep",
title="Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations",
journal="JMIR Aging",
year="2022",
month="Apr",
day="27",
volume="5",
number="2",
pages="e35925",
keywords="older adults",
keywords="digital technology",
keywords="transitions",
keywords="older adult population",
keywords="digital health",
keywords="Digital Hospital",
keywords="health intervention",
keywords="aging",
keywords="gender diversity",
keywords="home transition",
keywords="epidemiology",
abstract="Background: Digital health technologies have been proposed to support hospital-to-home transition for older adults. The COVID-19 pandemic and the associated physical distancing guidelines have propelled a shift toward digital health technologies. However, the characteristics of older adults who participated in digital health research interventions to support hospital-to-home transitions remain unclear. This information is needed to assess whether current digital health interventions are generalizable to the needs of the broader older adult population. Objective: This rapid review of the existing literature aimed to identify the characteristics of the populations targeted by studies testing the implementation of digital health interventions designed to support hospital-to-home transitions, identify the characteristics of the samples included in studies testing digital health interventions used to support hospital-to-home transitions, and create recommendations for enhancing the diversity of samples within future hospital-to-home digital health interventions. Methods: A rapid review methodology based on scoping review guidelines by Arksey and O'Malley was developed. A search for peer-reviewed literature published between 2010 and 2021 on digital health solutions that support hospital-to-home transitions for older adults was conducted using MEDLINE, Embase, and CINAHL databases. The data were analyzed using descriptive statistics and qualitative content analysis. The Sex- and Gender-Based Analysis Plus lens theoretically guided the study design, analysis, and interpretation. Results: A total of 34 studies met the inclusion criteria. Our findings indicate that many groups of older adults were excluded from these interventions and remain understudied. Specifically, the oldest old and those living with cognitive impairments were excluded from the studies included in this review. In addition, very few studies have described the characteristics related to gender diversity, education, race, ethnicity, and culture. None of the studies commented on the sexual orientation of the participants. Conclusions: This is the first review, to our knowledge, that has mapped the literature focusing on the inclusion of older adults in digital hospital-to-home interventions. The findings suggest that the literature on digital health interventions tends to operationalize older adults as a homogenous group, ignoring the heterogeneity in older age definitions. Inconsistency in the literature surrounding the characteristics of the included participants suggests a need for further study to better understand how digital technologies to support hospital-to-home transitions can be inclusive. ",
doi="10.2196/35925",
url="https://aging.jmir.org/2022/2/e35925",
url="http://www.ncbi.nlm.nih.gov/pubmed/35475971"
}


@Article{info:doi/10.2196/36256,
author="Marchetti, Armando Michael
and Sar-Graycar, Liliane
and Dusza, W. Stephen
and Nanda, K. Japbani
and Kurtansky, Nicholas
and Rotemberg, M. Veronica
and Hay, L. Jennifer",
title="Prevalence and Age-Related Patterns in Health Information--Seeking Behaviors and Technology Use Among Skin Cancer Survivors: Survey Study",
journal="JMIR Dermatol",
year="2022",
month="Apr",
day="22",
volume="5",
number="2",
pages="e36256",
keywords="skin cancer",
keywords="melanoma",
keywords="health information",
keywords="HINTS",
keywords="internet",
keywords="cancer",
keywords="dermatology",
keywords="information",
keywords="oncology",
keywords="survey",
keywords="analysis",
abstract="Background: Information is an unmet need among cancer survivors. There is a paucity of population-based data examining the health information--seeking behaviors and attitudes of skin cancer survivors. Objective: We aimed to identify the prevalence and patterns of health information--seeking behaviors and attitudes among skin cancer survivors across age groups. Methods: We analyzed population-based data from the 2019 Health Information National Trends Survey 5 (Cycle 3). Results: The 5438 respondents included 346 (6.4\%) skin cancer survivors (mean age 65.8 years); of the 346 skin cancer survivors, the majority were White (96.4\% [weighted percentages]), and 171 (47.8\%) were men. Most reported having ever looked for health- (86.1\%) or cancer-related (76.5\%) information; 28.2\% stated their last search took a lot of effort, and 21.6\% were frustrated. The internet was most often cited as being the first source that was recently used for health or medical information (45.6\%). Compared to skin cancer survivors younger than 65 years old, those 65 years of age or older were more likely to see a doctor first for important health information (?65 years: 68.3\%;<65 years: 36.2\%; P<.001) and less likely to have health and wellness apps (?65 years: 26.4\%; <65 years: 54.0\%, P=.10), to have watched a health-related YouTube video (?65 years: 13.3\%; <65 years: 27.4\%; P=.02), and to have used electronic means to look for information (?65 years: 61.4\%;<65 years: 82.3\%, P<.001) Conclusions: Searches for health information are common among skin cancer survivors, but behaviors and attitudes are associated with age, which highlights the importance of access to doctors and personalized information sources. ",
doi="10.2196/36256",
url="https://derma.jmir.org/2022/2/e36256",
url="http://www.ncbi.nlm.nih.gov/pubmed/36776536"
}


@Article{info:doi/10.2196/25688,
author="Crotty, H. Bradley
and Somai, Melek",
title="Bugs in the Virtual Clinic: Confronting Telemedicine's Challenges Through Empathy and Support",
journal="J Particip Med",
year="2022",
month="Apr",
day="22",
volume="14",
number="1",
pages="e25688",
keywords="telemedicine",
keywords="virtual care",
keywords="patient experience",
keywords="consumer informatics",
keywords="telehealth",
keywords="access",
keywords="challenge",
keywords="electronic health record",
keywords="digital health",
doi="10.2196/25688",
url="https://jopm.jmir.org/2022/1/e25688",
url="http://www.ncbi.nlm.nih.gov/pubmed/35452399"
}


@Article{info:doi/10.2196/37500,
author="Kainiemi, Emma
and Vehko, Tuulikki
and Kyyts{\"o}nen, Maiju
and H{\"o}rhammer, Iiris
and Kujala, Sari
and Jormanainen, Vesa
and Heponiemi, Tarja",
title="The Factors Associated With Nonuse of and Dissatisfaction With the National Patient Portal in Finland in the Era of COVID-19: Population-Based Cross-sectional Survey",
journal="JMIR Med Inform",
year="2022",
month="Apr",
day="22",
volume="10",
number="4",
pages="e37500",
keywords="patient portal",
keywords="digital technology",
keywords="eHealth",
keywords="nonuse",
keywords="dissatisfaction",
keywords="COVID-19",
keywords="digital health",
keywords="patient empowerment",
keywords="epidemiology",
keywords="population survey",
keywords="national survey",
abstract="Background: In the abnormal circumstances caused by the COVID-19 pandemic, patient portals have supported patient empowerment and engagement by providing patients with access to their health care documents and medical information. However, the potential benefits of patient portals cannot be utilized unless the patients accept and use the services. Disparities in the use of patient portals may exacerbate the already existing inequalities in health care access and health outcomes, possibly increasing the digital inequality in societies. Objective: The aim of this study is to examine the factors associated with nonuse of and dissatisfaction with the Finnish nationwide patient portal My Kanta Pages among the users of health care services during the COVID-19 outbreak. Several factors related to sociodemographic characteristics, health, and the use of health care services; experiences of guidance concerning electronic services; and digital skills and attitudes were evaluated. Methods: A national population survey was sent using stratified sampling to 13,200 Finnish residents who had reached the age of 20 years. Data were collected from September 2020 to February 2021 during the COVID-19 pandemic. Respondents who had used health care services and the internet for transactions or for searching for information in the past 12 months were included in the analyses. Bivariate logistic regression analyses were used to examine the adjusted associations of respondent characteristics with the nonuse of My Kanta Pages and dissatisfaction with the service. The inverse probability weighting (IPW) method was applied in all statistical analyses to correct for bias. Results: In total, 3919 (64.9\%) of 6034 respondents were included in the study. Most respondents (3330/3919, 85.0\%) used My Kanta Pages, and 2841 (85.3\%) of them were satisfied. Nonusers (589/3919, 15\%) were a minority among all respondents, and only 489 (14.7\%) of the 3330 users were dissatisfied with the service. Especially patients without a long-term illness (odds ratio [OR] 2.14, 95\% CI 1.48-3.10), those who were not referred to electronic health care services by a professional (OR 2.51, 95\% CI 1.70-3.71), and those in need of guidance using online social and health care services (OR 2.26, 95\% CI 1.41-3.65) were more likely nonusers of the patient portal. Perceptions of poor health (OR 2.10, 95\% CI 1.51-2.93) and security concerns (OR 1.87, 95\% CI 1.33-2.62) were associated with dissatisfaction with the service. Conclusions: Patients without long-term illnesses, those not referred to electronic health care services, and those in need of guidance on the use of online social and health care services seemed to be more likely nonusers of the Finnish nationwide patient portal. Moreover, poor health and security concerns appeared to be associated with dissatisfaction with the service. Interventions to promote referral to electronic health care services by professionals are needed. Attention should be targeted to information security of the service and promotion of the public's confidence in the protection of their confidential data. ",
doi="10.2196/37500",
url="https://medinform.jmir.org/2022/4/e37500",
url="http://www.ncbi.nlm.nih.gov/pubmed/35404831"
}


@Article{info:doi/10.2196/33240,
author="Mudaranthakam, Pal Dinesh
and Gajewski, Byron
and Krebill, Hope
and Coulter, James
and Springer, Michelle
and Calhoun, Elizabeth
and Hughes, Dorothy
and Mayo, Matthew
and Doolittle, Gary",
title="Barriers to Clinical Trial Participation: Comparative Study Between Rural and Urban Participants",
journal="JMIR Cancer",
year="2022",
month="Apr",
day="21",
volume="8",
number="2",
pages="e33240",
keywords="rural residents",
keywords="clinical trials",
keywords="screening",
keywords="cancer",
keywords="patients",
keywords="lung cancer",
keywords="health policy epidemiology",
keywords="cancer patients",
keywords="electronic screening logs",
keywords="electronic screening",
abstract="Background: The National Clinical Trials Network program conducts phase 2 or phase 3 treatment trials across all National Cancer Institute's designated cancer centers. Participant accrual across these clinical trials is a critical factor in deciding their success. Cancer centers that cater to rural populations, such as The University of Kansas Cancer Center, have an additional responsibility to ensure rural residents have access and are well represented across these studies. Objective: There are scant data available regarding the factors that act as barriers to the accrual of rural residents in these clinical trials. This study aims to use electronic screening logs that were used to gather patient data at several participating sites in The Kansas University of Cancer Center's Catchment area. Methods: Screening log data were used to assess what clinical trial participation barriers are faced by these patients. Additionally, the differences in clinical trial participation barriers were compared between rural and urban participating sites. Results: Analysis revealed that the hospital location rural urban category, defined as whether the hospital was in an urban or rural setting, had a medium effect on enrolment of patients in breast cancer and lung cancer trials (Cohen d=0.7). Additionally, the hospital location category had a medium effect on the proportion of recurrent lung cancer cases at the time of screening (d=0.6). Conclusions: In consideration of the financially hostile nature of cancer treatment as well as geographical and transportation barriers, clinical trials extended to rural communities are uniquely positioned to alleviate the burden of nonmedical costs in trial participation. However, these options can be far less feasible for patients in rural settings. Since the number of patients with cancer who are eligible for a clinical trial is already limited by the stringent eligibility criteria required of such a complex disease, improving accessibility for rural patients should be a greater focus in health policy. ",
doi="10.2196/33240",
url="https://cancer.jmir.org/2022/2/e33240",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451964"
}


@Article{info:doi/10.2196/34312,
author="Garbin, Alexander
and D{\'i}az, Jes{\'u}s
and Bui, Vy
and Morrison, Janina
and Fisher, E. Beth
and Palacios, Carina
and Estrada-Darley, Ingrid
and Haase, Danielle
and Wing, David
and Amezcua, Lilyana
and Jakowec, W. Michael
and Kaplan, Charles
and Petzinger, Giselle",
title="Promoting Physical Activity in a Spanish-Speaking Latina Population of Low Socioeconomic Status With Chronic Neurological Disorders: Proof-of-Concept Study",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="20",
volume="6",
number="4",
pages="e34312",
keywords="exercise",
keywords="quality of life",
keywords="motivation",
keywords="promotion",
keywords="community study",
keywords="clinical trial",
abstract="Background: Physical activity (PA) is known to improve quality of life (QoL) as well as reduce mortality and disease progression in individuals with chronic neurological disorders. However, Latina women are less likely to participate in recommended levels of PA due to common socioeconomic barriers, including limited resources and access to exercise programs. Therefore, we developed a community-based intervention with activity monitoring and behavioral coaching to target these barriers and facilitate sustained participation in an exercise program promoting PA. Objective: The aim of this study was to determine the feasibility and efficacy of a community-based intervention to promote PA through self-monitoring via a Fitbit and behavioral coaching among Latina participants with chronic neurological disorders.? Methods: We conducted a proof-of-concept study among 21 Spanish-speaking Latina participants recruited from the Los Angeles County and University of Southern California (LAC+USC) neurology clinic; participants enrolled in the 16-week intervention at The Wellness Center at The Historic General Hospital in Los Angeles. Demographic data were assessed at baseline. Feasibility was defined by participant attrition and Fitbit adherence. PA promotion was determined by examining change in time spent performing moderate-to-vigorous PA (MVPA) over the 16-week period. The effect of behavioral coaching was assessed by quantifying the difference in MVPA on days when coaching occurred versus on days without coaching. Change in psychometric measures (baseline vs postintervention) and medical center visits (16 weeks preintervention vs during the intervention) were also examined. Results: Participants were of low socioeconomic status and acculturation. A total of 19 out of 21 (90\%) participants completed the study (attrition 10\%), with high Fitbit wear adherence (mean 90.31\%, SD 10.12\%). Time performing MVPA gradually increased by a mean of 0.16 (SD 0.23) minutes per day (P<.001), which was equivalent to an increase of approximately 18 minutes in MVPA over the course of the 16-week study period. Behavioral coaching enhanced intervention effectiveness as evidenced by a higher time spent on MVPA on days when coaching occurred via phone (37 min/day, P=.02) and in person (45.5 min/day, P=.01) relative to days without coaching (24 min/day). Participants improved their illness perception (effect size g=0.30) and self-rated QoL (effect size g=0.32). Additionally, a reduction in the number of medical center visits was observed (effect size r=0.44), and this reduction was associated with a positive change in step count during the study period (P.=04). Conclusions: Self-monitoring with behavioral coaching is a feasible community-based intervention for PA promotion among Latina women of low socioeconomic status with chronic neurological conditions. PA is known to be important for brain health in neurological conditions but remains relatively unexplored in minority populations. Trial Registration: ClinicalTrials.gov NCT04820153; https://clinicaltrials.gov/ct2/show/NCT04820153 ",
doi="10.2196/34312",
url="https://formative.jmir.org/2022/4/e34312",
url="http://www.ncbi.nlm.nih.gov/pubmed/35442197"
}


@Article{info:doi/10.2196/34326,
author="Mao, Alice
and Tam, Lydia
and Xu, Audrey
and Osborn, Kim
and Sheffrin, Meera
and Gould, Christine
and Schillinger, Erika
and Martin, Marina
and Mesias, Matthew",
title="Barriers to Telemedicine Video Visits for Older Adults in Independent Living Facilities: Mixed Methods Cross-sectional Needs Assessment",
journal="JMIR Aging",
year="2022",
month="Apr",
day="19",
volume="5",
number="2",
pages="e34326",
keywords="telemedicine",
keywords="barriers to access to care",
keywords="older adults",
keywords="eHealth",
keywords="e-visit",
keywords="access",
keywords="accessibility",
keywords="barrier",
keywords="elder",
keywords="gerontology",
keywords="geriatric",
keywords="need assessment",
keywords="mixed method",
keywords="cross-sectional",
keywords="telehealth",
keywords="community care",
keywords="independent living",
abstract="Background: Despite the increasing availability of telemedicine video visits during the COVID-19 pandemic, older adults have greater challenges in getting care through telemedicine. Objective: We aim to better understand the barriers to telemedicine in community-dwelling older adults to improve the access to and experience of virtual visits. Methods: We conducted a mixed methods needs assessment of older adults at two independent living facilities (sites A and B) in Northern California between September 2020 and March 2021. Voluntary surveys were distributed. Semistructured interviews were then conducted with participants who provided contact information. Surveys ascertained participants' preferred devices as well as comfort level, support, and top barriers regarding telephonic and video visits. Qualitative analysis of transcribed interviews identified key themes. Results: Survey respondents' (N=249) average age was 84.6 (SD 6.6) years, and 76.7\% (n=191) of the participants were female. At site A, 88.9\% (111/125) had a bachelor's degree or beyond, and 99.2\% (124/125) listed English as their preferred language. At site B, 42.9\% (51/119) had a bachelor's degree or beyond, and 13.4\% (16/119) preferred English, while 73.1\% (87/119) preferred Mandarin. Regarding video visits, 36.5\% (91/249) of all participants felt comfortable connecting with their health care team through video visits. Regarding top barriers, participants at site A reported not knowing how to connect to the platform (30/125, 24\%), not being familiar with the technology (28/125, 22.4\%), and having difficulty hearing (19/125, 15.2\%), whereas for site B, the top barriers were not being able to speak English well (65/119, 54.6\%), lack of familiarity with technology and the internet (44/119, 36.9\%), and lack of interest in seeing providers outside of the clinic (42/119, 35.3\%). Three key themes emerged from the follow-up interviews (n=15): (1) the perceived limitations of video visits, (2) the overwhelming process of learning the technology for telemedicine, and (3) the desire for in-person or on-demand help with telemedicine. Conclusions: Substantial barriers exist for older adults in connecting with their health care team through telemedicine, particularly through video visits. The largest barriers include difficulty with technology or using the video visit platform, hearing difficulty, language barriers, and lack of desire to see providers virtually. Efforts to improve telemedicine access for older adults should take into account patient perspectives. ",
doi="10.2196/34326",
url="https://aging.jmir.org/2022/2/e34326",
url="http://www.ncbi.nlm.nih.gov/pubmed/35438648"
}


@Article{info:doi/10.2196/33165,
author="Ho, Vanda
and Merchant, A. Reshma",
title="The Acceptability of Digital Technology and Tele-Exercise in the Age of COVID-19: Cross-sectional Study",
journal="JMIR Aging",
year="2022",
month="Apr",
day="13",
volume="5",
number="2",
pages="e33165",
keywords="senior",
keywords="telehealth",
keywords="digital exercise",
keywords="acceptability",
keywords="telemedicine",
keywords="elderly",
keywords="older adults",
keywords="outcome",
keywords="isolation",
keywords="decline",
keywords="function",
keywords="adoption",
keywords="perception",
keywords="exercise",
keywords="physical activity",
keywords="questionnaire",
keywords="COVID-19",
abstract="Background: With the COVID-19 pandemic, telehealth has been increasingly used to offset the negative outcomes of social isolation and functional decline in older adults. Crucial to the success of telehealth is end user adoption. Objective: This study aims to investigate perception and acceptability of digital technology among Asian older adults. Methods: The Healthy Ageing Promotion Program for You (HAPPY) dual-task exercise was conducted virtually to participants aged ?60 years. Questionnaires were administered digitally and collected data on demographics, perceptions of digital technology and evaluation of HAPPY, the 6-item Lubben Social Network Scale, intrinsic capacity using the Integrated Care for Older People tool, and a functional screening with the FRAIL scale and five chair rises. Descriptive analysis was used. Results: A total of 42 participants were digitally interviewed. The mean age was 69.1 (4.7) years. Hearing, vision, and 3-item recall difficulty were present in 14\% (n=6), 12\% (n=5), and 24\% (n=10) of participants, respectively. Of the participants, 29\% (n=12) had possible sarcopenia and 14\% (n=6) were prefrail. Around 24\% (n=10) were at risk of social isolation. Most of the participants (n=38, 91\%) agreed that technology is good, and 79\% (n=33) agreed that technology would allow them to be independent for longer. Over three-quarters of participants (n=33, 79\%) agreed that they have the necessary knowledge, and 91\% (n=38) had technological assistance available. However, 57\% (n=24) were still apprehensive about using technology. Despite 71\% (n=30) of older adults owning their devices, 36\% (n=15) felt finances were limiting. Through digital HAPPY, 45\% (n=19) of participants reported feeling stronger, 48\% (n=20) had improved spirits, and 40\% (n=17) and 38\% (n=16) had improved mood and memory, respectively. Conclusions: The majority of older adults in this study believed in digital technology and had the necessary knowledge and help, but almost half still felt apprehensive and had financial barriers to adopting technology. A digitally administered exercise program especially in a group setting is a feasible option to enhance intrinsic capacity in older adults. However, more work is needed in elucidating sources of apprehension and financial barriers to adopting technology. ",
doi="10.2196/33165",
url="https://aging.jmir.org/2022/2/e33165",
url="http://www.ncbi.nlm.nih.gov/pubmed/35294921"
}


@Article{info:doi/10.2196/32570,
author="Dang, Stuti
and Muralidhar, Kiranmayee
and Li, Shirley
and Tang, Fei
and Mintzer, Michael
and Ruiz, Jorge
and Valencia, Marcos Willy",
title="Gap in Willingness and Access to Video Visit Use Among Older High-risk Veterans: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="8",
volume="24",
number="4",
pages="e32570",
keywords="high-risk veterans",
keywords="older adults",
keywords="telemedicine",
keywords="video visits",
keywords="health disparities",
keywords="Area Deprivation Index",
keywords="mobile phone",
abstract="Background: The recent shift to video care has exacerbated disparities in health care access, especially among high-need, high-risk (HNHR) adults. Developing data-driven approaches to improve access to care necessitates a deeper understanding of HNHR adults' attitudes toward telemedicine and technology access. Objective: This study aims to identify the willingness, access, and ability of HNHR veterans to use telemedicine for health care. Methods: WWe designed a questionnaire conducted via mail or telephone or in person. Among HNHR veterans who were identified using predictive modeling with national Veterans Affairs data, we assessed willingness to use video visits for health care, access to necessary equipment, and comfort with using technology. We evaluated physical health, including frailty, physical function, performance of activities of daily living (ADL) and instrumental ADL (IADL); mental health; and social needs, including Area Deprivation Index, transportation, social support, and social isolation. Results: The average age of the 602 HNHR veteran respondents was 70.6 (SD 9.2; range 39-100) years; 99.7\% (600/602) of the respondents were male, 61\% (367/602) were White, 36\% (217/602) were African American, 17.3\% (104/602) were Hispanic, 31.2\% (188/602) held at least an associate degree, and 48.2\% (290/602) were confident filling medical forms. Of the 602 respondents, 327 (54.3\%) reported willingness for video visits, whereas 275 (45.7\%) were unwilling. Willing veterans were younger (P<.001) and more likely to have an associate degree (P=.002), be health literate (P<.001), live in socioeconomically advantaged neighborhoods (P=.048), be independent in IADLs (P=.02), and be in better physical health (P=.04). A higher number of those willing were able to use the internet and email (P<.001). Of the willing veterans, 75.8\% (248/327) had a video-capable device. Those with video-capable technology were younger (P=.004), had higher health literacy (P=.01), were less likely to be African American (P=.007), were more independent in ADLs (P=.005) and IADLs (P=.04), and were more adept at using the internet and email than those without the needed technology (P<.001). Age, confidence in filling forms, general health, and internet use were significantly associated with willingness to use video visits. Conclusions: Approximately half of the HNHR respondents were unwilling for video visits and a quarter of those willing lacked requisite technology. The gap between those willing and without requisite technology is greater among older, less health literate, African American veterans; those with worse physical health; and those living in more socioeconomically disadvantaged neighborhoods. Our study highlights that HNHR veterans have complex needs, which risk being exacerbated by the video care shift. Although technology holds vast potential to improve health care access, certain vulnerable populations are less likely to engage, or have access to, technology. Therefore, targeted interventions are needed to address this inequity, especially among HNHR older adults. ",
doi="10.2196/32570",
url="https://www.jmir.org/2022/4/e32570",
url="http://www.ncbi.nlm.nih.gov/pubmed/35394440"
}


@Article{info:doi/10.2196/37127,
author="Yang, Eunjin
and Lee, Hee Kyung",
title="The Moderating Effects of Disability on Mobile Internet Use Among Older Adults: Population-Based Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="4",
volume="24",
number="4",
pages="e37127",
keywords="older adults",
keywords="people with disabilities",
keywords="digital divide",
keywords="mobile phone use",
abstract="Background: The preferred devices to access the internet are changing from personal computers to mobile devices, and the number of older adults with or without disabilities is rapidly increasing in an aging society. However, little is known about the moderating effects of disability on mobile internet use among older adults. Objective: This study aimed to examine the levels of mobile internet use and factors associated with this use among older adults according to their disabilities. In addition, moderating effects of disability on mobile internet use were investigated. Methods: This study consisted of a secondary data analysis using the 2020 Digital Divide Survey conducted in South Korea. The single inclusion criterion was participants being aged 55 years or older; accordingly, 2243 people without disabilities and 1386 people with disabilities were included in the study. Multiple regression analyses considering complex sample designs were conducted to identify mobile internet use factors and to test the moderating effects of disability on mobile internet use. Results: Older adults with disabilities used mobile internet less than older adults without disabilities. However, disability status had moderating effects on the relationships between mobile internet use and (1) operational skills regarding mobile devices (B=0.31, P=.004), (2) internet use skills (B=1.46, P<.001), (3) motivation to use digital devices (B=0.46, P=.01), and (4) attitude toward new technology (B=0.50, P=.002). The results revealed that these positive relationships were stronger among older adults with disabilities than among adults without disabilities. Conclusions: Although older adults and people with disabilities are considered vulnerable populations regarding technology adoption, disability creates a stronger association between several determinants and actual mobile internet use. Therefore, policy makers and practitioners should pay attention to older adults with disabilities to deliver appropriate information-literacy education. Older adults with disabilities could be the primary beneficiaries of mobile services and new technology. ",
doi="10.2196/37127",
url="https://www.jmir.org/2022/4/e37127",
url="http://www.ncbi.nlm.nih.gov/pubmed/35377329"
}


@Article{info:doi/10.2196/22124,
author="Senteio, Charles
and Murdock, Joseph Paul",
title="The Efficacy of Health Information Technology in Supporting Health Equity for Black and Hispanic Patients With Chronic Diseases: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="4",
volume="24",
number="4",
pages="e22124",
keywords="chronic disease",
keywords="minority health",
keywords="technology assessment",
keywords="biomedical",
keywords="self-management",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Racial inequity persists for chronic disease outcomes amid the proliferation of health information technology (HIT) designed to support patients in following recommended chronic disease self-management behaviors (ie, medication behavior, physical activity, and dietary behavior and attending follow-up appointments). Numerous interventions that use consumer-oriented HIT to support self-management have been evaluated, and some of the related literature has focused on racial minorities who experience disparate chronic disease outcomes. However, little is known about the efficacy of these interventions. Objective: This study aims to conduct a systematic review of the literature that describes the efficacy of consumer-oriented HIT interventions designed to support self-management involving African American and Hispanic patients with chronic diseases. Methods: We followed an a priori protocol using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-Equity 2012 Extension guidelines for systematic reviews that focus on health equity. Themes of interest included the inclusion and exclusion criteria. We identified 7 electronic databases, created search strings, and conducted the searches. We initially screened results based on titles and abstracts and then performed full-text screening. We then resolved conflicts and extracted relevant data from the included articles. Results: In total, there were 27 included articles. The mean sample size was 640 (SD 209.5), and 52\% (14/27) of the articles focused on African American participants, 15\% (4/27) of the articles focused on Hispanic participants, and 33\% (9/27) included both. Most articles addressed 3 of the 4 self-management behaviors: medication (17/27, 63\%), physical activity (17/27, 63\%), and diet (16/27, 59\%). Only 15\% (4/27) of the studies focused on follow-up appointment attendance. All the articles investigated HIT for use at home, whereas 7\% (2/27) included use in the hospital. Conclusions: This study addresses a key gap in research that has not sufficiently examined what technology designs and capabilities may be effective for underserved populations in promoting health behavior in concordance with recommendations. ",
doi="10.2196/22124",
url="https://www.jmir.org/2022/4/e22124",
url="http://www.ncbi.nlm.nih.gov/pubmed/35377331"
}


@Article{info:doi/10.2196/27924,
author="Lawrence, Katharine
and Chong, Stella
and Krelle, Holly
and Roberts, Timothy
and Thorpe, Lorna
and Trinh-Shevrin, Chau
and Yi, Stella
and Kwon, Simona",
title="Chinese Americans' Use of Patient Portal Systems: Scoping Review",
journal="JMIR Hum Factors",
year="2022",
month="Apr",
day="1",
volume="9",
number="2",
pages="e27924",
keywords="patient portal",
keywords="electronic health records",
keywords="personal health records",
keywords="ehealth",
keywords="health equity",
keywords="digital divide",
keywords="Chinese Americans",
keywords="Asian Americans",
abstract="Background: Electronic patient portals are increasingly used in health care systems as communication and information-sharing tools and show promise in addressing health care access, quality, and outcomes. However, limited research exists on portal use patterns and practices among diverse patient populations, resulting in the lack of culturally and contextually tailored portal systems for these patients. Objective: This study aimed to summarize existing evidence on the access and use patterns, barriers, and facilitators of patient portals among Chinese Americans, who represent a growing patient population in the United States with unique health care and health technology needs. Methods: The authors conducted a literature search using the PRISMA Protocol for Scoping Reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR) for extracting articles published in major databases (MEDLINE, Embase, and PsycINFO) on patient portals and Chinese Americans. Authors independently reviewed the papers during initial screening and full-text review. The studies were analyzed and coded for the study method type, sample population, and main outcomes of interest. Results: In total, 17 articles were selected for inclusion in the review. The included articles were heterogenous and varied in their study aims, methodologies, sample populations, and outcomes. Major findings identified from the articles include variable patterns of portal access and use among Chinese Americans compared to other racial or ethnic groups, with limited evidence on the specific barriers and facilitators for this group; a preference for cross-sectional quantitative tools such as patient surveys and electronic health record--based data over qualitative or other methodologies; and a pattern of aggregating Chinese American--related data into a larger Asian or Asian American designation. Conclusions: There is limited research evaluating the use patterns, experiences, and needs of Chinese Americans who access and use patient portal systems. Existing research is heterogeneous, largely cross-sectional, and does not disaggregate Chinese Americans from larger Asian demographics. Future research should be devoted to the specific portal use patterns, preferences, and needs of Chinese Americans to help ensure contextually appropriate and acceptable design and implementation of these digital health tools. ",
doi="10.2196/27924",
url="https://humanfactors.jmir.org/2022/2/e27924",
url="http://www.ncbi.nlm.nih.gov/pubmed/35363153"
}


@Article{info:doi/10.2196/28724,
author="Pang, Ning-Qi
and Lau, Jerrald
and Fong, Si-Ying
and Wong, Yu-Hui Celine
and Tan, Ker-Kan",
title="Telemedicine Acceptance Among Older Adult Patients With Cancer: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="29",
volume="24",
number="3",
pages="e28724",
keywords="older adult patients",
keywords="cancer",
keywords="telemedicine",
keywords="acceptability",
keywords="satisfaction",
abstract="Background: Cancer is likely to remain the most prevalent noncommunicable disease in high-income countries with an older population. Interestingly, no review of attitudes toward telemedicine among older adults has been performed. This is likely to be the group most affected by both cancer and the increasing use of technology in health care. Objective: We aimed to map research on the acceptance of telemedicine among older adults who are cancer patients. Methods: We conducted a scoping review. PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to September 2020. Articles were included if the study population had a mean or median age ?65 years, with cancer diagnoses and if the study assessed patients' acceptance of a telemedicine intervention. Quantitative, qualitative, and mixed method studies were included. Results: Out of a total of 887 articles that were identified, 19 were included in the review. Interventions were delivered via telephone, videoconference, web portal, mobile app, wearable technology, and text messaging and included teleconsultation, monitoring and follow-up, psychosocial support and nursing care, and prompts. The most often cited facilitating factor was convenience. Other facilitators included an increase in telemedicine care accessibility, previous positive experiences of telemedicine, appropriate technical knowledge and support, decreased cost, physician recommendations, and privacy conferred by the telemedicine intervention. Barriers include a preference for conventional care along with negative perceptions of telemedicine, concerns about technical difficulties, and confidentiality concerns in the adoption of telemedicine. Conclusions: None of the studies explored the ability of tailored interventions to address facilitators and barriers of the acceptance of telemedicine in order to increase its adoption by older adults. Facilitators and barriers will likely differ across different cultural contexts and by type of telemedicine; however, this is a gap in current knowledge. In-depth studies are necessary to determine if interventions could potentially address the barriers identified in this review, to increase acceptability. ",
doi="10.2196/28724",
url="https://www.jmir.org/2022/3/e28724",
url="http://www.ncbi.nlm.nih.gov/pubmed/35348462"
}


@Article{info:doi/10.2196/25005,
author="Gulbrandsen, Robert Trevor
and Skalitzky, Kate Mary
and Shamrock, Gregory Alan
and Gao, Burke
and Hasan, Obada
and Miller, James Benjamin",
title="Web-Based Patient Educational Material on Osteosarcoma: Quantitative Assessment of Readability and Understandability",
journal="JMIR Cancer",
year="2022",
month="Mar",
day="24",
volume="8",
number="1",
pages="e25005",
keywords="osteosarcoma",
keywords="patient education",
keywords="health literacy",
keywords="web-based health information",
abstract="Background: Patients often turn to web-based resources following the diagnosis of osteosarcoma. To be fully understood by average American adults, the American Medical Association (AMA) and National Institutes of Health (NIH) recommend web-based health information to be written at a 6th grade level or lower. Previous analyses of osteosarcoma resources have not measured whether text is written such that readers can process key information (understandability) or identify available actions to take (actionability). The Patient Education Materials Assessment Tool (PEMAT) is a validated measurement of understandability and actionability. Objective: The purpose of this study was to evaluate web-based osteosarcoma resources using measures of readability, understandability, and actionability. Methods: Using the search term ``osteosarcoma,'' two independent Google searches were performed on March 7, 2020 (by AGS), and March 11, 2020 (by TRG). The top 50 results were collected. Websites were included if they were directed at providing patient education on osteosarcoma. Readability was quantified using validated algorithms: Flesh-Kincaid Grade Ease (FKGE), Flesch-Kincaid Grade-Level (FKGL). A higher FKGE score indicates that the material is easier to read. All other readability scores represent the US school grade level. Two independent PEMAT assessments were performed with independent scores assigned for both understandability and actionability. A PEMAT score of 70\% or below is considered poorly understandable or poorly actionable. Statistical significance was defined as P?.05. Results: Two searches yielded 53 unique websites, of which 37 (70\%) met the inclusion criteria. The mean FKGE and FKGL scores were 40.8 (SD 13.6) and 12.0 (SD 2.4), respectively. No website scored within the acceptable NIH or AHA recommended reading level. Only 4 (11\%) and 1 (3\%) website met the acceptable understandability and actionability threshold. Both understandability and actionability were positively correlated with FKGE ($\rho$=0.55, P<.001; $\rho$=0.60, P<.001), but were otherwise not significantly associated with other readability scores. There were no associations between readability (P=.15), understandability (P=.20), or actionability (P=.31) scores and Google rank. Conclusions: Overall, web-based osteosarcoma patient educational materials scored poorly with respect to readability, understandability, and actionability. None of the web-based resources scored at the recommended reading level. Only 4 achieved the appropriate score to be considered understandable by the general public. Authors of patient resources should incorporate PEMAT and readability criteria to improve web-based resources to support patient understanding. ",
doi="10.2196/25005",
url="https://cancer.jmir.org/2022/1/e25005",
url="http://www.ncbi.nlm.nih.gov/pubmed/35323117"
}


@Article{info:doi/10.2196/35221,
author="Yu, Ellie
and Hagens, Simon",
title="Socioeconomic Disparities in the Demand for and Use of Virtual Visits Among Senior Adults During the COVID-19 Pandemic: Cross-sectional Study",
journal="JMIR Aging",
year="2022",
month="Mar",
day="22",
volume="5",
number="1",
pages="e35221",
keywords="virtual care",
keywords="virtual visit",
keywords="COVID-19",
keywords="survey",
keywords="virtual care demand",
keywords="virtual care use",
keywords="older adults",
keywords="elderly care",
keywords="aging",
keywords="digital health",
keywords="pandemic",
abstract="Background: The COVID-19 pandemic has limited the provision of in-person care and accelerated the need for virtual care. Older adults (65+ years) were 1 of the highest user groups of in-person health care services prior to the pandemic. Social distancing guidelines and high rates of mortality from coronavirus infections among older adults made receiving in-person health care services challenging for older adults. The provision of virtual care technologies can help to ensure continuity of care and provide essential health care services during the pandemic to those at high risk of contracting the COVID-19 coronavirus, including older adults. It is also essential to understand and address potential socioeconomic, demographic, and health disparities in the demand for and use of virtual care technologies among older adults. Objective: The objective of this study is to investigate socioeconomic disparities in the demand for and use of virtual visits during the COVID-19 pandemic among older adults in Canada. Methods: A cross-sectional web survey was conducted with 12,052 Canadians over the age of 16 years, selected from Leger's L{\'e}ger Opinion panel from July 14 to August 6, 2021. Associations between socioeconomic factors and the demand for and use of virtual visits were tested using $\chi$2 tests and logistic regression models for telephone visits, video visits, and secure messaging. Weighting was applied using the 2016 census reference variables to render a representative sample of the Canadian population. Results: A total of 2303 older adults were surveyed. Older adults expressed the highest demand for and use of telephone visits, following by video visits and secure messaging. eHealth literacy was positively associated with the use of all 3 virtual care modalities. Higher income was negatively associated with the use of video visits (odds ratio [OR] 0.65, 95\% CI 0.428-0.974, P=.03). Having no private insurance coverage was negatively associated with use of secure messaging (OR 0.73, 95\% CI 0.539-0.983, P=.04), but living in a rural community (OR 0.172, 95\% CI 1.12-2.645, P=.01) and being born outside of Canada (OR 0.150, 95\% CI 1.041-2.173, P=.03) were positively associated with the use of secure messaging. Higher education (OR 0.078, 95\% CI 0.633-0.97, P=.02) and being non-White (OR=0.054, 95\% CI 0.312-0.92, P=.02) were negatively associated with the use of the telephone. Conclusions: This study found that compared to video visits and secure messaging, the demand for and use of telephone visits were more prevalent among older adults during the pandemic. The gaps between the demand for and use of video and secure messaging services remain substantial. Our results highlight socioeconomic disparities among older adults that could potentially explain this trend. Lower income and a lower education level may act as barriers for older adults in acquiring the skills and technologies necessary to use more complex solutions, such as video and secure messaging. In addition, higher eHealth literacy was found to be critical for older adults to successfully navigate all types of virtual visit technologies. ",
doi="10.2196/35221",
url="https://aging.jmir.org/2022/1/e35221",
url="http://www.ncbi.nlm.nih.gov/pubmed/35134746"
}


@Article{info:doi/10.2196/34144,
author="Yao, Rui
and Zhang, Wenli
and Evans, Richard
and Cao, Guang
and Rui, Tianqi
and Shen, Lining",
title="Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="21",
volume="24",
number="3",
pages="e34144",
keywords="health inequities",
keywords="digital health technologies",
keywords="health care services",
keywords="socially disadvantaged groups",
keywords="scoping review",
keywords="mobile phone",
abstract="Background: Digital health technologies (ie, the integration of digital technology and health information) aim to increase the efficiency of health care delivery; they are rapidly adapting to health care contexts to provide improved medical services for citizens. However, contrary to expectations, their rapid adoption appears to have led to health inequities, with differences in health conditions or inequality in the distribution of health care resources among different populations. Objective: This scoping review aims to identify and describe the inequities of health care services brought about by the adoption of digital health technologies. The factors influencing such inequities, as well as the corresponding countermeasures to ensure health equity among different groups of citizens, were also studied. Methods: Primary studies and literature, including articles and reviews, published in English between 1990 and 2020 were retrieved using appropriate search strategies across the following three electronic databases: Clarivate Analytics' Web of Science, PubMed, and Scopus. Data management was performed by two authors (RY and WZ) using Thomson Endnote (Clarivate Analytics, Inc), by systematically screening and identifying eligible articles for this study. Any conflicts of opinion were resolved through discussions with the corresponding author. A qualitative descriptive synthesis was performed to determine the outcomes of this scoping review. Results: A total of 2325 studies were collected during the search process, of which 41 (1.76\%) papers were identified for further analysis. The quantity of literature increased until 2016, with a peak in 2020. The United States, the United Kingdom, and Norway ranked among the top 3 countries for publication output. Health inequities caused by the adoption of digital health technologies in health care services can be reflected in the following two dimensions: the inability of citizens to obtain and adopt technology and the different disease outcomes found among citizens under technical intervention measures. The factors that influenced inequities included age, race, region, economy, and education level, together with health conditions and eHealth literacy. Finally, action can be taken to alleviate inequities in the future by government agencies and medical institutions (eg, establishing national health insurance), digital health technology providers (eg, designing high-quality tools), and health care service recipients (eg, developing skills to access digital technologies). Conclusions: The application of digital health technologies in health care services has caused inequities to some extent. However, existing research has certain limitations. The findings provide a comprehensive starting point for future research, allowing for further investigation into how digital health technologies may influence the unequal distribution of health care services. The interaction between individual subjective factors as well as social support and influencing factors should be included in future studies. Specifically, access to and availability of digital health technologies for socially disadvantaged groups should be of paramount importance. ",
doi="10.2196/34144",
url="https://www.jmir.org/2022/3/e34144",
url="http://www.ncbi.nlm.nih.gov/pubmed/35311682"
}


@Article{info:doi/10.2196/27890,
author="Marziliano, Allison
and Diefenbach, A. Michael
and Hudson, V. Shawna
and Tagai, K. Erin
and Handorf, A. Elizabeth
and Bator, Alicja
and Miller, M. Suzanne",
title="Demographic and Psychosocial Characteristics Associated With Use of a Prostate Cancer Survivorship Website: Implications From a Multisite Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="21",
volume="24",
number="3",
pages="e27890",
keywords="prostate cancer",
keywords="cancer survivorship",
keywords="web-based resource",
keywords="monitoring style of coping",
keywords="cancer",
keywords="survivorship",
keywords="eHealth",
keywords="emotions",
keywords="interpersonal",
abstract="Background: Many prostate cancer (PC) survivors experience disease and treatment-related symptomatology in both the physical and psychosocial domains. Although the benefits and barriers to using web-based resources for cancer patients are well-documented, less research has focused on the personal characteristics important for efficient tailoring and targeting of information that are associated with usage. Objective: We used the Cognitive-Social Health Information Processing (C-SHIP) framework to guide our exploration of personal characteristics associated with use of PROGRESS, an informational PC survivorship website that addresses physical, emotional, interpersonal, and practical concerns relevant for PC survivors. Methods: PC survivors (N=217) were randomized to the intervention arm (PROGRESS) of a randomized controlled trial. Of those randomized to the intervention arm, 84 used PROGRESS, and 133 did not use PROGRESS. Multivariable analyses evaluated demographic and psychosocial characteristics (eg, style of coping, health literacy, self-efficacy, affective states of depression, anxiety, and fatigue) associated with website use. Results: A larger proportion of non-Hispanic White (68/160, 42.5\%), compared with non-Hispanic Black (9/40, 23\%), participants used PROGRESS (P<.001). Further, PROGRESS users were older in age (P<.001), had a monitoring style of coping (P=.01), and were less depressed (P=.004), anxious (P=.02), and fatigued (P<.001) than nonusers. Education, income, health literacy, blunting style of coping, self-efficacy, and treatment type (radiation therapy or surgery) were not significantly related to use. On multivariable analyses, race (OR 0.28, P<.001), age (OR 1.05, P<.001), monitoring style of coping (OR 1.27, P=.02), and overall mood (OR 0.98, P<.001) remained significant. Conclusions: A combination of monitoring and low levels of negative affect were associated with website use. Additionally, users were older, non-Hispanic White survivors. To ensure that important survivorship-relevant information reaches users, future efforts need to focus on enhancing patient engagement. Trial Registration: ClinicalTrials.gov NCT02224482; https://clinicaltrials.gov/ct2/show/NCT02224482 ",
doi="10.2196/27890",
url="https://www.jmir.org/2022/3/e27890",
url="http://www.ncbi.nlm.nih.gov/pubmed/35311678"
}


@Article{info:doi/10.2196/32538,
author="Jenkins, L. Catherine
and Imran, Sumayyah
and Mahmood, Aamina
and Bradbury, Katherine
and Murray, Elizabeth
and Stevenson, Fiona
and Hamilton, L. Fiona",
title="Digital Health Intervention Design and Deployment for Engaging Demographic Groups Likely to Be Affected by the Digital Divide: Protocol for a Systematic Scoping Review",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="18",
volume="11",
number="3",
pages="e32538",
keywords="digital divide",
keywords="digital health interventions",
keywords="DHIs",
keywords="eHealth",
keywords="digital health literacy",
keywords="health inequalities",
keywords="health inequities",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Digital health interventions refer to interventions designed to support health-related knowledge transfer and are delivered via digital technologies, such as mobile apps. Digital health interventions are a double-edged sword: they have the potential to reduce health inequalities, for example, by making treatments available remotely to rural populations underserved by health care facilities or by helping to overcome language barriers via in-app translation services; however, if not designed and deployed with care, digital health interventions also have the potential to increase health inequalities and exacerbate the effects of the digital divide. Objective: The aim of this study is to review ways to mitigate the digital divide through digital health intervention design, deployment, and engagement mechanisms sensitive to the needs of digitally excluded populations. Methods: This protocol outlines the procedure for a systematic scoping review that follows the methodology recommended by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidance. The following databases will be searched for primary research studies published in English from October 1, 2011, to October 1, 2021: Cochrane Library, Epistemonikos, NICE Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC), and Trip. In addition, the following sources of gray literature will be searched: Conference Proceedings Citation Index, Health Management Information Consortium, International HTA Database, OpenGrey, The Grey Literature Report, Google Scholar Basic Search UK, MedNar Deep Web Search Engine, and Carrot2. We will select publications that meet the following inclusion criteria: primary research papers that evaluated digital health interventions that describe features of digital health intervention design and deployment that enable or hinder access to and engagement with digital health interventions by adults from demographic groups likely to be affected by the digital divide (eg, older age, minority ethnic groups, lower income, and lower education level). A random selection of 25 publications identified from the search will be double screened by four reviewers. If there is >75\% agreement for included/excluded publications, the team will continue to screen all the identified publications. For all included publications, study characteristics will be extracted by one author and checked for agreement by a second author, with any disagreements resolved by consensus among the study team. Consultation digital health intervention design and deployment, and digital health intervention users will also be conducted in parallel. Results: The review is underway and is anticipated to be completed by September 2022. Conclusions: The results will have implications for researchers and policy makers using digital health interventions for health improvement peripandemic and post pandemic, and will inform best practices in the design and delivery of digital health interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/32538 ",
doi="10.2196/32538",
url="https://www.researchprotocols.org/2022/3/e32538",
url="http://www.ncbi.nlm.nih.gov/pubmed/35302946"
}


@Article{info:doi/10.2196/36446,
author="Lee, J. Jane
and Aguirre Herrera, Joel
and Cardona, Jos{\'e}
and Cruz, Yesenia Loren
and Mungu{\'i}a, L{\'e}sster
and Leyva Vera, A. Christopher
and Robles, Gabriel",
title="Culturally Tailored Social Media Content to Reach Latinx Immigrant Sexual Minority Men for HIV Prevention: Web-Based Feasibility Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="16",
volume="6",
number="3",
pages="e36446",
keywords="social media",
keywords="eHealth",
keywords="feasibility",
keywords="Latinx",
keywords="immigrant",
keywords="sexual minorities",
keywords="gay",
keywords="homosexual",
keywords="bisexual",
keywords="pre-exposure prophylaxis",
keywords="HIV prevention",
keywords="HIV",
keywords="prevention",
keywords="web-based",
keywords="internet-based",
keywords="sexual minority",
keywords="sexual health",
keywords="digital health",
keywords="health technology",
keywords="web-based health",
keywords="web-based prevention",
keywords="health information",
abstract="Background: Latinx gay, bisexual, and other sexual minority men are disproportionately affected by HIV in the United States. As Latinx sexual minority men, particularly those who are foreign-born, experience inequitable access to health services, tailored strategies to engage them for HIV prevention are urgently needed. Objective: Our study seeks to address the need for enhanced access to HIV prevention among Latinx immigrant sexual minority men. We developed and piloted a culturally sensitive technology-based campaign focused on HIV testing and pre-exposure prophylaxis (PrEP) uptake. Methods: We used a two-phase approach to assess the feasibility of community-informed social media content in engaging Latinx immigrant sexual minority men for HIV testing and PrEP use. First, we conducted three iterative focus groups with 15 Latinx immigrant sexual minority men to refine the HIV prevention content to be piloted on social media platforms. The finalized content was placed on Instagram and Facebook for 9 days in July and September 2021 to individuals who were in Washington State. Individuals who clicked on the content were directed to a website with additional HIV prevention information. Second, we conducted online surveys (n=60) with website visitors that assessed sociodemographic characteristics, barriers to HIV prevention, and HIV-related transmission risk and prevention behaviors. We conducted descriptive analyses to examine the overall profile of survey respondents and determine the feasibility of culturally informed social media content in reaching Latinx immigrant sexual minority men. Results: Overall, 739 unique users visited the website during the 9-day period when the social media content was posted on Instagram and Facebook. Our sample included 60 Latinx immigrant sexual minority men who completed the online survey. Participants' mean age was 30.8 years and more than half (n=34, 57\%) completed the survey in Spanish. A quarter of participants indicated that they were unauthorized immigrants and 57\% (n=34) reported not having medical insurance. Participants reported, on average, having 6 different sexual partners in the last 6 months. Nearly a third of respondents had not tested for HIV in the last 6 months. Only about half (n=32, 53\%) of respondents had used PrEP in the last 12 months. Conclusions: Community-driven social media and web-based strategies are feasible ways to engage Latinx immigrant sexual minority men who may traditionally lack access to HIV prevention information and services due to structural and social barriers. The results highlight that culturally relevant social media and web-based outreach strategies that are informed and developed by the community can reach Latinx immigrant sexual minority men for HIV prevention. Findings underscore the need to examine the effectiveness of social media content in promoting HIV testing and PrEP uptake in marginalized Latinx populations. ",
doi="10.2196/36446",
url="https://formative.jmir.org/2022/3/e36446",
url="http://www.ncbi.nlm.nih.gov/pubmed/35182416"
}


@Article{info:doi/10.2196/32678,
author="Medero, Kristina
and Merrill Jr, Kelly
and Ross, Quinn Morgan",
title="Modeling Access Across the Digital Divide for Intersectional Groups Seeking Web-Based Health Information: National Survey",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="15",
volume="24",
number="3",
pages="e32678",
keywords="Black",
keywords="African American",
keywords="first-level digital divide",
keywords="health disparities",
keywords="home computer",
keywords="internet access",
keywords="intersectionality",
keywords="Latino",
keywords="Latine",
keywords="Hispanic",
keywords="mobile",
keywords="online health information seeking",
keywords="public computer",
keywords="structural equation modeling",
keywords="work computer",
keywords="mobile phone",
abstract="Background: The digital divide refers to technological disparities based on demographic characteristics (eg, race and ethnicity). Lack of physical access to the internet inhibits online health information seeking (OHIS) and exacerbates health disparities. Research on the digital divide examines where and how people access the internet, whereas research on OHIS investigates how intersectional identities influence OHIS. We combine these perspectives to explicate how unique context--device access pairings operate differently across intersectional identities---particularly racial and ethnic groups---in the domain of OHIS. Objective: This study aims to examine how different types of internet access relate to OHIS for different racial and ethnic groups. We investigate relationships among predisposing characteristics (ie, age, sex, education, and income), internet access (home computer, public computer, work computer, and mobile), health needs, and OHIS. Methods: Analysis was conducted using data from the 2019 Health Information National Trends Survey. Our theoretical model of OHIS explicates the roles of internet access and health needs for racial and ethnic minority groups' OHIS. Participant responses were analyzed using structural equation modeling. Three separate group structural equation modeling models were specified based on Black, Latine, and White self-categorizations. Results: Overall, predisposing characteristics (ie, age, sex, education, and income) were associated with internet access, health needs, and OHIS; internet access was associated with OHIS; and health needs were associated with OHIS. Home computer and mobile access were most consistently associated with OHIS. Several notable linkages between predisposing characteristics and internet access differed for Black and Latine individuals. Older racial and ethnic minorities tended to access the internet on home and public computers less frequently; home computer access was a stronger predictor of OHIS for White individuals, and mobile access was a stronger predictor of OHIS for non-White individuals. Conclusions: Our findings necessitate a deeper unpacking of how physical internet access, the foundational and multifaceted level of the digital divide, affects specific racial and ethnic groups and their OHIS. We not only find support for prior work on the digital divide but also surface new insights, including distinct impacts of context--device access pairings for OHIS and several relationships that differ between racial and ethnic groups. As such, we propose interventions with an intersectional approach to access to ameliorate the impact of the digital divide. ",
doi="10.2196/32678",
url="https://www.jmir.org/2022/3/e32678",
url="http://www.ncbi.nlm.nih.gov/pubmed/35289761"
}


@Article{info:doi/10.2196/32499,
author="Fradkin, Nick
and Zbikowski, M. Susan
and Christensen, Trevor",
title="Analysis of Demographic Characteristics of Users of a Free Tobacco Cessation Smartphone App: Observational Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Mar",
day="9",
volume="8",
number="3",
pages="e32499",
keywords="mobile applications",
keywords="mHealth",
keywords="eHealth",
keywords="smartphone app",
keywords="tobacco",
keywords="smoking cessation",
keywords="public health",
keywords="smoking",
keywords="application",
abstract="Background: Tobacco use continues to be the leading preventable cause of death, disease, and disability in the United States. Since 2000, Washington state has offered free tobacco ``quitline'' services to help its residents stop using tobacco. In 2015, the state began offering free access to a tobacco cessation smartphone app to absorb excess quitline demand. Since most publicly funded tobacco cessation programs are designed to provide access to populations disproportionately impacted by tobacco use, it is important to consider who these public health interventions reach. Objective: The aim of this study is to understand who used a free cessation app and the extent to which users represented populations disproportionately impacted by tobacco use. Methods: This is an observational study of 1280 adult Washington state residents who registered for and activated the cessation app. Demographic data were collected as part of the sign-up process, examined using standard descriptive measures, and assessed against state-level surveillance data for representativeness. Results: Participants were primarily non-Hispanic White (978/1218, 80.3\%), identified as female (780/1236, 63.1\%), were between ages 25-54 years (903/1186, 76.1\%), had at least some college education (836/1222, 68.4\%), and reported a household income under US \$50,000 (742/1055, 70.3\%). Fewer respondents were from rural counties (359/1220, 29.4\%); identified as lesbian, gay, bisexual, pansexual, queer, questioning, or asexual (LGBQA; 153/1222, 12.5\%); were uninsured (147/1206, 12.2\%); or were currently pregnant, planning pregnancy, or breastfeeding (42/624, 6.7\%). However, relative to available state data for tobacco users, there was high representation of women, 35- to 54-year-olds, college graduates, and LGBQA individuals, as well as individuals with low household income, poor mental health, Medicaid insurance, and those residing in rural counties. Conclusions: A diverse population of tobacco users will use a free cessation app, including some demographic groups disproportionately impacted by tobacco use. With high reach and high efficacy, it is possible to address health disparities associated with tobacco use and dependence treatment among certain underserved and at-risk groups. ",
doi="10.2196/32499",
url="https://publichealth.jmir.org/2022/3/e32499",
url="http://www.ncbi.nlm.nih.gov/pubmed/35262491"
}


@Article{info:doi/10.2196/26764,
author="Jackson, N. Devlon
and Sehgal, Neil
and Baur, Cynthia",
title="Benefits of mHealth Co-design for African American and Hispanic Adults: Multi-Method Participatory Research for a Health Information App",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="9",
volume="6",
number="3",
pages="e26764",
keywords="mHealth app design",
keywords="health literacy",
keywords="health disparities",
keywords="health equity",
keywords="African Americans",
keywords="Hispanics",
keywords="mobile phone",
abstract="Background: Participatory research methodologies can provide insight into the use of mobile health (mHealth) apps, cultural preferences and needs, and health literacy issues for racial and ethnic groups, such as African Americans and Hispanics who experience health disparities. Objective: This methodological paper aims to describe a 1-year multi-method participatory research process that directly engaged English-speaking African American and bilingual or Spanish-speaking Hispanic adults in designing a prevention-focused, personalized mHealth, information-seeking smartphone app. We report design team participants' experiences with the methods to show why our approach is valuable in producing apps that are more aligned with their needs. Methods: Three design sessions were conducted to inform the iteration of a prevention-focused, personalized mHealth, information-seeking app. The research team led sessions with 2 community member design teams. Design team participants described their goals, motives, and interests regarding prevention information using different approaches, such as collage and card sorting (design session 1), interaction with the app prototype (design session 2), and rating of cultural appropriateness strategies (design session 3). Results: Each design team had 5 to 6 participants: 2 to 3 male participants and 3 female participants aged between 30 and 76 years. Design team participants shared their likes and dislikes about the sessions and the overall experience of the design sessions. Both African American and Hispanic teams reported positive participation experience. The primary reasons included the opportunity for their views to be heard, collectively working together in the design process, having their apprehension about mHealth reduced, and an opportunity to increase their knowledge of how they could manage their health through mHealth. The feedback from each session informed the following design sessions and a community-engaged process. In addition, the specific findings for each design session informed the design of the app for both communities. Conclusions: This multi-method participatory research process revealed 4 key lessons learned and recommendations for future research in mHealth app design for African Americans and Hispanics. Lesson 1---community partnerships are key because they provide the chain of trust that helps African American and Hispanic participants feel comfortable participating in app research. Lesson 2---community-based participatory research principles continue to yield promising results to engage these populations in mHealth research. Lesson 3---interactive design sessions uncover participants' needs and development opportunities for mHealth tools. Lesson 4---multiple design sessions with different methods provide an in-depth understanding of participants' mHealth preferences and needs. Future developers should consider these methods and lessons to ensure health apps in the marketplace contribute to eliminating health disparities and achieving health equity. ",
doi="10.2196/26764",
url="https://formative.jmir.org/2022/3/e26764",
url="http://www.ncbi.nlm.nih.gov/pubmed/35262496"
}


@Article{info:doi/10.2196/32957,
author="Kim, Sunyoung
and Yao, Willow
and Du, Xiaotong",
title="Exploring Older Adults' Adoption and Use of a Tablet Computer During COVID-19: Longitudinal Qualitative Study",
journal="JMIR Aging",
year="2022",
month="Mar",
day="8",
volume="5",
number="1",
pages="e32957",
keywords="older adults",
keywords="tablet computer",
keywords="technology acceptance",
keywords="mental model",
keywords="longitudinal study",
keywords="COVID-19",
abstract="Background: As mobile computing technology evolves, such as smartphones and tablet computers, it increasingly offers features that may be particularly beneficial to older adults. However, the digital divide exists, and many older adults have been shown to have difficulty using these devices. The COVID-19 pandemic has magnified how much older adults need but are excluded from having access to technologies to meet essential daily needs and overcome physical distancing restrictions. Objective: This study sought to understand how older adults who had never used a tablet computer learn to use it, what they want to use it for, and what barriers they experience as they continue to use it during social isolation caused by the COVID-19 pandemic. Methods: We conducted a series of semistructured interviews with eight people aged 65 years and older for 16 weeks, investigating older novice users' adoption and use of a tablet computer during the nationwide lockdown due to COVID-19. Results: Participants were gradually yet successfully accustomed to using a tablet computer to serve various daily needs, including entertainment, social connectedness, and information-seeking. However, this success was not achieved through developing sufficient digital skills but rather by applying the methods they were already familiar with in its operation, such as taking and referring to instruction notes. Conclusions: Our findings imply that older adults without digital literacy can still benefit from a digital device for quality of later life if proper traditional methods they are already familiar with are offered in its use. ",
doi="10.2196/32957",
url="https://aging.jmir.org/2022/1/e32957",
url="http://www.ncbi.nlm.nih.gov/pubmed/35134747"
}


@Article{info:doi/10.2196/19379,
author="van Eenbergen, C. Mies
and Vromans, D. Ruben
and Tick, W. Lidwine
and Vreugdenhil, Gerard
and Krahmer, J. Emiel
and Mols, Floortje
and van de Poll-Franse, V. Lonneke",
title="Comparing Survivors of Cancer in Population-Based Samples With Those in Online Cancer Communities: Cross-sectional Questionnaire Study",
journal="JMIR Cancer",
year="2022",
month="Mar",
day="8",
volume="8",
number="1",
pages="e19379",
keywords="internet use",
keywords="breast cancer",
keywords="prostate cancer",
keywords="lymphoma",
keywords="gynecological cancer",
keywords="cancer survivors",
keywords="online health community",
abstract="Background: Most Western countries have websites that provide information on cancer and the opportunity to participate in online cancer communities (OCCs). The number of patients with cancer that participate in these OCCs is growing. These patients are relatively easy to approach for research purposes. Objective: The objective of this study is to determine the differences and similarities between survivors of cancer in population-based samples and survivors participating in OCCs who use the internet in relation to their illness. Methods: In 2017, we drew a sample of 539 population-based patients and 531 OCC patients. The population-based patients were sent a paper-based questionnaire, and the OCC patients were sent the same questionnaire on the web. In the questionnaire, we asked patients about their sociodemographics, internet use, sources of information, media use, and wishes regarding future internet use for health care--related purposes, and the effect of internet use on their health care consumption. Results: The response rate of population-based internet users was 47\% (233/496), and that of the OCC group was 40.3\% (214/531). The OCC group had a significantly higher education level (P<.001), was younger (P<.001), had more survivors that were employed (P<.001), and attached greater importance to the internet (171/214, 79.9\% vs 126/233, 54.1\%; P<.001) and fellow survivors (107/214, 50\% vs 60/233, 25.8\%; P<.001). Compared with the population-based group, the OCC group reported more intensive internet use immediately after diagnosis, during treatment, and during follow-up (P<.001 in each case). There were similarities in terms of the relative importance that survivors attach to the various sources of information, the topics on which they seek information, and their wishes for future eHealth possibilities. The OCC group reported a greater need to participate in a web-based class or chat with others (92/214, 43\% vs 44/233, 18.9\%). Conclusions: We conclude that survivors who are members of an OCC are not representative of survivors of cancer in general. There are significant differences in sociodemographic characteristics, internet use during their treatment journey, internet search frequency during their cancer journey, and participation wishes. Using web-based information and communication can support shared decision-making and may facilitate the active participation of patients during their treatment. For research purposes, it is important to take the bias in OCC groups into account. ",
doi="10.2196/19379",
url="https://cancer.jmir.org/2022/1/e19379",
url="http://www.ncbi.nlm.nih.gov/pubmed/35258460"
}


@Article{info:doi/10.2196/34452,
author="Chen, Jinying
and Wijesundara, G. Jessica
and Enyim, E. Gabrielle
and Lombardini, M. Lisa
and Gerber, S. Ben
and Houston, K. Thomas
and Sadasivam, S. Rajani",
title="Understanding Patients' Intention to Use Digital Health Apps That Support Postdischarge Symptom Monitoring by Providers Among Patients With Acute Coronary Syndrome: Survey Study",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="7",
volume="9",
number="1",
pages="e34452",
keywords="coronary",
keywords="monitor",
keywords="elder",
keywords="health app",
keywords="symptom",
keywords="eHealth",
keywords="mobile health",
keywords="intention",
keywords="barrier",
keywords="facilitator",
abstract="Background: After hospital discharge, patients with acute coronary syndrome (ACS) often experience symptoms that prompt them to seek acute medical attention. Early evaluation of postdischarge symptoms by health care providers may reduce unnecessary acute care utilization. However, hospital-initiated follow-up encounters are insufficient for timely detection and assessment of symptoms. While digital health tools can help address this issue, little is known about the intention to use such tools in ACS patients. Objective: This study aimed to assess ACS patients' intention to use digital health apps that support postdischarge symptom monitoring by health care providers and identify patient-perceived facilitators and barriers to app use. Methods: Using email invitations or phone calls, we recruited ACS patients discharged from a central Massachusetts health care system between December 2020 and April 2021, to participate in the study. Surveys were delivered online or via phone to individual participants. Demographics and access to technology were assessed. The intention to use a symptom monitoring app was assessed using 5-point Likert-type (from strongly agree to strongly disagree) items, such as ``If this app were available to me, I would use it.'' Responses were compared across demographic subgroups and survey delivery methods. Two open-ended questions assessed perceived facilitators and barriers to app use, with responses analyzed using qualitative content analysis. Results: Among 100 respondents (response rate 8.1\%), 45 (45\%) completed the survey by phone. The respondents were on average 68 years old (SD 13 years), with 90\% (90/100) White, 39\% (39/100) women, and 88\% (88/100) having access to the internet or a mobile phone. Most participants (65/100, 65\%) agreed or strongly agreed that they would use the app, among which 53 (82\%) would use the app as often as possible. The percentage of participants with the intention to use the app was 75\% among those aged 65-74 years and dropped to 44\% among those older than 75 years. The intention to use was higher in online survey respondents (vs phone survey respondents; odds ratio 3.07, 95\% CI 1.20-7.88) after adjusting for age and access to technology. The analysis of open-ended questions identified the following 4 main facilitators (motivations): (1) easily reaching providers, (2) accessing or providing information, (3) quickly reaching providers, and (4) consulting providers for symptoms, and the following 4 main barriers: (1) privacy/security concerns, (2) uncomfortable using technology, (3) user-unfriendly app interface, and (4) preference for in-person/phone care. Conclusions: There was a strong intention to use a symptom monitoring app postdischarge among ACS patients. However, this intent decreased in patients older than 75 years. The survey identified barriers related to technology use, privacy/security, and the care delivery mode. Further research is warranted to determine if such intent translates into app use, and better symptom management and health care quality. ",
doi="10.2196/34452",
url="https://humanfactors.jmir.org/2022/1/e34452",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254269"
}


@Article{info:doi/10.2196/32406,
author="El Sherif, Reem
and Pluye, Pierre
and Schuster, Tibor
and Grad, Roland",
title="Proxy Information Seeking by Users of a Parenting Information Website: Quantitative Observational Study",
journal="JMIR Pediatr Parent",
year="2022",
month="Mar",
day="4",
volume="5",
number="1",
pages="e32406",
keywords="consumer health information",
keywords="information seeking behavior",
keywords="child development",
keywords="child health",
keywords="information outcomes",
keywords="health information",
keywords="digital health",
keywords="parenting",
keywords="online information",
abstract="Background: One of the largest groups of consumers who seek health information on the internet are parents of young children, as well as people in their social circle. The concept of proxy seeking (on behalf of others) has been explored in the literature, yet little is known about the outcomes. Objective: The main aim of this study was to describe consumer health information outcomes reported by proxy seekers using a parenting website. Methods: We conducted a 2-year quantitative observational study. Participants were parents of 0- to 8-year-old children and members of their entourage in Canada who had accessed Na{\^i}tre et Grandir through the website or through a weekly newsletter. For each Na{\^i}tre et Grandir webpage, participants' perceptions regarding the outcomes of seeking and using specific webpages were gathered using a content-validated Information Assessment Method questionnaire. We compared the outcomes reported by parents with those reported by members of their entourage after consulting a parenting information website and explored if the method of accessing the information by the proxy seekers (website or weekly newsletter) changed the outcomes reported. For key primary survey items, the chi-square test was conducted, and differences in relative frequencies of responses were computed along with confidence intervals. Results: A total of 51,325 completed questionnaires were included in the analysis, pertaining to 1079 Na{\^i}tre et Grandir webpages (mean 48; range 1-637). Compared to parents, individuals in the entourage are more likely to report using the information in discussion with others (mean difference 0.166, 95\% CI 0.155-0.176). Parents, on the other hand, were more likely than the entourage to report using the information to better understand (mean difference 0.084, 95\% CI 0.073-0.094), to decide to do something (mean difference 0.156, 95\% CI 0.146-0.166), or to do something in a different manner (mean difference 0.052, 95\% CI 0.042-0.061). In addition, results suggest that the differences in perceived benefits of parenting information by the entourage depend on how they access the information. Respondents who were actively seeking the information (through the website) were more likely to report that the information would help them be less worried (mean difference 0.047; 95\% CI 0.024-0.069), handle a problem (mean difference 0.083; 95\% CI 0.062-0.104), and decide what to do with someone else (mean difference 0.040, 95\% CI 0.020-0.058). Respondents who passively acquired the information (through the newsletter) were more likely to report that the information would help improve the health or well-being of a child (mean difference 0.090; 95\% CI 0.067-0.112). Conclusions: By better understanding how consumers and their entourages use information, information providers can adapt information to meet both individual and group needs, and health care practitioners can target patients' entourages with web-based health information resources for dissemination and use. ",
doi="10.2196/32406",
url="https://pediatrics.jmir.org/2022/1/e32406",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254283"
}


@Article{info:doi/10.2196/34901,
author="Sifat, S. Munjireen
and Saperstein, L. Sandra
and Tasnim, Naima
and Green, M. Kerry",
title="Motivations Toward Using Digital Health and Exploring the Possibility of Using Digital Health for Mental Health in Bangladesh University Students: Cross-sectional Questionnaire Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="4",
volume="6",
number="3",
pages="e34901",
keywords="digital health",
keywords="mental health",
keywords="Bangladesh",
keywords="university students",
keywords="mental health service use",
keywords="mobile phone",
abstract="Background: Digital health is efficacious for the management and prevention of mental health (MH) problems. It is particularly helpful for the young adult population, who appreciate the autonomy digital health provides, and in low-income countries, where the prevalence of MH problems is high but the supply of professionals trained in MH is low. Objective: The objectives of this study are 2-fold: to determine whether university students in Bangladesh find using digital health for MH promotion acceptable and to examine motivational factors for using digital health for MH. Methods: This study used a cross-sectional survey to examine the likelihood that university students in Bangladesh (n=311) would use different forms of digital health platforms for MH promotion and assessed drivers of intention to use and actual use of digital health generally and digital health for MH through the lens of the Technology Acceptance Model. The results provided evidence that the university student population in Bangladesh is likely to use digital health to promote their MH. Results: Social influence (adjusted odds ratio [aOR] 1.68, 95\% CI 1.40-2.01; P<.001), ease of use (aOR 1.85, 95\% CI 1.35-2.53; P<.001), and perceived usefulness (aOR 4.12, 95\% CI 1.79-9.51; P=.001) of digital health were found to be significant drivers of the intention to use general digital health, and having an intention to use digital health (aOR 2.10, 95\% CI 1.17-3.78; P=.01) had the greatest influence on actual use of digital health. Social influence (aOR 1.71, 95\% CI 1.43-2.04; P<.001), perceived usefulness (aOR 8.92, 95\% CI 4.18-19.04; P<.001), and use of general digital health (aOR 2.16, 95\% CI 1.18-3.97; P=.01) were associated with higher intention to use digital health for MH. The use of general digital health (aOR 4.19, 95\% CI 2.37-7.41; P<.001) was associated with the actual use of digital health for MH, as were greater non--stigma-related barriers to using traditional clinical MH services (aOR 2.05, 95\% CI 1.10-3.80; P=.02). Conclusions: Overall, we see that the use of digital health for MH is acceptable in this population and can be helpful for students who perceive barriers to receiving traditional care. We also gain insight into how to promote the intention to use digital health, which in turn promotes the actual use of digital health. ",
doi="10.2196/34901",
url="https://formative.jmir.org/2022/3/e34901",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254267"
}


@Article{info:doi/10.2196/30085,
author="Moon, Hana
and Lee, Ho Geon
and Cho, Jeong Yoon",
title="Readability of Korean-Language COVID-19 Information from the South Korean National COVID-19 Portal Intended for the General Public: Cross-sectional Infodemiology Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="3",
volume="6",
number="3",
pages="e30085",
keywords="COVID-19",
keywords="health literacy",
keywords="readability",
keywords="public health",
keywords="health equity",
keywords="consumer health information",
keywords="information dissemination",
keywords="health education",
keywords="eHealth",
keywords="online",
keywords="social media",
keywords="pandemic",
keywords="infodemic",
abstract="Background: The coronavirus pandemic has increased reliance on the internet as a tool for disseminating information; however, information is useful only when it can be understood. Prior research has shown that web-based health information is not always easy to understand. It is not yet known whether the Korean-language COVID-19 information from the internet is easy for the general public to understand. Objective: We aimed to evaluate the readability of Korean-language COVID-19 information intended for the general public from the national COVID-19 portal of South Korea. Methods: A total of 122 publicly available COVID-19 information documents written in Korean were obtained from the South Korean national COVID-19 portal. We determined the level of readability (at or below ninth grade, 10th to 12th grade, college, or professional) of each document using a readability tool for Korean-language text. We measured the reading time, character count, word count, sentence count, and paragraph count for each document. We also evaluated the characteristics of difficult-to-read documents to modify the readability from difficult to easy. Results: The median readability level was at a professional level; 90.2\% (110/122) of the information was difficult to read. In all 4 topics, few documents were easy to read (overview: 5/12, 41.7\%; prevention: 6/97, 6.2\%; test: 0/5, 0\%; treatment: 1/8, 12.5\%; P=.006), with a median 11th-grade readability level for overview, a median professional readability level for prevention, and median college readability levels for test and treatment. Difficult-to-read information had the following characteristics in common: literacy style, medical jargon, and unnecessary detail. Conclusions: In all 4 topics, most of the Korean-language COVID-19 web-based information intended for the general public provided by the national COVID-19 portal of South Korea was difficult to read; the median readability levels exceeded the recommended ninth-grade level. Readability should be a key consideration in developing public health documents, which play an important role in disease prevention and health promotion. ",
doi="10.2196/30085",
url="https://formative.jmir.org/2022/3/e30085",
url="http://www.ncbi.nlm.nih.gov/pubmed/35072633"
}


@Article{info:doi/10.2196/31533,
author="Sbardelotto, Jackson
and Martins, Birck B{\'a}rbara
and Buss, Caroline",
title="Use of Social Networks in the Context of the Dietitian's Practice in Brazil and Changes During the COVID-19 Pandemic: Exploratory Study",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="25",
volume="6",
number="2",
pages="e31533",
keywords="dietitian",
keywords="social networks",
keywords="nutrition",
keywords="health communication",
keywords="COVID-19",
keywords="social media",
keywords="Brazil",
keywords="perception",
keywords="health information",
keywords="usage",
keywords="behavior",
abstract="Background: Social networks have been pointed out as 1 of the greatest means of spreading information. A large part of the population is already present on these platforms, looking up subjects such as health, nutrition, and food. To reach this audience, it may be important for dietitians to explore social networks. However, there is a gap in scientific studies on exploring the ways in which these platforms are used by dietitians in Brazil, and the roles they play in the profession have not been well defined. Objective: This study aims to describe the roles that social networks play in dietitians' practice in Brazil and their mode of use of social networks. This study also aims to identify professionals' perceptions and opinions regarding the use of these tools, as well as changes in behavior on social network usage caused by the COVID-19 pandemic. Methods: We carried out a quantitative cross-sectional study, collecting data through an online questionnaire, submitted between October 2020 and January 2021 to dietitians registered on the Federal Council of Dietitians. All participants included in the study answered questions about the use of social networks in their professional context. Results: In total, 264 (91.7\%) of the 288 participants reported using social networks for professional practice. Instagram was the social network most often used by professionals (224/264, 84.8\%). Dietitians (N=288) related to the use of social networks (always to almost always) for sharing information about their services (n=114-72 [39.6\%-25\%], respectively), following the work of other dietitians (n=172-64 [59.7\%-22.2\%], respectively), and writing about topics related to food and nutrition (n=166-53 [57.6\%-18.4\%], respectively). The roles played by social networks in the professional context of dietitians were attracting more clients (210/289, 72.7\%) and keeping in touch with them (195/289, 67.5\%). Furthermore, 227 (78.5\%) of the 289 dietitians strongly agreed that social networks are good tools to promote their services. During the COVID-19 pandemic, 216 (74.7\%) of the 289 participants noticed changes in their behavior, feelings, or beliefs on the use of social networks related to professional practice, and 149 (51.6\%) have increased the frequency of sharing information about nutrition and health in general on social networks. Conclusions: The main roles of social networks in the professional context of dietitians are to attract clients and to facilitate the contact between professional and client. The modes of use reported by the professionals included sharing information about their services, following the work of professional colleagues, and writing about topics related to nutrition. Most of them reported believing that social networks are an effective way to disseminate their services. Moreover, most professionals claimed to have noticed changes in their behaviors or beliefs on social media during the COVID-19 pandemic. ",
doi="10.2196/31533",
url="https://formative.jmir.org/2022/2/e31533",
url="http://www.ncbi.nlm.nih.gov/pubmed/35023837"
}


@Article{info:doi/10.2196/34790,
author="Zhao, Chris Yuxiang
and Zhao, Mengyuan
and Song, Shijie",
title="Online Health Information Seeking Behaviors Among Older Adults: Systematic Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="16",
volume="24",
number="2",
pages="e34790",
keywords="older adults",
keywords="online health information seeking",
keywords="health information behavior",
keywords="aging technology",
keywords="systematic scoping review",
abstract="Background: With the world's population aging, more health-conscious older adults are seeking health information to make better-informed health decisions. The rapid growth of the internet has empowered older adults to access web-based health information sources. However, research explicitly exploring older adults' online health information seeking (OHIS) behavior is still underway. Objective: This systematic scoping review aims to understand older adults' OHIS and answer four research questions: (1) What types of health information do older adults seek and where do they seek health information on the internet? (2) What are the factors that influence older adults' OHIS? (3) What are the barriers to older adults' OHIS? (4) How can we intervene and support older adults' OHIS? Methods: A comprehensive literature search was performed in November 2020, involving the following academic databases: Web of Science; Cochrane Library database; PubMed; MEDLINE; CINAHL Plus; APA PsycINFO; Library and Information Science Source; Library, Information Science and Technology Abstracts; Psychology and Behavioral Sciences Collection; Communication \& Mass Media Complete; ABI/INFORM; and ACM Digital Library. The initial search identified 8047 publications through database search strategies. After the removal of duplicates, a data set consisting of 5949 publications was obtained for screening. Among these, 75 articles met the inclusion criteria. Qualitative content analysis was performed to identify themes related to the research questions. Results: The results suggest that older adults seek 10 types of health information from 6 types of internet-based information sources and that 2 main categories of influencing factors, individual-related and source-related, impact older adults' OHIS. Moreover, the results reveal that in their OHIS, older adults confront 3 types of barriers, namely individual, social, and those related to information and communication technologies. Some intervention programs based on educational training workshops have been created to intervene and support older adults' OHIS. Conclusions: Although OHIS has become increasingly common among older adults, the review reveals that older adults' OHIS behavior is not adequately investigated. The findings suggest that more studies are needed to understand older adults' OHIS behaviors and better support their medical and health decisions in OHIS. Based on the results, the review proposes multiple objectives for future studies, including (1) more investigations on the OHIS behavior of older adults above 85 years; (2) conducting more longitudinal, action research, and mixed methods studies; (3) elaboration of the mobile context and cross-platform scenario of older adults' OHIS; (4) facilitating older adults' OHIS by explicating technology affordance; and (5) promoting and measuring the performance of OHIS interventions for older adults. ",
doi="10.2196/34790",
url="https://www.jmir.org/2022/2/e34790",
url="http://www.ncbi.nlm.nih.gov/pubmed/35171099"
}


@Article{info:doi/10.2196/33356,
author="Wright, A. Julie
and Volkman, E. Julie
and Leveille, G. Suzanne
and Amante, J. Daniel",
title="Predictors of Online Patient Portal Use Among a Diverse Sample of Emerging Adults: Cross-sectional Survey",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="15",
volume="6",
number="2",
pages="e33356",
keywords="internet",
keywords="patient portal",
keywords="emerging adults",
keywords="portal",
keywords="predictor",
keywords="prediction",
keywords="sample",
keywords="cross-sectional",
keywords="survey",
keywords="usage",
keywords="young adult",
keywords="eHealth",
keywords="literacy",
abstract="Background: Health self-management is increasingly being influenced by emerging health information technologies (IT), especially online patient portals. Patient portals provide patients with direct access to their health information, electronic tools to manage their health, and additional opportunities to engage with their care team. Previous studies have found that patient portal use is highest among patients with high eHealth literacy, the ability to find health information from electronic sources and apply the knowledge gained to solve a health problem. The role of eHealth literacy on patient portal use appears to be especially strong among older adults with chronic diseases. The use of patient portals among emerging adults (ages 18-29) is much less understood. Although generally healthy, emerging adults are more regular IT users and just beginning to independently navigate the health care system. A good understanding of how emerging adults are using online patient portals and what factors, including eHealth, impact portal use is lacking. Objective: The aim of this study is to describe patient portal use and explore the predictors of portal use among a diverse sample of emerging adults. Methods: A cross-sectional survey study that used convenience sampling was conducted at two universities. Data on demographics, health care encounters, eHealth literacy, patient engagement, and use of patient portal features (administrative and clinical) were obtained via self-report and summarized. Logistic regression models were used to examine factors associated with portal use. Results: Of the 340 emerging adults, 257 (76\%) were female, 223 (65\%) White, 156 (47\%) low income, and 184 (54\%) reported having patient portal access. Of those reporting access, 142 (77\%) used at least 1 portal feature and 42 (23\%) reported using none. Significant predictors were patient engagement (odds ratio [OR] 1.08, 95\% CI 1.04-1.13, P=.001) and total encounters (OR 1.23, 95\% CI 1.05-1.44, P=.009) but not eHealth literacy. Hispanic and Asian emerging adults were more likely to be frequent users of clinical portal features than White emerging adults (Hispanic: OR 2.97, 95\% CI 1.03-8.52, P=.04; Asian: OR 4.28, 95\% CI 1.08-16.89, P=.04). Conclusions: We found that about half of emerging adults had access to a patient portal. Among those with access, a majority reported using at least one portal feature. Factors associated with increased portal use included increased patient engagement and total clinical encounters. Self-reported eHealth literacy was not associated with patient portal use in this diverse sample of emerging adults. This may have been due to high overall eHealth literacy levels in this population of frequent IT users. There may also be racial/ethnic differences that are important to consider, as we found Hispanic and Asian emerging adults reported more frequent portal use than White emerging adults. Interventions to promote patient portal use among emerging adults should include strategies to increase awareness of portal access and engagement among patients with fewer clinical encounters, with a focus on preventative health management. ",
doi="10.2196/33356",
url="https://formative.jmir.org/2022/2/e33356",
url="http://www.ncbi.nlm.nih.gov/pubmed/35166686"
}


@Article{info:doi/10.2196/29541,
author="Garcia, P. Angely
and De La Vega, F. Shelley
and Mercado, P. Susan",
title="Health Information Systems for Older Persons in Select Government Tertiary Hospitals and Health Centers in the Philippines: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="14",
volume="24",
number="2",
pages="e29541",
keywords="health information systems",
keywords="the Philippines",
keywords="aged",
keywords="hospitals",
keywords="community health centers",
keywords="database",
keywords="geriatric assessment",
keywords="elderly",
keywords="digital health",
keywords="medical records",
keywords="health policy",
abstract="Background: The rapid aging of the world's population requires systems that support health facilities' provision of integrated care at multiple levels of the health care system. The use of health information systems (HISs) at the point of care has shown positive effects on clinical processes and patient health in several settings of care. Objective: We sought to describe HISs for older persons (OPs) in select government tertiary hospitals and health centers in the Philippines. Specifically, we aimed to review the existing policies and guidelines related to HISs for OPs in the country, determine the proportion of select government hospitals and health centers with existing health information specific for OPs, and describe the challenges related to HISs in select health facilities. Methods: We utilized the data derived from the findings of the Focused Interventions for Frail Older Adults Research and Development Project (FITforFrail), a cross-sectional and ethics committee--approved study. A facility-based listing of services and human resources specific to geriatric patients was conducted in purposively sampled 27 tertiary government hospitals identified as geriatric centers and 16 health centers across all regions in the Philippines. We also reviewed the existing policies and guidelines related to HISs for OPs in the country. Results: Based on the existing guidelines, multiple agencies were involved in the provision of services for OPs, with several records containing health information of OPs. However, there is no existing HIS specific for OPs in the country. Only 14 (52\%) of the 27 hospitals and 4 (25\%) of the 16 health centers conduct comprehensive geriatric assessment (CGA). All tertiary hospitals and health centers are able to maintain medical records of their patients, and almost all (26/27, 96\%) hospitals and all (16/16, 100\%) health centers have data on top causes of morbidity and mortality. Meanwhile, the presence of specific disease registries varied per hospitals and health centers. Challenges to HISs include the inability to update databases due to inadequately trained personnel, use of an offline facility--based HIS, an unstable internet connection, and technical issues and nonuniform reporting of categories for age group classification. Conclusions: Current HISs for OPs are characterized by fragmentation, multiple sources, and inaccessibility. Barriers to achieving appropriate HISs for OPs include the inability to update HISs in hospitals and health centers and a lack of standardization by age group and disease classification. Thus, we recommend a 1-person, 1-record electronic medical record system for OPs and the disaggregation and analysis across demographic and socioeconomic parameters to inform policies and programs that address the complex needs of OPs. CGA as a required routine procedure for all OPs and its integration with the existing HISs in the country are also recommended. ",
doi="10.2196/29541",
url="https://www.jmir.org/2022/2/e29541",
url="http://www.ncbi.nlm.nih.gov/pubmed/35156927"
}


@Article{info:doi/10.2196/30838,
author="Hartford, Anna
and Stein, J. Dan",
title="Attentional Harms and Digital Inequalities",
journal="JMIR Ment Health",
year="2022",
month="Feb",
day="11",
volume="9",
number="2",
pages="e30838",
keywords="digital inequalities",
keywords="attentional harms",
keywords="excessive internet use",
keywords="persuasive technologies",
keywords="internet ethics",
keywords="attention economies",
doi="10.2196/30838",
url="https://mental.jmir.org/2022/2/e30838",
url="http://www.ncbi.nlm.nih.gov/pubmed/35147504"
}


@Article{info:doi/10.2196/30941,
author="Gehtland, M. Lisa
and Paquin, S. Ryan
and Andrews, M. Sara
and Lee, M. Adam
and Gwaltney, Angela
and Duparc, Martin
and Pfaff, R. Emily
and Bailey Jr, B. Donald",
title="Using a Patient Portal to Increase Enrollment in a Newborn Screening Research Study: Observational Study",
journal="JMIR Pediatr Parent",
year="2022",
month="Feb",
day="10",
volume="5",
number="1",
pages="e30941",
keywords="electronic health records",
keywords="patient portals",
keywords="patient selection",
keywords="research subject recruitment",
keywords="race factors",
keywords="racial disparities",
abstract="Background: Many research studies fail to enroll enough research participants. Patient-facing electronic health record applications, known as patient portals, may be used to send research invitations to eligible patients. Objective: The first aim was to determine if receipt of a patient portal research recruitment invitation was associated with enrollment in a large ongoing study of newborns (Early Check). The second aim was to determine if there were differences in opening the patient portal research recruitment invitation and study enrollment by race and ethnicity, age, or rural/urban home address. Methods: We used a computable phenotype and queried the health care system's clinical data warehouse to identify women whose newborns would likely be eligible. Research recruitment invitations were sent through the women's patient portals. We conducted logistic regressions to test whether women enrolled their newborns after receipt of a patient portal invitation and whether there were differences by race and ethnicity, age, and rural/urban home address. Results: Research recruitment invitations were sent to 4510 women not yet enrolled through their patient portals between November 22, 2019, through March 5, 2020. Among women who received a patient portal invitation, 3.6\% (161/4510) enrolled their newborns within 27 days. The odds of enrolling among women who opened the invitation was nearly 9 times the odds of enrolling among women who did not open their invitation (SE 3.24, OR 8.86, 95\% CI 4.33-18.13; P<.001). On average, it took 3.92 days for women to enroll their newborn in the study, with 64\% (97/161) enrolling their newborn within 1 day of opening the invitation. There were disparities by race and urbanicity in enrollment in the study after receipt of a patient portal research invitation but not by age. Black women were less likely to enroll their newborns than White women (SE 0.09, OR 0.29, 95\% CI 0.16-0.55; P<.001), and women in urban zip codes were more likely to enroll their newborns than women in rural zip codes (SE 0.97, OR 3.03, 95\% CI 1.62-5.67; P=.001). Black women (SE 0.05, OR 0.67, 95\% CI 0.57-0.78; P<.001) and Hispanic women (SE 0.07, OR 0.73, 95\% CI 0.60-0.89; P=.002) were less likely to open the research invitation compared to White women. Conclusions: Patient portals are an effective way to recruit participants for research studies, but there are substantial racial and ethnic disparities and disparities by urban/rural status in the use of patient portals, the opening of a patient portal invitation, and enrollment in the study. Trial Registration: ClinicalTrials.gov NCT03655223; https://clinicaltrials.gov/ct2/show/NCT03655223 ",
doi="10.2196/30941",
url="https://pediatrics.jmir.org/2022/1/e30941",
url="http://www.ncbi.nlm.nih.gov/pubmed/35142618"
}


@Article{info:doi/10.2196/20702,
author="Naeem, Iffat
and Quan, Hude
and Singh, Shaminder
and Chowdhury, Nashit
and Chowdhury, Mohammad
and Saini, Vineet
and TC, Turin",
title="Factors Associated With Willingness to Share Health Information: Rapid Review",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="9",
volume="9",
number="1",
pages="e20702",
keywords="health information",
keywords="information sharing",
keywords="health data",
keywords="EMR",
keywords="PHR",
keywords="mobile phone",
abstract="Background: To expand research and strategies to prevent disease, comprehensive and real-time data are essential. Health data are increasingly available from platforms such as pharmaceuticals, genomics, health care imaging, medical procedures, wearable devices, and internet activity. Further, health data are integrated with an individual's sociodemographic information, medical conditions, genetics, treatments, and health care. Ultimately, health information generation and flow are controlled by the patient or participant; however, there is a lack of understanding about the factors that influence willingness to share health information. A synthesis of the current literature on the multifactorial nature of health information sharing preferences is required to understand health information exchange. Objective: The objectives of this review are to identify peer-reviewed literature that reported factors associated with health information sharing and to organize factors into cohesive themes and present a narrative synthesis of factors related to willingness to share health information. Methods: This review uses a rapid review methodology to gather literature regarding willingness to share health information within the context of eHealth, which includes electronic health records, personal health records, mobile health information, general health information, or information on social determinants of health. MEDLINE and Google Scholar were searched using keywords such as electronic health records AND data sharing OR sharing preference OR willingness to share. The search was limited to any population that excluded health care workers or practitioners, and the participants aged ?18 years within the US or Canadian context. The data abstraction process using thematic analysis where any factors associated with sharing health information were highlighted and coded inductively within each article. On the basis of shared meaning, the coded factors were collated into major themes. Results: A total of 26 research articles met our inclusion criteria and were included in the qualitative analysis. The inductive thematic coding process revealed multiple major themes related to sharing health information. Conclusions: This review emphasized the importance of data generators' viewpoints and the complex systems of factors that shape their decision to share health information. The themes explored in this study emphasize the importance of trust at multiple levels to develop effective information exchange partnerships. In the case of improving precision health care, addressing the factors presented here that influence willingness to share information can improve sharing capacity for individuals and allow researchers to reorient their methods to address hesitation in sharing health information. ",
doi="10.2196/20702",
url="https://humanfactors.jmir.org/2022/1/e20702",
url="http://www.ncbi.nlm.nih.gov/pubmed/35138263"
}


@Article{info:doi/10.2196/27167,
author="Yang, Rumei
and Zeng, Kai
and Jiang, Yun",
title="Prevalence, Factors, and Association of Electronic Communication Use With Patient-Perceived Quality of Care From the 2019 Health Information National Trends Survey 5-Cycle 3: Exploratory Study",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="4",
volume="24",
number="2",
pages="e27167",
keywords="electronic communication",
keywords="quality of care",
keywords="person-related characteristics",
keywords="patient preference",
keywords="HINTS",
abstract="Background: Electronic communication (e-communication), referring to communication through electronic platforms such as the web, patient portal, or mobile phone, has become increasingly important, as it extends traditional in-person communication with fewer limitations of timing and locations. However, little is known about the current status of patients' use of e-communication with clinicians and whether the use is related to the better patient-perceived quality of care at the population level. Objective: The aim of this study was to explore the prevalence of and the factors associated with e-communication use and the association of e-communication use with patient-perceived quality of care by using the nationally representative sample of the 2019 Health Information National Trends Survey 5 (HINTS 5)-Cycle 3. Methods: Data from 5438 adult responders (mean age 49.04 years, range 18-98 years) were included in this analysis. Multiple logistic and linear regressions were conducted to explore responders' personal characteristics related to their use of e-communication with clinicians in the past 12 months and how their use was related to perceived quality of care. Descriptive analyses for e-communication use according to age groups were also performed. All analyses considered the complex survey design using the jackknife replication method. Results: The overall prevalence of e-communication use was 60.3\%, with a significantly lower prevalence in older adults (16.6\%) than that in <45-year-old adults (41\%) and 45-65-year-old adults (42.4\%). All percentages are weighted; therefore, absolute values are not shown. American adults who used e-communication were more likely to be high school graduates (odds ratio [OR] 1.95, 95\% CI 1.14-3.34; P=.02), some college degree holders (OR 3.34, 95\% CI 1.84-6.05; P<.001), and college graduates or more (OR 4.89, 95\% CI 2.67-8.95; P<.001). Further, people who were females (OR 1.47, 95\% CI 1.18-1.82; P=.001), with a household income ?US \$50,000 (OR 1.63, 95\% CI 1.23-2.16; P=.001), with more comorbidities (OR 1.22, 95\% CI 1.07-1.40; P=.004), or having a regular health care provider (OR 2.62, 95\% CI 1.98-3.47; P<.001), were more likely to use e-communication. In contrast, those who resided in rural areas (OR 0.61, 95\% CI 0.43-0.88; P=.009) were less likely to use e-communication. After controlling for the sociodemographics, the number of comorbidities, and relationship factors (ie, having a regular provider and trusting a doctor), e-communication use was found to be significantly associated with better perceived quality of care ($\beta$=.12, 95\% CI 0.02-0.22; P=.02). Conclusions: This study confirmed the positive association between e-communication use and patient-perceived quality of care and suggested that policy-level attention should be raised to engage the socially disadvantaged (ie, those with lower levels of education and income, without a regular health care provider, and living in rural areas) to maximize e-communication use and to support better patient-perceived quality of care among American adults. ",
doi="10.2196/27167",
url="https://www.jmir.org/2022/2/e27167",
url="http://www.ncbi.nlm.nih.gov/pubmed/35119369"
}


@Article{info:doi/10.2196/31569,
author="Neely, Stephen
and Eldredge, Christina
and Sanders, Ronald",
title="Authors' Reply: Understanding the Impact of Social Media Information and Misinformation Producers on Health Information Seeking. Comment on ``Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study''",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="4",
volume="24",
number="2",
pages="e31569",
keywords="social media",
keywords="internet",
keywords="communication",
keywords="public health",
keywords="COVID-19",
keywords="usage",
keywords="United States",
keywords="information seeking",
keywords="web-based health information",
keywords="online health information",
keywords="survey",
keywords="mistrust",
keywords="vaccination",
keywords="misinformation",
doi="10.2196/31569",
url="https://www.jmir.org/2022/2/e31569",
url="http://www.ncbi.nlm.nih.gov/pubmed/35119376"
}


@Article{info:doi/10.2196/31415,
author="Boudreau, Hunter
and Singh, Nikhi
and Boyd, J. Carter",
title="Understanding the Impact of Social Media Information and Misinformation Producers on Health Information Seeking. Comment on ``Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study''",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="4",
volume="24",
number="2",
pages="e31415",
keywords="social media",
keywords="internet",
keywords="communication",
keywords="public health",
keywords="COVID-19",
keywords="usage",
keywords="United States",
keywords="information seeking",
keywords="web-based health information",
keywords="online health information",
keywords="survey",
keywords="mistrust",
keywords="vaccination",
keywords="misinformation",
doi="10.2196/31415",
url="https://www.jmir.org/2022/2/e31415",
url="http://www.ncbi.nlm.nih.gov/pubmed/35076408"
}


@Article{info:doi/10.2196/30040,
author="Chukwu, Emeka
and Garg, Lalit
and Foday, Edward
and Konomanyi, Abdul
and Wright, Royston
and Smart, Francis",
title="Electricity, Computing Hardware, and Internet Infrastructures in Health Facilities in Sierra Leone: Field Mapping Study",
journal="JMIR Med Inform",
year="2022",
month="Feb",
day="3",
volume="10",
number="2",
pages="e30040",
keywords="digital health",
keywords="mHealth",
keywords="eHealth infrastructure",
keywords="health ICT",
keywords="SpaceX",
keywords="connectivity",
keywords="Sierra Leone",
keywords="rural-urban divide",
keywords="rural areas",
keywords="internet",
abstract="Background: Years of health information system investment in many countries have facilitated service delivery, surveillance, reporting, and monitoring. Electricity, computing hardware, and internet networks are vital for health facility--based information systems. Availability of these infrastructures at health facilities is crucial for achieving national digital health visions. Objective: The aim of this study was to gain insight into the state of computing hardware, electricity, and connectivity infrastructure at health facilities in Sierra Leone using a representative sample. Methods: Stratified sampling of 72 (out of 1284) health facilities distributed in all districts of Sierra Leone was performed, factoring in the rural-urban divide, digital health activity, health facility type, and health facility ownership. Enumerators visited each health facility over a 2-week period. Results: Among the 72 surveyed health facilities, 59 (82\%) do not have institutionally provided internet. Among the 15 Maternal and Child Health Posts, as a type of primary health care unit (PHU), 9 (60\%) use solar energy as their only electricity source and the other 6 (40\%) have no electricity source. Similarly, among the 13 hospitals, 5 (38\%) use a generator as a primary electricity source. All hospitals have at least one functional computer, although only 7 of the 13 hospitals have four or more functional computers. Similarly, only 2 of the 59 (3\%) PHUs have one computer each, and 37 (63\%) of the PHUs have one tablet device each. We consider this health care computing infrastructure mapping to be representative with a 95\% confidence level within an 11\% margin of error. Two-thirds of the PHUs have only alternate solar electricity, only 10 of the 72 surveyed health facilities have functional official internet, and most use suboptimal computing hardware. Overall, 43\% of the surveyed health facilities believe that inadequate electricity is the biggest threat to digitization. Similarly, 16 (22\%) of the 72 respondents stated that device theft is a primary hindrance to digitization. Conclusions: Electricity provision for off-electricity-grid health facilities using alternative and renewable energy sources is emerging. The current trend where GSM (Global System for Mobile Communication) service providers provide the internet to all health facilities may change to other promising alternatives. This study provides evidence of the critical infrastructure gaps in health facilities in Sierra Leone. ",
doi="10.2196/30040",
url="https://medinform.jmir.org/2022/2/e30040",
url="http://www.ncbi.nlm.nih.gov/pubmed/35113026"
}


@Article{info:doi/10.2196/34702,
author="Weatherburn, Christopher",
title="Digital Inclusion as a Foundation for Health Equity. Comment on ``Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study''",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="3",
volume="24",
number="2",
pages="e34702",
keywords="technology-enabled care",
keywords="video consultations",
keywords="quality improvement",
keywords="COVID-19",
keywords="PERCS framework",
keywords="remote consultation",
keywords="Scotland",
keywords="general practice",
keywords="digital inclusion",
keywords="digital divide",
keywords="digital health equity",
doi="10.2196/34702",
url="https://www.jmir.org/2022/2/e34702",
url="http://www.ncbi.nlm.nih.gov/pubmed/35038303"
}


@Article{info:doi/10.2196/28252,
author="Marsall, Matthias
and Engelmann, Gerrit
and Skoda, Eva-Maria
and Teufel, Martin
and B{\"a}uerle, Alexander",
title="Measuring Electronic Health Literacy: Development, Validation, and Test of Measurement Invariance of a Revised German Version of the eHealth Literacy Scale",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="2",
volume="24",
number="2",
pages="e28252",
keywords="eHealth",
keywords="eHeals",
keywords="health literacy",
keywords="factor analysis",
keywords="validation",
keywords="measurement invariance",
keywords="internet",
keywords="health information",
abstract="Background: The World Wide Web has become an essential source of health information. Nevertheless, the amount and quality of information provided may lead to information overload. Therefore, people need certain skills to search for, identify, and evaluate information from the internet. In the context of health information, these competencies are summarized as the construct of eHealth literacy. Previous research has highlighted the relevance of eHealth literacy in terms of health-related outcomes. However, the existing instrument assessing eHealth literacy in the German language reveals methodological limitations regarding test development and validation. The development and validation of a revised scale for this important construct is highly relevant. Objective: The objective of this study was the development and validation of a revised German eHealth literacy scale. In particular, this study aimed to focus on high methodological and psychometric standards to provide a valid and reliable instrument for measuring eHealth literacy in the German language. Methods: Two internationally validated instruments were merged to cover a wide scope of the construct of eHealth literacy and create a revised eHealth literacy scale. Translation into the German language followed scientific guidelines and recommendations to ensure content validity. Data from German-speaking people (n=470) were collected in a convenience sample from October to November 2020. Validation was performed by factor analyses. Further, correlations were performed to examine convergent, discriminant, and criterion validity. Additionally, analyses of measurement invariance of gender, age, and educational level were conducted. Results: Analyses revealed a 2-factorial model of eHealth literacy. By item-reduction, the 2 factors information seeking and information appraisal were measured with 8 items reaching acceptable-to-good model fits (comparative fit index [CFI]: 0.942, Tucker Lewis index [TLI]: 0.915, root mean square error of approximation [RMSEA]: 0.127, and standardized root mean square residual [SRMR]: 0.055). Convergent validity was comprehensively confirmed by significant correlations of information seeking and information appraisal with health literacy, internet confidence, and internet anxiety. Discriminant and criterion validity were examined by correlation analyses with various scales and could partly be confirmed. Scalar level of measurement invariance for gender (CFI: 0.932, TLI: 0.923, RMSEA: 0.122, and SRMR: 0.068) and educational level (CFI: 0.937, TLI: 0.934, RMSEA: 0.112, and SRMR: 0.063) were confirmed. Measurement invariance of age was rejected. Conclusions: Following scientific guidelines for translation and test validation, we developed a revised German eHealth Literacy Scale (GR-eHEALS). Our factor analyses confirmed an acceptable-to-good model fit. Construct validation in terms of convergent, discriminant, and criterion validity could mainly be confirmed. Our findings provide evidence for measurement invariance of the instrument regarding gender and educational level. The newly revised GR-eHEALS questionnaire represents a valid instrument to measure the important health-related construct eHealth literacy. ",
doi="10.2196/28252",
url="https://www.jmir.org/2022/2/e28252",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107437"
}


@Article{info:doi/10.2196/32112,
author="Agachi, Elena
and Bijmolt, A. Tammo H.
and Mierau, O. Jochen
and van Ittersum, Koert",
title="Adoption of the Website and Mobile App of a Preventive Health Program Across Neighborhoods With Different Socioeconomic Conditions in the Netherlands: Longitudinal Study",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="2",
volume="9",
number="1",
pages="e32112",
keywords="eHealth",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="internet",
keywords="preventive health program",
keywords="health disparities",
keywords="NSES",
keywords="program adoption",
keywords="survival analysis",
abstract="Background: Socioeconomic disparities in the adoption of preventive health programs represent a well-known challenge, with programs delivered via the web serving as a potential solution. The preventive health program examined in this study is a large-scale, open-access web-based platform operating in the Netherlands, which aims to improve the health behaviors and wellness of its participants. Objective: This study aims to examine the differences in the adoption of the website and mobile app of a web-based preventive health program across socioeconomic groups. Methods: The 83,466 participants in this longitudinal, nonexperimental study were individuals who had signed up for the health program between July 2012 and September 2019. The rate of program adoption per delivery means was estimated using the Prentice, Williams, and Peterson Gap--Time model, with the measure of neighborhood socioeconomic status (NSES) used to distinguish between population segments with different socioeconomic characteristics. Registration to the health program was voluntary and free, and not within a controlled study setting, allowing the observation of the true rate of adoption. Results: The estimation results indicate that program adoption across socioeconomic groups varies depending on the program's delivery means. For the website, higher NSES groups have a higher likelihood of program adoption compared with the lowest NSES group (hazard ratio 1.03, 95\% CI 1.01-1.05). For the mobile app, the opposite holds: higher NSES groups have a lower likelihood of program adoption compared with the lowest NSES group (hazard ratio 0.94, 95\% CI 0.91-0.97). Conclusions: Promoting preventive health programs using mobile apps can help to increase program adoption among the lowest socioeconomic segments. Given the increasing use of mobile phones among disadvantaged population groups, structuring future health interventions to include mobile apps as means of delivery can support the stride toward diminishing health disparities. ",
doi="10.2196/32112",
url="https://humanfactors.jmir.org/2022/1/e32112",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107433"
}


@Article{info:doi/10.2196/27355,
author="Hu, Lu
and Trinh-Shevrin, Chau
and Islam, Nadia
and Wu, Bei
and Cao, Shimin
and Freeman, Jincong
and Sevick, Ann Mary",
title="Mobile Device Ownership, Current Use, and Interest in Mobile Health Interventions Among Low-Income Older Chinese Immigrants With Type 2 Diabetes: Cross-sectional Survey Study",
journal="JMIR Aging",
year="2022",
month="Feb",
day="2",
volume="5",
number="1",
pages="e27355",
keywords="technology use",
keywords="Chinese immigrants",
keywords="type 2 diabetes",
keywords="mHealth",
keywords="health disparities",
keywords="immigrant health",
keywords="diabetes",
keywords="mobile health",
keywords="intervention",
keywords="smartphone",
keywords="immigrant",
abstract="Background: Chinese immigrants suffer a disproportionately high type 2 diabetes (T2D) burden and tend to have poorly controlled disease. Mobile health (mHealth) interventions have been shown to increase access to care and improve chronic disease management in minority populations. However, such interventions have not been developed for or tested in Chinese immigrants with T2D. Objective: This study aims to examine mobile device ownership, current use, and interest in mHealth interventions among Chinese immigrants with T2D. Methods: In a cross-sectional survey, Chinese immigrants with T2D were recruited from Chinese community centers in New York City. Sociodemographic characteristics, mobile device ownership, current use of social media software applications, current use of technology for health-related purposes, and interest in using mHealth for T2D management were assessed. Surveys were administered face-to-face by bilingual study staff in the participant's preferred language. Descriptive statistics were used to characterize the study sample and summarize technology use. Results: The sample (N=91) was predominantly female (n=57, 63\%), married (n=68, 75\%), and had a high school education or less (n=58, 64\%); most participants had an annual household income of less than US \$25,000 (n=63, 69\%) and had limited English proficiency (n=78, 86\%). The sample had a mean age of 70 (SD 11) years. Almost all (90/91, 99\%) participants had a mobile device (eg, basic cell phones, smart devices), and the majority (n=83, 91\%) reported owning a smart device (eg, smartphone or tablet). WeChat was the most commonly used social media platform (65/91, 71\%). When asked about their top source for diabetes-related information, 63 of the 91 participants (69\%) reported health care providers, followed by 13 who reported the internet (14\%), and 10 who reported family, friends, and coworkers (11\%). Less than one-quarter (21/91, 23\%) of the sample reported using the internet to search for diabetes-related information in the past 12 months. About one-third of the sample (34/91, 37\%) reported that they had watched a health-related video on their cell phone or computer in the past 12 months. The majority (69/91, 76\%) of participants reported interest in receiving an mHealth intervention in the future to help with T2D management. Conclusions: Despite high mobile device ownership, the current use of technology for health-related issues remained low in older Chinese immigrants with T2D. Given the strong interest in future mHealth interventions and high levels of social media use (eg, WeChat), future studies should consider how to leverage these existing low-cost platforms and deliver tailored mHealth interventions to this fast-growing minority group. ",
doi="10.2196/27355",
url="https://aging.jmir.org/2022/1/e27355",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107426"
}


@Article{info:doi/10.2196/26308,
author="Wang, Zhuoxin
and Fan, Yanyan
and Lv, Hekai
and Deng, Shanshan
and Xie, Hui
and Zhang, Li
and Luo, Aijing
and Wang, Fuzhi",
title="The Gap Between Self-Rated Health Information Literacy and Internet Health Information-Seeking Ability for Patients With Chronic Diseases in Rural Communities: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="31",
volume="24",
number="1",
pages="e26308",
keywords="online",
keywords="health information",
keywords="barriers to acquisition",
keywords="middle-aged patients with chronic diseases",
keywords="rural community",
keywords="chronic conditions",
keywords="chronic",
keywords="rural",
keywords="literacy",
keywords="information seeking",
abstract="Background: The internet has become one of the most important channels for residents to seek health information, particularly in remote rural areas in China. Objective: In this study, we aimed to explore the gap between self-rated health information literacy and internet health information seeking ability for patients with chronic diseases in rural communities and to preliminarily evaluate their barriers when seeking health information via the internet. Methods: Residents from rural communities near Bengbu City and with chronic diseases were included in this study. A self-rated questionnaire was used to evaluate their health information literacy, 3 behavioral competency tasks were designed to preliminarily evaluate their ability to seek health information on the internet and semistructured interviews were used to investigate their barriers to obtaining health information via the internet. A small audiorecorder was used to record the interview content, and screen-recording software was used to record the participants' behavior during the web-based operational tasks. Results: A total of 70 respondents completed the self-rated health information literacy questionnaire and the behavioral competence test, and 56 respondents participated in the semistructured interviews. Self-rated health information literacy (score out of 70: mean 46.21, SD 4.90) of the 70 respondents were moderate. Although 91\% (64/70) of the respondents could find health websites, and 93\% (65/70) of the respondents could find information on treatment that they thought was the best, 35\% (23/65) of respondents did not know how to save the results they had found. The operational tasks indicated that most articles selected by the respondents came from websites with encyclopedic knowledge or answers from people based on their own experiences rather than authoritative health information websites. After combining the results of the semistructured interviews with the DISCERN scale test results, we found that most interviewees had difficulty obtaining high-quality health information via the internet. Conclusions: Although the health information literacy level of patients with rural chronic disease was moderate, they lack the ability to access high-quality health information via the internet. The vast majority of respondents recognized the importance of accessing health information but were not very proactive in accessing such information. ",
doi="10.2196/26308",
url="https://www.jmir.org/2022/1/e26308",
url="http://www.ncbi.nlm.nih.gov/pubmed/35099401"
}


@Article{info:doi/10.2196/32764,
author="Wray, Charlie
and Tang, Janet
and Byers, Amy
and Keyhani, Salomeh",
title="Digital Health Skillsets and Digital Preparedness: Comparison of Veterans Health Administration Users and Other Veterans Nationally",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="28",
volume="6",
number="1",
pages="e32764",
keywords="digital health literacy",
keywords="Veterans Health Administration",
keywords="health care",
keywords="telemedicine",
keywords="veterans",
keywords="digital tools",
keywords="social risk factors",
keywords="digital uptake",
abstract="Background: As health care systems shift to greater use of telemedicine and digital tools, an individual's digital health literacy has become an important skillset. The Veterans Health Administration (VA) has invested resources in providing digital health care; however, to date, no study has compared the digital health skills and preparedness of veterans receiving care in the VA to veterans receiving care outside the VA. Objective: The goal of the research was to describe digital health skills and preparedness among veterans who receive care within and outside the VA health care system and examine whether receiving care in the VA is associated with digital preparedness (reporting more than 2 digital health skills) after accounting for demographic and social risk factors. Methods: We used cross-sectional data from the 2016-2018 National Health Interview Survey to identify veterans (aged over 18 years) who obtain health care either within or outside the VA health care system. We used multivariable logistic regression models to examine the association of sociodemographic (age, sex, race, ethnicity), social risk factors (economic instability, disadvantaged neighborhood, low educational attainment, and social isolation), and health care delivery location (VA and non-VA) with digital preparedness. Results: Those who received health care within the VA health care system (n=3188) were younger (age 18-49 years: 33.3\% [95\% CI 30.7-36.0] vs 24.2\% [95\% CI 21.9-26.5], P<.01), were more often female (34.7\% [95\% CI 32.0-37.3] vs 6.6\% [95\% CI 5.5-7.6], P<.01) and identified as Black (13.1\% [95\% CI 11.2-15.0] vs 10.2\% [95\% CI 8.7-11.8], P<.01), and reported greater economic instability (8.3\% [95\% CI 6.9-9.8] vs 5.5\% [95\% CI 4.6-6.5], P<.01) and social isolation (42.6\% [95\% CI 40.3-44.9] vs 35.4\% [95\% CI 33.4-37.5], P<.01) compared to veterans who received care outside the VA (n=3393). Veterans who obtained care within the VA reported more digital health skills than those who obtained care outside the VA, endorsing greater rates of looking up health information on the internet (51.8\% [95\% CI 49.2-54.4] vs 45.0\% [95\% CI 42.6-47.3], P<.01), filling a prescription using the internet (16.2\% [95\% CI 14.5-18.0] vs 11.3\% [95\% CI 9.6-13.0], P<.01), scheduling a health care appointment on the internet (14.1\% [95\% CI 12.4-15.8] vs 11.6\% [95\% CI 10.1-13.1], P=.02), and communicating with a health care provider by email (18.0\% [95\% CI 16.1-19.8] vs 13.3\% [95\% CI 11.6-14.9], P<.01). Following adjustment for sociodemographic and social risk factors, receiving health care from the VA was the only characteristic associated with higher odds (adjusted odds ratio [aOR] 1.36, 95\% CI 1.12-1.65) of being digitally prepared. Conclusions: Despite these demographic disadvantages to digital uptake, veterans who receive care in the VA reported more digital health skills and appear more digitally prepared than veterans who do not receive care within the VA, suggesting a positive, system-level influence on this cohort. ",
doi="10.2196/32764",
url="https://formative.jmir.org/2022/1/e32764",
url="http://www.ncbi.nlm.nih.gov/pubmed/35089147"
}


@Article{info:doi/10.2196/27719,
author="Moreno, Megan
and Riddle, Karyn
and Jenkins, C. Marina
and Singh, Paul Ajay
and Zhao, Qianqian
and Eickhoff, Jens",
title="Measuring Problematic Internet Use, Internet Gaming Disorder, and Social Media Addiction in Young Adults: Cross-sectional Survey Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Jan",
day="27",
volume="8",
number="1",
pages="e27719",
keywords="technology",
keywords="young adults",
keywords="addiction",
keywords="social media",
keywords="internet",
keywords="video games",
keywords="screening",
keywords="surveillance",
keywords="cross-sectional",
keywords="survey",
keywords="mobile phone",
abstract="Background: Digital technology use is nearly ubiquitous among young adults; this use provides both benefits and risks. The risks of technology use include maladaptive technology use or technology addiction. Several conceptualizations of these addictions have emerged, each with its own assessment tools. These conditions include problematic internet use (PIU), internet gaming disorder (IGD), and social media addiction (SMA). These conditions have been associated with health outcomes such as problematic alcohol use, sleep disorders, and mental illness. These maladaptive technology conditions have been most commonly studied in isolation from each other. Objective: The aim of this study is to examine PIU, IGD, and SMA together to better inform future research approaches and provider screening practices for young adults. Methods: This cross-sectional survey study was conducted using Qualtrics panel-based recruitment and survey hosting. We recruited US young adults aged 18-25 years. The survey assessed PIU, IGD, and SMA. Survey measures also included assessments of problematic alcohol use, sleep, depression, and anxiety. We evaluated the frequency of and overlap in positive screening scores among PIU, IGD, and SMA and modeled each condition using multivariate logistic regression. Finally, we calculated sensitivity and specificity, as well as the positive predictive value and negative predictive value of the screening tools using the most prevalent maladaptive technology type. Results: Our 6000 participants had an average age of 21.7 (SD 2.5) years. Of these 6000 participants, 3062 (51.03\%) were female, 3431 (57.18\%) were Caucasian, 1686 (28.1\%) were in a 4-year college program, and 2319 (38.65\%) worked full time. The mean PIU score was 3.5 (SD 3.1), and 53.58\% (3215/6000) of participants met the criteria for PIU. The mean IGD score was 2.7 (SD 2.6), and 24.33\% (1460/6000) of participants met the criteria for IGD. The mean SMA score was 7.5 (SD 5.7), and 3.42\% (205/6000) met the criteria for SMA. Across all 3 maladaptive technology use diagnoses, there were varied associations with demographic variables and similar overlap with health outcomes. The sensitivity of PIU screening to detect IGD was 82\% and to detect SMA was 93\%, whereas the specificity and positive predictive value were much lower (37\%-54\% specificity; 6\%-37\% positive predictive value). Conclusions: This cross-sectional survey screened a large national sample of adolescents and young adults for PIU, IGD, and SMA to determine prevalence and overlap, demographic associations with each, and associations between these technology-related conditions and health outcomes. There was overlap across PIU, IGD, and SMA in some associated demographic variables and health outcomes. However, the patterns in the associated variables demonstrated unique qualities of each of these conditions. ",
doi="10.2196/27719",
url="https://publichealth.jmir.org/2022/1/e27719",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081596"
}


@Article{info:doi/10.2196/33361,
author="Kim, William
and Sivesind, Torunn",
title="Patient Perceptions of Dermatologic Photography: Scoping Review",
journal="JMIR Dermatol",
year="2022",
month="Jan",
day="26",
volume="5",
number="1",
pages="e33361",
keywords="patient perceptions",
keywords="patient perspectives",
keywords="medical photography",
keywords="clinical photography",
keywords="dermatology",
keywords="skin disease",
keywords="dermatologic photography",
keywords="medical images",
keywords="skin of color",
keywords="SOC",
abstract="Background: Medical photography is used extensively in dermatology to record disease progression, measure treatment response, and help teach patients about skin disease; such photos are also commonly utilized in teledermatology, medical education, research, and medical reference websites. Understanding patient perceptions of medical photographs obtained during dermatologic care in the clinic or hospital setting is critical to enable the delivery of high-quality, patient-centered medical care. Objective: The aims of this study were to elucidate patient perceptions of skin photos in dermatology and to explore possible next steps in improving the patient experience with medical photography in the hospital or clinic setting. Methods: A scoping review of the literature was performed using the PubMed database, with clinic- or hospital-based full-text publications in English spanning the last 10 years considered for inclusion. Results: The majority of included studies (10/11, 91\%) found positive patient attitudes toward medical photographs. The majority of patients (1197/1511, 79.2\%) felt that medical photographs could improve medical care in the clinic setting. Written consent detailing all photo uses, including secondary uses (such as research or teaching), was preferred, apart from in 1 study. Patients preferred or found it acceptable for the photographer of their medical photos to be a physician (1301/1444, 90.1\%). Clinic-owned cameras with departmental record storage were the preferred modality. Latinx and African American patients expressed less trust in the utility of medical photographs to improve care, compared with Asian and White patients. The minimal number of available publications on this topic and the inclusion of articles older than 5 years are limitations, since patient perceptions of medical photography may have rapidly changed during this time span, particularly in light of the COVID-19 pandemic and the subsequent increase in teledermatology visits. Conclusions: Patients reported positive perceptions of dermatologic photography for improving their medical care. Ethnic disparities in patient perceptions require further exploration to better elucidate nuances and develop interventions to improve the experience of marginalized patients. Building patient trust in nonphysician photographers may enhance clinic efficiency. Although clinic-owned cameras are well-accepted by patients, improved patient education surrounding the safety of electronic medical record phone applications is needed. ",
doi="10.2196/33361",
url="https://derma.jmir.org/2022/1/e33361",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632867"
}


@Article{info:doi/10.2196/34616,
author="Lama, Yuki
and Davidoff, J. Amy
and Vanderpool, C. Robin
and Jensen, E. Roxanne",
title="Telehealth Availability and Use of Related Technologies Among Medicare-Enrolled Cancer Survivors: Cross-sectional Findings From the Onset of the COVID-19 Pandemic",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="25",
volume="24",
number="1",
pages="e34616",
keywords="cancer survivor",
keywords="Medicare",
keywords="telehealth",
keywords="COVID-19",
keywords="availability",
keywords="use",
keywords="elderly",
keywords="older adults",
keywords="cancer",
keywords="sociodemographic",
keywords="internet",
keywords="communication",
keywords="population",
keywords="access",
abstract="Background: There has been rapid integration of telehealth into care delivery during the COVID-19 pandemic. However, little is known about technology ownership, internet access and use for communication, and telehealth availability among cancer survivors, particularly those enrolled in Medicare. Objective: This study aims to identify sociodemographic associations with technology ownership, internet access and use for communication, and telehealth availability in a population-based sample of Medicare-enrolled cancer survivors. Methods: Data are from the Medicare Current Beneficiary Survey COVID-19 Summer 2020 Supplement administered between June 10 and July 15, 2020. Analyses were restricted to beneficiaries who reported a prior (nonskin) cancer diagnosis and a usual source of care (N=2044). Dichotomous outcomes included technology ownership, internet access, internet use for communication, and telehealth availability from providers. Sociodemographic correlates included sex, age, race/ethnicity, Medicare/Medicaid dual enrollment, rurality, census region, and self-reported comorbidities. Results: Over half (957/2044, 53\%) of cancer survivors reported using the internet for communication purposes, and 62\% (1218/2044) reported that their usual provider had telehealth services available. Using the internet for communication purposes was reported less frequently for rural compared to urban survivors (adjusted probability of 28\% vs 46\%; P<.001) and for Hispanic and Black survivors compared to non-Hispanic White survivors (29\%, 31\%, and 44\%, respectively; all P<.01). Rural survivors reported lower telehealth availability (53\% vs 63\%; P<.001); no significant differences in telehealth availability were identified by race/ethnicity. Conclusions: During the COVID-19 pandemic, study findings highlight a complex digital divide among Medicare beneficiaries with a history of cancer related to device ownership necessary for telehealth, internet access and use for communication, and reports of providers having telehealth available. Multilevel approaches are needed to increase equitable telehealth availability and use for cancer survivors. Suggested strategies include increasing broadband internet access to providers and patients in at-risk communities, supporting telehealth implementation among providers that serve populations with known health disparities, raising awareness of providers' available telehealth services among patients, and screening for technology use and provision of telehealth-related technical assistance among older and historically underserved cancer survivors. ",
doi="10.2196/34616",
url="https://www.jmir.org/2022/1/e34616",
url="http://www.ncbi.nlm.nih.gov/pubmed/34978531"
}


@Article{info:doi/10.2196/33188,
author="Eze, E. Chinwe
and West, T. Brady
and Dorsch, P. Michael
and Coe, B. Antoinette
and Lester, A. Corey
and Buis, R. Lorraine
and Farris, Karen",
title="Predictors of Smartphone and Tablet Use Among Patients With Hypertension: Secondary Analysis of Health Information National Trends Survey Data",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="24",
volume="24",
number="1",
pages="e33188",
keywords="hypertension",
keywords="mHealth",
keywords="remote monitoring",
keywords="telemonitoring",
keywords="smartphones",
keywords="tablets",
keywords="text messaging",
keywords="Health Information National Trends Survey",
keywords="mobile health",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Uncontrolled hypertension leads to significant morbidity and mortality. The use of mobile health technology, such as smartphones, for remote blood pressure (BP) monitoring has improved BP control. An increase in BP control is more significant when patients can remotely communicate with their health care providers through technologies and receive feedback. Little is known about the predictors of remote BP monitoring among hypertensive populations. Objective: The objective of this study is to quantify the predictors of smartphone and tablet use in achieving health goals and communicating with health care providers via SMS text messaging among hypertensive patients in the United States. Methods: This study was a cross-sectional, secondary analysis of the 2017 and 2018 Health Information National Trends Survey 5, cycles 1 and 2 data. A total of 3045 respondents answered ``Yes'' to the question ``Has a doctor or other healthcare provider ever told you that you had high blood pressure or hypertension?'', which defined the subpopulation used in this study. We applied the Health Information National Trends Survey full sample weight to calculate the population estimates and 50 replicate weights to calculate the SEs of the estimates. We used design-adjusted descriptive statistics to describe the characteristics of respondents who are hypertensive based on relevant survey items. Design-adjusted multivariable logistic regression models were fitted to estimate predictors of achieving health goals with the help of smartphone or tablet and sending or receiving an SMS text message to or from a health care provider in the last 12 months. Results: An estimated 36.9\%, SE 0.9\% (183,285,150/497,278,883) of the weighted adult population in the United States had hypertension. The mean age of the hypertensive population was 58.3 (SE 0.48) years. Electronic communication with the doctor or doctor's office through email or internet (odds ratio 2.93, 95\% CI 1.85-4.63; P<.001) and having a wellness app (odds ratio 1.82, 95\% CI 1.16-2.86; P=.02) were significant predictors of using SMS text message communication with a health care professional, adjusting for other demographic and technology-related variables. The odds of achieving health-related goals with the help of a tablet or smartphone declined significantly with older age (P<.001) and ownership of basic cellphones (P=.04). However, they increased significantly with being a woman (P=.045) or with being married (P=.03), having a wellness app (P<.001), using devices other than smartphones or tablets to monitor health (P=.008), making health treatment decisions (P=.048), and discussing with a provider (P=.02) with the help of a tablet or smartphone. Conclusions: Intervention measures accounting for age, gender, marital status, and the patient's technology-related health behaviors are required to increase smartphone and tablet use in self-care and SMS text message communication with health care providers. ",
doi="10.2196/33188",
url="https://www.jmir.org/2022/1/e33188",
url="http://www.ncbi.nlm.nih.gov/pubmed/35072647"
}


@Article{info:doi/10.2196/25760,
author="Yu, Xinyue
and Mu, Aruhan
and Wu, Xiang
and Zhou, Liqin",
title="Impact of Internet Use on Cognitive Decline in Middle-Aged and Older Adults in China: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="24",
volume="24",
number="1",
pages="e25760",
keywords="internet use",
keywords="cognitive decline",
keywords="China",
keywords="fixed-effects analysis",
abstract="Background: Given that cognitive decline lacks effective treatment options and has severe implications for healthy aging, internet use may achieve nonpharmacological relief of cognitive decline through cognitive stimulation and social engagement. Objective: This longitudinal study aimed to investigate the relationship between the diversity, frequency, and type of internet use and cognitive decline, and to provide theoretical support and suggestions for mitigating cognitive decline in middle-aged and older adults. Methods: Data were obtained from a total of 10,532 survey respondents from the China Family Panel Studies database from wave 3 (2014) and wave 5 (2018) of the survey. Cognitive function was measured using vocabulary tests, and internet use was categorized into five aspects: study, work, socializing, entertainment, and commercial-related activities. Associations between the diversity, frequency, and type of internet use and cognitive decline were estimated by controlling for demographic variables and health status risk factors through fixed-effects models. Results: After controlling for demographic and health status risk factors, the type and frequency of internet use were found to be associated with cognitive functioning during the subsequent 4-year period, and different types of internet use had different effects on cognitive decline. Frequency of internet use of at least once a week for study ($\beta$=0.620, 95\% CI 0.061 to 1.180; P=.04), work ($\beta$=0.896, 95\% CI 0.271 to 1.520; P=.01), and entertainment ($\beta$=0.385, 95\% CI --0.008 to 0.778; P=.06), as well as less than once a week for social purposes ($\beta$=0.860, 95\% CI 0.074 to 1.650; P=.06), were associated with better cognitive function. Frequency of internet use of less than once a week for commercial-related activities ($\beta$=--0.906, 95\% CI --1.480 to --0.337; P=.005) was associated with poorer cognitive function. Using the internet for more than one type of activity ($\beta$=0.458, 95\% CI 0.065 to 0.850; P=.03) and at least once a week ($\beta$=0.436, 95\% CI 0.066 to 0.806; P=.02) was associated with better cognitive function. Conclusions: This study shows that breadth and depth of internet use are positively associated with cognitive function and that different types of internet use have different roles in cognitive decline. The importance of the internet as a nonpharmacological intervention pathway for cognitive decline is emphasized. Future research could explore specific mechanisms of influence. ",
doi="10.2196/25760",
url="https://www.jmir.org/2022/1/e25760",
url="http://www.ncbi.nlm.nih.gov/pubmed/35072642"
}


@Article{info:doi/10.2196/32855,
author="Chen, Yu-Chi
and Cheng, Christina
and Osborne, H. Richard
and Kayser, Lars
and Liu, Chieh-Yu
and Chang, Li-Chun",
title="Validity Testing and Cultural Adaptation of the eHealth Literacy Questionnaire (eHLQ) Among People With Chronic Diseases in Taiwan: Mixed Methods Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="19",
volume="24",
number="1",
pages="e32855",
keywords="chronic illness",
keywords="eHealth literacy questionnaire",
keywords="eHLQ",
keywords="validation",
keywords="cultural adaptation",
keywords="eHealth",
abstract="Background: Advancements in digital technologies seek to promote health and access to services. However, people lacking abilities and confidence to use technology are likely to be left behind, leading to health disparities. In providing digital health services, health care providers need to be aware of users' diverse electronic health (eHealth) literacy to address their particular needs and ensure equitable uptake and use of digital services. To understand such needs, an instrument that captures users' knowledge, skills, trust, motivation, and experiences in relation to technology is required. The eHealth Literacy Questionnaire (eHLQ) is a multidimensional tool with 7 scales covering diverse dimensions of eHealth literacy. The tool was simultaneously developed in English and Danish using a grounded and validity-driven approach and has been shown to have strong psychometric properties. Objective: This study aims to translate and culturally adapt the eHLQ for application among Mandarin-speaking people with chronic diseases in Taiwan and then undertake a rigorous set of validity-testing procedures. Methods: The cross-cultural adaptation of the eHLQ included translation and evaluation of the translations. The measurement properties were assessed using classical test theory and item response theory (IRT) approaches. Content validity, known-group validity, and internal consistency were explored, as well as item characteristic curves (ICCs), item discrimination, and item location/difficulty. Results: The adapted version was reviewed, and a recommended forward translation was confirmed through consensus. The tool exhibited good content validity. A total of 420 people with 1 or more chronic diseases participated in a validity-testing survey. The eHLQ showed good internal consistency (Cronbach $\alpha$=.75-.95). For known-group validity, all 7 eHLQ scales showed strong associations with education. Unidimensionality and local independence assumptions were met except for scale 2. IRT analysis showed that all items demonstrated good discrimination (range 0.27-12.15) and a good range of difficulty (range 0.59-1.67) except for 2 items in scale 7. Conclusions: Using a rigorous process, the eHLQ was translated from English into a culturally appropriate tool for use in the Mandarin language. Validity testing provided evidence of satisfactory-to-strong psychometric properties of the eHLQ. The 7 scales are likely to be useful research tools for evaluating digital health interventions and for informing the development of health technology products and interventions that equitably suit diverse users' needs. ",
doi="10.2196/32855",
url="https://www.jmir.org/2022/1/e32855",
url="http://www.ncbi.nlm.nih.gov/pubmed/35044310"
}


@Article{info:doi/10.2196/23656,
author="Lim, C. Megan S.
and Molenaar, Annika
and Brennan, Linda
and Reid, Mike
and McCaffrey, Tracy",
title="Young Adults' Use of Different Social Media Platforms for Health Information: Insights From Web-Based Conversations",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="18",
volume="24",
number="1",
pages="e23656",
keywords="social media",
keywords="Facebook",
keywords="Instagram",
keywords="YouTube",
keywords="health information",
keywords="health communication",
keywords="young adults",
abstract="Background: Social media--delivered health promotion has demonstrated limited uptake and effectiveness among young adults. Understanding how young adults interact with existing social media platforms for health might provide insight for future health promotion interventions. Objective: The aim of this study is to describe how young adults interact with different social media platforms for health and health information. Methods: We used a web-based conversation methodology to collect data from 165 young adults aged 18 to 24 years. Participants participated in an extended conversation with moderators and other participants about health and social media. They were prompted to discuss how they find health information, how they use different social media platforms, and how they evaluate the trustworthiness of information. A thematic qualitative analysis was applied to the data. Results: Young adults spent a lot of time scrolling through Facebook newsfeeds, which often resulted in seeing health-related content either from their friends, news sources, or advertisements. Some actively sought out information about specific health areas by joining groups or following relevant pages. YouTube was considered a useful source for learning about everything and was often the go-to when searching for information or advice (after Google). Young adults found the video format easy to learn from. They stated that they could identify accurate YouTube health content by cross-checking multiple videos, by feeling that the presenter was real and relatable, or just through instinctively judging a video's credibility. Instagram was a source of inspiration for health and wellness from those whose lives were dedicated to healthy lifestyles and fitness. Twitter, Tumblr, and Snapchat were rarely used for health information. Conclusions: Most young adults obtain health information from social media, both actively and through passive exposure. Participants indicated looking to social media influencers for health and lifestyle inspiration and judged the credibility of sources by appearance and instinct. Health experts should try to use the channels in the way that young adults already use them; use relatable role models on Instagram and YouTube, eye-catching headlines and support groups on Facebook, and easy to follow instruction videos via YouTube. International Registered Report Identifier (IRRID): RR2-10.1111/1747-0080.12448 ",
doi="10.2196/23656",
url="https://www.jmir.org/2022/1/e23656",
url="http://www.ncbi.nlm.nih.gov/pubmed/35040796"
}


@Article{info:doi/10.2196/31982,
author="Leigh, W. Jonathan
and Gerber, S. Ben
and Gans, P. Christopher
and Kansal, M. Mayank
and Kitsiou, Spyros",
title="Smartphone Ownership and Interest in Mobile Health Technologies for Self-care Among Patients With Chronic Heart Failure: Cross-sectional Survey Study",
journal="JMIR Cardio",
year="2022",
month="Jan",
day="14",
volume="6",
number="1",
pages="e31982",
keywords="mHealth",
keywords="smartphone",
keywords="mobile phone",
keywords="heart failure",
keywords="self-care",
keywords="self-management",
abstract="Background: Heart failure (HF) is a highly prevalent chronic condition that places a substantial burden on patients, families, and health care systems worldwide. Recent advances in mobile health (mHealth) technologies offer great opportunities for supporting many aspects of HF self-care. There is a need to better understand patients' adoption of and interest in using mHealth for self-monitoring and management of HF symptoms. Objective: The purpose of this study is to assess smartphone ownership and patient attitudes toward using mHealth technologies for HF self-care in a predominantly minority population in an urban clinical setting. Methods: We conducted a cross-sectional survey of adult outpatients (aged ?18 years) at an academic outpatient HF clinic in the Midwest. The survey comprised 34 questions assessing patient demographics, ownership of smartphones and other mHealth devices, frequently used smartphone features, use of mHealth apps, and interest in using mHealth technologies for vital sign and HF symptom self-monitoring and management. Results: A total of 144 patients were approached, of which 100 (69.4\%) participated in the study (63/100, 63\% women). The participants had a mean age of 61.3 (SD 12.25) years and were predominantly Black or African American (61/100, 61\%) and Hispanic or Latino (18/100, 18\%). Almost all participants (93/100, 93\%) owned a cell phone. The share of patients who owned a smartphone was 68\% (68/100). Racial and ethnic minorities that identified as Black or African American or Hispanic or Latino reported higher smartphone ownership rates compared with White patients with HF (45/61, 74\% Black or African American and 11/18, 61\% Hispanic or Latino vs 9/17, 53\% White). There was a moderate and statistically significant association between smartphone ownership and age (Cram{\'e}r V [$\Phi$C]=0.35; P<.001), education ($\Phi$C=0.29; P=.001), and employment status ($\Phi$C=0.3; P=.01). The most common smartphone features used by the participants were SMS text messaging (51/68, 75\%), internet browsing (43/68, 63\%), and mobile apps (41/68, 60\%). The use of mHealth apps and wearable activity trackers (eg, Fitbits) for self-monitoring of HF-related parameters was low (15/68, 22\% and 15/100, 15\%, respectively). The most popular HF-related self-care measures participants would like to monitor using mHealth technologies were physical activity (46/68, 68\%), blood pressure (44/68, 65\%), and medication use (40/68, 59\%). Conclusions: Most patients with HF have smartphones and are interested in using commercial mHealth apps and connected health devices to self-monitor their condition. Thus, there is a great opportunity to capitalize on the high smartphone ownership among racial and ethnic minority patients to increase reach and enhance HF self-management through mHealth interventions. ",
doi="10.2196/31982",
url="https://cardio.jmir.org/2022/1/e31982",
url="http://www.ncbi.nlm.nih.gov/pubmed/35029533"
}


@Article{info:doi/10.2196/24086,
author="Wang, Xiaohui
and Shi, Jingyuan
and Lee, Min Kwan",
title="The Digital Divide and Seeking Health Information on Smartphones in Asia: Survey Study of Ten Countries",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="13",
volume="24",
number="1",
pages="e24086",
keywords="smartphone",
keywords="health information seeking",
keywords="Asia",
keywords="user profile",
keywords="digital divide",
abstract="Background: Although recent developments in mobile health have elevated the importance of how smartphones empower individuals to seek health information, research investigating this phenomenon in Asian countries has been rare. Objective: The goal of our study was to provide a comprehensive profile of mobile health information seekers and to examine the individual- and country-level digital divide in Asia. Methods: With survey data from 10 Asian countries (N=9086), we ran multilevel regression models to assess the effect of sociodemographic factors, technological factors, and country-level disparities on using smartphones to seek health information. Results: Respondents who were women ($\beta$=.13, P<.001), parents ($\beta$=.16, P<.001), employed ($\beta$=.08, P=.002), of higher social status ($\beta$=.08, P<.001), and/or from countries with low health expenditures ($\beta$=.19, P=.02) were more likely to use smartphones to seek health information. In terms of technological factors, technology innovativeness ($\beta$=.10, P<.001) and frequency of smartphone use ($\beta$=.42, P<.001) were important factors of health information seeking, whereas the effect of online information quality was marginal ($\beta$=--.04, P<.001). Conclusions: Among smartphone users in Asia, health information seeking varies according to individuals' socioeconomic status, their innovativeness toward technology, and their frequency of smartphone use. Although smartphones widen the digital divide among individuals with different socioeconomic status, they also bridge the divide between countries with varying health expenditures. Smartphones appear to be a particularly useful complement to manage health in developing countries. ",
doi="10.2196/24086",
url="https://www.jmir.org/2022/1/e24086",
url="http://www.ncbi.nlm.nih.gov/pubmed/35023845"
}


@Article{info:doi/10.2196/27220,
author="Wang, Y. Seamus
and Yeh, Hsin-Chieh
and Stein, Apfel Arielle
and Miller, R. Edgar",
title="Use of Health Information Technology by Adults With Diabetes in the United States: Cross-sectional Analysis of National Health Interview Survey Data (2016-2018)",
journal="JMIR Diabetes",
year="2022",
month="Jan",
day="12",
volume="7",
number="1",
pages="e27220",
keywords="health information technology",
keywords="National Health Interview Survey",
keywords="diabetes",
keywords="Healthy People 2020",
keywords="Healthy People 2030",
keywords="mobile phone",
abstract="Background: The use of health information technology (HIT) has been proposed to improve disease management in patients with type 2 diabetes mellitus. Objective: This study aims to report the prevalence of HIT use in adults with diabetes in the United States and examine the factors associated with HIT use. Methods: We analyzed data from 7999 adults who self-reported a diabetes diagnosis as collected by the National Health Interview Survey (2016-2018). All analyses were weighted to account for the complex survey design. Results: Overall, 41.2\% of adults with diabetes reported looking up health information on the web, and 22.8\% used eHealth services (defined as filled a prescription on the web, scheduled an appointment with a health care provider on the web, or communicated with a health care provider via email). In multivariable models, patients who were female (vs male: prevalence ratio [PR] 1.16, 95\% CI 1.10-1.24), had higher education (above college vs less than high school: PR 3.61, 95\% CI 3.01-4.33), had higher income (high income vs poor: PR 1.40, 95\% CI 1.23-1.59), or had obesity (vs normal weight: PR 1.11, 95\% CI 1.01-1.22) were more likely to search for health information on the web. Similar associations were observed among age, race and ethnicity, education, income, and the use of eHealth services. Patients on insulin were more likely to use eHealth services (on insulin vs no medication: PR 1.21, 95\% CI 1.04-1.41). Conclusions: Among adults with diabetes, HIT use was lower in those who were older, were members of racial minority groups, had less formal education, or had lower household income. Health education interventions promoted through HIT should account for sociodemographic factors. ",
doi="10.2196/27220",
url="https://diabetes.jmir.org/2022/1/e27220",
url="http://www.ncbi.nlm.nih.gov/pubmed/35019844"
}


@Article{info:doi/10.2196/32442,
author="Schuster, M. Amy
and Cotten, R. Shelia",
title="COVID-19's Influence on Information and Communication Technologies in Long-Term Care: Results From a Web-Based Survey With Long-Term Care Administrators",
journal="JMIR Aging",
year="2022",
month="Jan",
day="12",
volume="5",
number="1",
pages="e32442",
keywords="COVID-19",
keywords="pandemic",
keywords="socioemotional needs",
keywords="long-term care",
keywords="nursing home facility",
keywords="assisted living facility",
keywords="elderly",
keywords="older adults",
keywords="information and communication technologies",
keywords="support",
keywords="emotion",
keywords="needs",
keywords="access",
keywords="connection",
keywords="communication",
keywords="engagement",
abstract="Background: The prevalence of COVID-19 in the United States led to mandated lockdowns for long-term care (LTC) facilities, resulting in loss of in-person contact with social ties for LTC residents. Though information and communication technologies (ICTs) can be used by LTC residents to support their socioemotional needs, residents must have access to ICTs to use them. Objective: This study explored ICT access and use in LTC facilities and how LTC facilities adapted to try to enhance social connections for their residents during the COVID-19 pandemic. Methods: LTC administrators in South Carolina (United States) were invited to complete a web-based survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of the COVID-19 pandemic. Results: LTC administrators (N=70, 12 nursing homes [NHs], and 58 assisted living facilities [ALFs]) completed the web-based survey. Since March 2020, a total of 53\% (37/70) of the LTC facilities have purchased ICTs for residents' use. ICTs have mainly been used for videoconferencing with family members (31/36, 86\%), friends (25/36, 69\%), and health care providers (26/36, 72\%). NHs were 10.23 times more likely to purchase ICTs for residents' use during the COVID-19 pandemic than ALFs (odds ratio 11.23, 95\% CI 1.12-113.02; P=.04). Benefits of ICT use included residents feeling connected to their family members, friends, and other residents. Barriers to ICT use included staff not having time to assist residents with using the technology, nonfunctional technology, and residents who do not want to share technology. Conclusions: Our results suggest that over half of the LTC facilities in this study were able to acquire ICTs for their residents to use during the COVID-19 pandemic. Additional research is needed to explore how residents adapted to using the ICTs and whether LTC facilities developed and adopted technology integration plans, which could help them be prepared for future situations that may affect LTC residents' engagement and communication opportunities, such as another pandemic. ",
doi="10.2196/32442",
url="https://aging.jmir.org/2022/1/e32442",
url="http://www.ncbi.nlm.nih.gov/pubmed/34878989"
}


@Article{info:doi/10.2196/29876,
author="Pham, Quynh
and El-Dassouki, Noor
and Lohani, Raima
and Jebanesan, Aravinth
and Young, Karen",
title="The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="7",
volume="24",
number="1",
pages="e29876",
keywords="virtual care",
keywords="digital health",
keywords="health equity",
keywords="cultural equity",
keywords="chronic disease",
keywords="caregivers",
keywords="ethnocultural minority",
keywords="older adults",
keywords="ethnicity",
keywords="ethnic patients",
keywords="technology-mediated care",
keywords="equity",
keywords="diversity",
keywords="family",
doi="10.2196/29876",
url="https://www.jmir.org/2022/1/e29876",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994707"
}


@Article{info:doi/10.2196/25419,
author="Lee, WJ Edmund
and McCloud, F. Rachel
and Viswanath, Kasisomayajula",
title="Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="7",
volume="24",
number="1",
pages="e25419",
keywords="eHealth",
keywords="mobile health",
keywords="communication inequalities",
keywords="health disparities",
keywords="health informatics",
keywords="mobile phone",
doi="10.2196/25419",
url="https://www.jmir.org/2022/1/e25419",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994700"
}


@Article{info:doi/10.2196/27809,
author="Han, Sang Jae
and Park, Yong-Ho
and Song, Jae-Jun
and Moon, Joon Il
and Lee, Woojoo
and Kim, Yoonjoong
and Cho, Sang Young
and Seo, Jae-Hyun
and Park, Kyun Moo",
title="Knowledge and Expectations of Hearing Aid Apps Among Smartphone Users and Hearing Professionals: Cross-sectional Survey",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="7",
volume="10",
number="1",
pages="e27809",
keywords="smartphone",
keywords="hearing aids",
keywords="app",
keywords="perception",
keywords="survey",
keywords="hearing loss",
keywords="mobile phone",
abstract="Background: Despite the increasing prevalence of hearing loss, the cost and psychological barriers to the use of hearing aids may prevent their use in individuals with hearing loss. Patients with hearing loss can benefit from smartphone-based hearing aid apps (SHAAs), which are smartphone apps that use a mobile device as a sound amplifier. Objective: The aim of this study is to determine how ear, nose, and throat outpatients perceive SHAAs, analyze the factors that affect their perceptions, and estimate the costs of an annual subscription to an app through a self-administered questionnaire survey of smartphone users and hearing specialists. Methods: This study used a cross-sectional, multicenter survey of both ear, nose, and throat outpatients and hearing specialists. The questionnaire was designed to collect personal information about the respondents and their responses to 18 questions concerning SHAAs in five domains: knowledge, needs, cost, expectations, and information. Perception questions were rated on a scale of 1 (strongly disagree) to 5 (strongly agree). Questions about the expected cost of SHAAs were included in the questionnaire distributed to hearing experts. Results: Among the 219 smartphone users and 42 hearing specialists, only 8 (3.7\%) respondents recognized SHAAs, whereas 18\% (47/261) of respondents reported considering the use of an assistive device to improve their hearing capacity. The average perception score was 2.81 (SD 1.22). Among the factors that shaped perceptions of SHAAs, the needs category received the lowest scores (2.02, SD 1.42), whereas the cost category received the highest scores (3.29, SD 1.14). Age was correlated with the information domain (P<.001), and an increased level of hearing impairment resulted in significantly higher points in the needs category (P<.001). Patients expected the cost of an annual app subscription to an SHAA to be approximately US \$86, and the predicted cost was associated with economic status (P=.02) and was higher than the prices expected by hearing specialists (P<.001). Conclusions: Outpatients expected SHAAs to cost more than hearing specialists. However, the perception of the SHAA was relatively low. In this regard, enhanced awareness is required to popularize SHAAs. ",
doi="10.2196/27809",
url="https://mhealth.jmir.org/2022/1/e27809",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994699"
}


@Article{info:doi/10.2196/25251,
author="Zaman, Bin Sojib
and Khan, Kabir Raihan
and Evans, G. Roger
and Thrift, G. Amanda
and Maddison, Ralph
and Islam, Shariful Sheikh Mohammed",
title="Exploring Barriers to and Enablers of the Adoption of Information and Communication Technology for the Care of Older Adults With Chronic Diseases: Scoping Review",
journal="JMIR Aging",
year="2022",
month="Jan",
day="7",
volume="5",
number="1",
pages="e25251",
keywords="older adults",
keywords="gerontechnology",
keywords="usability challenges",
keywords="chronic disease",
keywords="information technology",
keywords="mobile phone",
abstract="Background: Information and communication technology (ICT) offers considerable potential for supporting older adults in managing their health, including chronic diseases. However, there are mixed opinions about the benefits and effectiveness of ICT interventions for older adults with chronic diseases. Objective: We aim to map the use of ICT interventions in health care and identified barriers to and enablers of its use among older adults with chronic disease. Methods: A scoping review was conducted using 5 databases (Ovid MEDLINE, Embase, Scopus, PsycINFO, and ProQuest) to identify eligible articles from January 2000 to July 2020. Publications incorporating the use of ICT interventions, otherwise known as eHealth, such as mobile health, telehealth and telemedicine, decision support systems, electronic health records, and remote monitoring in people aged ?55 years with chronic diseases were included. We conducted a strengths, weaknesses, opportunities, and threats framework analysis to explore the implied enablers of and barriers to the use of ICT interventions. Results: Of the 1149 identified articles, 31 (2.7\%; n=4185 participants) met the inclusion criteria. Of the 31 articles, 5 (16\%) mentioned the use of various eHealth interventions. A range of technologies was reported, including mobile health (8/31, 26\%), telehealth (7/31, 23\%), electronic health record (2/31, 6\%), and mixed ICT interventions (14/31, 45\%). Various chronic diseases affecting older adults were identified, including congestive heart failure (9/31, 29\%), diabetes (7/31, 23\%), chronic respiratory disease (6/31, 19\%), and mental health disorders (8/31, 26\%). ICT interventions were all designed to help people self-manage chronic diseases and demonstrated positive effects. However, patient-related and health care provider--related challenges, in integrating ICT interventions in routine practice, were identified. Barriers to using ICT interventions in older adults included knowledge gaps, a lack of willingness to adopt new skills, and reluctance to use technologies. Implementation challenges related to ICT interventions such as slow internet connectivity and lack of an appropriate reimbursement policy were reported. Advantages of using ICT interventions include their nonpharmacological nature, provision of health education, encouragement for continued physical activity, and maintenance of a healthy diet. Participants reported that the use of ICT was a fun and effective way of increasing their motivation and supporting self-management tasks. It gave them reassurance and peace of mind by promoting a sense of security and reducing anxiety. Conclusions: ICT interventions have the potential to support the care of older adults with chronic diseases. However, they have not been effectively integrated with routine health care. There is a need to improve awareness and education about ICT interventions among those who could benefit from them, including older adults, caregivers, and health care providers. More sustainable funding is required to promote the adoption of ICT interventions. We recommend involving clinicians and caregivers at the time of designing ICT interventions. ",
doi="10.2196/25251",
url="https://aging.jmir.org/2022/1/e25251",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994695"
}


@Article{info:doi/10.2196/28981,
author="Ly, Sophia
and Tsang, Ricky
and Ho, Kendall",
title="Patient Perspectives on the Digitization of Personal Health Information in the Emergency Department: Mixed Methods Study During the COVID-19 Pandemic",
journal="JMIR Med Inform",
year="2022",
month="Jan",
day="6",
volume="10",
number="1",
pages="e28981",
keywords="emergency medicine",
keywords="digital health",
keywords="health informatics",
keywords="electronic health record",
keywords="patient portal",
keywords="patient-physician relationship",
keywords="COVID-19",
abstract="Background: Although the digitization of personal health information (PHI) has been shown to improve patient engagement in the primary care setting, patient perspectives on its impact in the emergency department (ED) are unknown. Objective: The primary objective was to characterize the views of ED users in British Columbia, Canada, on the impacts of PHI digitization on ED care. Methods: This was a mixed methods study consisting of an online survey followed by key informant interviews with a subset of survey respondents. ED users in British Columbia were asked about their ED experiences and attitudes toward PHI digitization in the ED. Results: A total of 108 participants submitted survey responses between January and April 2020. Most survey respondents were interested in the use of electronic health records (79/105, 75\%) and patient portals (91/107, 85\%) in the ED and were amenable to sharing their ED PHI with ED staff (up to 90\% in emergencies), family physicians (up to 91\%), and family caregivers (up to 75\%). In addition, 16 survey respondents provided key informant interviews in August 2020. Interviewees expected PHI digitization in the ED to enhance PHI access by health providers, patient-provider relationships, patient self-advocacy, and postdischarge care management, although some voiced concerns about patient privacy risk and limited access to digital technologies (eg, smart devices, internet connection). Many participants thought the COVID-19 pandemic could provide momentum for the digitization of health care. Conclusions: Patients overwhelmingly support PHI digitization in the form of electronic health records and patient portals in the ED. The COVID-19 pandemic may represent a critical moment for the development and implementation of these tools. ",
doi="10.2196/28981",
url="https://medinform.jmir.org/2022/1/e28981",
url="http://www.ncbi.nlm.nih.gov/pubmed/34818211"
}


@Article{info:doi/10.2196/31752,
author="Kruse, Clemens
and Heinemann, Katharine",
title="Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="4",
volume="24",
number="1",
pages="e31752",
keywords="telemedicine",
keywords="pandemic",
keywords="technology acceptance",
keywords="COVID-19",
keywords="digital health",
keywords="telehealth",
keywords="health policy",
keywords="health care",
abstract="Background: The virulent and unpredictable nature of COVID-19 combined with a change in reimbursement mechanisms both forced and enabled the rapid adoption of telemedicine around the world. Thus, it is important to now assess the effects of this rapid adoption and to determine whether the barriers to such adoption are the same today as they were under prepandemic conditions. Objective: The objective of this systematic literature review was to examine the research literature published during the COVID-19 pandemic to identify facilitators, barriers, and associated medical outcomes as a result of adopting telemedicine, and to determine if changes have occurred in the industry during this time. Methods: The systematic review was performed in accordance with the Kruse protocol and the results are reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We analyzed 46 research articles from five continents published during the first year of the COVID-19 pandemic that were retrieved from searches in four research databases: PubMed (MEDLINE), CINAHL, Science Direct, and Web of Science. Results: Reviewers identified 25 facilitator themes and observations, 12 barrier themes and observations, and 14 results (compared to a control group) themes and observations. Overall, 22\% of the articles analyzed reported strong satisfaction or satisfaction (zero reported a decline in satisfaction), 27\% reported an improvement in administrative or efficiency results (as compared with a control group), 14\% reported no statistically significant difference from the control group, and 40\% and 10\% reported an improvement or no statistically significant difference in medical outcomes using the telemedicine modality over the control group, respectively. Conclusions: The pandemic encouraged rapid adoption of telemedicine, which also encouraged practices to adopt the modality regardless of the challenges identified in previous research. Several barriers remain for health policymakers to address; however, health care administrators can feel confident in the modality as the evidence largely shows that it is safe, effective, and widely accepted. ",
doi="10.2196/31752",
url="https://www.jmir.org/2022/1/e31752",
url="http://www.ncbi.nlm.nih.gov/pubmed/34854815"
}


@Article{info:doi/10.2196/20466,
author="Silva, Patr{\'i}cia
and Delerue Matos, Alice
and Martinez-Pecino, Roberto",
title="The Contribution of the Internet to Reducing Social Isolation in Individuals Aged 50 Years and Older: Quantitative Study of Data From the Survey of Health, Ageing and Retirement in Europe",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="3",
volume="24",
number="1",
pages="e20466",
keywords="social isolation",
keywords="internet",
keywords="50+ individuals",
keywords="e-inclusion",
keywords="SHARE",
abstract="Background: Social isolation has a negative impact on the quality of life of older people; therefore, studies have focused on identifying its sociodemographic, economic, and health determinants. In view of the growing importance of the internet as a means of communication, it is essential to assess whether internet use interferes with social isolation. Objective: This study specifically aims to clarify the relationship between internet use and social isolation of individuals aged ?50 years, for which other surveys present contradictory results. Methods: We performed logistic regression analysis with social isolation as the dependent variable, internet use as the interest variable, and several other sociodemographic, economic, and health characteristics of the individuals as control variables. The sample size was 67,173 individuals aged 50 years and older from 17 European countries (Portugal, Greece, Italy, Spain, Denmark, Sweden, Austria, Belgium, France, Germany, Switzerland, Luxemburg, Poland, Czech Republic, Slovenia, Estonia, and Croatia) plus Israel, who were interviewed in the Survey of Health, Ageing and Retirement in Europe (SHARE), wave 6. Results: The results show that countries differ in the level of social isolation and rate of internet use by individuals aged 50 years and older. They also evidence that in most of the countries analyzed, social isolation of internet users was lower compared to that of nonusers after controlling for a set of sociodemographic, economic, and health characteristics of the individuals that have been previously described in the literature as determinants of social isolation. Indeed, on average, although 31.4\% of individuals in the nonuser group experienced high social isolation, only 12.9\% of individuals who used the internet experienced this condition. Conclusions: Internet users show lower social isolation. This result underlines the importance of promoting e-inclusion in Europe as a way to counter social isolation of individuals aged 50 years and older. ",
doi="10.2196/20466",
url="https://www.jmir.org/2022/1/e20466",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982040"
}


@Article{info:doi/10.2196/31126,
author="Smith-Merry, Jennifer
and O'Donovan, Mary-Ann
and Dew, Angela
and Hemsley, Bronwyn
and Imms, Christine
and Carey, Gemma
and Darcy, Simon
and Ellem, Kathy
and Gallego, Gisselle
and Gilroy, John
and Guastella, Adam
and Marella, Manjula
and McVilly, Keith
and Plumb, Jenny",
title="The Future of Disability Research in Australia: Protocol for a Multiphase Research Agenda--Setting Study",
journal="JMIR Res Protoc",
year="2022",
month="Jan",
day="3",
volume="11",
number="1",
pages="e31126",
keywords="disability studies",
keywords="disabled persons",
keywords="disability research",
keywords="consumer-driven community-based research",
keywords="research priorities",
keywords="mixed methods",
keywords="research design",
abstract="Background: For people with disabilities to live a good life, it is essential that funded research in health and social care addresses their interests, meets their needs, and fills gaps in our understanding of the impact that services, systems, and policies may have on them. Decisions about research funding should be based on an understanding of the research priorities of people with disabilities, their supporters and allies, disability researchers, service providers, and policy makers working in the field. Objective: The aim of this protocol is to describe the research design and methods of a large-scale, disability research agenda--setting exercise conducted in 2021 in Australia. Methods: The research agenda--setting exercise involves 3 integrated phases of work. In the first phase, a previous audit of disability research in Australia is updated to understand previous research and continuing gaps in the research. Building on this, the second phase involves consultation with stakeholders---people with disabilities and their supporters and family members, the disability workforce, and people working within services and connected sectors (eg, aging, employment, education, and housing), academia, and public policy. Data for the second phase will be gathered as follows: a national web-based survey; a consultation process undertaken through the government and nongovernment sector; and targeted consultation with Aboriginal and Torres Strait Islander people, children with disabilities and their families, people with cognitive disability, and people with complex communication needs. The third phase involves a web-based survey to develop a research agenda based on the outcomes of all phases. Results: We have started working on 2 parts of the research prioritization exercise. Through the research-mapping exercise we identified 1241 journal articles and book chapters (referred to as research papers) and 225 publicly available reports (referred to as research reports) produced over the 2018-2020 period. Data collection for the national survey has also been completed. We received 973 fully completed responses to the survey. Analysis of these data is currently underway. Conclusions: This multi-method research agenda--setting study will be the first to provide an indication of the areas of health and social research that people across the Australian disability community consider should be prioritized in disability research funding decisions. Project results from all phases will be made publicly available through reports, open-access journal publications, and Easy Read documents. International Registered Report Identifier (IRRID): DERR1-10.2196/31126 ",
doi="10.2196/31126",
url="https://www.researchprotocols.org/2022/1/e31126",
url="http://www.ncbi.nlm.nih.gov/pubmed/34706859"
}


@Article{info:doi/10.2196/25230,
author="Forgie, E. Ella M.
and Lai, Hollis
and Cao, Bo
and Stroulia, Eleni
and Greenshaw, J. Andrew
and Goez, Helly",
title="Social Media and the Transformation of the Physician-Patient Relationship: Viewpoint",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="24",
volume="23",
number="12",
pages="e25230",
keywords="social media",
keywords="social determinants of health",
keywords="precision medicine",
keywords="patient care",
doi="10.2196/25230",
url="https://www.jmir.org/2021/12/e25230",
url="http://www.ncbi.nlm.nih.gov/pubmed/34951596"
}


@Article{info:doi/10.2196/31665,
author="M{\"o}relius, Evalotte
and Robinson, Suzanne
and Arabiat, Diana
and Whitehead, Lisa",
title="Digital Interventions to Improve Health Literacy Among Parents of Children Aged 0 to 12 Years With a Health Condition: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="22",
volume="23",
number="12",
pages="e31665",
keywords="child",
keywords="child health services",
keywords="digital technology",
keywords="health literacy",
keywords="infant",
keywords="internet-based intervention",
keywords="parents",
keywords="patient compliance",
keywords="pediatric hospitals",
abstract="Background: Parental health literacy is associated with child health outcomes. Parents are increasingly turning to the internet to obtain health information. In response, health care providers are using digital interventions to communicate information to assist parents in managing their child's health conditions. Despite the emergence of interventions to improve parental health literacy, to date, no systematic evaluation of the effectiveness of the interventions has been undertaken. Objective: The aim of this review is to examine the effect of digital health interventions on health literacy among parents of children aged 0-12 years with a health condition. This includes evaluating parents' engagement (use and satisfaction) with digital health interventions, the effect of these interventions on parental health knowledge and health behavior, and the subsequent impact on child health outcomes. Methods: This systematic review was registered a priori on PROSPERO (International Prospective Register of Systematic Reviews) and developed according to the Joanna Briggs Institute methodology for systematic reviews. The databases CINAHL, MEDLINE, and PsycINFO were searched for relevant literature published between January 2010 and April 2021. Studies were included if they were written in English. A total of 2 authors independently assessed the search results and performed a critical appraisal of the studies. Results: Following the review of 1351 abstracts, 31 (2.29\%) studies were selected for full-text review. Of the 31 studies, 6 (19\%) studies met the inclusion criteria. Of the 6 studies, 1 (17\%) was excluded following the critical appraisal, and the 5 (83\%) remaining studies were quantitative in design and included digital health interventions using web-based portals to improve parents' health knowledge and health behavior. Owing to heterogeneity in the reported outcomes, meta-analysis was not possible, and the findings were presented in narrative form. Of the 5 studies, satisfaction was measured in 3 (60\%) studies, and all the studies reported high satisfaction with the digital intervention. All the studies reported improvement in parental health literacy at postintervention as either increase in disease-specific knowledge or changes in health behavior. Of the 5 studies, only 1 (20\%) study included child health outcomes, and this study reported significant improvements related to increased parental health knowledge. Conclusions: In response to a pandemic such as COVID-19, there is an increased need for evidence-based digital health interventions for families of children living with health conditions. This review has shown the potential of digital health interventions to improve health knowledge and behavior among parents of young children with a health condition. However, few digital health interventions have been developed and evaluated for this population. Future studies with robust research designs are needed and should include the potential benefits of increased parent health literacy for the child. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020192386; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=192386 ",
doi="10.2196/31665",
url="https://www.jmir.org/2021/12/e31665",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941559"
}


@Article{info:doi/10.2196/27599,
author="van Wier, F. Marieke
and Urry, Emily
and Lissenberg-Witte, I. Birgit
and Kramer, E. Sophia",
title="A Comparison of the Use of Smart Devices, Apps, and Social Media Between Adults With and Without Hearing Impairment: Cross-sectional Web-Based Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="20",
volume="23",
number="12",
pages="e27599",
keywords="hearing impairment",
keywords="social media use",
keywords="app use",
keywords="benefits from social media",
keywords="eHealth",
keywords="mobile phone",
abstract="Background: eHealth and social media could be of particular benefit to adults with hearing impairment, but it is unknown whether their use of smart devices, apps, and social media is similar to that of the general population. Objective: Our aim is to study whether adults with normal hearing and those with impaired hearing differ in their weekly use of smart devices, apps, and social media; reasons for using social media; and benefits from using social media. Methods: We used data from a Dutch cohort, the National Longitudinal Study on Hearing. Data were collected from September 2016 to April 2020 using a web-based questionnaire and speech-in-noise test. The results from this test were used to categorize normal hearing and hearing impairment. Outcomes were compared using (multiple) logistic regression models. Results: Adults with impaired hearing (n=384) did not differ from normal hearing adults (n=341) in their use of a smartphone or tablet. They were less likely to make use of social media apps on a smartphone, tablet, or smartwatch (age-adjusted odds ratio [OR] 0.67, 95\% CI 0.48-0.92; P=.02). Use of social media on all devices and use of other apps did not differ. Adults with hearing impairment were more likely to agree with using social media to stay in touch with family members (OR 1.54, 95\% CI 1.16-2.07; P=.003) and friends (age-adjusted OR 1.35, 95\% CI 1.01-1.81; P=.046). Furthermore, they were more likely to agree with using social media to perform their work (age-adjusted OR 1.51, 95\% CI 1.04-2.18; P=.03). There were no differences in the experienced benefits from social media. Conclusions: The potential for eHealth is confirmed because adults with hearing impairment are not less likely to use smart devices than their normal hearing peers. Adults with hearing impairment are less likely to use social media apps on a smart device but not less likely to use social media on all types of internet-connected devices. This warrants further research on the types of social media platforms that adults with hearing impairment use and on the type of device on which they prefer to use social media. Given that participants with hearing impairment are more likely than their normal hearing peers to use social media to perform their work, use of social media may be seen as an opportunity to enhance vocational rehabilitation services for persons with hearing impairment. ",
doi="10.2196/27599",
url="https://www.jmir.org/2021/12/e27599",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932013"
}


@Article{info:doi/10.2196/25498,
author="Tossaint-Schoenmakers, Rosian
and Kasteleyn, Marise
and Goedhart, Annelijn
and Versluis, Anke
and Talboom-Kamp, Esther",
title="The Impact of Patient Characteristics on Their Attitudes Toward an Online Patient Portal for Communicating Laboratory Test Results: Real-World Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="17",
volume="5",
number="12",
pages="e25498",
keywords="patient portal",
keywords="eHealth impact questionnaire",
keywords="laboratory test results",
keywords="self-efficacy",
keywords="usability",
keywords="age",
keywords="gender",
keywords="chronic disease",
keywords="education",
keywords="patient characteristics",
abstract="Background: Patient portals are promising tools to increase patient involvement and allow them to manage their health. To optimally facilitate patients, laboratory test results should be explained in easy language. Patient characteristics affect the usage of portals and the user satisfaction. However, limited research is available, specified for online communicating laboratory test results, on whether portal use and acceptance differ between groups. Objective: The aim of this study was to assess the effect of patient characteristics (gender, age, education, and chronic disease) on the self-efficacy and perceived usability of an online patient portal that communicates diagnostic test results. Methods: We used the online-administered eHealth impact questionnaire (eHIQ) to explore patients' attitudes toward the portal. Patients visiting the portal were asked to complete the questionnaire and to answer questions regarding gender, age, education, and chronic disease. The subscale ``information and presentation'' of the eHIQ assessed the usability of the patient portal and the subscale ``motivation and confidence to act'' assessed self-efficacy to determine whether patients were motivated to act on the presented information. Age, gender, education, and chronic disease were the determinants to analyze the effect on usability and self-efficacy. Descriptive analyses were performed to explore patient characteristics, usability, and self-efficacy. Univariable and multivariable regression analyses were performed with age, gender, education, and chronic disease as determinants, and usability and self-efficacy as outcomes. Results: The questionnaire was completed by 748 respondents, of which 428 (57.2\%) were female, 423 (56.6\%) were highly educated, and 509 (68\%) had no chronic disease. The mean age was 58.5 years (SD 16.4). Higher age, high education, and asthma or chronic obstructive pulmonary disease were significant determinants for decreased usability; respectively, b=-.094, 95\% CI -1147 to 0.042 (P<.001); b=-2.512, 95\% CI -4.791 to -0.232 (P=.03); and b=-3.630, 95\% CI -6.545 to -0.715 (P=.02). High education was also a significant determinant for a lower self-efficacy (b=-3.521, 95\% CI -6.469 to -0.572; P=.02). Other determinants were not significant. Conclusions: This study showed that the higher-educated users of a patient portal scored lower on usability and self-efficacy. Usability was also lower for older people and for patients with asthma or chronic obstructive pulmonary disease. The results portal is not tailored for different groups. Further research should investigate which factors from a patient's perspective are essential to tailor the portal for different groups and how a result portal can be optimally integrated within the daily practice of a doctor. ",
doi="10.2196/25498",
url="https://formative.jmir.org/2021/12/e25498",
url="http://www.ncbi.nlm.nih.gov/pubmed/34927593"
}


@Article{info:doi/10.2196/33364,
author="Alkureishi, Alcocer Maria
and Choo, Zi-Yi
and Rahman, Ali
and Ho, Kimberly
and Benning-Shorb, Jonah
and Lenti, Gena
and Vel{\'a}zquez S{\'a}nchez, Itzel
and Zhu, Mengqi
and Shah, D. Sachin
and Lee, Wei Wei",
title="Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions",
journal="JMIR Hum Factors",
year="2021",
month="Dec",
day="15",
volume="8",
number="4",
pages="e33364",
keywords="telemedicine",
keywords="digital divide",
keywords="patient experience",
keywords="qualitative study",
abstract="Background: As telemedicine utilization increased during the COVID-19 pandemic, divergent usage patterns for video and audio-only telephone visits emerged. Older, low-income, minority, and non-English speaking Medicaid patients are at highest risk of experiencing technology access and digital literacy barriers. This raises concern for disparities in health care access and widening of the ``digital divide,'' the separation of those with technological access and knowledge and those without. While studies demonstrate correlation between racial and socioeconomic demographics and technological access and ability, individual patients' perspectives of the divide and its impacts remain unclear. Objective: We aimed to interview patients to understand their perspectives on (1) the definition, causes, and impact of the digital divide; (2) whose responsibility it is to address this divide, and (3) potential solutions to mitigate the digital divide. Methods: Between December 2020 and March 2021, we conducted 54 semistructured telephone interviews with adult patients and parents of pediatric patients who had virtual visits (phone, video, or both) between March and September 2020 at the University of Chicago Medical Center (UCMC) primary care clinics. A grounded theory approach was used to analyze interview data. Results: Patients were keenly aware of the digital divide and described impacts beyond health care, including employment, education, community and social contexts, and personal economic stability. Patients described that individuals, government, libraries, schools, health care organizations, and even private businesses all shared the responsibility to address the divide. Proposed solutions to address the divide included conducting community technology needs assessments and improving technology access, literacy training, and resource awareness. Recognizing that some individuals will never cross the divide, patients also emphasized continued support of low-tech communication methods and health care delivery to prevent widening of the digital divide. Furthermore, patients viewed technology access and literacy as drivers of the social determinants of health (SDOH), profoundly influencing how SDOH function to worsen or improve health disparities. Conclusions: Patient perspectives provide valuable insight into the digital divide and can inform solutions to mitigate health and resulting societal inequities. Future work is needed to understand the digital needs of disconnected individuals and communities. As clinical care and delivery continue to integrate telehealth, studies are needed to explore whether having a video or audio-only phone visit results in different patient outcomes and utilization. Advocacy efforts to disseminate public and private resources can also expand device and broadband internet access, improve technology literacy, and increase funding to support both high- and low-tech forms of health care delivery for the disconnected. ",
doi="10.2196/33364",
url="https://humanfactors.jmir.org/2021/4/e33364",
url="http://www.ncbi.nlm.nih.gov/pubmed/34705664"
}


@Article{info:doi/10.2196/25963,
author="Link, Elena
and Baumann, Eva
and Klimmt, Christoph",
title="Explaining Online Information Seeking Behaviors in People With Different Health Statuses: German Representative Cross-sectional Survey",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="10",
volume="23",
number="12",
pages="e25963",
keywords="online health information seeking behavior",
keywords="Planned Risk Information Seeking Model",
keywords="health status",
keywords="theory building",
keywords="personal survey",
abstract="Background: Worldwide, the internet is an increasingly important channel for health information. Many theories have been applied in research on online health information seeking behaviors (HISBs), with each model integrating a different set of predictors; thus, a common understanding of the predictors of (online) HISB is still missing. Another shortcoming of the theories explaining (online) HISB is that most existing models, so far, focus on very specific health contexts such as cancer. Therefore, the assumptions of the Planned Risk Information Seeking Model (PRISM) as the latest integrative model are applied to study online HISB, because this model identifies the general cognitive and sociopsychological factors that explain health information seeking intention. We shift away from single diseases and explore cross-thematic patterns of online HISB intention and compare predictors concerning different health statuses as it can be assumed that groups of people perceiving themselves as ill or healthy will differ concerning their drivers of online HISB. Considering the specifics of online HISB and variation in individual context factors is key for the development of generalizable theories. Objective: The objective of our study was to contribute to the development of the concept of online HISB in 2 areas. First, this study aimed to explore individual-level predictors of individuals' online HISB intention by applying the postulates of PRISM. Second, we compared relevant predictors of online HISB in groups of people with different health statuses to identify cross-thematic central patterns of online HISB. Methods: Data from a representative sample of German internet users (n=822) served to explain online HISB intentions and influencing patterns in different groups of people. The applicability of the PRISM to online HISB intention was tested by structural equation modeling and multigroup comparison. Results: Our results revealed PRISM to be an effective framework for explaining online HISB intention. For online HISB, attitudes toward seeking health information online provided the most important explanatory power followed by risk perceptions and affective risk responses. The multigroup comparison revealed differences both regarding the explanatory power of the model and the relevance of predictors of online HISB. The online HISB intention could be better explained for people facing a health threat, suggesting that the predictors adopted from PRISM were more suitable to explain a problem-driven type of information-seeking behavior. Conclusions: Our findings indicate that attitudes toward seeking health information online and risk perceptions are of central importance for online HISB across different health-conditional contexts. Predictors such as self-efficacy and perceived knowledge insufficiency play a context-dependent role---they are more influential when individuals are facing health threats and the search for health information is of higher personal relevance and urgency. These findings can be understood as the first step to develop a generalized theory of online HISB. ",
doi="10.2196/25963",
url="https://www.jmir.org/2021/12/e25963",
url="http://www.ncbi.nlm.nih.gov/pubmed/34890348"
}


@Article{info:doi/10.2196/30323,
author="Keselman, Alla
and Arnott Smith, Catherine
and Leroy, Gondy
and Kaufman, R. David",
title="Factors Influencing Willingness to Share Health Misinformation Videos on the Internet: Web-Based Survey",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="9",
volume="23",
number="12",
pages="e30323",
keywords="misinformation",
keywords="information literacy",
keywords="science literacy",
keywords="webcasts as topic",
keywords="YouTube",
abstract="Background: The rapidly evolving digital environment of the social media era has increased the reach of both quality health information and misinformation. Platforms such as YouTube enable easy sharing of attractive, if not always evidence-based, videos with large personal networks and the public. Although much research has focused on characterizing health misinformation on the internet, it has not sufficiently focused on describing and measuring individuals' information competencies that build resilience. Objective: This study aims to assess individuals' willingness to share a non--evidence-based YouTube video about strengthening the immune system; to describe types of evidence that individuals view as supportive of the claim by the video; and to relate information-sharing behavior to several information competencies, namely, information literacy, science literacy, knowledge of the immune system, interpersonal trust, and trust in health authority. Methods: A web-based survey methodology with 150 individuals across the United States was used. Participants were asked to watch a YouTube excerpt from a morning TV show featuring a wellness pharmacy representative promoting an immunity-boosting dietary supplement produced by his company; answer questions about the video and report whether they would share it with a cousin who was frequently sick; and complete instruments pertaining to the information competencies outlined in the objectives. Results: Most participants (105/150, 70\%) said that they would share the video with their cousins. Their confidence in the supplement would be further boosted by a friend's recommendations, positive reviews on a crowdsourcing website, and statements of uncited effectiveness studies on the producer's website. Although all information literacy competencies analyzed in this study had a statistically significant relationship with the outcome, each competency was also highly correlated with the others. Information literacy and interpersonal trust independently predicted the largest amount of variance in the intention to share the video (17\% and 16\%, respectively). Interpersonal trust was negatively related to the willingness to share the video. Science literacy explained 7\% of the variance. Conclusions: People are vulnerable to web-based misinformation and are likely to propagate it on the internet. Information literacy and science literacy are associated with less vulnerability to misinformation and a lower propensity to spread it. Of the two, information literacy holds a greater promise as an intervention target. Understanding the role of different kinds of trust in information sharing merits further research. ",
doi="10.2196/30323",
url="https://www.jmir.org/2021/12/e30323",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889750"
}


@Article{info:doi/10.2196/29744,
author="Pech, Marion
and Sauzeon, Helene
and Yebda, Thinhinane
and Benois-Pineau, Jenny
and Amieva, Helene",
title="Falls Detection and Prevention Systems in Home Care for Older Adults: Myth or Reality?",
journal="JMIR Aging",
year="2021",
month="Dec",
day="9",
volume="4",
number="4",
pages="e29744",
keywords="elderly people",
keywords="new technologies",
keywords="fall",
keywords="acceptability",
keywords="digital divide",
keywords="aging",
keywords="falls",
keywords="fall prevention",
keywords="detection",
keywords="geriatrics",
keywords="barriers",
keywords="technology acceptance",
keywords="home care",
keywords="seniors",
doi="10.2196/29744",
url="https://aging.jmir.org/2021/4/e29744",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889755"
}


@Article{info:doi/10.2196/31121,
author="Lajonchere, Clara
and Naeim, Arash
and Dry, Sarah
and Wenger, Neil
and Elashoff, David
and Vangala, Sitaram
and Petruse, Antonia
and Ariannejad, Maryam
and Magyar, Clara
and Johansen, Liliana
and Werre, Gabriela
and Kroloff, Maxwell
and Geschwind, Daniel",
title="An Integrated, Scalable, Electronic Video Consent Process to Power Precision Health Research: Large, Population-Based, Cohort Implementation and Scalability Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="8",
volume="23",
number="12",
pages="e31121",
keywords="biobanking",
keywords="precision medicine",
keywords="electronic consent",
keywords="privacy",
keywords="consent",
keywords="patient privacy",
keywords="clinical data",
keywords="eHealth",
keywords="recruitment",
keywords="population health",
keywords="data collection",
keywords="research methods",
keywords="video",
keywords="research",
keywords="validation",
keywords="scalability",
abstract="Background: Obtaining explicit consent from patients to use their remnant biological samples and deidentified clinical data for research is essential for advancing precision medicine. Objective: We aimed to describe the operational implementation and scalability of an electronic universal consent process that was used to power an institutional precision health biobank across a large academic health system. Methods: The University of California, Los Angeles, implemented the use of innovative electronic consent videos as the primary recruitment tool for precision health research. The consent videos targeted patients aged ?18 years across ambulatory clinical laboratories, perioperative settings, and hospital settings. Each of these major areas had slightly different workflows and patient populations. Sociodemographic information, comorbidity data, health utilization data (ambulatory visits, emergency room visits, and hospital admissions), and consent decision data were collected. Results: The consenting approach proved scalable across 22 clinical sites (hospital and ambulatory settings). Over 40,000 participants completed the consent process at a rate of 800 to 1000 patients per week over a 2-year time period. Participants were representative of the adult University of California, Los Angeles, Health population. The opt-in rates in the perioperative (16,500/22,519, 73.3\%) and ambulatory clinics (2308/3390, 68.1\%) were higher than those in clinical laboratories (7506/14,235, 52.7\%; P<.001). Patients with higher medical acuity were more likely to opt in. The multivariate analyses showed that African American (odds ratio [OR] 0.53, 95\% CI 0.49-0.58; P<.001), Asian (OR 0.72, 95\% CI 0.68-0.77; P<.001), and multiple-race populations (OR 0.73, 95\% CI 0.69-0.77; P<.001) were less likely to participate than White individuals. Conclusions: This is one of the few large-scale, electronic video--based consent implementation programs that reports a 65.5\% (26,314/40,144) average overall opt-in rate across a large academic health system. This rate is higher than those previously reported for email (3.6\%) and electronic biobank (50\%) informed consent rates. This study demonstrates a scalable recruitment approach for population health research. ",
doi="10.2196/31121",
url="https://www.jmir.org/2021/12/e31121",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889741"
}


@Article{info:doi/10.2196/26002,
author="Alodhayani, A. Abdulaziz
and Hassounah, Mazen Marwah
and Qadri, R. Fatima
and Abouammoh, A. Noura
and Ahmed, Zakiuddin
and Aldahmash, M. Abdullah",
title="Culture-Specific Observations in a Saudi Arabian Digital Home Health Care Program: Focus Group Discussions With Patients and Their Caregivers",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="8",
volume="23",
number="12",
pages="e26002",
keywords="connected health",
keywords="digital health",
keywords="telehealth",
keywords="telemedicine",
keywords="culture",
keywords="Islam",
keywords="Arab",
keywords="mobile phone",
abstract="Background: There is growing evidence of the need to consider cultural factors in the design and implementation of digital health interventions. However, there is still inadequate knowledge pertaining to the aspects of the Saudi Arabian culture that need to be considered in the design and implementation of digital health programs, especially in the context of home health care services for patients who are chronically and terminally ill. Objective: This study aims to explore the specific cultural factors related to patients and their caregivers from the perspective of physicians, nurses, and trainers that have influenced the pilot implementation of Remotely Accessible Healthcare At Home, a connected health program in the Home Health Care department at King Saud University Medical City, Riyadh, Saudi Arabia. Methods: A qualitative study design was adopted to conduct a focus group discussion in July 2019 using a semistructured interview guide with 3 female and 4 male participants working as nurses, family physicians, and information technologists. Qualitative data obtained were analyzed using a thematic framework analysis. Results: A total of 2 categories emerged from the focus group discussion that influenced the experiences of digital health program intervention: first, culture-related factors including language and communication, cultural views on using cameras during consultation, nonadherence to web-based consultations, and family role and commitment and second, caregiver characteristics in telemedicine that includes their skills and education and electronic literacy. Participants of this study revealed that indirect contact with patients and their family members may work as a barrier to proper communication through the Remotely Accessible Healthcare At Home program. Conclusions: We recommend exploring the use of interpreters in digital health, creating awareness among the local population regarding privacy in digital health, and actively involving direct family members with the health care providers. ",
doi="10.2196/26002",
url="https://www.jmir.org/2021/12/e26002",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889740"
}


@Article{info:doi/10.2196/27988,
author="Schroeder, Kristin
and Maiarana, James
and Gisiri, Mwitasrobert
and Joo, Emma
and Muiruri, Charles
and Zullig, Leah
and Masalu, Nestory
and Vasudevan, Lavanya",
title="Caregiver Acceptability of Mobile Phone Use for Pediatric Cancer Care in Tanzania: Cross-sectional Questionnaire Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Dec",
day="8",
volume="4",
number="4",
pages="e27988",
keywords="mHealth",
keywords="literacy",
keywords="smartphone use",
keywords="developing countries",
keywords="pediatric cancer",
keywords="cancer",
keywords="pediatrics",
keywords="children",
keywords="parents",
keywords="caregivers",
keywords="mobile health",
keywords="smartphone",
keywords="SMS",
keywords="education",
keywords="knowledge transfer",
keywords="communication",
abstract="Background: There is a 60\% survival gap between children diagnosed with cancer in low- and middle-income countries (LMICs) and those in high-income countries. Low caregiver knowledge about childhood cancer and its treatment results in presentation delays and subsequent treatment abandonment in LMICs. However, in-person education to improve caregiver knowledge can be challenging due to health worker shortages and inadequate training. Due to the rapid expansion of mobile phone use worldwide, mobile health (mHealth) technologies offer an alternative to delivering in-person education. Objective: The aim of this study is to assess patterns of mobile phone ownership and use among Tanzanian caregivers of children diagnosed with cancer as well as their acceptability of an mHealth intervention for cancer education, patient communication, and care coordination. Methods: In July 2017, caregivers of children <18 years diagnosed with cancer and receiving treatment at Bugando Medical Centre (BMC) were surveyed to determine mobile phone ownership, use patterns, technology literacy, and acceptability of mobile phone use for cancer education, patient communication, and care coordination. Descriptive statistics were generated from the survey data by using mean and SD values for continuous variables and percentages for binary or categorical variables. Results: All eligible caregivers consented to participate and completed the survey. Of the 40 caregivers who enrolled in the study, most used a mobile phone (n=34, 85\%) and expressed high acceptability in using these devices to communicate with a health care provider regarding treatment support (n=39, 98\%), receiving laboratory results (n=37, 93\%), receiving reminders for upcoming appointments (n=38, 95\%), and receiving educational information on cancer (n=35, 88\%). Although only 9\% (3/34) of mobile phone owners owned phones with smartphone capabilities, about 74\% (25/34) self-reported they could view and read SMS text messages. Conclusions: To our knowledge, this is the first study to assess patterns of mobile phone ownership and use among caregivers of children with cancer in Tanzania. The high rate of mobile phone ownership and caregiver acceptability for a mobile phone--based education and communication strategy suggests that a mobile phone--based intervention, particularly one that utilizes SMS technology, could be feasible in this setting. ",
doi="10.2196/27988",
url="https://pediatrics.jmir.org/2021/4/e27988",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889763"
}


@Article{info:doi/10.2196/27072,
author="North, Frederick
and Nelson, M. Elissa
and Buss, J. Rebecca
and Majerus, J. Rebecca
and Thompson, C. Matthew
and Crum, A. Brian",
title="The Effect of Automated Mammogram Orders Paired With Electronic Invitations to Self-schedule on Mammogram Scheduling Outcomes: Observational Cohort Comparison",
journal="JMIR Med Inform",
year="2021",
month="Dec",
day="7",
volume="9",
number="12",
pages="e27072",
keywords="electronic health record",
keywords="schedule",
keywords="patient appointment",
keywords="preventive health service",
keywords="office visit",
keywords="outpatient care",
keywords="mammogram",
keywords="software tool",
keywords="computer software application",
keywords="mobile applications",
keywords="self-schedule",
keywords="app",
keywords="EHR",
keywords="screening",
keywords="diagnostic",
keywords="cancer",
abstract="Background: Screening mammography is recommended for the early detection of breast cancer. The processes for ordering screening mammography often rely on a health care provider order and a scheduler to arrange the time and location of breast imaging. Self-scheduling after automated ordering of screening mammograms may offer a more efficient and convenient way to schedule screening mammograms. Objective: The aim of this study was to determine the use, outcomes, and efficiency of an automated mammogram ordering and invitation process paired with self-scheduling. Methods: We examined appointment data from 12 months of scheduled mammogram appointments, starting in September 2019 when a web and mobile app self-scheduling process for screening mammograms was made available for the Mayo Clinic primary care practice. Patients registered to the Mayo Clinic Patient Online Services could view the schedules and book their mammogram appointment via the web or a mobile app. Self-scheduling required no telephone calls or staff appointment schedulers. We examined uptake (count and percentage of patients utilizing self-scheduling), number of appointment actions taken by self-schedulers and by those using staff schedulers, no-show outcomes, scheduling efficiency, and weekend and after-hours use of self-scheduling. Results: For patients who were registered to patient online services and had screening mammogram appointment activity, 15.3\% (14,387/93,901) used the web or mobile app to do either some mammogram self-scheduling or self-cancelling appointment actions. Approximately 24.4\% (3285/13,454) of self-scheduling occurred after normal business hours/on weekends. Approximately 9.3\% (8736/93,901) of the patients used self-scheduling/cancelling exclusively. For self-scheduled mammograms, there were 5.7\% (536/9433) no-shows compared to 4.6\% (3590/77,531) no-shows in staff-scheduled mammograms (unadjusted odds ratio 1.24, 95\% CI 1.13-1.36; P<.001). The odds ratio of no-shows for self-scheduled mammograms to staff-scheduled mammograms decreased to 1.12 (95\% CI 1.02-1.23; P=.02) when adjusted for age, race, and ethnicity. On average, since there were only 0.197 staff-scheduler actions for each finalized self-scheduled appointment, staff schedulers were rarely used to redo or ``clean up'' self-scheduled appointments. Exclusively self-scheduled appointments were significantly more efficient than staff-scheduled appointments. Self-schedulers experienced a single appointment step process (one and done) for 93.5\% (7553/8079) of their finalized appointments; only 74.5\% (52,804/70,839) of staff-scheduled finalized appointments had a similar one-step appointment process (P<.001). For staff-scheduled appointments, 25.5\% (18,035/70,839) of the finalized appointments took multiple appointment steps. For finalized appointments that were exclusively self-scheduled, only 6.5\% (526/8079) took multiple appointment steps. The staff-scheduled to self-scheduled odds ratio of taking multiple steps for a finalized screening mammogram appointment was 4.9 (95\% CI 4.48-5.37; P<.001). Conclusions: Screening mammograms can be efficiently self-scheduled but may be associated with a slight increase in no-shows. Self-scheduling can decrease staff scheduler work and can be convenient for patients who want to manage their appointment scheduling activity after business hours or on weekends. ",
doi="10.2196/27072",
url="https://medinform.jmir.org/2021/12/e27072",
url="http://www.ncbi.nlm.nih.gov/pubmed/34878997"
}


@Article{info:doi/10.2196/25012,
author="Newton, S. Amanda
and March, Sonja
and Gehring, D. Nicole
and Rowe, K. Arlen
and Radomski, D. Ashley",
title="Establishing a Working Definition of User Experience for eHealth Interventions of Self-reported User Experience Measures With eHealth Researchers and Adolescents: Scoping Review",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="2",
volume="23",
number="12",
pages="e25012",
keywords="eHealth",
keywords="internet",
keywords="design",
keywords="development",
keywords="user experience",
keywords="health care",
keywords="scoping review",
keywords="Delphi",
abstract="Background: Across eHealth intervention studies involving children, adolescents, and their parents, researchers have measured user experience to assist with intervention development, refinement, and evaluation. To date, no widely accepted definitions or measures of user experience exist to support a standardized approach for evaluation and comparison within or across interventions. Objective: We conduct a scoping review with subsequent Delphi consultation to identify how user experience is defined and measured in eHealth research studies, characterize the measurement tools used, and establish working definitions for domains of user experience that could be used in future eHealth evaluations. Methods: We systematically searched electronic databases for published and gray literature available from January 1, 2005, to April 11, 2019. We included studies assessing an eHealth intervention that targeted any health condition and was designed for use by children, adolescents, and their parents. eHealth interventions needed to be web-, computer-, or mobile-based, mediated by the internet with some degree of interactivity. We required studies to report the measurement of user experience as first-person experiences, involving cognitive and behavioral factors reported by intervention users. We appraised the quality of user experience measures in included studies using published criteria: well-established, approaching well-established, promising, or not yet established. We conducted a descriptive analysis of how user experience was defined and measured in each study. Review findings subsequently informed the survey questions used in the Delphi consultations with eHealth researchers and adolescent users for how user experience should be defined and measured. Results: Of the 8634 articles screened for eligibility, 129 articles and 1 erratum were included in the review. A total of 30 eHealth researchers and 27 adolescents participated in the Delphi consultations. On the basis of the literature and consultations, we proposed working definitions for 6 main user experience domains: acceptability, satisfaction, credibility, usability, user-reported adherence, and perceived impact. Although most studies incorporated a study-specific measure, we identified 10 well-established measures to quantify 5 of the 6 domains of user experience (all except for self-reported adherence). Our adolescent and researcher participants ranked perceived impact as one of the most important domains of user experience and usability as one of the least important domains. Rankings between adolescents and researchers diverged for other domains. Conclusions: Findings highlight the various ways in which user experience has been defined and measured across studies and what aspects are most valued by researchers and adolescent users. We propose incorporating the working definitions and available measures of user experience to support consistent evaluation and reporting of outcomes across studies. Future studies can refine the definitions and measurement of user experience, explore how user experience relates to other eHealth outcomes, and inform the design and use of human-centered eHealth interventions. ",
doi="10.2196/25012",
url="https://www.jmir.org/2021/12/e25012",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860671"
}


@Article{info:doi/10.2196/23804,
author="Airola, Ella",
title="Learning and Use of eHealth Among Older Adults Living at Home in Rural and Nonrural Settings: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="2",
volume="23",
number="12",
pages="e23804",
keywords="aged",
keywords="barrier",
keywords="digital competence",
keywords="deinstitutionalization",
keywords="eHealth",
keywords="home care",
keywords="learning",
keywords="older adult",
keywords="rural health",
abstract="Background: Care policies emphasize deinstitutionalization and aging in place in response to demographic changes. Different eHealth technologies are one way to achieve this aim. However, there is a need to better understand older adults' needs for eHealth services, and thus, these health solutions require further exploration. Objective: The purpose of this systematic literature review is to appraise, synthesize, and summarize the literature on older adults' (aged ?60 years) eHealth learning and use in real home settings, particularly in rural and remote areas, with a focus on the social and cultural context. Methods: A systematic search was conducted in January 2020 using 4 academic databases. The studies by means of qualitative thematic analysis to identify the barriers, enablers, and support practices involved in the domestication process were examined. In addition, we identified the various meanings attached to eHealth technologies for older adults living in rural and remote areas. Results: In total, 31 empirical studies published between 2010 and 2020 were included in this review. A total of 17 articles included participants from rural and remote areas. The most regularly reported barriers related to older adults' learning to use and use of eHealth were health-related difficulties, such as cognitive impairment or impaired hearing. The most reported enabler was the support provided for older adults in learning and use of eHealth. Support mainly comprised older adults' own digital competences, which were distributed with their social network. It was found that eHealth technology is needed for rural and remote areas to facilitate access and reduce logistical barriers to health care services. Conclusions: The literature review provided information and practical implications for designers, health care providers, and policy makers. On the basis of these findings, eHealth technologies should be easy to use, and adequate support should be provided to older adults for use. ",
doi="10.2196/23804",
url="https://www.jmir.org/2021/12/e23804",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860664"
}


@Article{info:doi/10.2196/30525,
author="Trofholz, Amanda
and Tate, Allan
and Janowiec, Mark
and Fertig, Angela
and Loth, Katie
and de Brito, N. Junia
and Berge, Jerica",
title="Ecological Momentary Assessment of Weight-Related Behaviors in the Home Environment of Children From Low-Income and Racially and Ethnically Diverse Households: Development and Usability Study",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="1",
volume="10",
number="12",
pages="e30525",
keywords="methods",
keywords="ecological momentary assessment",
keywords="weight-related behaviors",
keywords="racially and ethnically diverse",
keywords="children",
keywords="mobile phone",
abstract="Background: Ecological momentary assessment (EMA) is an innovative tool for capturing in-the-moment health behaviors as people go about their daily lives. EMA is an ideal tool to measure weight-related behaviors, such as parental feeding practices, stress, and dietary intake, as these occur on a daily basis and vary across time and context. A recent systematic review recommended standardized reporting of EMA design for studies that address weight-related behaviors. Objective: To answer the call for reporting study designs using EMA, this paper describes in detail the EMA design of the Family Matters study and how it was adapted over time to improve functionality and meet the needs of a racially, ethnically, and socioeconomically diverse sample. Methods: Family Matters is an incremental, 2-phased, mixed methods study, conducted with a racially and ethnically diverse, immigrant and refugee sample from largely low-income households, designed to examine risk and protective factors for child weight and weight-related behaviors in the home environment. The Family Matters study intentionally recruited White, Black, Hmong, Latino, Native American, and Somali parents with young children. Parents in phase 1 of the study completed 8 days of EMA on their smartphones, which included signal-contingent surveys (eg, asking about the parent's stress at the time of the survey), event-contingent surveys (eg, descriptions of the meal the child ate), and end-of-day surveys (eg, overall assessment of the child's day). Results: A detailed description of EMA strategies, protocols, and methods used in phase 1 of the Family Matters study is provided. Compliance with EMA surveys and participants' time spent completing EMA surveys are presented and stratified by race and ethnicity. In addition, lessons learned while conducting phase 1 EMA are shared to document how EMA methods were improved and expanded upon for phase 2 of the Family Matters study. Conclusions: The results from this study provided an important next step in identifying best practices for EMA use in assessing weight-related behaviors in the home environment. International Registered Report Identifier (IRRID): DERR1-10.2196/30525 ",
doi="10.2196/30525",
url="https://www.researchprotocols.org/2021/12/e30525",
url="http://www.ncbi.nlm.nih.gov/pubmed/34855612"
}


@Article{info:doi/10.2196/25856,
author="Esmaeilzadeh, Pouyan
and Mirzaei, Tala
and Dharanikota, Spurthy",
title="Patients' Perceptions Toward Human--Artificial Intelligence Interaction in Health Care: Experimental Study",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="25",
volume="23",
number="11",
pages="e25856",
keywords="AI clinical applications",
keywords="collective intelligence",
keywords="in-person examinations",
keywords="perceived benefits",
keywords="perceived risks",
abstract="Background: It is believed that artificial intelligence (AI) will be an integral part of health care services in the near future and will be incorporated into several aspects of clinical care such as prognosis, diagnostics, and care planning. Thus, many technology companies have invested in producing AI clinical applications. Patients are one of the most important beneficiaries who potentially interact with these technologies and applications; thus, patients' perceptions may affect the widespread use of clinical AI. Patients should be ensured that AI clinical applications will not harm them, and that they will instead benefit from using AI technology for health care purposes. Although human-AI interaction can enhance health care outcomes, possible dimensions of concerns and risks should be addressed before its integration with routine clinical care. Objective: The main objective of this study was to examine how potential users (patients) perceive the benefits, risks, and use of AI clinical applications for their health care purposes and how their perceptions may be different if faced with three health care service encounter scenarios. Methods: We designed a 2{\texttimes}3 experiment that crossed a type of health condition (ie, acute or chronic) with three different types of clinical encounters between patients and physicians (ie, AI clinical applications as substituting technology, AI clinical applications as augmenting technology, and no AI as a traditional in-person visit). We used an online survey to collect data from 634 individuals in the United States. Results: The interactions between the types of health care service encounters and health conditions significantly influenced individuals' perceptions of privacy concerns, trust issues, communication barriers, concerns about transparency in regulatory standards, liability risks, benefits, and intention to use across the six scenarios. We found no significant differences among scenarios regarding perceptions of performance risk and social biases. Conclusions: The results imply that incompatibility with instrumental, technical, ethical, or regulatory values can be a reason for rejecting AI applications in health care. Thus, there are still various risks associated with implementing AI applications in diagnostics and treatment recommendations for patients with both acute and chronic illnesses. The concerns are also evident if the AI applications are used as a recommendation system under physician experience, wisdom, and control. Prior to the widespread rollout of AI, more studies are needed to identify the challenges that may raise concerns for implementing and using AI applications. This study could provide researchers and managers with critical insights into the determinants of individuals' intention to use AI clinical applications. Regulatory agencies should establish normative standards and evaluation guidelines for implementing AI in health care in cooperation with health care institutions. Regular audits and ongoing monitoring and reporting systems can be used to continuously evaluate the safety, quality, transparency, and ethical factors of AI clinical applications. ",
doi="10.2196/25856",
url="https://www.jmir.org/2021/11/e25856",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842535"
}


@Article{info:doi/10.2196/25887,
author="Kunonga, Patience Tafadzwa
and Spiers, Frances Gemma
and Beyer, R. Fiona
and Hanratty, Barbara
and Boulton, Elisabeth
and Hall, Alex
and Bower, Peter
and Todd, Chris
and Craig, Dawn",
title="Effects of Digital Technologies on Older People's Access to Health and Social Care: Umbrella Review",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="24",
volume="23",
number="11",
pages="e25887",
keywords="digital health",
keywords="social care",
keywords="access",
keywords="older adults",
keywords="review of reviews",
keywords="umbrella review",
abstract="Background: The 2020 COVID-19 pandemic prompted the rapid implementation of new and existing digital technologies to facilitate access to health and care services during physical distancing. Older people may be disadvantaged in that regard if they are unable to use or have access to smartphones, tablets, computers, or other technologies. Objective: In this study, we synthesized evidence on the impact of digital technologies on older adults' access to health and social services. Methods: We conducted an umbrella review of systematic reviews published from January 2000 to October 2019 using comprehensive searches of 6 databases. We looked for reviews in a population of adults aged ?65 years in any setting, reporting outcomes related to the impact of technologies on access to health and social care services. Results: A total of 7 systematic reviews met the inclusion criteria, providing data from 77 randomized controlled trials and 50 observational studies. All of them synthesized findings from low-quality primary studies, 2 of which used robust review methods. Most of the reviews focused on digital technologies to facilitate remote delivery of care, including consultations and therapy. No studies examined technologies used for first contact access to care, such as online appointment scheduling. Overall, we found no reviews of technology to facilitate first contact access to health and social care such as online appointment booking systems for older populations. Conclusions: The impact of digital technologies on equitable access to services for older people is unclear. Research is urgently needed in order to understand the positive and negative consequences of digital technologies on health care access and to identify the groups most vulnerable to exclusion. ",
doi="10.2196/25887",
url="https://www.jmir.org/2021/11/e25887",
url="http://www.ncbi.nlm.nih.gov/pubmed/34821564"
}


@Article{info:doi/10.2196/16006,
author="Seckin, Gul
and Hughes, Susan",
title="Patient-Reported Outcomes in a Nationally Representative Sample of Older Internet Users: Cross-sectional Survey",
journal="JMIR Aging",
year="2021",
month="Nov",
day="24",
volume="4",
number="4",
pages="e16006",
keywords="internet",
keywords="information",
keywords="health",
keywords="communication",
keywords="strain",
keywords="education",
keywords="eHealth literacy",
abstract="Background: The rapid diffusion of the internet has decreased consumer reliance on health care providers for health information and facilitated the patients' ability to be an agent in control of their own health. However, empirical evidence is limited regarding the effects of health-related internet use among older adults, which is complicated by the proliferation of online health and medical sources of questionable scientific accuracy. Objective: We explore the effects of health-related internet use, education, and eHealth literacy on medical encounters and patient-reported outcomes. Patient-reported outcomes are categorized into two dimensions: (1) self-reported health problem and (2) affective distress (feeling worried and anxious) due to information obtained. We were particularly interested in whether education and eHealth literacy moderate the association between perceived strain in medical encounters and patient-reported outcomes. Methods: Our study sample consisted of online panel members who have used the internet as a resource for health information, randomly drawn from one of the largest probability-based online research panels. This paper specifically reports results obtained from older panel members (age?60 years: n=194). First, we examined descriptive statistics and bivariate associations (Pearson correlations and independent samples t tests). We used hierarchical ordinary least squares regression analyses by running separate regressions for each patient-reported outcome. In model 1, we entered the main effects. In model 2, technology and medical encounter variables were included. Model 3 added the statistical interaction terms. Results: Age ($\beta$=--.17; P=.02), gender ($\beta$=--.22; P=.01), and medical satisfaction ($\beta$=--.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender ($\beta$=.13; P=.05) and satisfaction with medical encounters ($\beta$=.34; P<.001) but negatively predicted by education ($\beta$=--.18; P=.03) and eHealth literacy ($\beta$=--.32; P=.01). The association between experiencing a health problem in relation to health-related internet use and perception of strained medical encounters was greater among respondents with lower levels of education ($\beta$=--.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress ($\beta$=--.60; P=.05), which indicated that higher levels of education predicted lower averages of feeling anxiety and worry despite lower eHealth literacy. Older women reported higher averages of affective distress ($\beta$=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem ($\beta$=--.22; P=.01). Conclusions: This study provides evidence for the effect of health-related internet use on patient-reported outcomes with implications for medical encounters. The results could be used to guide educational and eHealth literacy interventions for older individuals. ",
doi="10.2196/16006",
url="https://aging.jmir.org/2021/4/e16006",
url="http://www.ncbi.nlm.nih.gov/pubmed/34822340"
}


@Article{info:doi/10.2196/30889,
author="Claesdotter-Knutsson, Emma
and Andr{\'e}, Frida
and Fridh, Maria
and Delfin, Carl
and Hakansson, Anders
and Lindstr{\"o}m, Martin",
title="Gender-Based Differences and Associated Factors Surrounding Excessive Smartphone Use Among Adolescents: Cross-sectional Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="22",
volume="4",
number="4",
pages="e30889",
keywords="smartphone",
keywords="cell phone",
keywords="adolescent",
keywords="sleep",
keywords="anxiety",
keywords="substance use",
keywords="nicotine",
keywords="alcohol drinking",
keywords="smartphone use",
keywords="addiction",
keywords="behavioral addiction",
keywords="worry",
keywords="pathology",
keywords="internet",
abstract="Background: Excessive smartphone use is a new and debated phenomenon frequently mentioned in the context of behavioral addiction, showing both shared and distinct traits when compared to pathological gaming and gambling. Objective: The aim of this study is to describe excessive smartphone use and associated factors among adolescents, focusing on comparisons between boys and girls. Methods: This study was based on data collected through a large-scale public health survey distributed in 2016 to pupils in the 9th grade of primary school and those in the 2nd grade of secondary school. Bayesian binomial regression models, with weakly informative priors, were used to examine whether the frequency of associated factors differed between those who reported excessive smartphone use and those who did not. Results: The overall response rate was 77\% (9143/11,868) among 9th grade pupils and 73.4\% (7949/10,832) among 2nd grade pupils, resulting in a total of 17,092 responses. Based on the estimated median absolute percentage differences, along with associated odds ratios, we found that excessive smartphone use was associated with the use of cigarettes, alcohol, and other substances. The reporting of anxiety and worry along with feeling low more than once a week consistently increased the odds of excessive smartphone use among girls, whereas anxiety and worry elevated the odds of excessive smartphone use among boys. The reporting of less than 7 hours of sleep per night was associated with excessive smartphone use in all 4 study groups. Conclusions: The results varied across gender and grade in terms of robustness and the size of estimated difference. However, excessive smartphone use was associated with a higher frequency of multiple suspected associated factors, including ever having tried smoking, alcohol, or other substances; poor sleep; and often feeling low and feeling anxious. This study sheds light on some features and distinctions of a potentially problematic behavior among adolescents. ",
doi="10.2196/30889",
url="https://pediatrics.jmir.org/2021/4/e30889",
url="http://www.ncbi.nlm.nih.gov/pubmed/34813492"
}


@Article{info:doi/10.2196/29181,
author="Jones, Kerina
and Thompson, Rachel",
title="To Use or Not to Use a COVID-19 Contact Tracing App: Mixed Methods Survey in Wales",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="22",
volume="9",
number="11",
pages="e29181",
keywords="COVID-19",
keywords="survey",
keywords="Wales",
keywords="contact tracing",
keywords="app",
keywords="mHealth",
keywords="mobile apps",
keywords="digital health",
keywords="public health",
abstract="Background: Many countries remain in the grip of the COVID-19 global pandemic, with a considerable journey still ahead toward normalcy and free mobility. Contact tracing smartphone apps are among a raft of measures introduced to reduce spread of the virus, but their uptake depends on public choice. Objective: The objective of this study was to ascertain the views of citizens in Wales on their intended use of a COVID-19 contact tracing smartphone app, including self-proposed reasons for or against use and what could lead to a change of decision. Methods: We distributed an anonymous survey among 4000 HealthWise Wales participants in May 2020. We adopted a mixed methods approach: responses to closed questions were analyzed using descriptive and inferential statistics; open question responses were analyzed and grouped into categories. Results: A total of 976 (24.4\%) people completed the survey. Smartphone usage was 91.5\% overall, but this varied among age groups. In total, 97.1\% were aware of contact tracing apps, but only 67.2\% felt sufficiently informed. Furthermore, 55.7\% intended to use an app, 23.3\% refused, and 21.0\% were unsure. The top reasons for app use were as follows: controlling the spread of the virus, mitigating risks for others and for oneself, and increasing freedoms. The top reasons against app use were as follows: mistrusting the government, concerns about data security and privacy, and doubts about efficacy. The top response for changing one's mind about app use from being willing to being unwilling was that nothing would; that is, they felt that nothing would cause them to become unwilling to use a contact tracing app. This was also the top response for changing one's mind from being unwilling to being willing to use contact tracing apps. Among those who were unsure of using contact tracing apps, the top response was the need for more information. Conclusions: Respondents demonstrated a keenness to help themselves, others, society, and the government to avoid contracting the virus and to control its spread. However, digital inclusion varied among age groups, precluding participation for some people. Nonetheless, unwillingness was significant, and considering the nature of the concerns raised and the perceived lack of information, policy and decision-makers need to do more to act openly, increase communication, and demonstrate trustworthiness if members of the public are to be confident in using an app. ",
doi="10.2196/29181",
url="https://mhealth.jmir.org/2021/11/e29181",
url="http://www.ncbi.nlm.nih.gov/pubmed/34698645"
}


@Article{info:doi/10.2196/32951,
author="De Santis, Karolina Karina
and Jahnel, Tina
and Sina, Elida
and Wienert, Julian
and Zeeb, Hajo",
title="Digitization and Health in Germany: Cross-sectional Nationwide Survey",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="22",
volume="7",
number="11",
pages="e32951",
keywords="digital health",
keywords="literacy",
keywords="survey",
keywords="attitude",
keywords="usage",
keywords="eHEALS",
keywords="COVID-19",
keywords="physical activity",
keywords="general population",
keywords="misinformation",
abstract="Background: Digital technologies are shaping medicine and public health. Objective: The aim of this study was to investigate the attitudes toward and the use of digital technologies for health-related purposes using a nationwide survey. Methods: We performed a cross-sectional study using a panel sample of internet users selected from the general population living in Germany. Responses to a survey with 28 items were collected using computer-assisted telephone interviews conducted in October 2020. The items were divided into four topics: (1) general attitudes toward digitization, (2) COVID-19 pandemic, (3) physical activity, and (4) perceived digital health (eHealth) literacy measured with the eHealth Literacy Scale (eHEALS; sum score of 8=lowest to 40=highest perceived eHealth literacy). The data were analyzed in IBM-SPSS24 using relative frequencies. Three univariate multiple regression analyses (linear or binary logistic) were performed to investigate the associations among the sociodemographic factors (age, gender, education, and household income) and digital technology use. Results: The participants included 1014 internet users (n=528, 52.07\% women) aged 14 to 93 years (mean 54, SD 17). Among all participants, 66.47\% (674/1014) completed up to tertiary (primary and secondary) education and 45.07\% (457/1017) reported a household income of up to 3500 Euro/month (1 Euro=US \$1.18). Over half (579/1014, 57.10\%) reported having used digital technologies for health-related purposes. The majority (898/1014, 88.56\%) noted that digitization will be important for therapy and health care, in the future. Only 25.64\% (260/1014) reported interest in smartphone apps for health promotion/prevention and 42.70\% (433/1014) downloaded the COVID-19 contact-tracing app. Although 52.47\% (532/1014) reported that they come across inaccurate digital information on the COVID-19 pandemic, 78.01\% (791/1014) were confident in their ability to recognize such inaccurate information. Among those who use digital technologies for moderate physical activity (n=220), 187 (85.0\%) found such technologies easy to use and 140 (63.6\%) reported using them regularly (at least once a week). Although the perceived eHealth literacy was high (eHEALS mean score 31 points, SD 6), less than half (43.10\%, 400/928) were confident in using digital information for health decisions. The use of digital technologies for health was associated with higher household income (odds ratio [OR] 1.28, 95\% CI 1.11-1.47). The use of digital technologies for physical activity was associated with younger age (OR 0.95, 95\% CI 0.94-0.96) and more education (OR 1.22, 95\% CI 1.01-1.46). A higher perceived eHealth literacy score was associated with younger age ($\beta$=--.22, P<.001), higher household income ($\beta$=.21, P<.001), and more education ($\beta$=.14, P<.001). Conclusions: Internet users in Germany expect that digitization will affect preventive and therapeutic health care in the future. The facilitators and barriers associated with the use of digital technologies for health warrant further research. A gap exists between high confidence in the perceived ability to evaluate digital information and low trust in internet-based information on the COVID-19 pandemic and health decisions. ",
doi="10.2196/32951",
url="https://publichealth.jmir.org/2021/11/e32951",
url="http://www.ncbi.nlm.nih.gov/pubmed/34813493"
}


@Article{info:doi/10.2196/31908,
author="Ahlers-Schmidt, R. Carolyn
and Schunn, Christy
and Hervey, M. Ashley
and Torres, Maria
and Nelson, V. Jill Elizabeth",
title="Promoting Safe Sleep, Tobacco Cessation, and Breastfeeding to Rural Women During the COVID-19 Pandemic: Quasi-Experimental Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="22",
volume="4",
number="4",
pages="e31908",
keywords="COVID-19",
keywords="SIDS",
keywords="sudden infant death syndrome",
keywords="safe sleep",
keywords="tobacco cessation",
keywords="breastfeeding",
keywords="virtual education",
abstract="Background: Safe Sleep Community Baby Showers address strategies to prevent sleep-related infant deaths. Due to the COVID-19 pandemic, these events transitioned from in-person to virtual. Objective: This study describes outcomes of transitioning Safe Sleep Community Baby Showers to a virtual format and compares outcomes to previous in-person events. Methods: Participants from four rural Kansas counties were emailed the presurvey, provided educational materials (videos, livestream, or digital documents), and completed a postsurvey. Those who completed both surveys received a portable crib and wearable blanket. Within-group comparisons were assessed between pre- and postsurveys; between-group comparisons (virtual vs in-person) were assessed by postsurveys. Results: Based on data from 145 in-person and 74 virtual participants, virtual participants were more likely to be married (P<.001) and have private insurance (P<.001), and were less likely to report tobacco use (P<.001). Both event formats significantly increased knowledge and intentions regarding safe sleep and avoidance of secondhand smoke (all P?.001). Breastfeeding intentions did not change. Differences were observed between in-person and virtual meetings regarding confidence in the ability to avoid secondhand smoke (in-person: 121/144, 84\% vs virtual: 53/74, 72\%; P=.03), intention to breastfeed ?6 months (in-person: 79/128, 62\% vs virtual: 52/66, 79\%; P=.008), and confidence in the ability to breastfeed ?6 months (in-person: 58/123, 47\% vs virtual: 44/69, 64\%; P=.02). Conclusions: Although both event formats demonstrated increased knowledge/intentions to follow safe sleep recommendations, virtual events may further marginalize groups who are at high risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations, and ensure disparities are not exacerbated will be critical for the implementation of future virtual events. ",
doi="10.2196/31908",
url="https://pediatrics.jmir.org/2021/4/e31908",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550075"
}


@Article{info:doi/10.2196/32320,
author="Robinson, A. Stephanie
and Netherton, Dane
and Zocchi, Mark
and Purington, Carolyn
and Ash, S. Arlene
and Shimada, L. Stephanie",
title="Differences in Secure Messaging, Self-management, and Glycemic Control Between Rural and Urban Patients: Secondary Data Analysis",
journal="JMIR Diabetes",
year="2021",
month="Nov",
day="19",
volume="6",
number="4",
pages="e32320",
keywords="diabetes",
keywords="secure messaging",
keywords="rural",
keywords="self-management",
keywords="patient portal",
keywords="urban",
keywords="data",
keywords="access",
keywords="risk",
keywords="portal",
keywords="eHealth",
keywords="digital health",
keywords="messaging",
keywords="support",
keywords="accessible",
keywords="cross-sectional",
keywords="veteran",
abstract="Background: Rural patients with diabetes have difficulty accessing care and are at higher risk for poor diabetes management. Sustained use of patient portal features such as secure messaging (SM) can provide accessible support for diabetes self-management. Objective: This study explored whether rural patients' self-management and glycemic control was associated with the use of SM. Methods: This secondary, cross-sectional, mixed methods analysis of 448 veterans with diabetes used stratified random sampling to recruit a diverse sample from the United States (rural vs urban and good vs poor glycemic control). Administrative, clinical, survey, and interview data were used to determine patients' rurality, use of SM, diabetes self-management behaviors, and glycemic control. Moderated mediation analyses assessed these relationships. Results: The sample was 51\% (n=229) rural and 49\% (n=219) urban. Mean participant age was 66.4 years (SD 7.7 years). More frequent SM use was associated with better diabetes self-management (P=.007), which was associated with better glycemic control (P<.001). Among rural patients, SM use was indirectly associated with better glycemic control through improved diabetes self-management (95\% CI 0.004-0.927). These effects were not observed among urban veterans with diabetes (95\% CI --1.039 to 0.056). Rural patients were significantly more likely than urban patients to have diabetes-related content in their secure messages (P=.01). Conclusions: More frequent SM use is associated with engaging in diabetes self-management, which, in turn, is associated with better diabetes control. Among rural patients with diabetes, SM use is indirectly associated with better diabetes control. Frequent patient-team communication through SM about diabetes-related content may help rural patients with diabetes self-management, resulting in better glycemic control. ",
doi="10.2196/32320",
url="https://diabetes.jmir.org/2021/4/e32320",
url="http://www.ncbi.nlm.nih.gov/pubmed/34807834"
}


@Article{info:doi/10.2196/28196,
author="Aylward, Marion Shannon
and Farrell, Alison
and Walsh, Anna
and Godwin, Marshall
and Chafe, Roger
and Asghari, Shabnam",
title="Quality of Primary Care for the Adult Population With Autism Spectrum Disorder: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="19",
volume="10",
number="11",
pages="e28196",
keywords="autism spectrum disorder",
keywords="primary care",
keywords="family physician",
keywords="quality",
keywords="scoping review",
keywords="protocol",
abstract="Background: A strong primary care system is vital to overall health. Research on the primary care of people with autism spectrum disorder (ASD) has mostly focused on children. A synthesis of the existing literature related to the quality of primary care for the adult population with ASD would elucidate what is known about the topic as well as inform future research and clinical practice. Objective: The purpose of our scoping review is to describe what is known about the quality of primary care for adults with ASD and identify knowledge gaps. Methods: Prior to beginning the literature search, we reviewed literature related to defining both primary care and primary care quality to establish the context and concept of the research question. The search strategy was designed and executed by a research librarian. The MEDLINE, CINAHL, EMBASE, PsycINFO, and ProQuest Dissertations and Theses databases were searched for relevant literature. Grey literature will include relevant reports from government websites and associations with a focus on ASD. Two members of the research team will independently screen the academic and grey literature. Quantitative, qualitative, or mixed methods study designs involving the quality of primary care services or patient-centered care for adults with ASD are eligible for inclusion in our scoping review. Studies that make it past the full-text review will undergo data extraction and quality appraisal by 2 independent reviewers. The data extraction results will be presented in a tabular format to clearly present what is known about the quality of primary care for adults with ASD; this table will be accompanied by a narrative synthesis. Literature selected for extraction will be coded for themes, which will form the basis of a thematic synthesis. The scoping review will follow the guidance proposed by the Joanna Briggs Institute. Results: The search of electronic databases was conducted in October 2020, and it returned 2820 results. This research is still in progress. The results from our scoping review are expected to be available by fall 2021. Conclusions: The results from our scoping review will be useful for guiding future research on the quality of primary care for adults with ASD. International Registered Report Identifier (IRRID): PRR1-10.2196/28196 ",
doi="10.2196/28196",
url="https://www.researchprotocols.org/2021/11/e28196",
url="http://www.ncbi.nlm.nih.gov/pubmed/34806989"
}


@Article{info:doi/10.2196/30420,
author="Pan, Jing
and Dong, Hua
and Bryan-Kinns, Nick",
title="Perception and Initial Adoption of Mobile Health Services of Older Adults in London: Mixed Methods Investigation",
journal="JMIR Aging",
year="2021",
month="Nov",
day="19",
volume="4",
number="4",
pages="e30420",
keywords="older adults",
keywords="mHealth",
keywords="initial adoption",
keywords="technology acceptance",
keywords="design",
keywords="mobile phone",
abstract="Background: Advances in mobile technology and public needs have resulted in the emergence of mobile health (mHealth) services. Despite the potential benefits of mHealth apps, older adults face challenges and barriers in adopting them. Objective: The aims of this study are to understand older adults' perception of mHealth services and to discover the barriers that older adults face in the initial adoption of mHealth apps. Methods: This paper systematically analyzed main determinants related to mHealth services and investigated them through questionnaires, interviews, and a workshop. Two studies were carried out in London. In study 1, the questionnaires with follow-up interviews were conducted based on the literature review to uncover older adults' perception (including perceived usefulness, perceived ease of use, and perceived behavioral control) of mHealth services. Study 2 was a workshop helping older adults to trial selected mHealth apps. The workshop was conducted by the first author (JP) with assistance from 5 research students. The barriers that older adults faced in the initial adoption period were observed. The interviews and workshop were audiotaped and transcribed. Descriptive statistics and the thematic analysis technique were used for data analysis. Results: In total, 30 older adults in London completed the questionnaires and interviews in study 1. The results of study 1 show that the lack of obvious advantage, low reliability, scary information, and the risk of privacy leakage would decrease older adults' perceived usefulness of mHealth services; the design of app interface would directly affect the perceived ease of use; and aging factors, especially the generation gap, would create barriers for older users. In total, 12 participants took part in the workshop of study 2, including 8 who took part in study 1. The results of study 2 identified that access to technology, the way of interaction, the risk of money loss, heavy workload of using an mHealth app, and different lifestyle are influential factors to older adults' adoption of mHealth services. Conclusions: The perceptions of mHealth services of older adults were investigated; the barriers that older adults may face in the initial adoption stage were identified. On the basis of the synthesis of these results, design suggestions were proposed, including technical improvement, free trial, information clarification, and participatory design. They will help inform the design of mHealth services to benefit older adults. ",
doi="10.2196/30420",
url="https://aging.jmir.org/2021/4/e30420",
url="http://www.ncbi.nlm.nih.gov/pubmed/34807836"
}


@Article{info:doi/10.2196/27835,
author="Schenkel, K. Sandra
and Jungmann, M. Stefanie
and Gropalis, Maria
and Witth{\"o}ft, Michael",
title="Conceptualizations of Cyberchondria and Relations to the Anxiety Spectrum: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="18",
volume="23",
number="11",
pages="e27835",
keywords="cyberchondria",
keywords="health anxiety",
keywords="online health information seeking",
keywords="anxiety",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Cyberchondria describes the detrimental effects of health-related internet use. Current conceptualizations agree that cyberchondria is associated with anxiety-related pathologies and may best be conceptualized as a safety behavior; however, little is known about its exact underlying mechanisms. Objective: This systematic review and meta-analysis aims to give an overview of the conceptualizations of cyberchondria and its relation to anxiety-related pathologies, quantify the strength of association to health anxiety by using meta-analyses, highlight gaps in the literature, and outline a hypothetical integrative cognitive-behavioral model of cyberchondria based on the available empirical evidence. Methods: A systematic literature search was conducted using PubMed, Web of Science, and PsycINFO electronic databases. A total of 25 studies were included for qualitative synthesis and 7 studies, comprising 3069 individuals, were included for quantitative synthesis. The meta-analysis revealed a strong association of cyberchondria (r=0.63) and its subfacets (r=0.24-0.66) with health anxiety. Results: The results indicate that cyberchondria is a distinct construct related to health anxiety, obsessive-compulsive symptoms, intolerance of uncertainty, and anxiety sensitivity. Further studies should distinguish between state and trait markers of anxiety-related pathologies and use experimental and naturalistic longitudinal designs to differentiate among risk factors, triggers, and consequences related to cyberchondria. Conclusions: Health-related internet use in the context of health anxiety is best conceptualized as health-related safety behavior maintained through intermittent reinforcement. Here, we present a corresponding integrative cognitive-behavioral model. ",
doi="10.2196/27835",
url="https://www.jmir.org/2021/11/e27835",
url="http://www.ncbi.nlm.nih.gov/pubmed/34792473"
}


@Article{info:doi/10.2196/20964,
author="Mallmann, A. Christoph
and Domr{\"o}se, M. Christian
and Schr{\"o}der, Lars
and Engelhardt, David
and Bach, Frederik
and Rueckel, Helena
and Abramian, Alina
and Kaiser, Christina
and Mustea, Alexander
and Faridi, Andree
and Malter, Wolfram
and Mallmann, Peter
and Rudlowski, Christian
and Zivanovic, Oliver
and Mallmann, R. Michael",
title="Digital Technical and Informal Resources of Breast Cancer Patients From 2012 to 2020: Questionnaire-Based Longitudinal Trend Study",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="18",
volume="7",
number="4",
pages="e20964",
keywords="digitalization",
keywords="eHealth",
keywords="breast cancer",
keywords="internet",
abstract="Background: Digitalization offers enormous potential in medicine. In the era of digitalization, the development of the use of digital, technical, and informal resources of breast cancer patients and factors influencing the degree of digitization of patients has been insufficiently researched. Objective: The aim of this study was to assess the development of the use of digital technical and informal resources in a well-defined patient cohort. Methods: A longitudinal study on 513 breast cancer patients from 2012 to 2020 was conducted using a questionnaire that included the main aspects of the degree of digitalization, including digital device availability and use, stationary and mobile internet access and use, and communication and information seeking regarding breast cancer diagnosis and treatment. Results: The majority of patients (421/513, 82.1\%) owned the technical resources to benefit from eHealth, used the internet to obtain information (292/509, 57.4\%), and were willing to use new eHealth solutions (379/426, 89\%). Two-thirds of the patients discussed information about their cancer on the internet with their doctor, one-third found additional treatment options on the internet, and 15.3\% (44/287) of the patients stated that this had changed their cancer therapy. The degree of digitization is increasing yet still significantly depends on 3 factors: (1) age (whereas 100\% [39/39] of the <59-year-old group used the internet in 2020, 92\% of the 60 to 69-year-old group [11/12] and only 47\% [6/13] of the >70-year-old group used the internet), (2) education (internet use significantly depended on education, as only 51.8\% [59/114] of patients with primary school education used the internet, but 82.4\% [126/153] with middle school education and 90.3\% [213/236] with high school education used the internet; P<.001), and (3) household size (67.7\% [111/164] of patients living alone used the internet, whereas 84.7\% [287/339] of patients living in a house with ?2 people used the internet; P<.001). Conclusions: To implement digital solutions in health care, knowledge of the composition and degree of the use of digital technical and informal resources of the patient group for which the respective solution is developed is crucial for success. Trial Registration: German Register of Clinical Studies DRKS00012364; https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00012364 ",
doi="10.2196/20964",
url="https://cancer.jmir.org/2021/4/e20964",
url="http://www.ncbi.nlm.nih.gov/pubmed/34792468"
}


@Article{info:doi/10.2196/30644,
author="Lee, Jiyeon
and Lee, Eun-Hyun
and Chae, Duckhee",
title="eHealth Literacy Instruments: Systematic Review of Measurement Properties",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="15",
volume="23",
number="11",
pages="e30644",
keywords="eHealth literacy",
keywords="systematic review",
keywords="meta-analysis",
keywords="psychometrics",
keywords="reliability",
keywords="validity",
keywords="scale",
keywords="instrument",
abstract="Background: The internet is now a major source of health information. With the growth of internet users, eHealth literacy has emerged as a new concept for digital health care. Therefore, health professionals need to consider the eHealth literacy of consumers when providing care utilizing digital health technologies. Objective: This study aimed to identify currently available eHealth literacy instruments and evaluate their measurement properties to provide robust evidence to researchers and clinicians who are selecting an eHealth literacy instrument. Methods: We conducted a systematic review and meta-analysis of self-reported eHealth literacy instruments by applying the updated COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodology. Results: This study included 7 instruments from 41 articles describing 57 psychometric studies, as identified in 4 databases (PubMed, CINAHL, Embase, and PsycInfo). No eHealth literacy instrument provided evidence for all measurement properties. The eHealth literacy scale (eHEALS) was originally developed with a single-factor structure under the definition of eHealth literacy before the rise of social media and the mobile web. That instrument was evaluated in 18 different languages and 26 countries, involving diverse populations. However, various other factor structures were exhibited: 7 types of two-factor structures, 3 types of three-factor structures, and 1 bifactor structure. The transactional eHealth literacy instrument (TeHLI) was developed to reflect the broader concept of eHealth literacy and was demonstrated to have a sufficient low-quality and very low-quality evidence for content validity (relevance, comprehensiveness, and comprehensibility) and sufficient high-quality evidence for structural validity and internal consistency; however, that instrument has rarely been evaluated. Conclusions: The eHealth literacy scale was the most frequently investigated instrument. However, it is strongly recommended that the instrument's content be updated to reflect recent advancements in digital health technologies. In addition, the transactional eHealth literacy instrument needs improvements in content validity and further psychometric studies to increase the credibility of its synthesized evidence. ",
doi="10.2196/30644",
url="https://www.jmir.org/2021/11/e30644",
url="http://www.ncbi.nlm.nih.gov/pubmed/34779781"
}


@Article{info:doi/10.2196/32707,
author="Raffaelli, Bianca
and Kull, Pia
and Mecklenburg, Jasper
and Overeem, Hendrik Lucas
and Storch, Elisabeth
and Terhart, Maria
and Neeb, Lars
and Reuter, Uwe",
title="Patients' and Health Care Workers' Perception of Migraine Images on the Internet: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="12",
volume="23",
number="11",
pages="e32707",
keywords="migraine",
keywords="stigma",
keywords="mass media",
keywords="stock photos",
keywords="advocacy",
keywords="internet",
keywords="perception",
keywords="headache",
keywords="pain",
keywords="cross-sectional",
keywords="survey",
keywords="stereotype",
keywords="media",
keywords="awareness",
abstract="Background: The representation of migraine in the media is stereotypical. Standard images of migraine attacks display stylish young women holding their head in a pain pose. This representation may contribute to the social stigmatization of patients with migraine. Objective: We aimed to analyze how patients with migraine and health care workers perceive online images of migraine. Methods: The study consisted of an anonymous web-based survey of patients with migraine at the Headache Center of Charit{\'e} -- Universit{\"a}tsmedizin Berlin (migraine group) and employees and students at our university (health care group). A total of 10 frequently used Adobe Stock photos of migraine attacks were presented to the participants. Each photo was rated on a scale of 0\% to 100\% based on how closely it resembled a realistic migraine attack (realism score). Patients with migraine also indicated how much each photo corresponded to their own experience of migraine as a percentage (representation score). We calculated the mean realism and representation scores for all photos and conducted further analyses using the categories male or female models, younger or older models, and unilateral or bilateral pain pose. Results: A total of 367 patients with migraine and 331 health care employees and students completed the survey. In both groups, the mean realism score was <50\% (migraine group: 47.8\%, SD 18.3\%; health care group: 46.0\%, SD 16.2\%). Patients with migraine identified their own migraine experience in these photos to a lesser degree (mean representation score 44.4\%, SD 19.8\%; P<.001 when compared to the realism score). Patients and health care workers considered photos with male models to be more realistic than photos with females (P<.001) and photos with older models to be more realistic than those with younger people (P<.001). In the health care group only, a bilateral pain posture was deemed more realistic than a unilateral pose (P<.001). Conclusions: Standard images of migraine attacks are considered only slightly or moderately realistic by patients and health care workers. Some characteristics perceived as more realistic such as male sex or older age are in contrast with migraine epidemiology. A more accurate representation of migraine in the media could help to raise awareness for migraine and reduce the associated stigma. ",
doi="10.2196/32707",
url="https://www.jmir.org/2021/11/e32707",
url="http://www.ncbi.nlm.nih.gov/pubmed/34766918"
}


@Article{info:doi/10.2196/21142,
author="Wasfi, Rania
and Poirier Stephens, Zoe
and Sones, Meridith
and Laberee, Karen
and Pugh, Caitlin
and Fuller, Daniel
and Winters, Meghan
and Kestens, Yan",
title="Recruiting Participants for Population Health Intervention Research: Effectiveness and Costs of Recruitment Methods for a Cohort Study",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="12",
volume="23",
number="11",
pages="e21142",
keywords="recruitment methods",
keywords="Facebook recruitment",
keywords="cost-effectiveness",
keywords="built environment",
keywords="intervention research",
keywords="natural experiment",
keywords="mobile phone",
abstract="Background: Public health research studies often rely on population-based participation and draw on various recruitment methods to establish samples. Increasingly, researchers are turning to web-based recruitment tools. However, few studies detail traditional and web-based recruitment efforts in terms of costs and potential biases. Objective: This study aims to report on and evaluate the cost-effectiveness, time effectiveness, and sociodemographic representation of diverse recruitment methods used to enroll participants in 3 cities of the Interventions, Research, and Action in Cities Team (INTERACT) study, a cohort study conducted in Canadian cities. Methods: Over 2017 and 2018 in Vancouver, Saskatoon, and Montreal, the INTERACT study used the following recruitment methods: mailed letters, social media (including sponsored Facebook advertisements), news media, partner communications, snowball recruitment, in-person recruitment, and posters. Participation in the study involved answering web-based questionnaires (at minimum), activating a smartphone app to share sensor data, and wearing a device for mobility and physical activity monitoring. We describe sociodemographic characteristics by the recruitment method and analyze performance indicators, including cost, completion rate, and time effectiveness. Effectiveness included calculating cost per completer (ie, a participant who completed at least one questionnaire), the completion rate of a health questionnaire, and the delay between completion of eligibility and health questionnaires. Cost included producing materials (ie, printing costs), transmitting recruitment messages (ie, mailing list rental, postage, and sponsored Facebook posts charges), and staff time. In Montreal, the largest INTERACT sample, we modeled the number of daily recruits through generalized linear models accounting for the distributed lagged effects of recruitment campaigns. Results: Overall, 1791 participants were recruited from 3 cities and completed at least one questionnaire: 318 in Vancouver, 315 in Saskatoon, and 1158 in Montreal. In all cities, most participants chose to participate fully (questionnaires, apps, and devices). The costs associated with a completed participant varied across recruitment methods and by city. Facebook advertisements generated the most recruits (n=687), at a cost of CAD \$15.04 (US \$11.57; including staff time) per completer. Mailed letters were the costliest, at CAD \$108.30 (US \$83.3) per completer but served to reach older participants. All methods resulted in a gender imbalance, with women participating more, specifically with social media. Partner newsletters resulted in the participation of younger adults and were cost-efficient (CAD \$5.16 [US \$3.97] per completer). A generalized linear model for daily Montreal recruitment identified 2-day lag effects on most recruitment methods, except for the snowball campaign (4 days), letters (15 days), and reminder cards (5 days). Conclusions: This study presents comprehensive data on the costs, effectiveness, and bias of population recruitment in a cohort study in 3 Canadian cities. More comprehensive documentation and reporting of recruitment efforts across studies are needed to improve our capacity to conduct inclusive intervention research. ",
doi="10.2196/21142",
url="https://www.jmir.org/2021/11/e21142",
url="http://www.ncbi.nlm.nih.gov/pubmed/34587586"
}


@Article{info:doi/10.2196/28024,
author="Cyriac, Jissy
and Jenkins, Sarah
and Patten, A. Christi
and Hayes, N. Sharonne
and Jones, Clarence
and Cooper, A. Lisa
and Brewer, C. LaPrincess",
title="Improvements in Diet and Physical Activity--Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="12",
volume="9",
number="11",
pages="e28024",
keywords="African Americans",
keywords="cardiovascular health disparities",
keywords="mHealth lifestyle intervention",
keywords="diet",
keywords="physical activity",
keywords="mobile phone",
abstract="Background: African Americans continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared with White people. Mobile health (mHealth) interventions are innovative platforms to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied among African Americans. Objective: This study aims to examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in African Americans and whether these changes correlate with diet and PA behavioral change. Methods: This study is a retrospective analysis evaluating changes in diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors (daily fruit and vegetable intake and moderate-intensity PA [MPA] per week) in 45 African American adults (mean age 48.7 years, SD 12.9 years; 33/45, 73\% women) enrolled in the FAITH! (Fostering African American Improvement in Total Health) app pilot study. The intervention is a 10-week, behavioral theory--informed, community-based mHealth lifestyle intervention delivered through a mobile app platform. Participants engaged with 3 core FAITH! app features: multimedia education modules focused on CVH with self-assessments of CVH knowledge, self-monitoring of daily fruit and vegetable intake and PA, and a sharing board for social networking. Changes in self-reported diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors were assessed by electronic surveys collected at baseline and 28 weeks postintervention. Changes in diet and PA-related psychosocial factors from pre- to postintervention were assessed using paired 2-tailed t tests. The association of changes in diet and PA-related psychosocial variables with daily fruit and vegetable intake and MPA per week was assessed using Spearman correlation. Associations between baseline and 28-week postintervention changes in diet and PA-related psychosocial measures and CVH behaviors with covariates were assessed by multivariable linear regression. Results: Participants reported improvements in 2 subscales of diet self-regulation (decrease fat and calorie intake, P=.01 and nutrition tracking, P<.001), one subscale of social support for healthy diet (friend discouragement, P=.001), perceived barriers to healthy diet (P<.001), and daily fruit and vegetable intake (P<.001). Improvements in diet self-regulation (increase fruit, vegetable, and grain intake, and nutrition tracking) and social support for healthy diet (friend encouragement) had moderate positive correlations with daily fruit and vegetable intake (r=0.46, r=0.34, and r=0.43, respectively). A moderate negative correlation was observed between perceived barriers to healthy diet and daily fruit and vegetable intake (r=?0.25). Participants reported increases in PA self-regulation (P<.001). Increase in social support subscales for PA (family and friend participation) had a moderate positive correlation with MPA per week (r=0.51 and r=0.61, respectively). Conclusions: Our findings highlight key diet and PA-related psychosocial factors to target in future mHealth lifestyle interventions aimed at promoting CVH in African Americans. ",
doi="10.2196/28024",
url="https://mhealth.jmir.org/2021/11/e28024",
url="http://www.ncbi.nlm.nih.gov/pubmed/34766917"
}


@Article{info:doi/10.2196/23481,
author="Neves, Luisa Ana
and Smalley, R. Katelyn
and Freise, Lisa
and Harrison, Paul
and Darzi, Ara
and Mayer, K. Erik",
title="Determinants of Use of the Care Information Exchange Portal: Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="11",
volume="23",
number="11",
pages="e23481",
keywords="patient portals",
keywords="electronic health records",
keywords="patient participation",
abstract="Background: Sharing electronic health records with patients has been shown to improve patient safety and quality of care. Patient portals represent a convenient tool to enhance patient access to their own health care data. However, the success of portals will only be possible through sustained adoption by its end users: the patients. A better understanding of the characteristics of users and nonusers is critical for understanding which groups remain excluded from using such tools. Objective: This study aims to identify the determinants of the use of the Care Information Exchange, a shared patient portal program in the United Kingdom. Methods: A cross-sectional study was conducted using a web-based questionnaire. Information collected included age, gender, ethnicity, educational level, health status, postcode, and digital literacy. Registered individuals were defined as having had an account created in the portal, independent of their actual use of the platform; users were defined as having ever used the portal. Multivariate logistic regression was used to model the probability of being a user. Statistical analysis was performed in R and Tableau was used to create maps of the proportion of Care Information Exchange users by postcode area. Results: A total of 1083 participants replied to the survey (186\% of the estimated minimum target sample). The proportion of users was 61.58\% (667/1083). Among these, most (385/667, 57.7\%) used the portal at least once a month. To characterize the system's users and nonusers, we performed a subanalysis of the sample, including only participants who had provided at least information regarding gender and age. The subanalysis included 650 individuals (389/650, 59.8\% women; 551/650, 84.8\% >40 years). Most participants were White (498/650, 76.6\%) and resided in London (420/650, 64.6\%). Individuals with a higher educational degree (undergraduate and professional, or postgraduate and higher) had higher odds of being a portal user (adjusted odds ratio [OR] 1.58, 95\% CI 1.04-2.39 and OR 2.38, 95\% CI 1.42-4.02, respectively) compared with those with a secondary degree or below. Higher digital literacy scores (?30) were associated with higher odds of being a user (adjusted OR 2.96, 95\% CI 2.02-4.35). Those with a good overall health status had lower odds of being a user (adjusted OR 0.58, 95\% CI 0.37-0.91). Conclusions: This work adds to the growing body of evidence highlighting the importance of educational aspects (educational level and digital literacy) in the adoption of patient portals. Further research should not only describe but also systematically address these inequalities through patient-centered interventions aimed at reducing the digital divide. Health care providers and policy makers must partner in investing and delivering strategic programs that improve access to technology and digital literacy in an effort to improve digital inclusion and reduce inequities in the delivery of care. ",
doi="10.2196/23481",
url="https://www.jmir.org/2021/11/e23481",
url="http://www.ncbi.nlm.nih.gov/pubmed/34762063"
}


@Article{info:doi/10.2196/30605,
author="Drazich, F. Brittany
and Nyikadzino, Yeukai
and Gleason, T. Kelly",
title="A Program to Improve Digital Access and Literacy Among Community Stakeholders: Cohort Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="10",
volume="5",
number="11",
pages="e30605",
keywords="technology",
keywords="disparities",
keywords="digital access",
keywords="digital literacy",
keywords="community",
keywords="stakeholders",
keywords="digital health",
keywords="digital divide",
keywords="patient-centered outcomes",
abstract="Background: For many research teams, the role of community stakeholders is critical. However, community stakeholders, especially those in low-income settings, are at risk of being excluded from research and community engagement initiatives during and after the COVID-19 pandemic because of the rapid transition to digital operations.  Objective: We aimed to describe the implementation and feasibility of a program called Addressing the Digital Divide to Improve Patient-Centered Outcomes Research, which was designed to address barriers to technology use, and to examine changes in participants' perceived comfort with digital technology before and after the program.  Methods: To promote full engagement, we worked with 20 existing community leaders to cocreate a training course on using digital technology. We assessed the frequency of technology use and comfort with technology through an adapted 8-item version of the Functional Assessment of Comfort Employing Technology Scale and used the Wilcoxon signed-rank test for survey analysis. We also conducted a focus group session with 10 participants and then performed reflective journaling and content analysis to determine emergent themes.  Results: We found that the program was feasible to implement and worthwhile for participants (15/16, 94\%). After the program, the participants perceived an increase in the frequency of technology use (z=2.76, P=.006). The participants reported that the program was successful because of the technology training program, but recommended that the program have a slower pace and include a helpline number that they could call with questions.  Conclusions: Future programs should consider that populations with low literacy view technology training as a core element to decreasing technology disparity. This study demonstrates that through low-cost input, community members can be provided the resources and training needed to virtually participate in research studies or community engagement initiatives.  ",
doi="10.2196/30605",
url="https://formative.jmir.org/2021/11/e30605",
url="http://www.ncbi.nlm.nih.gov/pubmed/34757316"
}


@Article{info:doi/10.2196/28191,
author="Levati, Sara
and Mellacqua, Zefiro
and Caiata-Zufferey, Maria
and Soldini, Emiliano
and Albanese, Emiliano
and Alippi, Maddalena
and Bolla, Emilio
and Colombo, Ada Raffaella
and Cordasco, Severino
and Kawohl, Wolfram
and Larghi, Giuseppina
and Lisi, Angela
and Lucchini, Mario
and Rossa, Simona
and Traber, Rafael
and Crivelli, Luca",
title="Home Treatment for Acute Mental Health Care: Protocol for the Financial Outputs, Risks, Efficacy, Satisfaction Index and Gatekeeping of Home Treatment (FORESIGHT) Study",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="9",
volume="10",
number="11",
pages="e28191",
keywords="acute mental healthcare",
keywords="home treatment",
keywords="crisis resolution",
keywords="home visits",
keywords="mental health",
keywords="home care",
keywords="crisis",
keywords="home",
keywords="community-based",
keywords="mental health services",
keywords="economic",
keywords="risk",
keywords="risks",
keywords="efficacy",
keywords="public health",
keywords="accessibility",
abstract="Background: Crisis Resolution and Home Treatment (CRHT) teams represent a community-based mental health service offering a valid alternative to hospitalization. CRHT teams have been widely implemented in various mental health systems worldwide, and their goal is to provide care for people with severe acute mental disorders who would be considered for admission to acute psychiatric wards. The evaluation of several home-treatment experiences shows promising results; however, it remains unclear which specific elements and characteristics of CRHT are more effective and acceptable. Objective: This study aims to assess the acceptability, effectiveness, and cost-effectiveness of a new CRHT intervention in Ticino, Southern Switzerland. Methods: This study includes an interventional, nonrandomized, quasi-experimental study combined with a qualitative study and an economic evaluation to be conducted over a 48-month period. The quasi-experimental evaluation involves two groups: patients in the northern area of the region who were offered the CRHT service (ie, intervention group) and patients in the southern area of the region who received care as usual (ie, control group). Individual interviews will be conducted with patients receiving the home treatment intervention and their family members. CRHT members will also be asked to participate in a focus group. The economic evaluation will include a cost-effectiveness analysis. Results: The project is funded by the Swiss National Science Foundation as part of the National Research Program NRP74 for a period of 48 months starting from January 2017. As of October 2021, data for the nonrandomized, quasi-experimental study and the qualitative study have been collected, and the results are expected to be published by the end of the year. Data are currently being collected for the economic evaluation. Conclusions: Compared to other Swiss CRHT experiences, the CRHT intervention in Ticino represents a unique case, as the introduction of the service is backed by the closing of one of its acute wards. The proposed study will address several areas where there are evidence gaps or contradictory findings relating to the home treatment of acute mental crisis. Findings from this study will allow local services to improve their effectiveness in a challenging domain of public health and contribute to improving access to more effective care for people with severe mental disorders. Trial Registration: ISRCTN registry ISRCTN38472626; https://www.isrctn.com/ISRCTN38472626 International Registered Report Identifier (IRRID): DERR1-10.2196/28191 ",
doi="10.2196/28191",
url="https://www.researchprotocols.org/2021/11/e28191",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751660"
}


@Article{info:doi/10.2196/18969,
author="Nwaogu, Mayowa Janet
and Chan, C. Albert P.
and Naslund, A. John
and Hon, H. Carol K.
and Belonwu, Christopher
and Yang, Jackie",
title="Exploring the Barriers to and Motivators for Using Digital Mental Health Interventions Among Construction Personnel in Nigeria: Qualitative Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="9",
volume="5",
number="11",
pages="e18969",
keywords="mental health",
keywords="construction personnel",
keywords="digital technology",
keywords="digital intervention",
keywords="barriers",
keywords="motivators",
keywords="mobile phone",
abstract="Background: Work-related stress in the construction industry increases the prevalence of depression and anxiety among personnel. In low-resource settings such as Nigeria, construction personnel face high demands and severe working conditions but only have a few services to address their mental health needs. With emerging research showing that digital interventions can be used to self-manage mental health across diverse settings, there may be new opportunities to support construction personnel in the construction industry. Objective: This study aims to determine the use of digital interventions for mental health management among construction personnel in Nigeria and to explore the factors that facilitate or impede the use of these interventions. Methods: This qualitative study explored the perspectives of a convenience sample of 62 construction personnel. The data were subjected to inductive content analysis. Results: A total of 6 barrier and 3 motivator themes were identified and categorized into 2 groups. The barrier themes were subcategorized into barriers to adoption and barriers to persistent use, whereas the motivator themes were subcategorized into intrinsic and extrinsic motivators. Lack of awareness and knowledge about the interventions may constitute a barrier to adoption and use. Participants frequently reported concerns regarding their effectiveness and usability. Conclusions: This study provides an understanding of the design needs required to facilitate sustained self-management of mental health based on the experiences and expectations of construction personnel with digital interventions. ",
doi="10.2196/18969",
url="https://formative.jmir.org/2021/11/e18969",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751652"
}


@Article{info:doi/10.2196/30356,
author="Wang, Jie
and Wang, Xin
and Wang, Lei
and Peng, Yan",
title="Health Information Needs of Young Chinese People Based on an Online Health Community: Topic and Statistical Analysis",
journal="JMIR Med Inform",
year="2021",
month="Nov",
day="8",
volume="9",
number="11",
pages="e30356",
keywords="information needs",
keywords="young people",
keywords="online health community",
keywords="topic analysis",
abstract="Background: The internet has been widely accessible and well accepted by young people; however, there is a limited understanding of the internet usage patterns and characteristics on issues related to health problems. The contents posted on online health communities (OHCs) are valuable resources to learn about youth's health information needs. Objective: In this study, we concurrently exploited statistical analysis and topic analysis of online health information needs to explore the distribution, impact factors, and topics of interest relevant to Chinese young people. Methods: We collected 60,478 health-related data sets posted by young people from a well-known Chinese OHC named xywy.com. Descriptive statistical analysis and correlation analysis were applied to find the distribution and influence factors of the information needs of Chinese young people. Furthermore, a general 4-step topic mining strategy was presented for sparse short texts, which included sentence vectorization, dimension reduction, clustering, and keyword generation. Results: In the Chinese OHC, Chinese young people had a high demand for information in the areas of gynecology and obstetrics, internal medicine, dermatology, plastic surgery, and surgery, and they focused on topics such as treatment, symptoms, causes, pathology, and diet. Females accounted for 69.67\% (42,136/60,478) and young adults accounted for 87.44\% (52,882/60,478) of all data. Gender, age, and disease type all had a significant effect on young people's information needs and topic preferences (P<.001). Conclusions: We conducted comprehensive analyses to discover the online health information needs of Chinese young people. The research findings are of great practical value to carry out health education and health knowledge dissemination inside and outside of schools according to the interests of youth, enable the innovation of information services in OHCs, and improve the health literacy of young people. ",
doi="10.2196/30356",
url="https://medinform.jmir.org/2021/11/e30356",
url="http://www.ncbi.nlm.nih.gov/pubmed/34747707"
}


@Article{info:doi/10.2196/31951,
author="Sabherwal, Shalinder
and Chinnakaran, Anand
and Sood, Ishaana
and Garg, K. Gaurav
and Singh, P. Birendra
and Shukla, Rajan
and Reddy, A. Priya
and Gilbert, Suzanne
and Bassett, Ken
and Murthy, S. Gudlavalleti V.
and ",
title="Effect of Door-to-Door Screening and Awareness Generation Activities in the Catchment Areas of Vision Centers on Service Use: Protocol for a Randomized Experimental Study",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="4",
volume="10",
number="11",
pages="e31951",
keywords="study protocol",
keywords="randomized intervention study",
keywords="vision centers",
keywords="door-to-door screening",
keywords="cost-effectiveness",
keywords="sustainability",
keywords="screening",
keywords="awareness",
keywords="vision",
keywords="eye",
keywords="utilization",
keywords="usage",
keywords="India",
keywords="rural",
keywords="intervention",
keywords="engagement",
keywords="scalability",
abstract="Background: A vision center (VC) is a significant eye care service model to strengthen primary eye care services. VCs have been set up at the block level, covering a population of 150,000-250,000 in rural areas in North India. Inadequate use by rural communities is a major challenge to sustainability of these VCs. This not only reduces the community's vision improvement potential but also impacts self-sustainability and limits expansion of services in rural areas. The current literature reports a lack of awareness regarding eye diseases and the need for care, social stigmas, low priority being given to eye problems, prevailing gender discrimination, cost, and dependence on caregivers as factors preventing the use of primary eye care. Objective: Our organization is planning an awareness-cum-engagement intervention---door-to-door basic eye checkup and visual acuity screening in VCs coverage areas---to connect with the community and improve the rational use of VCs. Methods: In this randomized, parallel-group experimental study, we will select 2 VCs each for the intervention arm and the control arm from among poor, low-performing VCs (ie, walk-in of ?10 patients/day) in our 2 operational regions (Vrindavan, Mathura District, and Mohammadi, Kheri District) of Uttar Pradesh. Intervention will include door-to-door screening and awareness generation in 8-12 villages surrounding the VCs, and control VCs will follow existing practices of awareness generation through community activities and health talks. Data will be collected from each VC for 4 months of intervention. Primary outcomes will be an increase in the number of walk-in patients, spectacle advise and uptake, referral and uptake for cataract and specialty surgery, and operational expenses. Secondary outcomes will be uptake of refraction correction and referrals for cataract and other eye conditions. Differences in the number of walk-in patients, referrals, uptake of services, and cost involved will be analyzed. Results: Background work involved planning of interventions and selection of VCs has been completed. Participant recruitment has begun and is currently in progress. Conclusions: Through this study, we will analyze whether our door-to-door intervention is effective in increasing the number of visits to a VC and, thus, overall sustainability. We will also study the cost-effectiveness of this intervention to recommend its scalability. Trial Registration: ClinicalTrials.gov NCT04800718; https://clinicaltrials.gov/ct2/show/NCT04800718 International Registered Report Identifier (IRRID): DERR1-10.2196/31951 ",
doi="10.2196/31951",
url="https://www.researchprotocols.org/2021/11/e31951",
url="http://www.ncbi.nlm.nih.gov/pubmed/34734839"
}


@Article{info:doi/10.2196/29155,
author="Chae, Steve
and Lee, Yoon-Jae
and Han, Hae-Ra",
title="Sources of Health Information, Technology Access, and Use Among Non--English-Speaking Immigrant Women: Descriptive Correlational Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="29",
volume="23",
number="10",
pages="e29155",
keywords="technology use",
keywords="internet",
keywords="text messaging",
keywords="health literacy",
keywords="English proficiency",
keywords="immigrant",
keywords="health disparities",
keywords="Korean American",
keywords="women",
keywords="mobile phone",
abstract="Background: As the world is becoming increasingly connected by the World Wide Web, the internet is becoming the main source of health information. With the novel COVID-19 pandemic, ubiquitous use of the internet has changed the daily lives of individuals, from working from home to seeking and meeting with health care providers through web-based sites. Such heavy reliance on internet-based technologies raises concerns regarding the accessibility of the internet for minority populations who are likely to already face barriers when seeking health information. Objective: This study aims to examine the level of technology access and common modes of technology used by Korean American women and to investigate how key psychosocial determinants of health such as age, education, English proficiency, and health literacy are correlated with sources of health information used by Korean American women and by their use of the internet. Methods: We used data from a subsample of Korean American women (N=157) who participated in a community-based randomized trial designed to test a health literacy--focused cancer screening intervention. In addition to descriptive statistics to summarize Korean American women's internet access and common modes of technology use, we conducted backward stepwise logistic regression analyses to substantiate the association between the psychosocial determinants of health and internet use. Results: Approximately two-thirds (103/157, 65.6\%) of the sample had access to the internet, and nearly all had access to a mobile phone. The internet was the most commonly used channel to obtain health information 63\% (99/157), and 70\% (110/157) of the sample used text messaging. Nevertheless, only approximately 38.8\% (40/103) of the sample were very confident in using the internet, and only 29.9\% (47/157) were very confident in using text messaging. Multivariate analyses revealed that older age (>50 years) was associated with 79\% lower odds of using the internet to seek health information (adjusted odds ratio [AOR] 0.21, 95\% CI 0.10-0.46). The higher health literacy group (19+ on Rapid Estimate of Adult Literacy in Medicine) had 56\% lower odds of using the internet to acquire health information (AOR 0.44, 95\% CI 1.13-11.18). Higher education (college+) was associated with both internet use (AOR 4.42, 95\% CI 1.88-9.21) and text messaging (AOR 3.42, 95\% CI 1.55-7.54). Finally, English proficiency was associated with text messaging (AOR 4.20, 95\% CI 1.44-12.24). Conclusions: The differences in modes of technology access, use, and confidence by some of the key psychosocial determinants, as observed in our study sample, have important implications when health care teams develop dissemination plans. ",
doi="10.2196/29155",
url="https://www.jmir.org/2021/10/e29155",
url="http://www.ncbi.nlm.nih.gov/pubmed/34714249"
}


@Article{info:doi/10.2196/28924,
author="Fujioka, Keiko Jamie
and Bickford, Julia
and Gritke, Jennifer
and Stamenova, Vess
and Jamieson, Trevor
and Bhatia, Sacha R.
and Desveaux, Laura",
title="Implementation Strategies to Improve Engagement With a Multi-Institutional Patient Portal: Multimethod Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="28",
volume="23",
number="10",
pages="e28924",
keywords="patient portal",
keywords="electronic health record",
keywords="patient health record",
keywords="digital health",
abstract="Background: Comprehensive multi-institutional patient portals that provide patients with web-based access to their data from across the health system have been shown to improve the provision of patient-centered and integrated care. However, several factors hinder the implementation of these portals. Although barriers and facilitators to patient portal adoption are well documented, there is a dearth of evidence examining how to effectively implement multi-institutional patient portals that transcend traditional boundaries and disparate systems. Objective: This study aims to explore how the implementation approach of a multi-institutional patient portal impacted the adoption and use of the technology and to identify the lessons learned to guide the implementation of similar patient portal models. Methods: This multimethod study included an analysis of quantitative and qualitative data collected during an evaluation of the multi-institutional MyChart patient portal that was deployed in Southwestern Ontario, Canada. Descriptive statistics were performed to understand the use patterns during the first 15 months of implementation (between August 2018 and October 2019). In addition, 42 qualitative semistructured interviews were conducted with 18 administrative stakeholders, 16 patients, 7 health care providers, and 1 informal caregiver to understand how the implementation approach influenced user experiences and to identify strategies for improvement. Qualitative data were analyzed using an inductive thematic analysis approach. Results: Between August 2018 and October 2019, 15,271 registration emails were sent, with 67.01\% (10,233/15,271) registered for an account across 38 health care sites. The median number of patients registered per site was 19, with considerable variation (range 1-2114). Of the total number of sites, 55\% (21/38) had ?30 registered patients, whereas only 2 sites had over 1000 registered patients. Interview participants perceived that the patient experience of the portal would have been improved by enhancing the data comprehensiveness of the technology. They also attributed the lack of enrollment to the absence of a broad rollout and marketing strategy across sites. Participants emphasized that provider engagement, change management support, and senior leadership endorsement were central to fostering uptake. Finally, many stated that regional alignment and policy support should have been sought to streamline implementation efforts across participating sites. Conclusions: Without proper management and planning, multi-institutional portals can suffer from minimal adoption. Data comprehensiveness is the foundational component of these portals and requires aligned policies and a key base of technology infrastructure across all participating sites. It is important to look beyond the category of the technology (ie, patient portal) and consider its functionality (eg, data aggregation, appointment scheduling, messaging) to ensure that it aligns with the underlying strategic priorities of the deployment. It is also critical to establish a clear vision and ensure buy-ins from organizational leadership and health care providers to support a cultural shift that will enable a meaningful and widespread engagement. ",
doi="10.2196/28924",
url="https://www.jmir.org/2021/10/e28924",
url="http://www.ncbi.nlm.nih.gov/pubmed/34709195"
}


@Article{info:doi/10.2196/27966,
author="Luo, Yan
and Dozier, Krystal
and Ikenberg, Carin",
title="Human-Technology Interaction Factors Associated With the Use of Electronic Personal Health Records Among Younger and Older Adults: Secondary Data Analysis",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="26",
volume="23",
number="10",
pages="e27966",
keywords="electronic personal health records",
keywords="human-technology interaction factors",
keywords="clinical notes",
keywords="smartphone app",
keywords="ease of understanding",
abstract="Background: An electronic personal health record (ePHR), also known as a personal health record (PHR), has been broadly defined as an electronic application through which individuals can access, manage, and share their health information in a secure and confidential environment. Although ePHRs can benefit individuals as well as caregivers and health care providers, the use of ePHRs among individuals continues to remain low. Objective: The current study aims to examine the relationship between human-technology interaction factors and ePHR use among adults and then to compare the different effects of human-technology interaction factors on ePHR use between younger adults (18-54 years old) and older adults (55 years of age and over). Methods: We analyzed data from the Health Information National Trends Survey (HINTS 5 cycle 3) collected from US adults aged 18 years old and over in 2019. Descriptive analysis was conducted for all variables and each item of ePHR use. Bivariate tests (Pearson correlation coefficient for categorical variable and F test for continuous variables) were conducted over 2 age groups. Finally, after adjustments were made for sociodemographics and health care resources, a weighted multiple linear regression was conducted to examine the relationship between human-technology interaction factors and ePHR use. Results: The final sample size of 1363 (average age 51.19) was divided into 2 age groups: 18 to 54 years old and 55 years old and older. The average level of ePHR use was low (mean 2.76, range 0-8). There was no significant difference in average ePHR use between the 2 age groups. Including clinical notes was positively related to ePHR use in both groups: 18 to 54 years old ($\beta$=.28, P=.005), 55 years old and older ($\beta$=.15, P=.006). Although accessing ePHRs using a smartphone app was only associated with ePHR use among younger adults ($\beta$=.29; P<.001), ease of understanding health information in ePHRs was positively linked to ePHR use only among older adults ($\beta$=.13; P=.003). Conclusions: This study found that including clinical notes was positively related to ePHR use in both age groups, which suggested that including clinical notes as a part of ePHRs might improve the effective use of ePHRs among patients. Moreover, accessing ePHRs using a smartphone app was associated with higher ePHR use among younger adults while ease of understanding health information in ePHRs was linked to higher ePHR use among older adults. The design of ePHRs should provide the option of being accessible through mobile devices to promote greater ePHR use among young people. For older adults, providers could add additional notes to explain the health information recorded in the ePHRs. ",
doi="10.2196/27966",
url="https://www.jmir.org/2021/10/e27966",
url="http://www.ncbi.nlm.nih.gov/pubmed/34698646"
}


@Article{info:doi/10.2196/31582,
author="Yousef, Cheriece Consuela
and Salgado, M. Teresa
and Farooq, Ali
and Burnett, Keisha
and McClelland, E. Laura
and Abu Esba, Carolina Laila
and Alhamdan, Solaiman Hani
and Khoshhal, Sahal
and Aldossary, Fahad Ibrahim
and Alyas, Anwar Omar
and DeShazo, P. Jonathan",
title="Health Care Providers' Acceptance of a Personal Health Record: Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="21",
volume="23",
number="10",
pages="e31582",
keywords="personal health records",
keywords="patient portals",
keywords="Ministry of National Guard Health Affairs",
keywords="UTAUT",
keywords="eHealth",
keywords="Middle East",
abstract="Background: Personal health records (PHRs) are eHealth tools designed to support patient engagement, patient empowerment, and patient- and person-centered care. Endorsement of a PHR by health care providers (HCPs) facilitates patient acceptance. As health care organizations in the Kingdom of Saudi Arabia begin to adopt PHRs, understanding the perspectives of HCPs is important because it can influence patient adoption. However, no studies evaluated HCPs' acceptance of PHRs in the Kingdom of Saudi Arabia. Objective: The aim of this study was to identify predictors of HCPs' acceptance of PHRs using behavioral intention to recommend as a proxy for adoption. Methods: This cross-sectional study was conducted among HCPs (physicians, pharmacists, nurses, technicians, others) utilizing a survey based on the Unified Theory of Acceptance and Use of Technology. The main theory constructs of performance expectancy, effort expectancy, social influence, facilitating conditions, and positive attitude were considered independent variables. Behavioral intention was the dependent variable. Age, years of experience, and professional role were tested as moderators between the main theory constructs and behavioral intention using partial least squares structural equation modeling. Results: Of the 291 participants, 246 were included in the final analysis. Behavioral intention to support PHR use among patients was significantly influenced by performance expectancy ($\beta$=.17, P=.03) and attitude ($\beta$=.61, P<.01). No moderating effects were present. Conclusions: This study identified performance expectancy and attitude as predictors of HCPs' behavioral intention to recommend PHR to patients. To encourage HCPs to endorse PHRs, health care organizations should involve HCPs in the implementation and provide training on the features available as well as expected benefits. Future studies should be conducted in other contexts and include other potential predictors. ",
doi="10.2196/31582",
url="https://www.jmir.org/2021/10/e31582",
url="http://www.ncbi.nlm.nih.gov/pubmed/34569943"
}


@Article{info:doi/10.2196/30243,
author="Cheng, Christina
and Elsworth, Gerald
and Osborne, H. Richard",
title="Validity Evidence Based on Relations to Other Variables of the eHealth Literacy Questionnaire (eHLQ): Bayesian Approach to Test for Known-Groups Validity",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="14",
volume="23",
number="10",
pages="e30243",
keywords="eHealth",
keywords="digital health",
keywords="health literacy",
keywords="health equity",
keywords="questionnaire design",
keywords="health literacy questionnaire",
keywords="validity evidence",
keywords="mediation effect",
keywords="mobile phone",
abstract="Background: As health resources and services are increasingly delivered through digital platforms, eHealth literacy is becoming a set of essential capabilities to improve consumer health in the digital era. To understand eHealth literacy needs, a meaningful measure is required. Strong initial evidence for the reliability and construct validity of inferences drawn from the eHealth Literacy Questionnaire (eHLQ) was obtained during its development in Denmark, but validity testing for varying purposes is an ongoing and cumulative process. Objective: This study aims to examine validity evidence based on relations to other variables---using data collected with the known-groups approach---to further explore if the eHLQ is a robust tool to understand eHealth literacy needs in different contexts. A priori hypotheses are set for the expected score differences among age, sex, education, and information and communication technology (ICT) use for each of the 7 eHealth literacy constructs represented by the 7 eHLQ scales. Methods: A Bayesian mediated multiple indicators multiple causes model approach was used to simultaneously identify group differences and test measurement invariance through differential item functioning across the groups, with ICT use as a mediator. A sample size of 500 participants was estimated. Data were collected at 3 diverse health sites in Australia. Results: Responses from 525 participants were included for analysis. Being older was significantly related to lower scores in 4 eHLQ scales, with 3. Ability to actively engage with digital services having the strongest effect (total effect --0.37; P<.001), followed by 1. Using technology to process health information (total effect --0.32; P<.001), 5. Motivated to engage with digital services (total effect --0.21; P=.01), and 7. Digital services that suit individual needs (total effect --0.21; P=.02). However, the effects were only partially mediated by ICT use. Higher education was associated with higher scores in 1. Using technology to process health information (total effect 0.22; P=.01) and 3. Ability to actively engage with digital services (total effect 0.25; P<.001), with the effects mostly mediated by ICT use. Higher ICT use was related to higher scores in all scales except 2. Understanding health concepts and language and 4. Feel safe and in control. Either no or ignorable cases of differential item functioning were found across the 4 groups. Conclusions: By using a Bayesian mediated multiple indicators multiple causes model, this study provides supportive validity evidence for the eHLQ based on relations to other variables as well as established evidence regarding internal structure related to measurement invariance across the groups for the 7 scales in the Australian community health context. This study also demonstrates that the eHLQ can be used to gain valuable insights into people's eHealth literacy needs to help optimize access and use of digital health and promote health equity. ",
doi="10.2196/30243",
url="https://www.jmir.org/2021/10/e30243",
url="http://www.ncbi.nlm.nih.gov/pubmed/34647897"
}


@Article{info:doi/10.2196/29495,
author="Adu, Kofi Medard
and Shalaby, Reham
and Eboreime, Ejemai
and Sapara, Adegboyega
and Nkire, Nnamdi
and Chawla, Rajan
and Chima, Chidi
and Achor, Michael
and Osiogo, Felix
and Chue, Pierre
and Greenshaw, J. Andrew
and Agyapong, Israel Vincent",
title="Text Messaging Versus Email Messaging to Support Patients With Major Depressive Disorder: Protocol for a Randomized Hybrid Type II Effectiveness-Implementation Trial",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="13",
volume="10",
number="10",
pages="e29495",
keywords="email messaging",
keywords="text messaging",
keywords="supportive",
keywords="major depressive disorder",
keywords="randomized trial",
keywords="mental health",
keywords="digital health",
keywords="mobile health",
keywords="mHealth",
keywords="patient care",
keywords="health policy",
keywords="decision-making",
keywords="health care resources",
abstract="Background: Major depressive disorder (MDD) accounts for 40.5\% of disability-adjusted life years?caused by mental and substance use disorders. Barriers such as stigma and financial and physical access to care have been reported, highlighting the need for innovative, accessible, and cost-effective psychological interventions. The effectiveness of supportive SMS text messaging in alleviating depression symptoms has been proven in clinical trials, but this approach can only help those with mobile phones. Objective: This paper presents the protocol for a study that will aim to evaluate the feasibility, comparative effectiveness, and user satisfaction of daily supportive email messaging as an effective strategy compared to daily supportive text messaging as part of the treatment of patients with MDD. Methods: This trial will be carried out using a hybrid type II implementation-effectiveness design. This design evaluates the effectiveness of an implementation strategy or intervention, while also evaluating the implementation context associated with the intervention. Patients with MDD receiving usual care will be randomized to receive either daily supportive email messaging or daily supportive text messaging of the same content for 6 months. The Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the 5-item World Health Organization Well-Being Index will be used to evaluate the effectiveness of both strategies. The implementation evaluation will be guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, as well as the Consolidated Framework for Implementation Research. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. Results: Data collection for this trial began in April 2021. We expect the study results to be available within 18 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated emails as a strategy for delivering supportive messages to patients with MDD in comparison to text messaging. Conclusions: The outcome of this trial will have translational impact on routine patient care and access to mental health, as well as potentially support mental health policy decision-making for health care resource allocation. Trial Registration: ClinicalTrials.gov NCT04638231; https://clinicaltrials.gov/ct2/show/NCT04638231 International Registered Report Identifier (IRRID): DERR1-10.2196/29495 ",
doi="10.2196/29495",
url="https://www.researchprotocols.org/2021/10/e29495",
url="http://www.ncbi.nlm.nih.gov/pubmed/34643541"
}


@Article{info:doi/10.2196/29984,
author="Marshall, Gard Emily
and Breton, Mylaine
and Cossette, Benoit
and Isenor, Jennifer
and Mathews, Maria
and Ayn, Caitlyn
and Smithman, Ann M{\'e}lanie
and Stock, David
and Frymire, Eliot
and Edwards, Lynn
and Green, Michael",
title="Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year (the PUPPY Study): Protocol for a Longitudinal Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="13",
volume="10",
number="10",
pages="e29984",
keywords="primary care",
keywords="health services research",
keywords="health policy",
keywords="mixed methods research",
keywords="COVID-19",
keywords="protocol",
keywords="policy",
keywords="longitudinal",
keywords="coordination",
keywords="access",
keywords="impact",
keywords="virtual care",
keywords="virtual health",
keywords="Canada",
abstract="Background: The COVID-19 pandemic has significantly disrupted primary care in Canada, with many walk-in clinics and family practices initially closing or being perceived as inaccessible; pharmacies remaining open with restrictions on patient interactions; rapid uptake of virtual care; and reduced referrals for lab tests, diagnostics, and specialist care. Objective: The PUPPY Study (Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year) seeks to understand the impact of the COVID-19 pandemic across the quadruple aims of primary care, with particular focus on the effects on patients without attachment to a regular provider and those with chronic health conditions. Methods: The PUPPY study builds on an existing research program exploring patients' access and attachment to a primary care practice, pivoted to adapt to the emerging COVID-19 context. We intend to undertake a longitudinal mixed methods study to understand critical gaps in primary care access and coordination, as well as compare prepandemic and postpandemic data across 3 Canadian provinces (Quebec, Ontario, and Nova Scotia). Multiple data sources will be used such as a policy review; qualitative interviews with primary care policymakers, providers (ie, family physicians, nurse practitioners, and pharmacists), and patients (N=120); and medication prescriptions and health care billing data. Results: This study has received funding by the Canadian Institutes of Health Research COVID-19 Rapid Funding Opportunity Grant. Ethical approval to conduct this study was granted in Ontario (Queens Health Sciences \& Affiliated Teaching Hospitals Research Ethics Board, file 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol 40335) in November 2020, Qu{\'e}bec (Centre int{\'e}gr{\'e} universitaire de sant{\'e} et de services sociaux de l'Estrie, project 2020-3446) in December 2020, and Nova Scotia (Nova Scotia Health Research Ethics Board, file 1024979) in August 2020. Conclusions: To our knowledge, this is the first study of its kind to explore the effects of the COVID-19 pandemic on primary care systems, with particular focus on the issues of patient's attachment and access to primary care. Through a multistakeholder, cross-jurisdictional approach, the findings of the PUPPY study will inform the strengthening of primary care during and beyond the COVID-19 pandemic, as well as have implications for future policy and practice. International Registered Report Identifier (IRRID): DERR1-10.2196/29984 ",
doi="10.2196/29984",
url="https://www.researchprotocols.org/2021/10/e29984",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559672"
}


@Article{info:doi/10.2196/27723,
author="Dolcini, Margaret M.
and Canchola, A. Jesse
and Catania, A. Joseph
and Song Mayeda, M. Marissa
and Dietz, L. Erin
and Cotto-Negr{\'o}n, Coral
and Narayanan, Vasudha",
title="National-Level Disparities in Internet Access Among Low-Income and Black and Hispanic Youth: Current Population Survey",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="12",
volume="23",
number="10",
pages="e27723",
keywords="internet access",
keywords="smartphone use",
keywords="Black youth",
keywords="Hispanic youth",
keywords="low-income youth",
keywords="disparities",
keywords="mobile phone",
abstract="Background: Internet access is increasingly critical for adolescents with regard to obtaining health information and resources, participating in web-based health promotion, and communicating with health practitioners. However, past work demonstrates that access is not uniform among youth in the United States, with lower access found among groups with higher health-related needs. Population-level data yield important insights about access and internet use in the United States. Objective: The aim of this study is to examine internet access and mode of access by social class and race and ethnicity among youth (aged 14-17 years) in the United States. Methods: Using the Current Population Survey, we examined internet access, cell phone or smartphone access, and modes of connecting to the internet for adolescents in 2015 (unweighted N=6950; expanded weights N=17,103,547) and 2017 (unweighted N=6761; expanded weights N=17,379,728). Results: Internet access increased from 2015 to 2017, but socioeconomic status (SES) and racial and ethnic disparities remained. In 2017, the greatest disparities were found for youth in low-income households (no home access=23\%) and for Black youth (no home access=18\%) and Hispanic youth (no home access=14\%). Low-income Black and Hispanic youth were the most likely to lack home internet access (no home access, low SES Black youth=29\%; low SES Hispanic youth=21\%). The mode of access (eg, from home and smartphone) and smartphone-only analyses also revealed disparities. Conclusions: Without internet access, web-based dissemination of information, health promotion, and health care will not reach a significant segment of youth. Currently, SES and racial and ethnic disparities in access prolong health inequalities. Moreover, the economic impact of COVID-19 on Black, Hispanic, and low-income communities may lead to losses in internet access for youth that will further exacerbate disparities. ",
doi="10.2196/27723",
url="https://www.jmir.org/2021/10/e27723",
url="http://www.ncbi.nlm.nih.gov/pubmed/34636728"
}


@Article{info:doi/10.2196/31733,
author="Gold, Rachel
and Sheppler, Christina
and Hessler, Danielle
and Bunce, Arwen
and Cottrell, Erika
and Yosuf, Nadia
and Pisciotta, Maura
and Gunn, Rose
and Leo, Michael
and Gottlieb, Laura",
title="Using Electronic Health Record--Based Clinical Decision Support to Provide Social Risk--Informed Care in Community Health Centers: Protocol for the Design and Assessment of a Clinical Decision Support Tool",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="8",
volume="10",
number="10",
pages="e31733",
keywords="social determinants of health",
keywords="decision support systems, clinical",
keywords="electronic health records",
keywords="community health centers",
keywords="health status disparities",
abstract="Background: Consistent and compelling evidence demonstrates that social and economic adversity has an impact on health outcomes. In response, many health care professional organizations recommend screening patients for experiences of social and economic adversity or social risks---for example, food, housing, and transportation insecurity---in the context of care. Guidance on how health care providers can act on documented social risk data to improve health outcomes is nascent. A strategy recommended by the National Academy of Medicine involves using social risk data to adapt care plans in ways that accommodate patients' social risks. Objective: This study's aims are to develop electronic health record (EHR)--based clinical decision support (CDS) tools that suggest social risk--informed care plan adaptations for patients with diabetes or hypertension, assess tool adoption and its impact on selected clinical quality measures in community health centers, and examine perceptions of tool usability and impact on care quality. Methods: A systematic scoping review and several stakeholder activities will be conducted to inform development of the CDS tools. The tools will be pilot-tested to obtain user input, and their content and form will be revised based on this input. A randomized quasi-experimental design will then be used to assess the impact of the revised tools. Eligible clinics will be randomized to a control group or potential intervention group; clinics will be recruited from the potential intervention group in random order until 6 are enrolled in the study. Intervention clinics will have access to the CDS tools in their EHR, will receive minimal implementation support, and will be followed for 18 months to evaluate tool adoption and the impact of tool use on patient blood pressure and glucose control. Results: This study was funded in January 2020 by the National Institute on Minority Health and Health Disparities of the National Institutes of Health. Formative activities will take place from April 2020 to July 2021, the CDS tools will be developed between May 2021 and November 2022, the pilot study will be conducted from August 2021 to July 2022, and the main trial will occur from December 2022 to May 2024. Study data will be analyzed, and the results will be disseminated in 2024. Conclusions: Patients' social risk information must be presented to care teams in a way that facilitates social risk--informed care. To our knowledge, this study is the first to develop and test EHR-embedded CDS tools designed to support the provision of social risk--informed care. The study results will add a needed understanding of how to use social risk data to improve health outcomes and reduce disparities. International Registered Report Identifier (IRRID): PRR1-10.2196/31733 ",
doi="10.2196/31733",
url="https://www.researchprotocols.org/2021/10/e31733",
url="http://www.ncbi.nlm.nih.gov/pubmed/34623308"
}


@Article{info:doi/10.2196/29074,
author="Raj, Minakshi
and Iott, Bradley",
title="Evaluation of Family Caregivers' Use of Their Adult Care Recipient's Patient Portal From the 2019 Health Information National Trends Survey: Secondary Analysis",
journal="JMIR Aging",
year="2021",
month="Oct",
day="4",
volume="4",
number="4",
pages="e29074",
keywords="informal caregivers",
keywords="family caregivers",
keywords="patient portal",
keywords="electronic health record",
keywords="telehealth",
keywords="aging in place",
keywords="web-based medical record",
abstract="Background: Patient engagement is critical for realizing the value of telehealth modalities such as the patient portal. Family caregiver engagement may also be critical for facilitating the use of the patient portal among adult patients, including older adults. Objective: This study aims to analyze the 2019 Health Information National Trends Survey to characterize family caregivers' use of their care recipient's patient portal in terms of sociodemographic, health, and caregiving characteristics and caregivers' use of their own portal. Methods: We conducted a secondary analysis of cross-sectional data from the National Cancer Institute's Health Information National Trends Survey 5 Cycle 3. This survey was administered to 5438 US adults between January and May 2019. We analyzed data from 320 respondents who were identified as family caregivers. We created measures to reflect family caregivers' use of their care recipient's and their own portal, caregiver demographic and caregiving characteristics, and care recipient health characteristics. Results: Over half of the caregivers (179/320, 55.9\%) reported using their own portal at least once, whereas only one-third (105/320, 32.8\%) reported using their care recipient's record in the previous 12 months. Caregivers using their own portal were significantly more likely to use their care recipient's portal (odds ratio 11.18; P<.001). Conclusions: Policies should enable patients to designate family caregivers who can access their patient portal. Providers could screen caregivers for challenges in their caregiving responsibilities that may be addressed through the portal so they can better support their adult relatives. Interventions to support family caregivers, especially older caregivers, in using their own portal may facilitate their use of their care recipient's portal. ",
doi="10.2196/29074",
url="https://aging.jmir.org/2021/4/e29074",
url="http://www.ncbi.nlm.nih.gov/pubmed/34605766"
}


@Article{info:doi/10.2196/29990,
author="Gandrakota, Nikhila
and Ali, K. Mohammed
and Shah, K. Megha",
title="Trends in Health Information Technology Use Among the US Population With and Without Cardiovascular Risk Factors, 2012-2018: Evidence From the National Health Interview Survey",
journal="JMIR Public Health Surveill",
year="2021",
month="Sep",
day="30",
volume="7",
number="9",
pages="e29990",
keywords="telemedicine",
keywords="cardiovascular risk factors",
keywords="health information technology",
keywords="telehealth",
keywords="digital health",
keywords="public health",
keywords="surveillance",
abstract="Background: The COVID-19 pandemic has required clinicians to pivot to offering services via telehealth; however, it is unclear which patients (users of care) are equipped to use digital health. This is especially pertinent for adults managing chronic diseases, such as obesity, hypertension, and diabetes, which require regular follow-up, medication management, and self-monitoring. Objective: The aim of this study is to measure the trends and assess factors affecting health information technology (HIT) use among members of the US population with and without cardiovascular risk factors. Methods: We used serial cross-sectional data from the National Health Interview Survey for the years 2012-2018 to assess trends in HIT use among adults, stratified by age and cardiovascular risk factor status. We developed multivariate logistic regression models adjusted for age, sex, race, insurance status, marital status, geographic region, and perceived health status to assess the likelihood of HIT use among patients with and without cardiovascular disease risk factors. Results: A total of 14,304 (44.6\%) and 14,644 (58.7\%) participants reported using HIT in 2012 and 2018, respectively. When comparing the rates of HIT use for the years 2012 and 2018, among participants without cardiovascular risk factors, the HIT use proportion increased from 51.1\% to 65.8\%; among those with one risk factor, it increased from 43.9\% to 59\%; and among those with more than one risk factor, it increased from 41.3\% to 54.7\%. Increasing trends in HIT use were highest among adults aged >65 years (annual percentage change [APC] 8.3\%), who had more than one cardiovascular risk factor (APC 5\%) and among those who did not graduate from high school (APC 8.8\%). Likelihood of HIT use was significantly higher in individuals who were younger, female, and non-Hispanic White; had higher education and income; were married; and reported very good or excellent health status. In 2018, college graduates were 7.18 (95\% CI 5.86-8.79), 6.25 (95\% CI 5.02-7.78), or 7.80 (95\% CI 5.87-10.36) times more likely to use HIT compared to adults without high school education among people with multiple cardiovascular risk factors, one cardiovascular risk factor, or no cardiovascular risk factors, respectively. Conclusions: Over 2012-2018, HIT use increased nationally, with greater use noted among younger and higher educated US adults. Targeted strategies are needed to engage wider age, racial, education, and socioeconomic groups by lowering barriers to HIT access and use. ",
doi="10.2196/29990",
url="https://publichealth.jmir.org/2021/9/e29990",
url="http://www.ncbi.nlm.nih.gov/pubmed/34591026"
}


@Article{info:doi/10.2196/27787,
author="Thurman, Whitney
and Semwal, Monika
and Moczygemba, R. Leticia
and Hilbelink, Mark",
title="Smartphone Technology to Empower People Experiencing Homelessness: Secondary Analysis        ",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="29",
volume="23",
number="9",
pages="e27787",
keywords="homelessness",
keywords="self-management",
keywords="smartphone technology",
keywords="social needs",
keywords="mobile phone",
abstract="Background: In the United States, the number of people experiencing homelessness has continually increased over the last 3 years. Homelessness is associated with poor health, and people experiencing homelessness are often burdened with high rates of chronic and mental health conditions, functional limitations, and cognitive impairment. Despite the high burden of chronic illness and functional limitations, there is limited literature exploring self-management among homeless populations. Objective: This study aims to investigate how access to smartphone technology facilitates self-management, including the attainment of social needs within the context of homelessness. Methods: A secondary analysis of 33 exit interviews from 2 feasibility studies related to mobile health interventions among people experiencing homelessness was conducted. Iterative thematic analysis was used to identify themes representative of participants' experiences using smartphone technology. Results: Collectively, participants revealed not only how the context of homelessness constrained their ability to engage in activities necessary to self-manage health and meet social needs but also how consistent and predictable access to the tools available through a smartphone changed their behaviors and outlook. The global theme of empowered by technology was identified and defined as how having a smartphone with a plan for unlimited text, calling, data, and transportation allowed participants to navigate homelessness and facilitated self-management. Conclusions: People experiencing homelessness used the tools on a smartphone to make decisions, take action, solve problems, and use the resources---skills necessary for fulfilling tasks required for effective self-management. Further, consistent access to smartphone technology and transportation empowered participants to meet the requirements for the attainment of social needs. ",
doi="10.2196/27787",
url="https://www.jmir.org/2021/9/e27787",
url="http://www.ncbi.nlm.nih.gov/pubmed/34586073"
}


@Article{info:doi/10.2196/26721,
author="Xu, Huan Richard
and Zhou, Ling-Ming
and Wong, Lai-Yi Eliza
and Wang, Dong",
title="The Association Between Patients' eHealth Literacy and Satisfaction With Shared Decision-making and Well-being: Multicenter Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="24",
volume="23",
number="9",
pages="e26721",
keywords="eHealth literacy",
keywords="shared decision-making",
keywords="well-being",
keywords="eHEALS",
keywords="ICECAP-A",
abstract="Background: Although previous studies have shown that a high level of health literacy can improve patients' ability to engage in health-related shared decision-making (SDM) and improve their quality of life, few studies have investigated the role of eHealth literacy in improving patient satisfaction with SDM (SSDM) and well-being. Objective: This study aims to assess the relationship between patients' eHealth literacy and their socioeconomic determinants and to investigate the association between patients' eHealth literacy and their SSDM and well-being. Methods: The data used in this study were obtained from a multicenter cross-sectional survey in China. The eHealth Literacy Scale (eHEALS) and Investigating Choice Experiments Capability Measure for Adults were used to measure patients' eHealth literacy and capability well-being, respectively. The SSDM was assessed by using a self-administered questionnaire. The Kruskal-Wallis one-way analysis of variance and Wilcoxon signed-rank test were used to compare the differences in the eHEALS, SSDM, and Investigating Choice Experiments Capability Measure for Adults scores of patients with varying background characteristics. Ordinary least square regression models were used to assess the relationship among eHealth literacy, SSDM, and well-being adjusted by patients' background characteristics. Results: A total of 569 patients completed the questionnaire. Patients who were male, were highly educated, were childless, were fully employed, were without chronic conditions, and indicated no depressive disorder reported a higher mean score on the eHEALS. Younger patients (SSDM?61 years=88.6 vs SSDM16-30 years=84.2) tended to show higher SSDM. Patients who were rural residents and were well paid were more likely to report good capability well-being. Patients who had a higher SSDM and better capability well-being reported a significantly higher level of eHealth literacy than those who had lower SSDM and poorer capability well-being. The regression models showed a positive relationship between eHealth literacy and both SSDM ($\beta$=.22; P<.001) and well-being ($\beta$=.26; P<.001) after adjusting for patients' demographic, socioeconomic status, lifestyle, and health status variables. Conclusions: This study showed that patients with a high level of eHealth literacy are more likely to experience optimal SDM and improved capability well-being. However, patients' depressive status may alter the relationship between eHealth literacy and SSDM. ",
doi="10.2196/26721",
url="https://www.jmir.org/2021/9/e26721",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559062"
}


@Article{info:doi/10.2196/31627,
author="Liu, Hua-Xuan
and Chow, Bik-Chu
and Liang, Wei
and Hassel, Holger
and Huang, Wendy YaJun",
title="Measuring a Broad Spectrum of eHealth Skills in the Web 3.0 Context Using an eHealth Literacy Scale: Development and Validation Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="23",
volume="23",
number="9",
pages="e31627",
keywords="eHealth literacy",
keywords="scale development",
keywords="validation",
keywords="college students",
abstract="Background: eHealth literacy (EHL) refers to a variety of capabilities that enable individuals to obtain health information from electronic resources and apply it to solve health problems. With the digitization of health care and the wide availability of health apps, a more diverse range of eHealth skills is required to properly use such health facilities. Existing EHL measurements focus mainly on the skill of obtaining health information (Web 1.0), whereas skills for web-based interactions (Web 2.0) and self-managing health data and applying information (Web 3.0) have not been well measured. Objective: This study aims to develop an EHL scale (eHLS) termed eHLS-Web3.0 comprising a comprehensive spectrum of Web 1.0, 2.0, and 3.0 skills to measure EHL, and evaluate its validity and reliability along with the measurement invariance among college students. Methods: In study 1, 421 Chinese college students (mean age 20.5, SD 1.4 years; 51.8\% female) and 8 health experts (mean age 38.3, SD 5.9 years; 87.5\% female) were involved to develop the eHLS-Web3.0. The scale development included three steps: item pool generation, content validation, and exploratory factor analysis. In study 2, 741 college students (mean age 21.3, SD 1.4 years; 52.2\% female) were recruited from 4 Chinese cities to validate the newly developed eHLS-Web3.0. The construct validity, convergent validity, concurrent validity, internal consistency reliability, test-retest reliability, and measurement invariance across genders, majors, and regions were examined by a series of statistical analyses, including confirmatory factor analysis (CFA) and multigroup CFAs using SPSS and Mplus software packages. Results: Based on the item pool of 374 statements collected during the conceptual development, 24 items (4-10 items per subscale) were generated and adjusted after cognitive testing and content validity examination. Through exploratory factor analysis, a 3-factor eHLS-Web3.0 was finally developed, and it included acquisition (8 items), verification (6 items), and application (10 items). In study 2, CFAs supported the construct validity of the 24-item 3D eHLS-Web3.0 ($\chi$2244=903.076, $\chi$2244=3.701, comparative fit index=0.924, Tucker-Lewis index=0.914, root mean square error of approximation [RMSEA]=0.06, and standardized root mean residual [SRMR]=0.051). The average variance extracted (AVE) value of 0.58 and high correlation between eHLS-Web3.0 subscales and the eHealth Literacy Scale (r=0.725-0.880, P<.001) indicated the convergent validity and concurrent validity of the eHLS-Web3.0. The results also indicated satisfactory internal consistency reliability ($\alpha$=.976, $\rho$=0.934-0.956) and test-retest reliability (r=0.858, P<.001) of the scale. Multigroup CFA demonstrated the 24-item eHLS-Web3.0 to be invariant at all configural, metric, strength, and structural levels across genders (female and male), majors (sport-related, medical, and general), and regions (Yinchuan, Kunming, Xiamen, and Beijing). Conclusions: The 24-item 3D eHLS-Web3.0 proved to be a reliable and valid measurement tool for EHL in the Web 3.0 context among Chinese college students. ",
doi="10.2196/31627",
url="https://www.jmir.org/2021/9/e31627",
url="http://www.ncbi.nlm.nih.gov/pubmed/34554098"
}


@Article{info:doi/10.2196/19896,
author="Oktay, Alperen Liam
and Abuelgasim, Eyad
and Abdelwahed, Aida
and Houbby, Nour
and Lampridou, Smaragda
and Normahani, Pasha
and Peters, Nicholas
and Jaffer, Usman",
title="Factors Affecting Engagement in Web-Based Health Care Patient Information: Narrative Review of the Literature",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="23",
volume="23",
number="9",
pages="e19896",
keywords="patient education",
keywords="web-based health information",
keywords="internet",
keywords="patient engagement",
keywords="mobile phone",
abstract="Background: Web-based content is rapidly becoming the primary source of health care information. There is a pressing need for web-based health care content to not only be accurate but also be engaging. Improved engagement of people with web-based health care content has the potential to inform as well as influence behavioral change to enable people to make better health care choices. The factors associated with better engagement with web-based health care content have previously not been considered. Objective: The aims of this study are to identify the factors that affect engagement with web-based health care content and develop a framework to be considered when creating such content. Methods: A comprehensive search of the PubMed and MEDLINE database was performed from January 1, 1946, to January 5, 2020. The reference lists of all included studies were also searched. The Medical Subject Headings database was used to derive the following keywords: ``patient information,'' ``online,'' ``internet,'' ``web,'' and ``content.'' All studies in English pertaining to the factors affecting engagement in web-based health care patient information were included. No restrictions were set on the study type. Analysis of the themes arising from the results was performed using inductive content analysis. Results: The search yielded 814 articles, of which 56 (6.9\%) met our inclusion criteria. The studies ranged from observational and noncontrolled studies to quasi-experimental studies. Overall, there was significant heterogeneity in the types of interventions and outcome assessments, which made quantitative assessment difficult. Consensus among all authors of this study resulted in six categories that formed the basis of a framework to assess the factors affecting engagement in web-based health care content: easy to understand, support, adaptability, accessibility, visuals and content, and credibility and completeness. Conclusions: There is a paucity of high-quality data relating to the factors that improve the quality of engagement with web-based health care content. Our framework summarizes the reported studies, which may be useful to health care content creators. An evaluation of the utility of web-based content to engage users is of significant importance and may be accessible through tools such as the Net Promoter score. Web 3.0 technology and development of the field of psychographics for health care offer further potential for development. Future work may also involve improvement of the framework through a co-design process. ",
doi="10.2196/19896",
url="https://www.jmir.org/2021/9/e19896",
url="http://www.ncbi.nlm.nih.gov/pubmed/34554104"
}


@Article{info:doi/10.2196/25472,
author="Neves, Lu{\'i}sa Ana
and J{\'a}come, Cristina
and Taveira-Gomes, Tiago
and Pereira, Margarida Ana
and Almeida, Rute
and Amaral, Rita
and Alves-Correia, Magna
and Mendes, Sandra
and Chaves-Loureiro, Cl{\'a}udia
and Val{\'e}rio, Margarida
and Lopes, Cristina
and Carvalho, Joana
and Mendes, Ana
and Ribeiro, Carmelita
and Prates, Sara
and Ferreira, Alberto Jos{\'e}
and Teixeira, Fernanda Maria
and Branco, Joana
and Santalha, Marta
and Vasconcelos, Jo{\~a}o Maria
and Lozoya, Carlos
and Santos, Natacha
and Cardia, Francisca
and Moreira, Sofia Ana
and Taborda-Barata, Lu{\'i}s
and Pinto, Sofia Cl{\'a}udia
and Ferreira, Ros{\'a}rio
and Morais Silva, Pedro
and Monteiro Ferreira, Tania
and C{\^a}mara, Raquel
and Lobo, Rui
and Bordalo, Diana
and Guimar{\~a}es, Cristina
and Esp{\'i}rito Santo, Maria
and Ferraz de Oliveira, Jos{\'e}
and C{\'a}lix Augusto, Jos{\'e} Maria
and Gomes, Ricardo
and Vieira, In{\^e}s
and da Silva, Sofia
and Marques, Maria
and Cardoso, Jo{\~a}o
and Morete, Ana
and Aroso, Margarida
and Cruz, Margarida Ana
and Nunes, Carlos
and C{\^a}mara, Rita
and Rodrigues, Natalina
and Abreu, Carmo
and Albuquerque, Lu{\'i}sa Ana
and Vieira, Cla{\'u}dia
and Santos, Carlos
and P{\'a}scoa, Ros{\'a}lia
and Chaves-Loureiro, Carla
and Alves, Adelaide
and Neves, {\^A}ngela
and Varanda Marques, Jos{\'e}
and Reis, Bruno
and Ferreira-Magalh{\~a}es, Manuel
and Almeida Fonseca, Jo{\~a}o",
title="Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="22",
volume="23",
number="9",
pages="e25472",
keywords="mobile apps",
keywords="smartphone",
keywords="patient participation",
keywords="self-management",
keywords="asthma",
abstract="Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients' daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ?40 years old (66.4\%), had at least 10 years of education (57.4\%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1\%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1\%) and the prevalence of anxiety and depression was 34.3\% and 11.9\%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1\% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95\%CI 1.05-4.75 and aOR 1.95, 95\%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95\%CI 2.90-17.40), 10.30 (95\%CI 4.28-27.56), and 11.52 (95\%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95\%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users' general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use. ",
doi="10.2196/25472",
url="https://www.jmir.org/2021/9/e25472",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550077"
}


@Article{info:doi/10.2196/17913,
author="Nowaskie, Z. Dustin",
title="Development, Implementation, and Effectiveness of a Self-sustaining, Web-Based LGBTQ+ National Platform: A Framework for Centralizing Local Health Care Resources and Culturally Competent Providers",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="22",
volume="5",
number="9",
pages="e17913",
keywords="cultural competency",
keywords="disparities",
keywords="e-health",
keywords="healthcare",
keywords="internet",
keywords="LGBTQ+",
keywords="online platform",
keywords="providers",
keywords="resources",
keywords="eHealth",
keywords="health care",
abstract="Background: The lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) population has long faced substantial marginalization, discrimination, and health care disparities compared to the cisgender, heterosexual population. As the etiology of such disparities is multifaceted, finding concrete solutions for LGBTQ+ health care equity is challenging. However, the internet may offer the space to initiate an effective model. Objective: In an effort to make LGBTQ+ public resources and culturally competent providers transparent, modernize medical education, and promote cultural competency, OutCare Health---a nonprofit 501(c)(3) multidisciplinary, multicenter web-based platform---was created. Methods: The organization employs a cyclic, multidimensional framework to conduct needs assessments, identify resources and providers, promote these efforts on the website, and educate the next generation of providers. LGBTQ+ public health services are identified via the internet, email, and word of mouth and added to the Public Resource Database; culturally competent providers are recruited to the OutList directory via listservs, medical institutions, local organizations, and word of mouth; and mentors are invited to the Mentorship Program by emailing OutList providers. These efforts are replicated across nearly 30 states in the United States. Results: The organization has identified over 500 public health organizations across all states, recognized more than 2000 OutList providers across all states and 50 specialties, distributed hundreds of thousands of educational materials, received over 10,000 monthly website visits (with 83\% unique viewership), and formed nearly 30 state-specific teams. The total number of OutList providers and monthly website views has doubled every 12-18 months. The majority of OutList providers are trained in primary, first point-of-care specialties such as family medicine, infectious disease, internal medicine, mental health, obstetrics and gynecology, and pediatrics. Conclusions: A web-based LGBTQ+ platform is a feasible, effective model to identify public health resources, culturally competent providers, and mentors as well as provide cultural competency educational materials and education across the country. Such a platform also has the opportunity to reach self-perpetuating sustainability. The cyclic, multidisciplinary, multidimensional, multicenter framework presented here appears to be pivotal in achieving such growth and stability. Other organizations and medical institutions should heavily consider using this framework to reach their own communities with high-quality, culturally competent care for the LGBTQ+ population. ",
doi="10.2196/17913",
url="https://formative.jmir.org/2021/9/e17913",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550083"
}


@Article{info:doi/10.2196/28066,
author="Rantanen, Teemu
and Gluschkoff, Kia
and Silvennoinen, Piia
and Heponiemi, Tarja",
title="The Associations Between Mental Health Problems and Attitudes Toward Web-Based Health and Social Care Services: Evidence From a Finnish Population-Based Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="21",
volume="23",
number="9",
pages="e28066",
keywords="digital inclusion",
keywords="digital exclusion",
keywords="digital divide",
keywords="mental health",
keywords="attitudes",
abstract="Background: The significance of web-based health and social care services has been highlighted in recent years. There is a risk that the digitalization of public services will reinforce the digital and social exclusion of vulnerable groups, such as individuals with mental health problems. Objective: This study aims to examine the associations between mental health problems and attitudes toward web-based health and social care services in the general population. The attitudes measured include lack of interest, perceived need for face-to-face encounters, and concern for safety. The study also evaluates whether sociodemographic characteristics (age, gender, education level, and poverty) modify these associations. Methods: Cross-sectional population-based data were collected from 4495 Finnish adults in 2017. Linear regression was used to examine the main effects and interactions of poor mental health and sociodemographic characteristics on attitudes toward web-based health and social care services. Results: The results show that mental health was associated with attitudes toward web-based health and social care services. Individuals with mental health problems were especially concerned about the safety of web-based services. Poor mental health was independently associated with negative attitudes toward web-based services over the effects of sociodemographic factors. Some of the associations between poor mental health and negative attitudes toward web-based services were stronger among older people and men. With regard to sociodemographic characteristics, particularly higher age, low education, and poverty were associated with negative attitudes toward web-based health and social care services. Conclusions: Poor mental health is associated with negative attitudes toward web-based health and social care services and thus indirectly with exclusion. It seems that being older and being male both reinforce the link between poor mental health and exclusion. In supporting the digital inclusion of people with mental health problems, attention should be paid to guidance and counseling, reliability, and the user-friendliness of web-based services as well as to the prevention of poverty. In addition, it is essential to see web-based services as complementary to, and not a substitute for, face-to-face services. ",
doi="10.2196/28066",
url="https://www.jmir.org/2021/9/e28066",
url="http://www.ncbi.nlm.nih.gov/pubmed/34546184"
}


@Article{info:doi/10.2196/21316,
author="Li, Ji-Bin
and Feng, Li-Fen
and Wu, S. Anise M.
and Mai, Jin-Chen
and Chen, Yu-Xia
and Mo, H. Phoenix K.
and Lau, F. Joseph T.",
title="Roles of Psychosocial Factors on the Association Between Online Social Networking Use Intensity and Depressive Symptoms Among Adolescents: Prospective Cohort Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="21",
volume="23",
number="9",
pages="e21316",
keywords="online social networking use intensity",
keywords="depressive symptoms",
keywords="psychosocial factors",
keywords="mediation and suppression",
keywords="longitudinal study",
abstract="Background: The potential mechanisms underlying the association between online social networking use intensity and depressive symptoms are unclear and underresearched. Objective: We aimed to investigate the potential roles of interpersonal psychosocial factors on the association between online social networking use intensity and depressive symptoms among early adolescents. Methods: A total of 4237 adolescents from a 9-month longitudinal study were included. Score changes (indicated as ?) for the social function use intensity (SFUI) and entertainment function use intensity (EFUI) subscales of the Online Social Networking Activity Intensity Scale and for friendship quality, perceived family support, perceived friend support, parent--adolescent conflict, social nonconfidence, and depressive symptoms were analyzed. The potential mediation effects of unfavorable psychosocial factors and suppression effects of favorable psychosocial factors on the association of ?SFUI with ?CES-D and the association of ?EFUI with ?CES-D were tested using hierarchical regression models. Results: The association between ?SFUI and ?CES-D was partially mediated by ?mother--adolescent conflict (mediation effect size 5.11\%, P=.02) and ?social nonconfidence (mediation effect size 20.97\%, P<.001) but partially suppressed by ?friendship quality, ?perceived family support, and ?perceived friend support, with suppression effects of --0.011 (P=.003), --0.009 (P=.003), and --0.022 (P<.001), respectively. The association between ?EFUI and ?CES-D was partially mediated by ?social nonconfidence (mediation effect size 30.65\%, P<.001) but partially suppressed by ?perceived family support and ?perceived friend support, with suppression effects of --0.036 (P<.001) and --0.039 (P<.001), respectively. Conclusions: The association between online social networking use intensity and depressive symptoms was partially mediated through the indirect increase in social nonconfidence and mother--adolescent conflict; however, better perceived social support and friendship quality would partially compensate for the harmful impact of online social networking use intensity on depressive symptoms among early adolescents. ",
doi="10.2196/21316",
url="https://www.jmir.org/2021/9/e21316",
url="http://www.ncbi.nlm.nih.gov/pubmed/34546173"
}


@Article{info:doi/10.2196/28501,
author="Yin, Rong
and Law, Katherine
and Neyens, David",
title="Examining How Internet Users Trust and Access Electronic Health Record Patient Portals: Survey Study",
journal="JMIR Hum Factors",
year="2021",
month="Sep",
day="21",
volume="8",
number="3",
pages="e28501",
keywords="internet",
keywords="consumer health informatics",
keywords="patient portal",
keywords="participatory medicine",
keywords="electronic health records",
keywords="logistic model",
keywords="surveys",
keywords="questionnaires",
abstract="Background: Electronic health record (EHR) patient portals are designed to provide medical health records to patients. Using an EHR portal is expected to contribute to positive health outcomes and facilitate patient-provider communication. Objective: Our objective was to examine how portal users report using their portals and the factors associated with obtaining health information from the internet. We also examined the desired portal features, factors impacting users' trust in portals, and barriers to using portals. Methods: An internet-based survey study was conducted using Amazon Mechanical Turk. All the participants were adults in the United States who used patient portals. The survey included questions about how the participants used their portals, what factors acted as barriers to using their portals, and how they used and how much they trusted other web-based health information sources as well as their portals. A logistic regression model was used to examine the factors influencing the participants' trust in their portals. Additionally, the desired features and design characteristics were identified to support the design of future portals. Results: A total of 394 participants completed the survey. Most of the participants were less than 35 years old (212/394, 53.8\%), with 36.3\% (143/394) aged between 35 and 55 years, and 9.9\% (39/394) aged above 55 years. Women accounted for 48.5\% (191/394) of the survey participants. More than 78\% (307/394) of the participants reported using portals at least monthly. The most common portal features used were viewing lab results, making appointments, and paying bills. Participants reported some barriers to portal use including data security and limited access to the internet. The results of a logistic regression model used to predict the trust in their portals suggest that those comfortable using their portals (odds ratio [OR] 7.97, 95\% CI 1.11-57.32) thought that their portals were easy to use (OR 7.4, 95\% CI 1.12-48.84), and frequent internet users (OR 43.72, 95\% CI 1.83-1046.43) were more likely to trust their portals. Participants reporting that the portals were important in managing their health (OR 28.13, 95\% CI 5.31-148.85) and that their portals were a valuable part of their health care (OR 6.75, 95\% CI 1.51-30.11) were also more likely to trust their portals. Conclusions: There are several factors that impact the trust of EHR patient portal users in their portals. Designing easily usable portals and considering these factors may be the most effective approach to improving trust in patient portals. The desired features and usability of portals are critical factors that contribute to users' trust in EHR portals. ",
doi="10.2196/28501",
url="https://humanfactors.jmir.org/2021/3/e28501",
url="http://www.ncbi.nlm.nih.gov/pubmed/34546182"
}


@Article{info:doi/10.2196/28797,
author="Ingle, Pilar M.
and Valdovinos, Cristina
and Ford, L. Kelsey
and Zhou, Shou
and Bull, Sheana
and Gornail, Starlynne
and Zhang, Xuhong
and Moore, Susan
and Portz, Jennifer",
title="Patient Portals to Support Palliative and End-of-Life Care: Scoping Review",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="16",
volume="23",
number="9",
pages="e28797",
keywords="patient portal",
keywords="electronic health record",
keywords="digital health",
keywords="palliative care",
keywords="end-of-life care",
abstract="Background: Although patient portals are widely used for health promotion, little is known about the use of palliative care and end-of-life (PCEOL) portal tools available for patients and caregivers. Objective: This study aims to identify and assess the user perspectives of PCEOL portal tools available to patients and caregivers described and evaluated in the literature. Methods: We performed a scoping review of the academic literature directed by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) extension for Scoping Review and searched three databases. Sources were included if they reported the development or testing of a feature, resource, tool, or intervention; focused on at least one PCEOL domain defined by the National Coalition for Hospice and Palliative Care; targeted adults with serious illness or caregivers; and were offered via a patient portal tethered to an electronic medical record. We independently screened the titles and abstracts (n=796) for eligibility. Full-text (84/796, 10.6\%) sources were reviewed. We abstracted descriptions of the portal tool name, content, targeted population, and reported user acceptability for each tool from included sources (n=19). Results: In total, 19 articles describing 12 tools were included, addressing the following PCEOL domains: ethical or legal (n=5), physical (n=5), and psychological or psychiatric (n=2). No tools for bereavement or hospice care were identified. Studies have reported high acceptability of tools among users; however, few sources commented on usability among older adults. Conclusions: PCEOL patient portal tools are understudied. As medical care increasingly moves toward virtual platforms, future research should investigate the usability and acceptability of PCEOL patient portal resources and evaluate their impact on health outcomes. ",
doi="10.2196/28797",
url="https://www.jmir.org/2021/9/e28797",
url="http://www.ncbi.nlm.nih.gov/pubmed/34528888"
}


@Article{info:doi/10.2196/26273,
author="Hamilton, Leigh Jessica
and Lee, Woanjun",
title="Associations Between Social Media, Bedtime Technology Use Rules, and Daytime Sleepiness Among Adolescents: Cross-sectional Findings From a Nationally Representative Sample",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26273",
keywords="adolescents",
keywords="social media",
keywords="daytime sleepiness",
keywords="parenting",
keywords="bedtime",
keywords="mental health",
keywords="mobile phone",
abstract="Background: Social media use is associated with poor sleep among adolescents, including daytime sleepiness, which affects adolescents' mental health. Few studies have examined the associations among specific aspects of social media, such as frequency of checking and posting, perceived importance of social media for social belonging, and daytime sleepiness. Identifying whether certain adolescents are more at risk or protected from the effects of social media on sleepiness may inform future interventions for social media, sleep, and mental health. Objective: This study aims to examine the association between social media use frequency and importance, daytime sleepiness, and whether the perceived importance of social media for social interactions and parental rules around bedtime technology moderated these relationships. Methods: This cross-sectional survey study was conducted with a sample of 4153 adolescents from across the United States. Qualtrics was used to collect data via panel recruitment from a national sample representing the US demographics of teens aged 12 to 17 years. Participants completed measures of daytime sleepiness, frequency of social media checking and posting, and the importance of social media for social interactions. Parents reported whether they had a household rule around bedtime media and screen use. Hierarchical regressions and moderation analyses were conducted, covarying for age, gender, and age at first smartphone use. Results: Participants had a mean age of 14.64 (SD 1.66) years in grades 6 to 12, 46.45\% (1929/4153) identified as female, and 67.93\% (2821/4153) identified as White. The results indicated that adolescents who posted (B=0.70, SE 0.04; P<.001) or checked (B=0.76, SE 0.04; P<.001) social media more frequently or who perceived social media to be more important for social belonging (B=0.36, SE 0.02; P<.001) had higher levels of daytime sleepiness. Moderation analyses indicated that the relationship between social media use frequency and daytime sleepiness was exacerbated by higher levels of perceived social media importance (B=0.04, SE 0.01; P<.001). Adolescents without household rules around bedtime technology use were more likely to be affected by social media checking (B=?0.34, SE 0.09; P<.001) and importance (B=?0.16, SE 0.04; P<.001) on daytime sleepiness. Conclusions: The findings suggest that social media use frequency and perceived importance of social interactions are associated with daytime sleepiness among adolescents. It is important to consider youth's perceptions of social media when assessing the potential effects of social media use frequency on youth well-being. Furthermore, youth who did not have parental rules around bedtime technology use were most likely to be affected by social media use and perceived importance. The findings may extend to other mental health outcomes and may guide future prevention and intervention programs designed to improve social media use, sleep, and mental health. ",
doi="10.2196/26273",
url="https://mental.jmir.org/2021/9/e26273",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524967"
}


@Article{info:doi/10.2196/27745,
author="Borghouts, Judith
and Eikey, V. Elizabeth
and Mark, Gloria
and De Leon, Cinthia
and Schueller, M. Stephen
and Schneider, Margaret
and Stadnick, Nicole
and Zheng, Kai
and Mukamel, B. Dana
and Sorkin, H. Dara",
title="Understanding Mental Health App Use Among Community College Students: Web-Based Survey Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="14",
volume="23",
number="9",
pages="e27745",
keywords="mHealth",
keywords="mental health",
keywords="community college",
keywords="students",
keywords="structural equation modeling",
keywords="mobile apps",
keywords="services",
keywords="mental health services",
keywords="stress",
keywords="privacy",
abstract="Background: Mental health concerns are a significant issue among community college students, who often have less access to resources than traditional university college students. Mobile apps have the potential to increase access to mental health care, but there has been little research investigating factors associated with mental health app use within the community college population. Objective: This study aimed to understand facilitators of and barriers to mental health app use among community college students. Methods: A web-based survey was administered to a randomly selected sample of 500 community college students from April 16 to June 30, 2020. Structural equation modeling was used to test the relationships between the use of mental health apps, perceived stress, perceived need to seek help for mental health concerns, perceived stigma, past use of professional mental health services, privacy concerns, and social influence of other people in using mental health apps. Results: Of the 500 participants, 106 (21.2\%) reported use of mental health apps. Perceived stress, perceived need to seek help, past use of professional services, and social influence were positively associated with mental health app use. Furthermore, the effect of stress was mediated by a perceived need to seek help. Privacy concerns were negatively associated with mental health app use. Stigma, age, and gender did not have a statistically significant effect. Conclusions: These findings can inform development of new digital interventions and appropriate outreach strategies to engage community college students in using mental health apps. ",
doi="10.2196/27745",
url="https://www.jmir.org/2021/9/e27745",
url="http://www.ncbi.nlm.nih.gov/pubmed/34519668"
}


@Article{info:doi/10.2196/26881,
author="AshaRani, PV
and Jue Hua, Lau
and Roystonn, Kumarasan
and Siva Kumar, Devi Fiona
and Peizhi, Wang
and Ying Jie, Soo
and Shafie, Saleha
and Chang, Sherilyn
and Jeyagurunathan, Anitha
and Boon Yiang, Chua
and Abdin, Edimansyah
and Ajit Vaingankar, Janhavi
and Sum, Fang Chee
and Lee, Sing Eng
and Chong, Ann Siow
and Subramaniam, Mythily",
title="Readiness and Acceptance of eHealth Services for Diabetes Care in the General Population: Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="2",
volume="23",
number="9",
pages="e26881",
keywords="eHealth",
keywords="diabetes",
keywords="general population",
keywords="acceptance",
keywords="readiness",
abstract="Background: Diabetes management is a growing health care challenge worldwide. eHealth can revolutionize diabetes care, the success of which depends on end user acceptance. Objective: This study aims to understand the readiness and acceptance of eHealth services for diabetes care among the general population, perceived advantages and disadvantages of eHealth, and factors associated with eHealth readiness and acceptance in a multiethnic Asian country. Methods: In this cross-sectional epidemiological study, participants (N=2895) were selected through disproportionate stratified random sampling from a population registry. Citizens or permanent residents of Singapore aged >18 years were recruited. The data were captured through computer-assisted personal interviews. An eHealth questionnaire was administered in one of four local languages (English, Chinese, Malay, or Tamil), as preferred by the participant. Bivariate chi-square analyses were performed to compare the sociodemographic characteristics and perception of advantages and disadvantages of eHealth services between the diabetes and nondiabetes groups. Multivariable logistic regression models were used to determine factors associated with eHealth readiness and acceptance. All analyses were weighted using survey weights to account for the complex survey design. Results: The sample comprised participants with (n=436) and without (n=2459) diabetes. eHealth readiness was low, with 47.3\% of the overall sample and 75.7\% of the diabetes group endorsing that they were not ready for eHealth (P<.001). The most acceptable eHealth service overall was booking appointments (67.4\%). There was a significantly higher preference in the diabetes group for face-to-face sessions for consultation with the clinician (nondiabetes: 83.5\% vs diabetes: 92.6\%; P<.001), receiving prescriptions (61.9\% vs 79.3\%; P<.001), referrals to other doctors (51.4\% vs 72.2\%; P<.001), and receiving health information (34\% vs 63.4\%; P<.001). The majority of both groups felt that eHealth requires users to be computer literate (90.5\% vs 94.3\%), does not build clinician-patient rapport compared with face-to-face sessions (77.5\% vs 81\%), and might not be credible (56.8\% vs 64.2\%; P=.03). Age (?35 years), ethnicity (Indian), and lower education status had lower odds of eHealth readiness. Age (?35 years), ethnicity (Indian), lower education status (primary school), BMI (being underweight), and marital status (being single) were associated with a lower likelihood of eHealth acceptance. Among only those with diabetes, a longer duration of diabetes (4-18 years), higher education (degree or above), and younger age (23-49 years) were associated with eHealth readiness, whereas younger age and income (SGD 2000-3999 [US \$1481-\$2961]) were associated with acceptance. Conclusions: Overall, an unfavorable attitude toward eHealth was observed, with a significantly higher number of participants with diabetes reporting their unwillingness to use these services for their diabetes care. Sociodemographic factors associated with acceptance and readiness identified a group of people who were unlikely to accept the technology and thus need to be targeted for eHealth literacy programs to avoid health care disparity. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-037125 ",
doi="10.2196/26881",
url="https://www.jmir.org/2021/9/e26881",
url="http://www.ncbi.nlm.nih.gov/pubmed/34473062"
}


@Article{info:doi/10.2196/25873,
author="Khairat, Saif
and McDaniel, Phillip
and Jansen, Matthew
and Francis, Tia
and Edson, Barbara
and Gianforcaro, Robert",
title="Analysis of Social Determinants and the Utilization of Pediatric Tele--Urgent Care During the COVID-19 Pandemic: Cross-sectional Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Aug",
day="30",
volume="4",
number="3",
pages="e25873",
keywords="telehealth",
keywords="pediatrics",
keywords="social",
keywords="determinants",
keywords="COVID-19",
keywords="use",
keywords="children",
keywords="infant",
keywords="consultation",
keywords="telemedicine",
keywords="urgent care",
keywords="vulnerable population",
keywords="cross-sectional",
keywords="minority",
abstract="Background: Telehealth is increasingly used to provide specialty consultations to infants and children receiving care. However, there is uncertainty if the COVID-19 pandemic has influenced the use of telehealth among vulnerable populations. Objective: This research aims to compare the overall use of tele--urgent care visits for pediatric patients before and after the pandemic, especially among vulnerable populations. Methods: We conducted a cross-sectional analysis of pediatric tele--urgent care visits at a virtual care center at a southeastern health care center. The main outcome of this study was the use of pediatrics tele--urgent visits across geographical regions with different levels of social disparities and between 2019 and 2020. Results: Of 584 tele--urgent care visits, 388 (66.4\%) visits occurred in 2020 during the pandemic compared to 196 (33.6\%) visits in 2019. Among 808 North Carolina zip codes, 181 (22\%) consisted of a high concentration of vulnerable populations, where 17.7\% (56/317) of the tele--urgent care visits originated from. The majority (215/317, 67.8\%) of tele--urgent care visits originated from zip codes with a low concentration of vulnerable populations. There was a significant association between the rate of COVID-19 cases and the concentration level of social factors in a given Zip Code Tabulation Area. Conclusions: The use of tele--urgent care visits for pediatric care doubled during the COVID-19 pandemic. The majority of the tele--urgent care visits after COVID-19 originated from regions where there is a low presence of vulnerable populations. In addition, our geospatial analysis found that geographic regions with a high concentration of vulnerable populations had a significantly higher rate of COVID-19--confirmed cases and deaths compared to regions with a low concentration of vulnerable populations. ",
doi="10.2196/25873",
url="https://pediatrics.jmir.org/2021/3/e25873",
url="http://www.ncbi.nlm.nih.gov/pubmed/34459742"
}


@Article{info:doi/10.2196/30987,
author="Scheim, I. Ayden
and Bauer, R. Greta
and Bastos, L. Jo{\~a}o
and Poteat, Tonia",
title="Advancing Intersectional Discrimination Measures for Health Disparities Research: Protocol for a Bilingual Mixed Methods Measurement Study",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="30",
volume="10",
number="8",
pages="e30987",
keywords="stigma",
keywords="discrimination",
keywords="racism",
keywords="measurement",
keywords="health disparities",
keywords="survey research",
keywords="psychometrics",
abstract="Background: Guided by intersectionality frameworks, researchers have documented health disparities at the intersection of multiple axes of social status and position, particularly race and ethnicity, gender, and sexual orientation. To advance from identifying to intervening in such intersectional health disparities, studies that examine the underlying mechanisms are required. Although much research demonstrates the negative health impacts of perceived discrimination along single axes, quantitative approaches to assessing the role of discrimination in generating intersectional health disparities remain in their infancy. Members of our team recently introduced the Intersectional Discrimination Index (InDI) to address this gap. The InDI comprises three measures of enacted (day-to-day and major) and anticipated discrimination. These attribution-free measures ask about experiences of mistreatment because of who you are. These measures show promise for intersectional health disparities research but require further validation across intersectional groups and languages. In addition, the proposal to remove attributions is controversial, and no direct comparison has ever been conducted. Objective: This study aims to cognitively and psychometrically evaluate the InDI in English and Spanish and determine whether attributions should be included. Methods: The study will draw on a preliminary validation data set and three original sequentially collected sources of data: qualitative cognitive interviews in English and Spanish with a sample purposively recruited across intersecting social status and position (gender, sexual orientation, race and ethnicity, socioeconomic status, age, and nativity); a Spanish quantitative survey (n=500; 250/500, 50\% sexual and gender minorities); and an English quantitative survey (n=3000), with quota sampling by race and ethnicity (Black, Latino/a/x, and White), sexual or gender minority status, and gender. Results: The study was funded by the National Institute on Minority Health and Health Disparities in May 2021, and data collection began in July 2021. Conclusions: The key deliverables of the study will be bilingual measures of anticipated, day-to-day, and major discrimination validated for multiple health disparity populations using qualitative, quantitative, and mixed methods. International Registered Report Identifier (IRRID): PRR1-10.2196/30987 ",
doi="10.2196/30987",
url="https://www.researchprotocols.org/2021/8/e30987",
url="http://www.ncbi.nlm.nih.gov/pubmed/34459747"
}


@Article{info:doi/10.2196/19820,
author="Kinney, P. Aaron
and Sankaranarayanan, Balaji",
title="Effects of Patient Portal Use on Patient Satisfaction: Survey and Partial Least Squares Analysis",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="27",
volume="23",
number="8",
pages="e19820",
keywords="patient portal",
keywords="patient satisfaction",
keywords="gratification",
keywords="health self-awareness",
keywords="post-adoptive use",
keywords="health perceptions",
abstract="Background: With digital delivery of health care services gaining prominence, patient portals have become a mainstay of many health care organizations. Despite the importance of patient portals, inconclusive data exist regarding the effect of patient portal use on patient satisfaction. Objective: The aim of this study is to understand the relationship between the postadoptive use of patient portals and patient satisfaction outcomes. Methods: Postadoptive use of patient portals has a positive relationship with the 3 dimensions of patient satisfaction, mediated by gratification, health self-awareness, and health perceptions. A total of 504 valid patient portal user responses were collected, and partial least squares analysis was performed to analyze the data. Results: Patient satisfaction was captured using three dimensions: care team interaction, atmosphere, and instruction effectiveness. The results show that postadoptive use of patient portals has a positive influence on all 3 dimensions of patient satisfaction through the mediating variables of gratification, health self-awareness, and health perceptions. Specifically, postadoptive use had significant positive influence on gratification, health self-awareness, and health perceptions. Each of the 3 patient perceptions had significant positive influence on all 3 dimensions of patient satisfaction: care team interaction, atmosphere, and instruction effectiveness. Specifically, our model explained 31.8\% of the care team interaction, 40.6\% of the atmosphere, and 39.1\% of the instruction effectiveness. Conclusions: Our model shows that patient portal use can influence patient satisfaction through the mediating effects of gratification, health self-awareness, and health perception. Patient satisfaction is an important outcome for health care organizations. Therefore, by promoting effective patient portal use and fostering patient perceptions, health care organizations can improve patient satisfaction. ",
doi="10.2196/19820",
url="https://www.jmir.org/2021/8/e19820",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448712"
}


@Article{info:doi/10.2196/23765,
author="Nwokeji, Uchenna
and Spaulding, M. Erin
and Shan, Rongzi
and Turkson-Ocran, Ruth-Alma
and Baptiste, Diana
and Koirala, Binu
and Plante, B. Timothy
and Martin, S. Seth
and Commodore-Mensah, Yvonne",
title="Health Information Technology Use Among Persons With Self-reported Atherosclerotic Cardiovascular Disease: Analysis of the 2011-2018 National Health Interview Survey",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="13",
volume="23",
number="8",
pages="e23765",
keywords="health information technology",
keywords="cardiovascular disease",
keywords="digital health",
keywords="eHealth",
keywords="mobile phone",
abstract="Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality in the United States. Health information technologies (HITs) have recently emerged as a viable intervention to mitigate the burden of ASCVD. Approximately 60\% of US adults report searching the internet for health information; however, previous research has not examined the prevalence of general technology or HIT use among adults with and without ASCVD. In addition, social determinants in HIT use among adults with ASCVD are not well understood. Objective: The aim of this study was to evaluate the prevalence and social determinants of HIT use among US adults with versus without self-reported ASCVD. Methods: We pooled cross-sectional data from the 2011-2018 National Health Interview Survey (NHIS) to examine the general technology and HIT use among adults aged ?18 years with and without self-reported ASCVD (coronary heart disease, stroke, or both). General technology use was defined as mobile phone ownership, internet use, and computer use. HIT use was defined as looking up health information on the internet, filling a web-based prescription, scheduling a medical appointment on the internet, communicating with a health care provider by email, or using web-based group chats to learn about health topics. We evaluated sociodemographic differences in HIT use among respondents by using Poisson regression. Analyses were weighted according to NHIS standards. Results: A total sample of 256,117 individuals were included, of which 2194 (0.9\%) reported prior ASCVD. Among adults with prior ASCVD, the mean age was 70.6 (SD 11.5) years, and 47.4\% (1048/2194) of the adults were females. General technology use differed between participants with and without prior ASCVD, with 36.0\% (614/1826) and 76.2\% (157,642/213,816) indicating internet usage and 24.6\% (374/1575) and 60.7\% (107,742/184,557) indicating using a computer every day, respectively. Similarly, adults with ASCVD were less likely to use HIT than those without ASCVD (515/2194, 25.1\% vs 123,966/253,923, 51.0\%; P<.001). Among adults with prior ASCVD, social determinants that were associated with HIT use included younger age, higher education, higher income, being employed, and being married. Conclusions: HIT use was low among adults with a history of ASCVD, which may represent a barrier to delivering care via emerging HIT. Given the associations with social determinants such as income, education, and employment, targeted strategies and policies are needed to eliminate barriers to impact HIT usage. ",
doi="10.2196/23765",
url="https://www.jmir.org/2021/8/e23765",
url="http://www.ncbi.nlm.nih.gov/pubmed/34397391"
}


@Article{info:doi/10.2196/25947,
author="Yousef, Hind
and Al-Sheyab, Nihaya
and Al Nsour, Mohannad
and Khader, Yousef
and Al Kattan, Malika
and Bardus, Marco
and Alyahya, Mohammad
and Taha, Hana
and Amiri, Mirwais",
title="Perceptions Toward the Use of Digital Technology for Enhancing Family Planning Services: Focus Group Discussion With Beneficiaries and Key Informative Interview With Midwives",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="28",
volume="23",
number="7",
pages="e25947",
keywords="family planning",
keywords="mobile apps",
keywords="social media",
keywords="digital technology",
keywords="contraceptives",
abstract="Background: Modern family planning (FP) methods allow married couples to discuss and determine the number of children and years of spacing between them. Despite many significant improvements in FP services in Jordan, there are still many issues related to the uptake of FP services for both host communities and Syrian refugees, due to limitations in the health care system based on public health facilities. Digital technologies can provide opportunities to address the challenges faced in the health system, thus offering the potential to improve both coverage and quality of FP services and practices. Objective: The aim of this study was to explore the perceptions of Jordanian women, Syrian refugees, and midwives in Jordan toward the use of digital health technology to support and enhance access to FP services. Methods: We employed a qualitative study based on semistructured, face-to face key informative interviews with 17 midwives (providers) and focus group discussions with 32 married women of reproductive age (clients). Both midwives and clients were recruited from 9 health centers in 2 major governorates in Jordan (Irbid and Mafraq), where 17 in-depth interviews were conducted with midwives and 4 focus groups were conducted with the women. Each focus group included 4 Syrian refugees and 4 Jordanian women. The transcribed narratives were analyzed using inductive thematic analysis. Results: Three major themes were derived from the narratives analysis, which covered the pros of using digital technology, concerns about digital technology use, and the ideal app or website characteristics. Ten subthemes emerged from these 3 main themes. Overall, midwives and women (Syrian refugees and host communities) agreed that digital technology can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman's awareness and knowledge regarding the FP methods and their side effect. Furthermore, digital technology can assist in enabling women's empowerment, which will allow them to make better decisions regarding FP use. No harmful risks or consequences were perceived to be associated with using digital technology. However, several concerns regarding digital technology use were related to eHealth literacy and the accuracy of the information provided. Midwives were mainly concerned about the patients who would rely mostly on the technology and choose to avoid consulting a health care professional. Conclusions: As perceived by midwives and women, incorporating digital technology in FP services can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman's awareness regarding the FP methods and their side effect. It may also empower the women to play an active role in the shared (with their husband and family) decision-making process. Therefore, digital technologies are recommended to address the challenges faced in health system and to improve both the coverage and the quality of FP services and practices. ",
doi="10.2196/25947",
url="https://www.jmir.org/2021/7/e25947",
url="http://www.ncbi.nlm.nih.gov/pubmed/34319250"
}


@Article{info:doi/10.2196/27982,
author="Miyawaki, Atsushi
and Tabuchi, Takahiro
and Ong, K. Michael
and Tsugawa, Yusuke",
title="Age and Social Disparities in the Use of Telemedicine During the COVID-19 Pandemic in Japan: Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="23",
volume="23",
number="7",
pages="e27982",
keywords="telemedicine",
keywords="telehealth",
keywords="disparity",
keywords="access to care",
keywords="COVID-19",
keywords="Japan",
abstract="Background: The use of telemedicine outpatient visits has increased dramatically during the COVID-19 pandemic in many countries. Although disparities in access to telemedicine by age and socioeconomic status (SES) have been well-documented, evidence is limited as to how these disparities changed during the COVID-19 pandemic. Moreover, the equity of patient access to telemedicine has been scarcely reported in Japan, despite the huge potential for telemedicine expansion. Objective: We aimed to investigate changes due to age and SES disparities in telemedicine use during the COVID-19 pandemic in Japan. Methods: Using data from a large internet survey conducted between August 25 and September 30, 2020, in Japan, we examined the associations of participant age and SES (educational attainment, urbanicity of residence, and income level) with their telemedicine use in the following two time periods during the pandemic: April 2020 and August-September 2020. Results: Of the 24,526 participants aged 18 to 79 years (50.8\% [n=12,446] women), the proportion of individuals who reported using telemedicine increased from 2.0\% (n=497) in April 2020 to 4.7\% (n=1159) in August-September 2020. After adjusting for potential confounders, younger individuals were more likely to use telemedicine than older individuals in April 2020. Although this pattern persisted in August-September 2020, we also observed a substantial increase in telemedicine use among individuals aged 70 to 79 years (adjusted rates, 0.2\% in April 2020 vs 3.8\% in August-September 2020; P<.001 after multiple comparisons). We found disparities in telemedicine use by SES in August-September 2020 that did not exist in April 2020. In August-September 2020, individuals with a university degree were more likely to use telemedicine than those with a high school diploma or less (adjusted rates, 6.6\% vs 3.5\%; P<.001). Individuals living in urban areas exhibited higher rates of telemedicine use than those living in rural areas only in August-September 2020 (adjusted rates, 5.2\% vs 3.8\%; P<.001). Disparities in telemedicine use by income level were not observed in either time period. Conclusions: In general, younger individuals increased their use of telemedicine compared to older individuals during the pandemic, although individuals in their 70s also increased their use of telemedicine. Disparities in telemedicine use by educational attainment and urbanicity of residence widened during the COVID-19 pandemic. ",
doi="10.2196/27982",
url="https://www.jmir.org/2021/7/e27982",
url="http://www.ncbi.nlm.nih.gov/pubmed/34259641"
}


@Article{info:doi/10.2196/29865,
author="Gao, Zhiwei
and Fujita, Sumio
and Shimizu, Nobuyuki
and Liew, Kongmeng
and Murayama, Taichi
and Yada, Shuntaro
and Wakamiya, Shoko
and Aramaki, Eiji",
title="Measuring Public Concern About COVID-19 in Japanese Internet Users Through Search Queries: Infodemiological Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jul",
day="20",
volume="7",
number="7",
pages="e29865",
keywords="COVID-19",
keywords="search query",
keywords="infodemiology",
keywords="quantitative analysis",
keywords="concern",
keywords="rural",
keywords="urban",
keywords="Internet",
keywords="information-seeking behavior",
keywords="attitude",
keywords="Japan",
abstract="Background: COVID-19 has disrupted lives and livelihoods and caused widespread panic worldwide. Emerging reports suggest that people living in rural areas in some countries are more susceptible to COVID-19. However, there is a lack of quantitative evidence that can shed light on whether residents of rural areas are more concerned about COVID-19 than residents of urban areas. Objective: This infodemiology study investigated attitudes toward COVID-19 in different Japanese prefectures by aggregating and analyzing Yahoo! JAPAN search queries. Methods: We measured COVID-19 concerns in each Japanese prefecture by aggregating search counts of COVID-19--related queries of Yahoo! JAPAN users and data related to COVID-19 cases. We then defined two indices---the localized concern index (LCI) and localized concern index by patient percentage (LCIPP)---to quantitatively represent the degree of concern. To investigate the impact of emergency declarations on people's concerns, we divided our study period into three phases according to the timing of the state of emergency in Japan: before, during, and after. In addition, we evaluated the relationship between the LCI and LCIPP in different prefectures by correlating them with prefecture-level indicators of urbanization. Results: Our results demonstrated that the concerns about COVID-19 in the prefectures changed in accordance with the declaration of the state of emergency. The correlation analyses also indicated that the differentiated types of public concern measured by the LCI and LCIPP reflect the prefectures' level of urbanization to a certain extent (ie, the LCI appears to be more suitable for quantifying COVID-19 concern in urban areas, while the LCIPP seems to be more appropriate for rural areas). Conclusions: We quantitatively defined Japanese Yahoo users' concerns about COVID-19 by using the search counts of COVID-19--related search queries. Our results also showed that the LCI and LCIPP have external validity. ",
doi="10.2196/29865",
url="https://publichealth.jmir.org/2021/7/e29865",
url="http://www.ncbi.nlm.nih.gov/pubmed/34174781"
}


@Article{info:doi/10.2196/22203,
author="Williamson, Alicia
and Barbarin, Andrea
and Campbell, Bettina
and Campbell, Terrance
and Franzen, Susan
and Reischl, M. Thomas
and Zimmerman, Marc
and Veinot, Christine Tiffany",
title="Uptake of and Engagement With an Online Sexual Health Intervention (HOPE eIntervention) Among African American Young Adults: Mixed Methods Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="16",
volume="23",
number="7",
pages="e22203",
keywords="HIV prevention",
keywords="consumer health informatics",
keywords="sexual health",
keywords="health equity",
keywords="technology adoption",
keywords="technology usage",
abstract="Background: Regarding health technologies, African American young adults have low rates of uptake, ongoing usage, and engagement, which may widen sexual health inequalities. Objective: We aimed to examine rates of uptake and ongoing usage, and factors influencing uptake, ongoing usage, and engagement for a consumer health informatics (CHI) intervention for HIV/sexually transmitted infection (STI) prevention among African American young adults, using the diffusion of innovation theory, trust-centered design framework, and O'Brien and Toms' model of engagement. Methods: This community-based participatory mixed methods study included surveys at four time points (n=315; 280 African American participants) among young adults aged 18 to 24 years involved in a blended offline/online HIV/STI prevention intervention (HIV Outreach, Prevention, and Education [HOPE] eIntervention), which was described as a ``HOPE party.'' Qualitative interviews were conducted with a subset of participants (n=19) after initial surveys and website server logs indicated low uptake and ongoing usage. A generalized linear mixed-effects model identified predictors of eIntervention uptake, server logs were summarized to describe use over time, and interview transcripts were coded and thematically analyzed to identify factors affecting uptake and engagement. Results: Participants' initial self-reported eIntervention uptake was low, but increased significantly over time, although uptake never reached expectations. The most frequent activity was visiting the website. Demographic factors and HOPE party social network characteristics were not significantly correlated with uptake, although participant education and party network gender homophily approached significance. According to interviews, one factor driving uptake was the desire to share HIV/STI prevention information with others. Survey and interview results showed that technology access, perceived time, and institutional and technological trust were necessary conditions for uptake. Interviews revealed that factors undermining uptake were insufficient promotion and awareness building, and the platform of the intervention, with social media being less appealing due to previous negative experiences concerning discussion of sexuality on social media. During the interaction with the eIntervention, interview data showed that factors driving initial engagement were audience-targeted website esthetics and appealing visuals. Ongoing usage was impeded by insufficiently frequent updates. Similarly, lack of novelty drove disengagement, although a social media contest for sharing intervention content resulted in some re-engagement. Conclusions: To encourage uptake, CHI interventions for African American young adults can better leverage users' desires to share information about HIV/STI prevention with others. Ensuring implementation through trusted organizations is also important, though vigorous promotion is needed. Visual appeal and targeted content foster engagement at first, but ongoing usage may require continual content changes. A thorough analysis of CHI intervention use can inform the development of future interventions to promote uptake and engagement. To guide future analyses, we present an expanded uptake and engagement model for CHI interventions targeting African American young adults based on our empirical results. ",
doi="10.2196/22203",
url="https://www.jmir.org/2021/7/e22203",
url="http://www.ncbi.nlm.nih.gov/pubmed/34269689"
}


@Article{info:doi/10.2196/26180,
author="Sherman, D. Ledric
and Goidel, Kirby
and Bergeron, D. Caroline
and Smith, Lee Matthew",
title="Web-Based Health Information Seeking Among African American and Hispanic Men Living With Chronic Conditions: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="14",
volume="23",
number="7",
pages="e26180",
keywords="minority men",
keywords="online information seeking",
keywords="chronic disease",
keywords="communication with health care providers",
keywords="mobile phone",
abstract="Background: Previous research has identified disparities in seeking and using web-based health information to inform health-related behaviors. Relatively few studies however have examined the correlations between web-based health information seeking and use based on race, gender, age, and the presence of chronic health conditions. Objective: In this study, we identify factors associated with seeking and using web-based health information among a uniquely vulnerable and intersectional population---middle-aged and older (40 years and older) African American and Hispanic men living with one or more chronic conditions. Methods: Survey responses were collected from a purposive sample of African American and Hispanic men using Qualtrics web-based survey management software. To qualify for inclusion in the study, respondents had to identify as African American or Hispanic men, report having at least one chronic condition, and be aged 40 years and older. A series of binary logistic regression models was created using backward elimination. Statistical significance was determined at P<.05 for all analyses. Results: Web-based health information seeking among African American and Hispanic men is a function of education, the presence of multiple chronic conditions, frustration with health care providers, internet use, and the perceived reliability of web-based health information. The use of web-based health information to inform interactions with health care providers was more common among African American and Hispanic men, who rated their health as relatively good, perceived barriers to care, used technology regularly, and took more daily medications. Conclusions: Understanding the factors that influence African American and Hispanic men seeking web-based health information may help improve the care and treatment of chronic conditions. African American and Hispanic men seek web-based health information as a substitute for routine care and to inform their discussions with health care providers. ",
doi="10.2196/26180",
url="https://www.jmir.org/2021/7/e26180",
url="http://www.ncbi.nlm.nih.gov/pubmed/34259646"
}


@Article{info:doi/10.2196/27682,
author="Shah, K. Megha
and Gibbs, Christina Ashley
and Ali, K. Mohammed
and Narayan, Venkat K. M.
and Islam, Nadia",
title="Overcoming the Digital Divide in the Post--COVID-19 ``Reset'': Enhancing Group Virtual Visits with Community Health Workers",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="8",
volume="23",
number="7",
pages="e27682",
keywords="community health workers",
keywords="COVID-19",
keywords="diabetes mellitus",
keywords="eHealth",
keywords="elderly",
keywords="health equity",
keywords="telemedicine",
keywords="virtual",
keywords="vulnerable populations",
doi="10.2196/27682",
url="https://www.jmir.org/2021/7/e27682",
url="http://www.ncbi.nlm.nih.gov/pubmed/34152995"
}


@Article{info:doi/10.2196/26485,
author="Shen, Chen
and Dumontheil, Iroise
and Thomas, Michael
and R{\"o}{\"o}sli, Martin
and Elliott, Paul
and Toledano, Mireille",
title="Digital Technology Use and BMI: Evidence From a Cross-sectional Analysis of an Adolescent Cohort Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="5",
volume="23",
number="7",
pages="e26485",
keywords="adolescent",
keywords="digital technology",
keywords="obesity",
keywords="insufficient sleep",
keywords="mediation analysis",
keywords="mobile phone",
abstract="Background: The use of digital technology such as mobile phones is ubiquitous in adolescents. However, excessive use may have adverse health effects, possibly partially mediated by disruptions to sleep. Objective: This study aims to assess the social predictors of digital technology use and their cross-sectional association with BMI z scores and being overweight in a large sample of adolescents. Methods: We used baseline data from a subset of a large adolescent cohort from 39 schools across Greater London who participated in the Study of Cognition, Adolescents and Mobile Phones (n=1473). Digital technology use included phone calls, internet use on mobile phones, and video gaming on any device. Multilevel regression was used to assess the associations between digital technology use and age-specific and sex-specific BMI z scores and being overweight (including obesity). Measurements were derived from height and weight, obtained by the Tanita BC-418 Body Composition Analyzer. We examined whether these associations were mediated by insufficient sleep. Results: Generally, participants with lower socioeconomic status reported more use of digital technology. Controlling for socioeconomic status, internet use on mobile phones for more than 3 hours per day was associated with higher BMI z scores (adjusted $\beta$=.30, 95\% CI 0.11-0.48) and greater odds of being overweight (adjusted odds ratio 1.60, 95\% CI 1.09-2.34), compared with low use (?30 minutes). Similar associations were found between video gaming and BMI z scores and being overweight. The BMI z score was more strongly related to weekday digital technology use (internet use on mobile phones and video gaming) than weekend use. Insufficient sleep partly mediated the associations between digital technology use and BMI z scores (proportion of mediation from 8.6\% to 17.8\%) by an indirect effect. Conclusions: We found an association between digital technology use and BMI in adolescents, partly mediated by insufficient sleep, suggesting that the underlying mechanisms may be multifactorial. Further research with longitudinal data is essential to explore the direction of the relationships. ",
doi="10.2196/26485",
url="https://www.jmir.org/2021/7/e26485",
url="http://www.ncbi.nlm.nih.gov/pubmed/35143408"
}


@Article{info:doi/10.2196/25616,
author="Kebede, Sahilemichael Abraham
and Ozolins, Lise-Lotte
and Holst, Hanna
and Galvin, Kathleen",
title="The Digital Engagement of Older People: Systematic Scoping Review Protocol",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="5",
volume="10",
number="7",
pages="e25616",
keywords="digital divide",
keywords="digital engagement",
keywords="digital inclusion",
keywords="initial adoption",
keywords="older people",
keywords="older users",
keywords="sustained engagement",
keywords="technological nonuse",
keywords="older adults",
abstract="Background: There is an ongoing negative narrative about aging that portrays older people as a socioeconomic burden on society. However, increased longevity and good health will allow older adults to contribute meaningfully to society and maximize their well-being. As such, a paradigm shift toward healthy and successful aging can be potentially facilitated by the growing digital technology use for mainstream (day-to-day activities) and assisted living (health and social care). Despite the rising digital engagement trend, digital inequality between the age groups persists. Objective: The aims of this scoping review are to identify the extent and breadth of existing literature of older people's perspectives on digital engagement and summarize the barriers and facilitators for technological nonuse, initial adoption, and sustained digital technology engagement. Methods: This review will be based on the Arksey and O'Malley framework for scoping reviews. The 6-stage framework includes: identifying research questions, identifying relevant studies, study selection, charting the data, summarizing and reporting the results, and a consultation exercise. Published literature will be searched on primary electronic databases such as the Association of Computing Machinery, Web of Science, MEDLINE, PsycINFO, CINAHL, and ScienceDirect. Common grey literature sources will complement the database search on the topic. A two-stage (title/abstract and full article) screening will be conducted to obtain eligible studies for final inclusion. A standardized data extraction tool will be used to extract variables such as the profile of the study population, technologies under investigation, stage of digital engagement, and the barriers and facilitators. Identified and eligible studies will be analyzed using a quantitative (ie, frequency analysis) and qualitative (ie, content analysis) approach suitable for comparing and evaluating literature to provide an evaluation of the current state of the older person's digital engagement. Inclusion will be based on the Joanna Briggs Institute--recommended participant, concept, and context framework. Articles on older people (65 years and older), on digital technology engagement, and from a global context will be included in our review. Results: The results of this review are expected in July 2021. Conclusions: The findings from this review will identify the extent and nature of empirical evidence on how older people digitally engage and the associated barriers and facilitators. International Registered Report Identifier (IRRID): PRR1-10.2196/25616 ",
doi="10.2196/25616",
url="https://www.researchprotocols.org/2021/7/e25616",
url="http://www.ncbi.nlm.nih.gov/pubmed/36260392"
}


@Article{info:doi/10.2196/26085,
author="Bernier, Th{\'e}r{\`e}se
and Shah, Amika
and Ross, E. Lori
and Logie, H. Carmen
and Seto, Emily",
title="The Use of Information and Communication Technologies by Sex Workers to Manage Occupational Health and Safety: Scoping Review",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="24",
volume="23",
number="6",
pages="e26085",
keywords="sex work",
keywords="smartphone",
keywords="mobile phone",
keywords="occupational health and safety",
keywords="online",
keywords="internet",
keywords="website",
abstract="Background: In many countries, sex work is criminalized, driving sex work underground and leaving sex workers vulnerable to a number of occupational health and safety risks, including violence, assault, and robbery. With the advent of widely accessible information and communication technologies (ICTs), sex workers have begun to use electronic occupational health and safety tools to mitigate these risks. Objective: This study aims to explore the use of ICTs by sex workers for managing occupational health and safety risks and strategies for reducing these risks. This paper aims to answer the following question: what is known about sex workers' use of ICTs in the delivery of occupational health and safety strategies? Methods: A literature review following the methodological framework for scoping reviews was conducted to analyze studies describing the use of ICTs by sex workers to mitigate occupational health and safety risks. Experimental, observational, and descriptive studies, as well as protocol papers, were included in this scoping review. Results: Of the 2477 articles initially identified, 41 (1.66\%) met the inclusion criteria. Of these studies, 71\% (29/41) were published between 2015 and 2019. In these studies, the internet was the predominant ICT (24/41, 58\%), followed by text messaging (10/41, 24\%) and assorted communication technologies associated with mobile phones without internet access (7/41, 17\%; eg, voice mail). In 56\% (23/41) of the studies, sex workers located in high-income countries created occupational health and safety strategies (eg, bad date lists) and shared them through the internet. In 24\% (10/41) of the studies, mostly in low- and middle-income countries, organizations external to sex work developed and sent (through text messages) occupational health and safety strategies focused on HIV. In 20\% (8/41) of the studies, external organizations collaborated with the sex worker community in the development of occupational health and safety strategies communicated through ICTs; through this collaboration, concerns other than HIV (eg, mental health) emerged. Conclusions: Although there has been an increase in the number of studies on the use of ICTs by sex workers for managing occupational health and safety over the past 5 years, knowledge of how to optimally leverage ICTs for this purpose remains scarce. Recommendations for expanding the use of ICTs by sex workers for occupational health and safety include external organizations collaborating with sex workers in the design of ICT interventions to mitigate occupational health and safety risks; to examine whether ICTs used in low- and middle-income countries would have applications in high-income countries as a substitute to the internet for sharing occupational health and safety strategies; and to explore the creation of innovative, secure, web-based communities that use existing or alternative digital technologies that could be used by sex workers to manage their occupational health and safety. ",
doi="10.2196/26085",
url="https://www.jmir.org/2021/6/e26085/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34185001"
}


@Article{info:doi/10.2196/26195,
author="Larsen, Britta
and Greenstadt, D. Emily
and Olesen, L. Brittany
and Marcus, H. Bess
and Godino, Job
and Zive, M. Michelle",
title="An mHealth Physical Activity Intervention for Latina Adolescents: Iterative Design of the Chicas Fuertes Study",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="15",
volume="5",
number="6",
pages="e26195",
keywords="mobile health",
keywords="human-centered design",
keywords="qualitative research",
keywords="adolescent health",
keywords="health disparities",
keywords="mobile phone",
abstract="Background: Only 3\% of Latina teens meet the national physical activity (PA) guidelines, and these habits appear to persist into adulthood. Developing effective interventions to increase PA in Latina teens is necessary to prevent disease and reduce disparities. Mobile technologies may be especially appropriate for this population, but mobile health (mHealth) intervention content must be designed in collaboration with the target population.  Objective: This study aims to develop an mHealth PA intervention for Latina adolescents using a multistage iterative process based on the principles of human-centered design and multiple iterations of the design phase of the IDEAS (Integrate, Design, Assess, Share) framework.  Methods: On the basis of the feedback from a previous pilot study, the planned intervention included visual social media posts and text messaging, a commercial wearable tracker, and a primarily visual website. The development of the requested mHealth intervention components was accomplished through the following 2 phases: conducting focus groups with the target population and testing the usability of the final materials with a youth advisory board (YAB) comprising Latina adolescents. Participants for focus groups (N=50) were girls aged 13-18 years who could speak and read in English and who were recruited from local high schools and after-school programs serving a high proportion of Latinos. Facilitated discussions focused on experience with PA and social media apps and specific feedback on intervention material prototypes and possible names and logos. Viable products were designed based on their feedback and then tested for usability by the YAB. YAB members (n=4) were Latinas aged 13-18 years who were not regularly active and were recruited via word of mouth and selected through an application process. Results: The focus group discussions yielded the following findings: PA preferences included walking, running, and group fitness classes, whereas the least popular activities were running, swimming, and biking. Most participants (n=48, 96\%) used some form of social media, with Instagram being the most favored. Participants preferred text messages to be sent no more than once per day, be personalized, and be positively worded. The focus group participants preferred an intervention directly targeting Latinas and social media posts that were brightly colored, included girls of all body types, and provided specific tips and information. Modified intervention materials were generally perceived favorably by the YAB members, who provided suggestions for further refinement, including the shortening of texts and the incorporation of some Spanish phrases.  Conclusions: Latina teens were generally enthusiastic about an mHealth PA intervention, provided that the materials were targeted specifically to them and their preferences. Through multiple iterations of development and feedback from the target population, we gained insight into the needs of Latina teens and joined with industry partners to build a viable final product. ",
doi="10.2196/26195",
url="https://formative.jmir.org/2021/6/e26195",
url="http://www.ncbi.nlm.nih.gov/pubmed/34128823"
}


@Article{info:doi/10.2196/26242,
author="Okoye, M. Safiyyah
and Mulcahy, F. John
and Fabius, D. Chanee
and Burgdorf, G. Julia
and Wolff, L. Jennifer",
title="Neighborhood Broadband and Use of Telehealth Among Older Adults: Cross-sectional Study of National Survey Data Linked With Census Data",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="14",
volume="23",
number="6",
pages="e26242",
keywords="aging",
keywords="broadband internet",
keywords="neighborhood",
keywords="telehealth",
abstract="Background: The COVID-19 pandemic has amplified the role of telehealth in health care delivery. Regional variation in internet access and telehealth use are well-documented, but the effect of neighborhood factors, including the pervasiveness of broadband internet, on older adults' telehealth usage in the context of internet access is not known. Objective: This study aimed to investigate how individual and neighborhood characteristics, including the pervasiveness of neighborhood broadband internet subscription, are associated with engagement in telehealth among older adults with internet access. Methods: In this cross-sectional study, we included 5117 community-living older adults aged ?65 years, who participated in the 2017 National Health and Aging Trends Study with census tract--level data for participants' places of residence from the American Community Survey. Results: Of an estimated 35.3 million community-living older adults, 21.1 million (59.7\%) were internet users, and of this group, more than one-third (35.8\%) engaged in telehealth. In a multivariable regression model adjusted for individual- and neighborhood-level factors, age, education, income, and the pervasiveness of neighborhood broadband internet subscription were associated with engagement in telehealth, while race, health, county metropolitan status, and neighborhood social deprivation were not. Among internet users, living in a neighborhood at the lowest (versus highest) tertile of broadband internet subscription was associated with being 40\% less likely to engage in telehealth (adjusted odds ratio 0.61, 95\% CI 0.42-0.87), all else equal. Conclusions: Neighborhood broadband internet stands out as a mutable characteristic that is consequential to engagement in telehealth. ",
doi="10.2196/26242",
url="https://www.jmir.org/2021/6/e26242",
url="http://www.ncbi.nlm.nih.gov/pubmed/34125071"
}


@Article{info:doi/10.2196/20988,
author="Kouvonen, Anne
and Kemppainen, Laura
and Ketonen, Eeva-Leena
and Kemppainen, Teemu
and Olakivi, Antero
and Wrede, Sirpa",
title="Digital Information Technology Use, Self-Rated Health, and Depression: Population-Based Analysis of a Survey Study on Older Migrants",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="14",
volume="23",
number="6",
pages="e20988",
keywords="digital information technology",
keywords="older adults",
keywords="migrants",
keywords="health",
keywords="depression",
keywords="mobile phone",
abstract="Background: Previous studies have found that in general, poor health is associated with a lower likelihood of internet use in older adults, but it is not well known how different indicators of health are associated with different types of digital information technology (DIT) use. Moreover, little is known about the relationship between health and the types of DIT use in older ethnic minority and migrant populations. Objective: The aim of this study is to examine the associations among depressive symptoms and self-rated health (SRH) with different dimensions of DIT use in older migrants. Methods: We analyzed data from the Care, Health and Ageing of Russian-speaking Minority (CHARM) study, which is based on a nationally representative sample of community-dwelling, Russian-speaking adults aged 50 years or older residing permanently in Finland (men: 616/1082, 56.93\%; age: mean 63.2 years, SD 8.4 years; response rate: 1082/3000, 36.07\%). Data were collected in 2019 using a postal survey. Health was measured using depressive symptoms (measured using the Center for Epidemiologic Studies Depression Scale) and SRH. Binary logistic regression analyses were used to investigate the associations between the two health indicators and the following six outcomes: daily internet use, smartphone ownership, the use of the internet for messages and calls, social media use, the use of the internet for personal health data, and obtaining health information from the internet. A number of sociodemographic and socioeconomic factors were controlled for in the logistic regression regression analysis. Analyses were performed with weights accounting for the survey design and nonresponse. Results: After adjusting for sociodemographic and socioeconomic factors, depressive symptoms (odds ratio [OR] 2.68, 95\% CI 1.37-5.24; P=.004) and poor SRH (OR 7.90, 95\% CI 1.88-33.11; P=.005) were associated with a higher likelihood of not using the internet daily. Depressive symptoms (OR 1.88, 95\% CI 1.06-3.35; P=.03) and poor SRH (OR 5.05, 95\% CI 1.58-16.19; P=.006) also increased the likelihood of smartphone nonuse. Depressive symptoms were additionally associated with a lower likelihood of social media use, and poor SRH was associated with a lower likelihood of using the internet for messaging and calling. Conclusions: Poor SRH and depressive symptoms are associated with a lower likelihood of DIT use in older adults. Longitudinal studies are required to determine the directions of these relationships. ",
doi="10.2196/20988",
url="https://www.jmir.org/2021/6/e20988",
url="http://www.ncbi.nlm.nih.gov/pubmed/34125069"
}


@Article{info:doi/10.2196/29802,
author="Neely, Stephen
and Eldredge, Christina
and Sanders, Ron",
title="Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="11",
volume="23",
number="6",
pages="e29802",
keywords="social media",
keywords="internet",
keywords="communication",
keywords="public health",
keywords="COVID-19",
keywords="usage",
keywords="United States",
keywords="information seeking",
keywords="web-based health information",
keywords="survey",
keywords="mistrust",
abstract="Background: In recent years, medical journals have emphasized the increasingly critical role that social media plays in the dissemination of public health information and disease prevention guidelines. However, platforms such as Facebook and Twitter continue to pose unique challenges for clinical health care providers and public health officials alike. In order to effectively communicate during public health emergencies, such as the COVID-19 pandemic, it is increasingly critical for health care providers and public health officials to understand how patients gather health-related information on the internet and adjudicate the merits of such information. Objective: With that goal in mind, we conducted a survey of 1003 US-based adults to better understand how health consumers have used social media to learn and stay informed about the COVID-19 pandemic, the extent to which they have relied on credible scientific information sources, and how they have gone about fact-checking pandemic-related information. Methods: A web-based survey was conducted with a sample that was purchased through an industry-leading market research provider. The results were reported with a 95\% confidence level and a margin of error of 3. Participants included 1003 US-based adults (aged ?18 years). Participants were selected via a stratified quota sampling approach to ensure that the sample was representative of the US population. Balanced quotas were determined (by region of the country) for gender, age, race, and ethnicity. Results: The results showed a heavy reliance on social media during the COVID-19 pandemic; more than three-quarters of respondents (762/1003, 76\%) reported that they have relied on social media at least ``a little,'' and 59.2\% (594/1003) of respondents indicated that they read information about COVID-19 on social media at least once per week. According to the findings, most social media users (638/1003, 63.6\%) were unlikely to fact-check what they see on the internet with a health professional, despite the high levels of mistrust in the accuracy of COVID-19--related information on social media. We also found a greater likelihood of undergoing vaccination among those following more credible scientific sources on social media during the pandemic ($\chi$216=50.790; $\phi$=0.258; P<.001). Conclusions: The findings suggest that health professionals will need to be both strategic and proactive when engaging with health consumers on social media if they hope to counteract the deleterious effects of misinformation and disinformation. Effective training, institutional support, and proactive collaboration can help health professionals adapt to the evolving patterns of health information seeking. ",
doi="10.2196/29802",
url="https://www.jmir.org/2021/6/e29802",
url="http://www.ncbi.nlm.nih.gov/pubmed/34043526"
}


@Article{info:doi/10.2196/27526,
author="Lester, Gabriel Ethan
and Hopkins, Whitall Sarah
and Popok, Jean Paula
and Vranceanu, Ana-Maria",
title="Adaptation of a Live Video Mind--Body Program to a Web-Based Platform for English-Speaking Adults With Neurofibromatosis: Protocol for the NF-Web Study",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="10",
volume="10",
number="6",
pages="e27526",
keywords="neurofibromatosis",
keywords="quality of life",
keywords="stress management",
keywords="mind--body",
keywords="asynchronous delivery",
keywords="resiliency",
keywords="mobile phone",
abstract="Background: Neurofibromatosis (NF) is a rare genetic condition associated with lower but modifiable quality of life (QoL). Although a virtual live video program (Relaxation Response Resiliency Program for Neurofibromatosis [3RP-NF]; efficacy randomized controlled trial underway) that we created has been made available, ongoing barriers impede some patients from engaging in this intervention. A necessary next step is to develop a stand-alone web-based intervention that reduces barriers to accessing NF-specific psychosocial care. Objective: First, we aim to develop a web-based platform (Neurofibromatosis-Web [NF-Web]) of our mind--body resiliency program (3RP-NF) through qualitative interviews with participants from an adult efficacy randomized controlled trial. Second, we aim to iteratively optimize the feasibility, acceptability, credibility, and satisfaction of the NF-Web platform through open pilot trials with participant exit interviews and explore quantitative outcomes within this sample. Here, we describe the protocol and study design, intervention, and analysis plan. Methods: For aim 1, we will invite completers from our efficacy trial to participate in qualitative interviews. We will use data from these interviews to adapt the content of the live video program for asynchronous delivery and understand how to create a user-friendly format for an engaging web platform. For aim 2, we will enroll eligible participants recruited for the efficacy trial who could not enroll because of treatment barriers. Eligible participants will complete QoL, depression, anxiety, pain, treatment satisfaction, and program credibility measures at baseline and posttest. Inclusion criteria are identical to those for the efficacy trial, including stress and coping difficulties (self-report), no change in antidepressant medication in the past 3 months, no psychotherapy in the past 3 months, no major upcoming surgeries in the next 12 months, English speaking, ability to complete questionnaires on the web and participate in live video interventions, and consent before participation. The primary outcomes are feasibility, treatment satisfaction, and credibility. The secondary outcomes include physical, psychological, social, and environmental QoL; depression; anxiety; pain intensity; and pain interference. We will enroll at least two group cohorts and iteratively refine the program based on participant feedback after each cohort completes the open pilot trial. Results: This trial is ongoing. We have completed the interviews (n=23) and analyzed the data to construct the website. Afterward, we will recruit our cohorts for the trial (approximately n=15/cohort; total=30). Recruitment will end by May 2021, with plans to analyze the data by October 2021. Conclusions: We will develop the first web platform for people with NF with difficulties managing stress and NF symptoms and report on feasibility and preliminary effects in improving QoL and psychosocial functioning. NF-Web has potential to extend the reach of our 3RP-NF intervention by removing barriers to care, including lack of trained providers, scheduling difficulties, and appearance concerns. International Registered Report Identifier (IRRID): DERR1-10.2196/27526 ",
doi="10.2196/27526",
url="https://www.researchprotocols.org/2021/6/e27526",
url="http://www.ncbi.nlm.nih.gov/pubmed/34110294"
}


@Article{info:doi/10.2196/24947,
author="Oshima, M. Sachiko
and Tait, D. Sarah
and Thomas, M. Samantha
and Fayanju, M. Oluwadamilola
and Ingraham, Kearston
and Barrett, J. Nadine
and Hwang, Shelley E.",
title="Association of Smartphone Ownership and Internet Use With Markers of Health Literacy and Access: Cross-sectional Survey Study of Perspectives From Project PLACE (Population Level Approaches to Cancer Elimination)",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="9",
volume="23",
number="6",
pages="e24947",
keywords="telehealth",
keywords="technology",
keywords="health literacy",
keywords="access to health care",
keywords="mobile phone",
abstract="Background: Telehealth is an increasingly important component of health care delivery in response to the COVID-19 pandemic. However, well-documented disparities persist in the use of digital technologies. Objective: This study aims to describe smartphone and internet use within a diverse sample, to assess the association of smartphone and internet use with markers of health literacy and health access, and to identify the mediating factors in these relationships. Methods: Surveys were distributed to a targeted sample designed to oversample historically underserved communities from April 2017 to December 2017. Multivariate logistic regression was used to estimate the association of internet and smartphone use with outcomes describing health care access and markers of health literacy for the total cohort and after stratifying by personal history of cancer. Health care access was captured using multiple variables, including the ability to obtain medical care when needed. Markers of health literacy included self-reported confidence in obtaining health information. Results: Of the 2149 participants, 1319 (61.38\%) were women, 655 (30.48\%) were non-Hispanic White, and 666 (30.99\%) were non-Hispanic Black. The median age was 51 years (IQR 38-65). Most respondents reported using the internet (1921/2149, 89.39\%) and owning a smartphone (1800/2149, 83.76\%). Compared with the respondents with smartphone or internet access, those without smartphone or internet access were more likely to report that a doctor was their most recent source of health information (344/1800, 19.11\% vs 116/349, 33.2\% for smartphone and 380/1921, 19.78\% vs 80/228, 35.1\% for internet, respectively; both P<.001). Internet use was associated with having looked for information on health topics from any source (odds ratio [OR] 3.81, 95\% CI 2.53-5.75) and confidence in obtaining health information when needed (OR 1.83, 95\% CI 1.00-3.34) compared with noninternet users. Smartphone owners had lower odds of being unable to obtain needed medical care (OR 0.62, 95\% CI 0.40-0.95) than nonsmartphone owners. Among participants with a prior history of cancer, smartphone ownership was significantly associated with higher odds of confidence in ability to obtain needed health information (OR 5.63, 95\% CI 1.05-30.23) and lower odds of inability to obtain needed medical care (OR 0.17, 95\% CI 0.06-0.47), although these associations were not significant among participants without a prior history of cancer. Conclusions: We describe widespread use of digital technologies in a community-based cohort, although disparities persist. In this cohort, smartphone ownership was significantly associated with ability to obtain needed medical care, suggesting that the use of smartphone technology may play a role in increasing health care access. Similarly, major illnesses such as cancer have the potential to amplify health engagement. Finally, special emphasis must be placed on reaching patient populations with limited digital access, so these patients are not further disadvantaged in the new age of telehealth. ",
doi="10.2196/24947",
url="https://www.jmir.org/2021/6/e24947",
url="http://www.ncbi.nlm.nih.gov/pubmed/34106076"
}


@Article{info:doi/10.2196/27820,
author="Ordaz, H. Omar
and Croff, L. Raina
and Robinson, D. LaTroy
and Shea, A. Steven
and Bowles, P. Nicole",
title="Optimization of Primary Care Among Black Americans Using Patient Portals: Qualitative Study",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="3",
volume="23",
number="6",
pages="e27820",
keywords="health promotion",
keywords="patient engagement",
keywords="telehealth",
keywords="telemedicine",
keywords="health disparities",
keywords="technology acceptance model",
keywords="health belief model",
abstract="Background: Reduced patient portal use has previously been reported among Black Americans when compared with that of the general population. This statistic is concerning because portals have been shown to improve the control of chronic conditions that are more prevalent and severe in Black Americans. At their very simplest, portals allow patients to access their electronic health records and often provide tools for patients to interact with their own health information, treatment team members, and insurance companies. However, research suggests that Black American patients have greater concerns over a lack of support, loss of privacy, and reduced personalization of care compared with other Americans, which results in a disparity of portal use.  Objective: This qualitative investigation of primary care experiences of Black Americans from across the United States who participated in remote focus groups in April and May 2020 aims to explore the use and perceived value of patient portals to better understand any barriers to optimized treatment in the primary care setting. Methods: We performed an inductive thematic analysis of 8 remote focus group interviews with 29 Black American patients aged 30-60 years to qualitatively assess the experiences of Black American patients with regular access to portals.  Results: Thematic analysis uncovered the following interrelated themes regarding patient portals in primary care: the optimization of care, patient empowerment, patient-provider communication, and patient burden.  Conclusions: In contrast to what has been described regarding the reluctance of Black Americans to engage with patient portals, our focus groups revealed the general acceptance of patient portals, which were described overwhelmingly as tools with the potential for providing exceptional, personalized care that may even work to mitigate the unfair burden of disease for Black Americans in primary care settings. Thus, opportunities for better health care will clearly arise with increased communication, experience, and adoption of remote health care practices among Black Americans. ",
doi="10.2196/27820",
url="https://www.jmir.org/2021/6/e27820",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081016"
}


@Article{info:doi/10.2196/19697,
author="Chung, Alicia
and Vieira, Dorice
and Donley, Tiffany
and Tan, Nicholas
and Jean-Louis, Girardin
and Kiely Gouley, Kathleen
and Seixas, Azizi",
title="Adolescent Peer Influence on Eating Behaviors via Social Media: Scoping Review",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="3",
volume="23",
number="6",
pages="e19697",
keywords="social media",
keywords="eating behaviors",
keywords="adolescent health",
abstract="Background: The influence of social media among adolescent peer groups can be a powerful change agent. Objective: Our scoping review aimed to elucidate the ways in which social media use among adolescent peers influences eating behaviors. Methods: A scoping review of the literature of articles published from journal inception to 2019 was performed by searching PubMed (ie, MEDLINE), Embase, CINAHL, PsycINFO, Web of Science, and other databases. The review was conducted in three steps: (1) identification of the research question and clarification of criteria using the population, intervention, comparison, and outcome (PICO) framework; (2) selection of articles from the literature using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines; and (3) charting and summarizing information from selected articles. PubMed's Medical Subject Headings (MeSH) and Embase's Emtree subject headings were reviewed along with specific keywords to construct a comprehensive search strategy. Subject headings and keywords were based on adolescent age groups, social media platforms, and eating behaviors. After screening 1387 peer-reviewed articles, 37 articles were assessed for eligibility. Participant age, gender, study location, social media channels utilized, user volume, and content themes related to findings were extracted from the articles. Results: Six articles met the final inclusion criteria. A final sample size of 1225 adolescents (aged 10 to 19 years) from the United States, the United Kingdom, Sweden, Norway, Denmark, Portugal, Brazil, and Australia were included in controlled and qualitative studies. Instagram and Facebook were among the most popular social media platforms that influenced healthful eating behaviors (ie, fruit and vegetable intake) as well as unhealthful eating behaviors related to fast food advertising. Online forums served as accessible channels for eating disorder relapse prevention among youth. Social media influence converged around four central themes: (1) visual appeal, (2) content dissemination, (3) socialized digital connections, and (4) adolescent marketer influencers. Conclusions: Adolescent peer influence in social media environments spans the spectrum of healthy eating (ie, pathological) to eating disorders (ie, nonpathological). Strategic network-driven approaches should be considered for engaging adolescents in the promotion of positive dietary behaviors. ",
doi="10.2196/19697",
url="https://www.jmir.org/2021/6/e19697",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081018"
}


@Article{info:doi/10.2196/26110,
author="Karim, Lynn Jalisa
and Talhouk, Aline",
title="Person-Generated Health Data in Women's Health: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="28",
volume="10",
number="5",
pages="e26110",
keywords="digital health",
keywords="women's health",
keywords="mobile health",
keywords="health app",
keywords="wearables",
keywords="femtech",
keywords="self-tracking",
keywords="personalized health",
keywords="person-generated health data",
keywords="patient-generated health data",
keywords="scoping review",
abstract="Background: Due to their ability to collect person-generated health data, digital tools and connected health devices may hold great utility in disease prevention, chronic disease self-monitoring and self-tracking, as well as in tailoring information and educational content to fit individual needs. Facilitators and barriers to the use of digital health technologies vary across demographics, including sex. The ``femtech'' market is growing rapidly, and women are some of the largest adopters of digital health technologies. Objective: This paper aims to provide the background and methods for conducting a scoping review on the use of person-generated health data from connected devices in women's health. The objectives of the scoping review are to identify the various contexts of digital technologies in women's health and to consolidate women's views on the usability and acceptability of the devices. Methods: Searches were conducted in the following databases: Medline, Embase, APA PsycInfo, CINAHL Complete, and Web of Science Core Collection. We included articles from January 2015 to February 2020. Screening of articles was done independently by at least two authors in two stages. Data charting is being conducted in duplicate. Results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Results: Our search identified 9102 articles after deduplication. As of November 2020, the full-text screening stage is almost complete and data charting is in progress. The scoping review is expected to be completed by Fall 2021. Conclusions: This scoping review will broadly map the literature regarding the contexts and acceptability of digital health tools for women. The results from this review will be useful in guiding future digital health and women's health research. International Registered Report Identifier (IRRID): DERR1-10.2196/26110 ",
doi="10.2196/26110",
url="https://www.researchprotocols.org/2021/5/e26110",
url="http://www.ncbi.nlm.nih.gov/pubmed/34047708"
}


@Article{info:doi/10.2196/26037,
author="Bhuiyan, Nishat
and Puzia, Megan
and Stecher, Chad
and Huberty, Jennifer",
title="Associations Between Rural or Urban Status, Health Outcomes and Behaviors, and COVID-19 Perceptions Among Meditation App Users: Longitudinal Survey Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="26",
volume="9",
number="5",
pages="e26037",
keywords="mHealth",
keywords="rural health",
keywords="physical activity",
keywords="mental health",
keywords="COVID-19",
abstract="Background: Rural and urban differences in health outcomes and behaviors have been well-documented, with significant rural health disparities frequently highlighted. Mobile health (mHealth) apps, such as meditation apps, are a novel method for improving health and behaviors. These apps may be a critical health promotion strategy during the COVID-19 pandemic and could potentially be used to address rural health disparities. However, limited research has assessed whether meditation app health outcomes are associated with rural and urban residence, and it is unclear whether disparities in health and behaviors between rural and urban populations would persist among meditation app users. Objective: We aimed to explore associations between rural or urban status, psychological outcomes, and physical activity among users of a mobile meditation app. We further aimed to explore associations between rural or urban status and perceived effects of COVID-19 on stress, mental health, and physical activity, and to explore changes in these outcomes in rural versus urban app users over time. Methods: This study was a secondary analysis of a national survey conducted among subscribers to the meditation app Calm. Eligible participants completed online baseline surveys from April to June 2020, and follow-up surveys from June to September 2020, assessing demographics, psychological outcomes, physical activity, and perceived effects of COVID-19 on stress, mental health, and physical activity. Results: Participants (N=8392) were mostly female (7041/8392, 83.9\%), non-Hispanic (7855/8392, 93.6\%), and White (7704/8392, 91.8\%); had high socioeconomic status (income ?US \$100,000: 4389/8392, 52.3\%; bachelor's degree or higher: 7251/8392, 86.4\%); and resided in a metropolitan area core (rural-urban commuting area code 1: 7192/8392, 85.7\%). Rural or urban status was not associated with baseline stress, depression, anxiety, pre--COVID-19 and current physical activity, or perceived effects of COVID-19 on stress, mental health, and physical activity. Repeated-measures models showed overall decreases in depression, anxiety, and perceived effects of COVID-19 on physical activity from baseline to follow-up, and no significant changes in stress or perceived effects of COVID-19 on stress and mental health over time. Models also showed no significant main effects of rural or urban status, COVID-19 statewide prevalence at baseline, or change in COVID-19 statewide prevalence. Conclusions: We did not find associations between rural or urban status and psychological outcomes (ie, stress, depression, and anxiety), physical activity, or perceived effects of COVID-19 on stress, mental health, and physical activity. Rural or urban status does not appear to drive differences in outcomes among meditation app users, and the use of mHealth apps should continue to be explored as a health promotion strategy in both rural and urban populations. Furthermore, our results did not show negative cumulative effects of COVID-19 on psychological outcomes and physical activity among app users in our sample, the majority of whom were urban, White, female, and of high socioeconomic status. Further research is needed to investigate meditation app use as a health promotion strategy in rural and urban populations. ",
doi="10.2196/26037",
url="https://mhealth.jmir.org/2021/5/e26037",
url="http://www.ncbi.nlm.nih.gov/pubmed/33900930"
}


@Article{info:doi/10.2196/18771,
author="Donelle, Lorie
and Facca, Danica
and Burke, Shauna
and Hiebert, Bradley
and Bender, Emma
and Ling, Stephen",
title="Exploring Canadian Children's Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="26",
volume="5",
number="5",
pages="e18771",
keywords="child",
keywords="children",
keywords="internet",
keywords="social media",
keywords="digital literacy",
keywords="digital inclusion",
keywords="quality of life",
keywords="mobile phone",
abstract="Background: Understanding social media use and digital literacy among young Canadian children is an increasing area of concern, given the importance of digital inclusion for full and informed participation in evolving educational, civic, corporate, social, and economic spaces. Objective: The aim of this study was to explore internet and social media knowledge as well as social media use among Canadian children aged between 6 and 10 years. Methods: We conducted interview surveys with 42 children aged between 6 and 10 years who participated in an after-school health promotion program in an urban community in Southwestern Ontario to understand their digital literacy skills and social media use. The data were analyzed using both quantitative and qualitative methods. Results: Of the 42 children who participated in this study, 24 (57\%) reported that they used social media, specifically YouTube (19/24, 79\% reported use), Snapchat (16/24, 67\% reported use), and Facebook (8/24, 33\% reported use). While using social media, children reported sharing personal information, including videos or pictures of themselves (12/24, 50\%), videos or pictures of others (8/24, 33\%), and their birthday (12/24, 50\%), whereas only one-third (9/24, 38\%) of the children believed that only close family and friends had access to the content they shared. When reporting on the quality of life in the context of using social media, most (17/24, 71\%) children never felt sad, half (12/24, 50\%) never had difficulty making new friends, and nearly one-third (7/24, 30\%) indicated that they never had difficulty wanting to play outside. Conclusions: Owing to the rapidly evolving uptake and use of social media among young Canadians, the implementation of childhood digital health literacy education is vital to best support digital inclusion and well-being in Canada. The findings of our study highlight the need for future research to understand where children receive their digital literacy knowledge from and whether this knowledge is gained through self-directed social media use or observation from other actors, such as parents, siblings, or friends. ",
doi="10.2196/18771",
url="https://formative.jmir.org/2021/5/e18771",
url="http://www.ncbi.nlm.nih.gov/pubmed/34037525"
}


@Article{info:doi/10.2196/29245,
author="Brown, I. Nashira
and Powell, Anne Mary
and Baskin, Monica
and Oster, Robert
and Demark-Wahnefried, Wendy
and Hardy, Claudia
and Pisu, Maria
and Thirumalai, Mohanraj
and Townsend, Sh'Nese
and Neal, N. Whitney
and Rogers, Q. Laura
and Pekmezi, Dori",
title="Design and Rationale for the Deep South Interactive Voice Response System--Supported Active Lifestyle Study: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="25",
volume="10",
number="5",
pages="e29245",
keywords="exercise",
keywords="health disparities",
keywords="interactive voice response system",
keywords="physical activity",
keywords="rural health",
keywords="telehealth",
abstract="Background: The rates of physical inactivity and related cancer incidence and mortality are disproportionately high in the Deep South region in the United States, a rural, medically underserved region with a large African American population compared with the rest of the nation. Given this region's lower rates of literacy and internet access, interactive voice response (IVR) system--automated telephone-based interventions have the potential to help overcome physical activity intervention barriers (literacy, internet access, costs, and transportation) but have yet to be extended to rural, underserved populations, such as in the Deep South. Thus, extensive formative research is being conducted to develop and beta test the Deep South IVR System--Supported Active Lifestyle intervention in preparation for dissemination in rural Alabama counties. Objective: This paper aims to describe the design and rationale of an ongoing efficacy trial of the Deep South IVR System--Supported Active Lifestyle intervention. Methods: A two-arm randomized controlled trial will be conducted to compare a 12-month physical activity intervention versus a wait-list control condition in 240 underactive adults from 6 rural Alabama counties. The Deep South IVR System--Supported Active Lifestyle intervention is based on the Social Cognitive Theory and includes IVR-automated physical activity--related phone counseling (daily in months 0-3, twice weekly in months 4-6, and weekly in months 7-12) and support from local rural county coordinators with the University of Alabama O'Neal Comprehensive Cancer Center Community Outreach and Engagement Office. The primary outcome is weekly minutes of moderate- to vigorous-intensity physical activity (7-day physical activity recall; accelerometry) at baseline, 6 months, 12 months, and 18 months. Rural Active Living Assessments will be conducted in each rural county to assess walkability, assess recreational amenities, and inform future environment and policy efforts. Results: This study was funded in March 2019 and approved by the institutional review board of the University of Alabama at Birmingham in April 2019. As of February 2020, start-up activities (hiring and training staff and purchasing supplies) were completed. Study recruitment and assessments began in September 2020 and are ongoing. As of February 2021, a total of 43 participants have been enrolled in Dallas County, 42 in Sumter County, and 51 in Greene County. Conclusions: IVR-supported phone counseling has great potential for addressing physical activity barriers (eg, culture, literacy, cost, or transportation) and reducing related rural health disparities in this region. Trial Registration: ClinicalTrials.gov NCT03903874; https://clinicaltrials.gov/ct2/show/NCT03903874. International Registered Report Identifier (IRRID): DERR1-10.2196/29245 ",
doi="10.2196/29245",
url="https://www.researchprotocols.org/2021/5/e29245",
url="http://www.ncbi.nlm.nih.gov/pubmed/34032575"
}


@Article{info:doi/10.2196/25016,
author="Diniz, Grilo Carmen Simone
and Franzon, Arruda Ana Carolina
and Fioretti-Foschi, Beatriz
and Niy, Yoshie Denise
and Pedrilio, Sanches Livia
and Amaro Jr, Edson
and Sato, Ricardo Jo{\~a}o",
title="Communication Intervention Using Digital Technology to Facilitate Informed Choices at Childbirth in the Context of the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="21",
volume="10",
number="5",
pages="e25016",
keywords="app",
keywords="childbirth",
keywords="communication",
keywords="COVID-19",
keywords="health literacy",
keywords="informatics",
keywords="internet",
keywords="intervention",
keywords="maternal health",
keywords="neonatal health",
keywords="neonate public health",
keywords="society",
keywords="technology",
keywords="women",
abstract="Background: In Brazil and other low- and middle-income countries, excess interventions in childbirth are associated with an increase in preterm and early-term births, contributing to stagnant morbidity and mortality of mothers and neonates. The fact that women often report a negative experience with vaginal childbirth, with physical pain and feelings of unsafety, neglect, or abuse, may explain the high acceptability of elective cesarean sections. The recognition of information needs and of the right to informed choice during childbirth can help change this reality. The internet has been the main source of health information, but its quality is highly variable. Objective: This study aimed to develop and evaluate an information and communication strategy through a smartphone app with respect to childbirth, to facilitate informed choices for access to safer and evidence-based care in the context of the COVID-19 pandemic. Methods: A randomized controlled trial, with 2 arms (intervention and control) and a closed, blind, parallel design, will be conducted with a smartphone app designed for behavior and opinion research in Brazil, with women of reproductive age previously registered on the app. After completing an entry questionnaire to verify the eligibility criteria and obtaining ethical consent, approximately 20,000 participants will be randomly allocated to the intervention and control groups at a 1:1 ratio. Participants allocated to the intervention group will be invited to engage in a digital information and communication strategy, which is designed to expand evidence-based knowledge on the advantages and disadvantages of options for labor and childbirth and the safety of the care processes. The information is based on the guidelines of the Ministry of Health and the World Health Organization for a positive childbirth experience and has been updated to include the new challenges and disruptions in maternity care within the context of the COVID-19 pandemic. The control group will receive information regarding disposable and reusable diapers as a placebo intervention. The groups will be compared in their responses in generating the birth plan and the entry and exit questionnaires, regarding responses less or more aligned with the guidelines for a positive childbirth experience. A qualitative component to map information needs is included. Results: The digital trial started recruiting participants in late October 2020, and data collection has been projected to be complete by December 2020. Conclusions: This study will evaluate an innovative intervention that has the potential to promote better communication between women and providers, such that they can make better choices using an approach suitable for use during the COVID-19 pandemic. Trial Registration: The Brazilian Clinical Trials Registry U1111-1255-8683; http://www.ensaiosclinicos.gov.br/rg/RBR-3g5f9f/ International Registered Report Identifier (IRRID): PRR1-10.2196/25016 ",
doi="10.2196/25016",
url="https://www.researchprotocols.org/2021/5/e25016",
url="http://www.ncbi.nlm.nih.gov/pubmed/33945496"
}


@Article{info:doi/10.2196/23591,
author="Anderberg, Peter
and Abrahamsson, Linda
and Berglund, Sanmartin Johan",
title="An Instrument for Measuring Social Participation to Examine Older Adults' Use of the Internet as a Social Platform: Development and Validation Study",
journal="JMIR Aging",
year="2021",
month="May",
day="17",
volume="4",
number="2",
pages="e23591",
keywords="internet",
keywords="older people",
keywords="social participation",
keywords="aging",
keywords="instrument",
keywords="elderly",
keywords="social platform",
keywords="perception",
keywords="connectedness",
abstract="Background: Older people's use of the internet is increasingly coming into focus with the demographic changes of a growing older population. Research reports several benefits of older people's internet use and highlights problems such as various forms of inequality in use within the group. There is a need for consistent measurements to follow the development and use of the internet in this group and to be able to compare groups both within and between countries, as well as follow the changes over time. Objective: The aim of this study was to create an instrument to measure an older person's perception of the benefits of their online social participation, unconnected to specific applications and services. The instrument to measure internet social participation proposed in this paper builds on social participation factors and is a multidimensional construct incorporating both social relations and societal connectedness. Methods: A short instrument for measuring social participation over the internet was created. An exploratory factor analysis (EFA) was conducted in a random selection of persons aged 65 years or older (n=193) on 10 initial items. Further validation was made by confirmatory factor analysis (CFA) in the remaining group (n=193). Results: A 1-factor solution for the social internet score was decided upon after exploratory factor analysis (EFA; based on a random sample of half the data set). None of the questionnaire items were excluded based on the EFA, as they all had high loadings, the lowest being 0.61. The Cronbach $\alpha$ coefficient was .92. The 1-factor solution explained 55\% of the variance. CFA was performed and included all 10 questionnaire items in a 1-factor solution. Indices of goodness of fit of the model showed room for improvement. Removal of 4 questions in a stepwise procedure resulted in a 6-item model ($\chi$26=13.985; $\chi$2/degrees of freedom=1.554; comparative fit index=0.992; root mean square error of approximation=0.054; standardized root mean square residual=0.025). Conclusions: The proposed instrument can be used to measure digital social participation and coherence with society. The factor analysis is based on a sufficient sample of the general population of older adults in Sweden, and overall the instrument performed as expected. ",
doi="10.2196/23591",
url="https://aging.jmir.org/2021/2/e23591",
url="http://www.ncbi.nlm.nih.gov/pubmed/33999004"
}


@Article{info:doi/10.2196/25273,
author="Fischer, Emilio Alex
and Van Tonder, Tanya
and Gumede, B. Siphamandla
and Lalla-Edward, T. Samanta",
title="Changes in Perceptions and Use of Mobile Technology and Health Communication in South Africa During the COVID-19 Lockdown: Cross-sectional Survey Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="17",
volume="5",
number="5",
pages="e25273",
keywords="coronavirus",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="technology",
keywords="mHealth",
keywords="app",
abstract="Background: In late March 2020, South Africa implemented a 5-stage COVID-19 Risk Adjusted Strategy, which included a lockdown that required all residents to remain home to prevent the spread of COVID-19. Due to this lockdown, individuals have been forced to find and use alternatives for accomplishing tasks including shopping, socializing, working, and finding information, and many have turned to the internet and their mobile devices. Objective: This study aimed to describe how South Africans consume and internalize information surrounding the COVID-19 outbreak in order to determine whether the COVID-19 lockdown and social isolation have influenced technology behavior, particularly in terms of health communication and information. Methods: From June 24 to August 24, 2020, people in South Africa were invited to complete a survey through the Upinion mobile app, an online data collection resource. The survey collected information on demographics, and technology use during the lockdown, and COVID-19 knowledge. Results: There were 405 participants, of which 296 (73.06\%) were female. A total of 320 (79.01\%) participants had a tertiary school education, 242 (59.75\%) were single, and 173 (42.72\%) had full-time employment. The lockdown forced 363 (89.63\%) participants to use more technology, especially for work (n=140, 24.05\%) and social media/communication (n=133, 22.85\%). Security or privacy issues (n=46, 38.98\%) and unfamiliarity with technology (n=32, 27.12\%) were identified as the most common issues faced by the 127 (31.36\%) participants who were unsure about using technology prior to the lockdown. Almost all participants (n=392, 96.79\%) stated that they would continue using technology after the lockdown. Multimedia (n=215, 53.09\%), mobile phone content (n=99, 24.44\%), and health organizations and professionals (n=91, 22.47\%) were the main sources of COVID-19 information. Most participants (n=282, 69.63\%) felt that they had enough information. Two-thirds (n=275, 67.90\%) of participants stated that they had used their mobile phones for health information before the lockdown, with web searches (n=109, 26.91\%), social media (n=58, 14.32\%), and government and institutional websites (n=52; 12.84\%) serving as their main sources of information. Overall, the mean COVID-19 knowledge score was 8.8 (out of 10), and 335 (82.72\%) had adequate knowledge (scored ?8). Males were less likely to identify the correct transmission routes, and single participants were less likely to identify the signs and symptoms of the coronavirus. Tertiary school graduates were 4 times more likely to correctly identify the routes and 2 times more likely to identify how to stop the spread of the virus. People aged 43-56 years were 4 times more likely to identify how the coronavirus can be prevented, and participants ?57 years were 2.6 times more likely to obtain a knowledge score of 10 when compared to those under 29 years of age. Conclusions: This study has shown that the COVID-19 lockdown has forced people to increase technology use, and people plan to continue using technology after the lockdown is lifted. Increased technology use was seen across a variety of fields; however, barriers including privacy, unfamiliarity, and data costs were identified. This population showed high COVID-19 knowledge, although the use of web searches and social media, instead of government and institutional websites, increases the potential for health misinformation to be spread. ",
doi="10.2196/25273",
url="https://formative.jmir.org/2021/5/e25273",
url="http://www.ncbi.nlm.nih.gov/pubmed/33956640"
}


@Article{info:doi/10.2196/22549,
author="Cross, A. Dori
and Levin, Zachary
and Raj, Minakshi",
title="Patient Portal Use, Perceptions of Electronic Health Record Value, and Self-Rated Primary Care Quality Among Older Adults: Cross-sectional Survey",
journal="J Med Internet Res",
year="2021",
month="May",
day="10",
volume="23",
number="5",
pages="e22549",
keywords="patient portals",
keywords="electronic health records",
keywords="primary care",
keywords="older adults",
keywords="patient satisfaction",
abstract="Background: Older adults are increasingly accessing information and communicating using patient-facing portals available through their providers' electronic health record (EHR). Most theories of technology acceptance and use suggest that patients' overall satisfaction with care should be independent of their chosen level of portal engagement. However, achieving expected benefits of portal use depends on demonstrated support from providers to meet these expectations. This is especially true among older adults, who may require more guidance. However, little is known about whether misalignment of expectations around technology-facilitated care is associated with lower perceptions of care quality. Objective: The aims of this study were to analyze whether older adults' assessment of primary care quality differs across levels of patient portal engagement and whether perceptions of how well their provider uses the EHR to support care moderates this relationship. Methods: We conducted a cross-sectional survey analysis of 158 older adults over the age of 65 (average age 71.4 years) across Michigan using a 13-measure composite of self-assessed health care quality. Portal use was categorized as none, moderate (use of 1-3 functionalities), or extensive (use of 4-7 functionalities). EHR value perception was measured by asking respondents how they felt their doctor's EHR use improved the patient--provider relationship. Results: Moderate portal users, compared to those who were extensive users, had lower estimated care quality (--0.214 on 4-point scale; P=.03). Differences between extensive portal users and nonportal users were not significant. Quality perception was only particularly low among moderate portal users with low EHR value perception; those with high EHR value perception rated quality similarly to other portal user groups. Conclusions: Older adults who are moderate portal users are the least satisfied with their care, and the most sensitive to perceptions of how well their provider uses the EHR to support the relationship. Encouraging portal use without compromising perceptions of quality requires thinking beyond patient-focused education. Achieving value from use of patient-facing technologies with older adults is contingent upon matched organizational investments that support technology-enabled care delivery. Providers and staff need policies and practices that demonstrate technology adeptness. Older adults may need more tailored signaling and accommodation for technology to be maximally impactful. ",
doi="10.2196/22549",
url="https://www.jmir.org/2021/5/e22549",
url="http://www.ncbi.nlm.nih.gov/pubmed/33970111"
}


@Article{info:doi/10.2196/21555,
author="Ghani, Maham
and Adler, Colin
and Yeung, Howa",
title="Patient Factors Associated with Interest in Teledermatology: Cross-sectional Survey",
journal="JMIR Dermatol",
year="2021",
month="May",
day="10",
volume="4",
number="1",
pages="e21555",
keywords="digital divide",
keywords="e-health literacy",
keywords="Internet",
keywords="modifiable behaviors",
keywords="teledermatology",
abstract="Background: Teledermatology is a conduit for patients communicating with dermatologists on the internet, which bypasses in-person visits. It holds promise to address access needs for dermatologic care; however, the interest in using teledermatology is unknown in underserved populations with potential barriers to the use of health care technology. Objective: This study aimed to characterize the association between demographic characteristics with interest in exchanging digital images or videos of skin lesions with health care providers electronically. Methods: We examined data from the Health Information National Trends Survey (HINTS) 4 cycle 4 (2014) of the National Cancer Institute. HINTS is a cross-sectional, nationally representative household survey conducted annually, which collects information on demographics, perceptions and use of health information, and provides information on how cancer risks are perceived. HINTS 4 cycle 4 had a sample of 3677 participants. We examined the outcome to the question, ``how interested are you in exchanging digital images or videos (eg, photos of skin lesions) with a health care provider electronically?'' We dichotomized the outcome by a high level of interest (responding with ``very'') and those who did not have a high level of interest (responding with ``somewhat,'' ``a little,'' or ``not at all'') in exchanging images or videos. We used a multivariable logistic regression model developed through backwards selection, with all final covariates associated with varying levels of teledermatology use at P<.05. Sensitivity analysis was performed by changing the outcome dichotomy to model those who were ``not at all'' interested. Two-sided tests were performed with P<.05 considered significant. Results: Among 3447 respondents, 888 (weighted prevalence=26.2\%) were ``very'' interested in participating in teledermatology. A higher interest in using teledermatology was associated with a younger age, higher educational attainment, higher household income, internet usage, type of mobile device ownership, history of electronic medical information exchange with a clinician within the past 12 months, and high level of trust in web-based information on cancer (for all, P<.01), but not with the female gender, race or ethnicity, health insurance status, or having a regular medical provider. Conclusions: Modifiable access barriers to teledermatology adoption include trust, experience with teledermatology, and use of health apps. Teledermatology program implementation should address these specific factors within the digital divide to promote equitable access to care across diverse patient populations. ",
doi="10.2196/21555",
url="https://derma.jmir.org/2021/1/e21555",
url="http://www.ncbi.nlm.nih.gov/pubmed/37625162"
}


@Article{info:doi/10.2196/23866,
author="Fareed, Naleef
and Jonnalagadda, Pallavi
and MacEwan, R. Sarah
and Di Tosto, Gennaro
and Scarborough, Seth
and Huerta, R. Timothy
and McAlearney, Scheck Ann",
title="Differential Effects of Outpatient Portal User Status on Inpatient Portal Use: Observational Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="30",
volume="23",
number="4",
pages="e23866",
keywords="patient portals",
keywords="technology experience",
keywords="health information technology",
keywords="technology acceptance",
keywords="technology use",
keywords="log files",
keywords="mobile phone",
abstract="Background: The decision to use patient portals can be influenced by multiple factors, including individuals' perceptions of the tool, which are based on both their personal skills and experiences. Prior experience with one type of portal may make individuals more comfortable with using newer portal technologies. Experienced outpatient portal users in particular may have confidence in their ability to use inpatient portals that have similar functionality. In practice, the use of both outpatient and inpatient portal technologies can provide patients with continuity of access to their health information across care settings, but the influence of one type of portal use on the use of other portals has not been studied. Objective: This study aims to understand how patients' use of an inpatient portal is influenced by outpatient portal use. Methods: This study included patients from an academic medical center who were provided access to an inpatient portal during their hospital stays between 2016 and 2018 (N=1571). We analyzed inpatient portal log files to investigate how inpatient portal use varied by using 3 categories of outpatient portal users: prior users, new users, and nonusers. Results: Compared with prior users (695/1571, 44.24\%) of an outpatient portal, new users (214/1571, 13.62\%) had higher use of a select set of inpatient portal functions (messaging function: incidence rate ratio [IRR] 1.33, 95\% CI 1.06-1.67; function that provides access to the outpatient portal through the inpatient portal: IRR 1.34, 95\% CI 1.13-1.58). Nonusers (662/1571, 42.14\%), compared with prior users, had lower overall inpatient portal use (all active functions: IRR 0.68, 95\% CI 0.60-0.78) and lower use of specific functions, which included the function to review vitals and laboratory results (IRR 0.51, 95\% CI 0.36-0.73) and the function to access the outpatient portal (IRR 0.53, 95\% CI 0.45-0.62). In comparison with prior users, nonusers also had lower odds of being comprehensive users (defined as using 8 or more unique portal functions; odds ratio [OR] 0.57, 95\% CI 0.45-0.73) or composite users (defined as comprehensive users who initiated a 75th or greater percentile of portal sessions) of the inpatient portal (OR 0.42, 95\% CI 0.29-0.60). Conclusions: Patients' use of an inpatient portal during their hospital stay appeared to be influenced by a combination of factors, including prior outpatient portal use. For new users, hospitalization itself, a major event that can motivate behavioral changes, may have influenced portal use. In contrast, nonusers might have lower self-efficacy in their ability to use technology to manage their health, contributing to their lower portal use. Understanding the relationship between the use of outpatient and inpatient portals can help direct targeted implementation strategies that encourage individuals to use these tools to better manage their health across care settings. ",
doi="10.2196/23866",
url="https://www.jmir.org/2021/4/e23866",
url="http://www.ncbi.nlm.nih.gov/pubmed/33929328"
}


@Article{info:doi/10.2196/25299,
author="Hernandez-Ramos, Rosa
and Aguilera, Adrian
and Garcia, Faviola
and Miramontes-Gomez, Jose
and Pathak, Elizabeth Laura
and Figueroa, Astrid Caroline
and Lyles, Rees Courtney",
title="Conducting Internet-Based Visits for Onboarding Populations With Limited Digital Literacy to an mHealth Intervention: Development of a Patient-Centered Approach",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="29",
volume="5",
number="4",
pages="e25299",
keywords="digital literacy",
keywords="digital divide",
keywords="underserved",
keywords="patient-centered",
keywords="digital health",
keywords="mhealth",
keywords="intervention",
keywords="telehealth",
keywords="COVID-19",
abstract="Background: The COVID-19 pandemic has propelled patient-facing research to shift to digital and telehealth strategies. If these strategies are not adapted for minority patients of lower socioeconomic status, health inequality will further increase. Patient-centered models of care can successfully improve access and experience for minority patients. Objective: This study aims to present the development process and preliminary acceptability of altering in-person onboarding procedures into internet-based, remote procedures for a mobile health (mHealth) intervention in a population with limited digital literacy. Methods: We actively recruited safety-net patients (English- and Spanish-speaking adults with diabetes and depression who were receiving care at a public health care delivery system in San Francisco, United States) into a randomized controlled trial of text messaging support for physical activity. Because of the COVID-19 pandemic, we modified the in-person recruitment and onboarding procedures to internet-based, remote processes with human support. We conducted a preliminary evaluation of how the composition of the recruited cohort might have changed from the pre--COVID-19 period to the COVID-19 enrollment period. First, we analyzed the digital profiles of patients (n=32) who had participated in previous in-person onboarding sessions prior to the COVID-19 pandemic. Next, we documented all changes made to our onboarding processes to account for remote recruitment, especially those needed to support patients who were not very familiar with downloading apps onto their mobile phones on their own. Finally, we used the new study procedures to recruit patients (n=11) during the COVID-19 social distancing period. These patients were also asked about their experience enrolling into a fully digitized mHealth intervention. Results: Recruitment across both pre--COVID-19 and COVID-19 periods (N=43) demonstrated relatively high rates of smartphone ownership but lower self-reported digital literacy, with 32.6\% (14/43) of all patients reporting they needed help with using their smartphone and installing apps. Significant changes were made to the onboarding procedures, including facilitating app download via Zoom video call and/or a standard phone call and implementing brief, one-on-one staff-patient interactions to provide technical assistance personalized to each patient's digital literacy skills. Comparing recruitment during pre--COVID-19 and COVID-19 periods, the proportion of patients with digital literacy barriers reduced from 34.4\% (11/32) in the pre--COVID-19 cohort to 27.3\% (3/11) in the COVID-19 cohort. Differences in digital literacy scores between both cohorts were not significant (P=.49). Conclusions: Patients of lower socioeconomic status have high interest in using digital platforms to manage their health, but they may require additional upfront human support to gain access. One-on-one staff-patient partnerships allowed us to provide unique technical assistance personalized to each patient's digital literacy skills, with simple strategies to troubleshoot patient barriers upfront. These additional remote onboarding strategies can mitigate but not eliminate digital barriers for patients without extensive technology experience. Trial Registration: Clinicaltrials.gov NCT0349025, https://clinicaltrials.gov/ct2/show/NCT03490253 ",
doi="10.2196/25299",
url="https://formative.jmir.org/2021/4/e25299",
url="http://www.ncbi.nlm.nih.gov/pubmed/33872184"
}


@Article{info:doi/10.2196/26232,
author="Mannheim, Ittay
and Wouters, M. Eveline J.
and van Boekel, C. Leonieke
and van Zaalen, Yvonne",
title="Attitudes of Health Care Professionals Toward Older Adults' Abilities to Use Digital Technology: Questionnaire Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="21",
volume="23",
number="4",
pages="e26232",
keywords="ageism",
keywords="attitudes",
keywords="stereotype activation",
keywords="digital technology",
abstract="Background: Digital technologies (DTs) for older adults focus mainly on health care and are considered to have the potential to improve the well-being of older adults. However, adoption rates of these DTs are considered low. Although previous research has investigated possible reasons for adoption and acceptance of DT, age-based stereotypes (eg, those held by health care professionals) toward the abilities of older adults to use DTs have yet to be considered as possible barriers to adoption. Objective: The aim of this study was to investigate the influencing role of ageism in the context of health care professionals attitudes toward older adults' abilities to use health care DT. A further goal was to examine if social comparison and stereotype activation affect and moderate this association. Methods: A new measurement to assess health care professionals' attitudes toward older adults using technology (ATOAUT-10) was developed and used in 2 studies. Study 1 involved the development of the ATOAUT-10 scale using a principal component analysis and further examined health care professionals' attitudes toward the use of health care DTs and correlations with ageism. Study 2 further explored the correlation between ageism and ATOAUT in an experimental design with health care professionals. Results: In study 1, physiotherapists (N=97) rated older adults as young as 50 years as less able to use health care DT compared to younger adults (P<.001). A multiple regression analysis revealed that higher levels of ageism, beyond other predictors, were predictive of more negative ATOAUT, ($\beta$=.36; t=3.73; P<.001). In study 2, the salience of age was manipulated. Health care professionals (N=93) were randomly assigned to rate the abilities of a young or old person to use health care DT. Old age salience moderated the correlation between ageism and ATOAUT (R2=0.19; F6,85=3.35; P=.005), such that higher levels of ageism correlated with more negative ATOAUT in the old age salient condition, but not the young condition. Stereotype activation accounted for health care professionals' attitudes more than did the experience of working with older patients or the professionals' age. Conclusions: Negative and ageist attitudes of health care professionals can potentially affect how older adults are viewed in relation to DT and consequently might influence actual use and adoption of technology-based treatment. Future studies should broaden the validation of the ATOAUT-10 scale on more diverse samples and focus on the discriminatory aspect of ageism and self-ageism of older adults. This study calls for a focus on ageism as a determinant of adoption of DT. ",
doi="10.2196/26232",
url="https://www.jmir.org/2021/4/e26232",
url="http://www.ncbi.nlm.nih.gov/pubmed/33881408"
}


@Article{info:doi/10.2196/24716,
author="Mahalingaiah, Shruthi
and Cheng, Jojo J.
and Winter, R. Michael
and Rodriguez, Erika
and Fruh, Victoria
and Williams, Anna
and Nguyen, MyMy
and Madhavan, Rashmi
and Karanja, Pascaline
and MacRae, Jill
and Konanki, Charan Sai
and Lane, J. Kevin
and Aschengrau, Ann",
title="Multimodal Recruitment to Study Ovulation and Menstruation Health: Internet-Based Survey Pilot Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="16",
volume="23",
number="4",
pages="e24716",
keywords="polycystic ovary syndrome",
keywords="PCOS",
keywords="menstrual cycle",
keywords="multimodal recruitment strategy",
keywords="epidemiology",
keywords="recruitment",
keywords="pilot",
keywords="strategy",
keywords="women",
keywords="feasibility",
keywords="online survey",
keywords="ovulation",
keywords="menstrual",
abstract="Background: Multimodal recruitment strategies are a novel way to increase diversity in research populations. However, these methods have not been previously applied to understanding the prevalence of menstrual disorders such as polycystic ovary syndrome. Objective: The purpose of this study was to test the feasibility of recruiting a diverse cohort to complete a web-based survey on ovulation and menstruation health. Methods: We conducted the Ovulation and Menstruation Health Pilot Study using a REDCap web-based survey platform. We recruited 200 women from a clinical population, a community fair, and the internet. Results: We recruited 438 women over 29 weeks between September 2017 and March 2018. After consent and eligibility determination, 345 enrolled, 278 started (clinic: n=43; community fair: n=61; internet: n=174), and 247 completed (clinic: n=28; community fair: n=60; internet: n=159) the survey. Among all participants, the median age was 25.0 (SD 6.0) years, mean BMI was 26.1 kg/m2 (SD 6.6), 79.7\% (216/271) had a college degree or higher, and 14.6\% (37/254) reported a physician diagnosis of polycystic ovary syndrome. Race and ethnicity distributions were 64.7\% (176/272) White, 11.8\% (32/272) Black/African American, 7.7\% (21/272) Latina/Hispanic, and 5.9\% (16/272) Asian individuals; 9.9\% (27/272) reported more than one race or ethnicity. The highest enrollment of Black/African American individuals was in clinic (17/42, 40.5\%) compared to 1.6\% (1/61) in the community fair and 8.3\% (14/169) using the internet. Survey completion rates were highest among those who were recruited from the internet (159/174, 91.4\%) and community fairs (60/61, 98.4\%) compared to those recruited in clinic (28/43, 65.1\%). Conclusions: Multimodal recruitment achieved target recruitment in a short time period and established a racially diverse cohort to study ovulation and menstruation health. There were greater enrollment and completion rates among those recruited via the internet and community fair. ",
doi="10.2196/24716",
url="https://www.jmir.org/2021/4/e24716",
url="http://www.ncbi.nlm.nih.gov/pubmed/33861203"
}


@Article{info:doi/10.2196/18799,
author="Ducrot, Pauline
and Montagni, Ilaria
and Nguyen Thanh, Viet
and Serry, Anne-Juliette
and Richard, Jean-Baptiste",
title="Evolution of Online Health-Related Information Seeking in France From 2010 to 2017: Results From Nationally Representative Surveys",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="14",
volume="23",
number="4",
pages="e18799",
keywords="internet",
keywords="health information",
keywords="information-seeking behavior",
keywords="eHealth literacy",
abstract="Background: Given the rapid ongoing progression of the internet and increase in health information available from disparate online sources, it is important to understand how these changes impact online health information-seeking behavior of the population and the way of managing one's health. Objective: This paper aims at describing the evolution of internet use as a source of health information between 2010 and 2017, as well as the characteristics of online health information seekers, topics of interest, sources of information, and trust in retrieved information and potential impact on behavior. Methods: Data from the French nationally representative surveys Health Barometers were used (N=4141 in 2010, 4811 in 2014, and 6255 in 2017). Evolutions over time were assessed using chi-square tests. Associations with sociodemographic characteristics and health status were evaluated using logistic regression models. Results: The use of the internet as a source of health information rose between 2010 and 2014 (from 37.3\% to 67.9\%, P<.001) but decreased significantly in 2017 (60.3\%, P<.001). Overall, the profile of health information seekers compared with nonseekers did not change over time. They were more likely to be women, to be younger, to have a higher educational level, to have a higher household income, and to be executives. Between 2014 and 2017, the proportion of those who did not pay attention to the source of information significantly increased to reach 39.7\% (P<.001). In 2017 as in 2014, general health-related websites remained the first source of information (38.6\%) while institutional websites were the third source (8.1\%). Most information seekers trusted the information found online in 2010 (more than 80\%), with a slight decrease between 2014 and 2017 (P=.048). Among individual characteristics, trust in the information was the main determinant of the way of managing one's health (odds ratio 4.06, 95\% CI 3.26-5.06). Conclusions: After a rapid growth in the internet use for seeking health information in the 2010 to 2014 period, a decrease was recorded in 2017, in parallel with a decrease in trust in the quality and reliability of information found online. These findings underline the need for public health authorities to increase citizens' eHealth literacy and to provide alternative trustworthy sources combining the popularity and accessibility of general health information websites. ",
doi="10.2196/18799",
url="https://www.jmir.org/2021/4/e18799",
url="http://www.ncbi.nlm.nih.gov/pubmed/33851927"
}


@Article{info:doi/10.2196/24828,
author="De La Torre, Steven
and Spruijt-Metz, Donna
and Farias, J. Albert",
title="Associations Among Wearable Activity Tracker Use, Exercise Motivation, and Physical Activity in a Cohort of Cancer Survivors: Secondary Data Analysis of the Health Information National Trends Survey",
journal="JMIR Cancer",
year="2021",
month="Apr",
day="12",
volume="7",
number="2",
pages="e24828",
keywords="mHealth",
keywords="mobile health",
keywords="cancer survivors",
keywords="exercise",
keywords="physical activity",
keywords="motivation",
keywords="wearable electronic devices",
keywords="fitness trackers",
abstract="Background: Cancer survivors who meet physical activity (PA) recommendations (?150 minutes of moderate-to-vigorous physical activity [MVPA] per week) experience better health outcomes. With the growing availability of wearable activity trackers (WATs), it may be easier to track PA. However, it is unknown what motivates survivors to use these devices. Objective: The aim of this study is to investigate the associations among motivations for exercise, previous WAT use for tracking a health goal or activity, and meeting the recommended amount of PA among a cohort of cancer survivors. Methods: Data on WAT users who reported having a previous cancer diagnosis were analyzed from the National Cancer Institute's Health Information National Trends Survey 5 Cycle 3. All survivors with complete information on demographics, exercise motivations (internal guilt, external pressure, physical appearance, and exercise enjoyment), previous WAT use (yes or no), and minutes of MVPA per week (N=608) were included. Multivariate logistic regression models were used to test these associations. A separate cluster analysis was conducted to identify the profiles of exercise motivation that were associated with reporting WAT use. Results: The mean age of the cohort was 66.9 years (SD 12.1). The majority were non-Hispanic White (473/608, 78.8\%) and female (322/608, 54.9\%), and skin cancer was the most commonly reported diagnosed cancer (154/608, 27.8\%). Survivors who reported using WATs to track a health goal or activity were 1.6 times more likely to meet MVPA recommendations than those who did not use WATs (odds ratio [OR] 1.65, 95\% CI 1.03-2.65; P=.04). When exercise motivations were assessed independently, survivors who reported not feeling any internal guilt as an exercise motivation were 73\% less likely to report having used a WAT than those who felt any internal guilt (OR 0.27, 95\% CI 0.14-0.54; P<.001). A total of 3 distinct motivational profiles emerged from the cluster analysis. WAT users had an increased probability of membership in profile 3, which was characterized as being strongly motivated to exercise by internal guilt, physical appearance, and exercise enjoyment (OR 4.5, 95\% CI 2.1-9.7; P<.001). Conclusions: Among this cohort, survivors who reported using WATs to track a health goal or activity were significantly more likely to report meeting PA recommendations. Survivors who reported feeling internal guilt as an exercise motivation were significantly more likely to report using WATs to track a health goal or activity. When examining clusters of motivation, survivors who reported previous WAT use were more likely to report being motivated to exercise by a mix of intrinsic and extrinsic motivations, including internal guilt, exercise enjoyment, and physical appearance. Given the health benefits of PA for cancer survivors, technology-focused interventions that use WATs and target exercise motivation may aid in cancer survivors meeting the level of recommended PA. ",
doi="10.2196/24828",
url="https://cancer.jmir.org/2021/2/e24828",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843595"
}


@Article{info:doi/10.2196/21726,
author="Davies, R. Alisha
and Honeyman, Matthew
and Gann, Bob",
title="Addressing the Digital Inverse Care Law in the Time of COVID-19: Potential for Digital Technology to Exacerbate or Mitigate Health Inequalities",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="7",
volume="23",
number="4",
pages="e21726",
keywords="COVID-19",
keywords="digital divide",
keywords="digital exclusion",
keywords="digital health",
keywords="health inequality",
keywords="population health",
doi="10.2196/21726",
url="https://www.jmir.org/2021/4/e21726",
url="http://www.ncbi.nlm.nih.gov/pubmed/33735096"
}


@Article{info:doi/10.2196/23914,
author="Kazevman, Gill
and Mercado, Marck
and Hulme, Jennifer
and Somers, Andrea",
title="Prescribing Phones to Address Health Equity Needs in the COVID-19 Era: The PHONE-CONNECT Program",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="6",
volume="23",
number="4",
pages="e23914",
keywords="digital health equity",
keywords="health inequity",
keywords="digital determinants of health",
keywords="emergency medicine",
keywords="COVID-19",
keywords="public health",
keywords="health policy",
keywords="primary care",
keywords="cell phone",
doi="10.2196/23914",
url="https://www.jmir.org/2021/4/e23914",
url="http://www.ncbi.nlm.nih.gov/pubmed/33760753"
}


@Article{info:doi/10.2196/23205,
author="Farsi, Deema",
title="Social Media and Health Care, Part I: Literature Review of Social Media Use by Health Care Providers",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="5",
volume="23",
number="4",
pages="e23205",
keywords="social media",
keywords="social networking",
keywords="internet",
keywords="health care",
keywords="COVID-19",
keywords="research activity",
keywords="medical education",
keywords="telemedicine",
keywords="mobile phone",
abstract="Background: As the world continues to advance technologically, social media (SM) is becoming an essential part of billions of people's lives worldwide and is affecting almost every industry imaginable. As the world is becoming more digitally oriented, the health care industry is increasingly visualizing SM as an important channel for health care promotion, employment, recruiting new patients, marketing for health care providers (HCPs), building a better brand name, etc. HCPs are bound to ethical principles toward their colleagues, patients, and the public in the digital world as much as in the real world. Objective: This review aims to shed light on SM use worldwide and to discuss how it has been used as an essential tool in the health care industry from the perspective of HCPs. Methods: A literature review was conducted between March and April 2020 using MEDLINE, PubMed, Google Scholar, and Web of Science for all English-language medical studies that were published since 2007 and discussed SM use in any form for health care. Studies that were not in English, whose full text was not accessible, or that investigated patients' perspectives were excluded from this part, as were reviews pertaining to ethical and legal considerations in SM use. Results: The initial search yielded 83 studies. More studies were included from article references, and a total of 158 studies were reviewed. SM uses were best categorized as health promotion, career development or practice promotion, recruitment, professional networking or destressing, medical education, telemedicine, scientific research, influencing health behavior, and public health care issues. Conclusions: Multidimensional health care, including the pairing of health care with SM and other forms of communication, has been shown to be very successful. Striking the right balance between digital and traditional health care is important. ",
doi="10.2196/23205",
url="https://www.jmir.org/2021/4/e23205",
url="http://www.ncbi.nlm.nih.gov/pubmed/33664014"
}


@Article{info:doi/10.2196/23233,
author="Shaw, James
and Brewer, C. LaPrincess
and Veinot, Tiffany",
title="Recommendations for Health Equity and Virtual Care Arising From the COVID-19 Pandemic: Narrative Review",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="5",
volume="5",
number="4",
pages="e23233",
keywords="virtual care",
keywords="health equity",
keywords="health disparities",
keywords="health informatics",
keywords="COVID-19",
keywords="telemedicine",
keywords="telehealth",
keywords="digital health",
abstract="Background: The COVID-19 health crisis has disproportionately impacted populations who have been historically marginalized in health care and public health, including low-income and racial and ethnic minority groups. Members of marginalized communities experience undue barriers to accessing health care through virtual care technologies, which have become the primary mode of ambulatory health care delivery during the COVID-19 pandemic. Insights generated during the COVID-19 pandemic can inform strategies to promote health equity in virtual care now and in the future. Objective: The aim of this study is to generate insights arising from literature that was published in direct response to the widespread use of virtual care during the COVID-19 pandemic, and had a primary focus on providing recommendations for promoting health equity in the delivery of virtual care. Methods: We conducted a narrative review of literature on health equity and virtual care during the COVID-19 pandemic published in 2020, describing strategies that have been proposed in the literature at three levels: (1) policy and government, (2) organizations and health systems, and (3) communities and patients. Results: We highlight three strategies for promoting health equity through virtual care that have been underaddressed in this literature: (1) simplifying complex interfaces and workflows, (2) using supportive intermediaries, and (3) creating mechanisms through which marginalized community members can provide immediate input into the planning and delivery of virtual care. Conclusions: We conclude by outlining three areas of work that are required to ensure that virtual care is employed in ways that are equity enhancing in a post--COVID-19 reality. ",
doi="10.2196/23233",
url="https://formative.jmir.org/2021/4/e23233",
url="http://www.ncbi.nlm.nih.gov/pubmed/33739931"
}


@Article{info:doi/10.2196/25042,
author="An, Lawrence
and Bacon, Elizabeth
and Hawley, Sarah
and Yang, Penny
and Russell, Daniel
and Huffman, Scott
and Resnicow, Ken",
title="Relationship Between Coronavirus-Related eHealth Literacy and COVID-19 Knowledge, Attitudes, and Practices among US Adults: Web-Based Survey Study",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="29",
volume="23",
number="3",
pages="e25042",
keywords="internet",
keywords="digital health",
keywords="eHealth",
keywords="eHealth literacy",
keywords="coronavirus",
keywords="COVID-19",
keywords="knowledge",
keywords="conspiracy beliefs",
keywords="protective behaviors",
keywords="social distancing",
keywords="survey",
keywords="health communication",
keywords="attitude",
keywords="behavior",
abstract="Background: During a global pandemic, it is critical that the public is able to rapidly acquire new and accurate health information. The internet is a major source of health information. eHealth literacy is the ability of individuals to find, assess, and use health information available on the internet. Objective: The goals of this study were to assess coronavirus-related eHealth literacy and examine the relationship between eHealth literacy and COVID-19?related knowledge, attitudes, and practices (KAPs). Methods: We conducted a web-based survey of a representative sample of 1074 US adults. We adapted the 8-item eHealth Literacy Scale to develop the Coronavirus-Related eHealth Literacy Scale (CoV-eHEALS) to measure COVID-19?related knowledge, conspiracy beliefs, and adherence to  protective behaviors (eg, wearing facial masks and social distancing). Our analyses identified sociodemographic associations with the participants' CoV-eHEALS scores and an association between the CoV-eHEALS measure and COVID-19 KAPs. Results: The internal consistency of the adapted CoV-eHEALS measure was high (Cronbach $\alpha$=.92). The mean score for the CoV-eHEALS was 29.0 (SD 6.1). A total of 29\% (306/1074) of the survey participants were classified as having low coronavirus-related eHealth literacy (CoV-eHEALS score <26). Independent associations were found between CoV-eHEALS scores and ethnicity (standardized $\beta$=--.083, P=.016 for Black participants) and education level (standardized $\beta$=--.151, P=.001 for participants with high-school education or lower). Controlling for demographic characteristics, CoV-eHEALS scores demonstrated positive independent associations with knowledge (standardized $\beta$=.168, P<.001) and adherence to protective behaviors (standardized $\beta$=.241, P<.001) and a negative association with conspiracy beliefs (standardized $\beta$=--.082, P=.009). Conclusions: This study provides an estimate of coronavirus-related eHealth literacy among US adults. Our findings suggest that a substantial proportion of US adults have low coronavirus-related eHealth literacy and are thus at a greater risk of lower and less-protective COVID-19 KAPs. These findings highlight the need to assess and address eHealth literacy as part of COVID-19 control efforts. Potential strategies include improving the quality of health information about COVID-19 available on the internet, assisting or simplifying web-based search for information about COVID-19, and training to improve general or coronavirus-specific search skills. ",
doi="10.2196/25042",
url="https://www.jmir.org/2021/3/e25042",
url="http://www.ncbi.nlm.nih.gov/pubmed/33626015"
}


@Article{info:doi/10.2196/20030,
author="Chiu, Yen-Lin
and Lee, Yu-Chen
and Tsai, Chin-Chung",
title="Internet-Specific Epistemic Beliefs in Medicine and Intention to Use Evidence-Based Online Medical Databases Among Health Care Professionals: Cross-sectional Survey",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="18",
volume="23",
number="3",
pages="e20030",
keywords="evidence-based medicine (EBM)",
keywords="health care professionals",
keywords="internet-specific epistemic beliefs",
keywords="medical informatics",
abstract="Background: Evidence-based medicine has been regarded as a prerequisite for ensuring health care quality. The increase in health care professionals' adoption of web-based medical information and the lack of awareness of alternative access to evidence-based online resources suggest the need for an investigation of their information-searching behaviors of using evidence-based online medical databases. Objective: The main purposes of this study were to (1) modify and validate the internet-specific epistemic beliefs in medicine (ISEBM) questionnaire and (2) explore the associations between health care professionals' demographics, ISEBM, and intention to use evidence-based online medical databases for clinical practice. Methods: Health care professionals in a university-affiliated teaching hospital were surveyed using the ISEBM questionnaire. The partial least squares-structural equation modeling was conducted to analyze the reliability and validity of ISEBM. Furthermore, the structural model was analyzed to examine the possible linkages between health professionals' demographics, ISEBM, and intention to utilize the evidence-based online medical databases for clinical practice. Results: A total of 273 health care professionals with clinical working experience were surveyed. The results of the measurement model analysis indicated that all items had significant loadings ranging from 0.71 to 0.92 with satisfactory composite reliability values ranging from 0.87 to 0.94 and average variance explained values ranging from 0.70 to 0.84. The results of the structural relationship analysis revealed that the source of internet-based medical knowledge (path coefficient --0.26, P=.01) and justification of internet-based knowing in medicine (path coefficient 0.21, P=.001) were correlated with the intention to use evidence-based online medical databases. However, certainty and simplicity of internet-based medical knowledge were not. In addition, gender (path coefficient 0.12, P=.04) and academic degree (path coefficient 0.15, P=.004) were associated with intention to use evidence-based online medical databases for clinical practice. Conclusions: Advancing health care professionals' ISEBM regarding source and justification may encourage them to retrieve valid medical information through evidence-based medical databases. Moreover, providing support for specific health care professionals (ie, females, without a master's degree) may promote their intention to use certain databases for clinical practice. ",
doi="10.2196/20030",
url="https://www.jmir.org/2021/3/e20030",
url="http://www.ncbi.nlm.nih.gov/pubmed/33734092"
}


@Article{info:doi/10.2196/23662,
author="Yang, Lin-Ya
and Lyons, G. Jennifer
and Erickson, R. Steven
and Wu, Chung-Hsuen",
title="Trends and Characteristics of the US Adult Population's Behavioral Patterns in Web-Based Prescription Filling: National Survey Study",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="16",
volume="23",
number="3",
pages="e23662",
keywords="internet",
keywords="prescription",
keywords="online pharmacy",
keywords="National Health Interview Survey",
keywords="trend",
abstract="Background: Filling a prescription on the web has become an alternative to in-person pharmacies for individuals to access their medications. However, the adoption of web-based filling has been gradual, and the use patterns remain to be unclear. Objective: This study aims to estimate the trend and prevalence of web-based prescription-filling behavior and identify associated factors among adults in the United States. Methods: We used data from the US National Health Interview Survey (NHIS) from 2009 to 2018. Adult respondents (aged ?18 years and over) self-reported their behavior of web-based prescription filling, which was defined as having filled a prescription using the internet in the past 12 months during the survey year. We reported trends using weighted percentages adjusted by the NHIS complex sampling design. We used descriptive statistics and multivariable logistic regression models to examine trends and identify factors associated with web-based prescription-filling behavior. Results: The estimated number of adults reporting web-based prescription-filling behavior significantly increased from 13,319,877 (13,319,877/225,217,942, 5.91\%) in 2009 to 28,308,262 (28,308,262/246,611,125, 11.48\%) in 2018 (P<.001). Those who were more likely to report filling a prescription on the web were aged between 35 and 74 years, female, White, and frequent users of the computer or internet; these adults also reported higher education, higher income, insurance coverage, and poorer health status. Conclusions: Web-based prescription-filling behavior among US adults has increased significantly from 2009 to 2018. Health care providers should be aware of the upward trend in the use of web-based pharmacies and ensure the clinical safety of web-based prescriptions. ",
doi="10.2196/23662",
url="https://www.jmir.org/2021/3/e23662",
url="http://www.ncbi.nlm.nih.gov/pubmed/33724193"
}


@Article{info:doi/10.2196/18876,
author="Zhao, Zhi Sheng
and Luk, Tsun Tzu
and Guo, Ningyuan
and Wang, Ping Man
and Lai, Kwan Agnes Yuen
and Wong, Man Bonny Yee
and Fong, Tak Daniel Yee
and Chan, Chee Sophia Siu
and Lam, Hing Tai",
title="Association of Mobile Instant Messaging Chat Group Participation With Family Functioning and Well-Being: Population-Based Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="15",
volume="23",
number="3",
pages="e18876",
keywords="mobile instant messaging",
keywords="chat groups",
keywords="family communication",
keywords="family well-being",
keywords="family functioning",
abstract="Background: Convenient and quality family communication improves family functioning and well-being. Using mobile instant messaging (IM) for family communication is increasingly popular, but its association with family functioning and family well-being has not been reported. Objective: The aim of this study was to examine the association of the use of family IM chat groups with family functioning and well-being, and the mediating effect of family communication quality among Chinese adults in Hong Kong. Methods: We analyzed data from the Family and Health Information Trend Survey (FHInTS), a territory-wide, probability-based telephone survey conducted in 2017. The quality of family communication, family functioning, and well-being was assessed using the Family Communication Scale; Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Scale; and Family Well-Being Scale (family heath, harmony, and happiness), respectively. Respondents also reported the number of family IM chat groups (0, 1, 2, ?3), and numbers of IM messages received (<1, 1-2, 3-10, 11-20, >20) and sent (<1, 1-2, 3-10, 11-20, >20) daily. The frequency of family IM chat interaction (range 0-8) was calculated by combining the number of messages received from and sent to the family IM chat groups daily. Covariates included sociodemographic characteristics and the frequency of family face-to-face communication (often, sometimes, seldom, or never). Data were weighted by sex, age, and education of the general population. Adjusted $\beta$ coefficients of family functioning and well-being in relation to having a family IM chat group, and numbers of messages received and sent were calculated. The mediation effects of family communication on these associations were assessed, controlling for the covariates. Results: A random sample of 1638 Chinese adults (45.6\% men; 78.1\% aged 25 to 64 years) were interviewed (response rate: 74.4\%). Female, younger age, being married or cohabiting, higher education, higher income, better family functioning, and well-being were associated with having at least one family IM chat group (all P<.01). Higher scores of family communication, family APGAR, and family well-being were associated with having more family IM chat groups and more messages received from and sent to family IM chat groups daily (all P for trend <.01). More frequent family IM chat interaction was associated with higher scores of family communication, family APGAR, and family well-being ($\beta$=.16-.83, all P for trend <.001). The associations of family IM chat interaction with family functioning and well-being were moderately (51.0\%-59.6\%) mediated by family communication. Conclusions: Use of a family IM chat group was associated with higher family functioning and well-being, and the association was partially mediated by family communication. ",
doi="10.2196/18876",
url="https://www.jmir.org/2021/3/e18876",
url="http://www.ncbi.nlm.nih.gov/pubmed/33720034"
}


@Article{info:doi/10.2196/25123,
author="Naqvi, Ali Imama
and Montiel, Casameni Tahani
and Bittar, Yazan
and Hunter, Norma
and Okpala, Munachi
and Johnson, Constance
and Weiner, G. Mark
and Savitz, Sean
and Sharrief, Anjail
and Beauchamp, Sanner Jennifer Elizabeth",
title="Internet Access and Usage Among Stroke Survivors and Their Informal Caregivers: Cross-sectional Study",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="8",
volume="5",
number="3",
pages="e25123",
keywords="internet access",
keywords="stroke",
keywords="caregivers",
keywords="surveys",
keywords="questionnaires",
keywords="mobile phone",
abstract="Background: Web-based interventions have shown promise for chronic disease management but have not been widely applied to populations with stroke. Existing barriers may inhibit the adoption of web-based interventions among stroke survivors and necessitate the involvement of informal caregivers. However, limited information is available on internet accessibility and usability among stroke survivors and their caregivers. Objective: This study aims to investigate internet access and usage in a cohort of stroke survivors and their caregivers. Methods: A cross-sectional survey was conducted with 375 participants (248 stroke survivors and 127 caregivers). Descriptive statistics were generated using cross-tabulation. Comparisons with categorical data were conducted using the chi-square test, whereas the Mann-Whitney U test was used for comparisons involving ordinal variables. Results: Overall, 86.1\% (323/375) of the participants reported having internet access. Caregivers were more likely than stroke survivors to access the internet (N=375, $\chi$21=18.5, P<.001) and used text messaging (n=321, $\chi$21=14.7, P<.001). Stroke survivors and caregivers with internet access were younger than stroke survivors and caregivers without internet access. The highest number of participants who reported internet access were non-Hispanic White. Smartphones were the most common devices used to access the internet. Email was the most common type of internet usage reported. Patients who survived for >12 months after a stroke reported higher internet access than those who survived <3 months (P<.001). The number of hours per week spent using the internet was higher for caregivers than for stroke survivors (P<.001). Conclusions: Future feasibility and acceptability studies should consider the role of the informal caregiver, participant age, race and ethnicity, the use of smartphone apps, email and text correspondence, and the amount of time elapsed since the stroke event in the design and implementation of web-based interventions for populations with stroke. ",
doi="10.2196/25123",
url="https://formative.jmir.org/2021/3/e25123",
url="http://www.ncbi.nlm.nih.gov/pubmed/33683206"
}


@Article{info:doi/10.2196/19134,
author="Niu, Zhaomeng
and Willoughby, Jessica
and Zhou, Rongting",
title="Associations of Health Literacy, Social Media Use, and Self-Efficacy With Health Information--Seeking Intentions Among Social Media Users in China: Cross-sectional Survey",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="25",
volume="23",
number="2",
pages="e19134",
keywords="behavioral intention",
keywords="health literacy",
keywords="self-efficacy",
keywords="social media",
abstract="Background: Empirical research has demonstrated that people frequently use social media for gathering and sharing online health information. Health literacy, social media use, and self-efficacy are important factors that may influence people's health behaviors online. Objective: We aimed to examine the associations between health literacy, health-related social media use, self-efficacy, and health behavioral intentions online. Methods: We conducted a cross-sectional survey of adults 18 years and older (n=449) to examine predictors of health-related behavioral intentions online including health literacy, social media use, and self-efficacy in China using 2 moderated mediation models. Mediation and moderation analyses were conducted. Results: Self-efficacy mediated the effects of health literacy (Bindirect=0.213, 95\% CI 0.101 to 0.339) and social media use (Bindirect=0.023, 95\% CI 0.008 to 0.045) on health behavioral intentions on social media. Age moderated the effects of health literacy on self-efficacy (P=.03), while previous experience moderated the effects of social media use on self-efficacy (P<.001). Conclusions: Health literacy and health-related social media use influenced health behavioral intentions on social media via their prior effects on self-efficacy. The association between health literacy and self-efficacy was stronger among younger respondents, whereas the association between health-related social media use and self-efficacy was stronger among those who previously had positive experiences with health information on social media. Health practitioners should target self-efficacy among older populations and increase positive media experience related to health. ",
doi="10.2196/19134",
url="https://www.jmir.org/2021/2/e19134",
url="http://www.ncbi.nlm.nih.gov/pubmed/33629955"
}


@Article{info:doi/10.2196/24767,
author="Elkefi, Safa
and Yu, Zhongyuan
and Asan, Onur",
title="Online Medical Record Nonuse Among Patients: Data Analysis Study of the 2019 Health Information National Trends Survey",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="22",
volume="23",
number="2",
pages="e24767",
keywords="online medical records",
keywords="cancer",
keywords="patient portals",
keywords="communication",
keywords="medical records",
keywords="health information",
keywords="eHealth",
abstract="Background: Online medical records are being used to organize processes in clinical and outpatient settings and to forge doctor-patient communication techniques that build mutual understanding and trust.  Objective: We aimed to understand the reasons why patients tend to avoid using online medical records and to compare the perceptions that patients have of online medical records based on demographics and cancer diagnosis. Methods: We used data from the Health Information National Trends Survey Cycle 3, a nationally representative survey, and assessed outcomes using descriptive statistics and chi-square tests. The patients (N=4328) included in the analysis had experienced an outpatient visit within the previous 12 months and had answered the online behavior question regarding their use of online medical records.  Results: Patients who were nonusers of online medical records consisted of 58.36\% of the sample (2526/4328). The highest nonuser rates were for patients who were Hispanic (460/683, 67.35\%), patients who were non-Hispanic Black (434/653, 66.46\%), and patients who were older than 65 years (968/1520, 63.6\%). Patients older than 65 years were less likely to use online medical records (odds ratio [OR] 1.51, 95\% CI 1.24-1.84, P<.001). Patients who were White were more likely to use online medical records than patients who were Black (OR 1.71, 95\% CI 1.43-2.05, P<.001) or Hispanic (OR 1.65, 95\% CI 1.37-1.98, P<.001). Patients who were diagnosed with cancer were more likely to use online medical records compared to patients with no cancer (OR 1.31, 95\% CI 1.11-1.55, 95\% CI 1.11-1.55, P=.001). Among nonusers, older patients (?65 years old) preferred speaking directly to their health care providers (OR 1.76, 95\% CI 1.35-2.31, P<.001), were more concerned about privacy issues caused by online medical records (OR 1.79, 95\% CI 1.22-2.66, P<.001), and felt uncomfortable using the online medical record systems (OR 10.55, 95\% CI 6.06-19.89, P<.001) compared to those aged 18-34 years. Patients who were Black or Hispanic were more concerned about privacy issues (OR 1.42, 1.09-1.84, P=.007).  Conclusions: Studies should consider social factors such as gender, race/ethnicity, and age when monitoring trends in eHealth use to ensure that eHealth use does not induce greater health status and health care disparities between people with different backgrounds and demographic characteristics. ",
doi="10.2196/24767",
url="https://www.jmir.org/2021/2/e24767",
url="http://www.ncbi.nlm.nih.gov/pubmed/33616539"
}


@Article{info:doi/10.2196/25809,
author="Yang, Xin
and Yang, Ning
and Lewis, Dwight
and Parton, Jason
and Hudnall, Matthew",
title="Patterns and Influencing Factors of eHealth Tools Adoption Among Medicaid and Non-Medicaid Populations From the Health Information National Trends Survey (HINTS) 2017-2019: Questionnaire Study",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="18",
volume="23",
number="2",
pages="e25809",
keywords="Medicaid program",
keywords="eHealth",
keywords="internet access",
keywords="digital divide",
keywords="health information technology",
abstract="Background: Evidence suggests that eHealth tools adoption is associated with better health outcomes among various populations. The patterns and factors influencing eHealth adoption among the US Medicaid population remain obscure. Objective: The objective of this study is to explore patterns of eHealth tools adoption among the Medicaid population and examine factors associated with eHealth adoption. Methods: Data from the Health Information National Trends Survey from 2017 to 2019 were used to estimate the patterns of eHealth tools adoption among Medicaid and non-Medicaid populations. The effects of Medicaid insurance status and other influencing factors were assessed with logistic regression models. Results: Compared with the non-Medicaid population, the Medicaid beneficiaries had significantly lower eHealth tools adoption rates for health information management (11.2\% to 17.5\% less) and mobile health for self-regulation (0.8\% to 9.7\% less). Conversely, the Medicaid population had significantly higher adoption rates for using social media for health information than their counterpart (8\% higher in 2018, P=.01; 10.1\% higher in 2019, P=.01). Internet access diversity, education, and cardiovascular diseases were positively associated with health information management and mobile health for self-regulation among the Medicaid population. Internet access diversity is the only factor significantly associated with social media adoption for acquisition of health information (OR 1.98, 95\% CI 1.26-3.11). Conclusions: Our results suggest digital disparities in eHealth tools adoption between the Medicaid and non-Medicaid populations. Future research should investigate behavioral correlates and develop interventions to improve eHealth adoption and use among underserved communities. ",
doi="10.2196/25809",
url="http://www.jmir.org/2021/2/e25809/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33599619"
}


@Article{info:doi/10.2196/23826,
author="Han, Madeline
and Tan, Yi Xin
and Lee, Rachael
and Lee, Kyu Jeong
and Mahendran, Rathi",
title="Impact of Social Media on Health-Related Outcomes Among Older Adults in Singapore: Qualitative Study",
journal="JMIR Aging",
year="2021",
month="Feb",
day="17",
volume="4",
number="1",
pages="e23826",
keywords="aging",
keywords="social media",
keywords="health",
keywords="qualitative research",
keywords="communication",
keywords="mobile phone",
abstract="Background: The worldwide spread of digitalization has led to the harnessing of technology to improve health outcomes. Paying attention to older adults' social needs via social media is one way to promote healthy aging. Although 56\% of older adults are smartphone users, little is known about their use patterns of social media. Objective: This exploratory study aims to determine the experiences of social media apps' use among older adults in Singapore and understand their perceptions of its impact on health-related outcomes. Methods: This study used a qualitative research design with an interpretative approach. Using maximum variation purposive sampling, normal aging older adults (N=16) who were aged between 60 and 80 years and experienced in the use of internet-enabled technology were recruited from an existing community study. Semistructured, in-depth interviews were conducted. Employing a thematic analysis, interviews were transcribed verbatim and analyzed for codes inductively. Results: The following themes and subthemes were identified as key moderators of older adults' experiences on social media apps: (1) personal attitudes: participants were encouraged to use social media due to the increased accessibility, which enabled the ease of contact, but perceptions that the quality of interactions was compromised and its associated risks reduced their use; and (2) social influences: the desire to bond with co-users and the availability of support increased use. In addition, use of social media apps was perceived to positively impact health through its ability to keep older adults cognitively engaged, improve health communication, and increase social connectedness. However, opinions remained mixed on older adults' vulnerability to social media addiction. Conclusions: Personal and social contexts determine older adults' social media use. This study's findings provide practical insights into how social media can be deployed to improve health-related outcomes in older adults. ",
doi="10.2196/23826",
url="http://aging.jmir.org/2021/1/e23826/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33595437"
}


@Article{info:doi/10.2196/17837,
author="Kreniske, Philip
and Basmajian, Alyssa
and Nakyanjo, Neema
and Ddaaki, William
and Isabirye, Dauda
and Ssekyewa, Charles
and Nakubulwa, Rosette
and Hirsch, S. Jennifer
and Deisher, Andrea
and Nalugoda, Fred
and Chang, W. Larry
and Santelli, S. John",
title="The Promise and Peril of Mobile Phones for Youth in Rural Uganda: Multimethod Study of Implications for Health and HIV",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="2",
volume="23",
number="2",
pages="e17837",
keywords="adolescence",
keywords="youth",
keywords="mobile phones",
keywords="cell phones",
keywords="mobility",
keywords="HIV",
keywords="East Africa",
abstract="Background: In East Africa, where landlines are used by 1\% of the population and access to the internet is limited, owning a cell phone is rapidly becoming essential for acquiring information and resources. Our analysis illuminates the perils and potential promise of mobile phones with implications for future interventions to promote the health of adolescents and young adults (AYAs) and to prevent HIV infection. Objective: The aim of this study is to describe the current state of AYAs' phone use in the region and trace out the implications for mobile health interventions. Methods: We identified 2 trading centers that were representative of southern Uganda in terms of key demographics, proportion of cell phone ownership, and community HIV prevalence. We stratified the sample of potential informants by age group (15-19 years and 20-24 years), gender, and phone ownership and randomly sampled 31 key informant interview participants within these categories. In addition, we conducted 24 ethnographic participant observations among AYAs in the communities of study. Results: AYA frequently reported barriers to using their phones, such as difficulty accessing electricity. Nearly all AYAs used mobile phones to participate in the local economy and communicate with sexual partners. Phone use was frequently a point of contention between sexual partners, with many AYAs reporting that their sexual partners associated phone use with infidelity. Few AYAs reported using their phones for health-related purposes, with most getting health information in person from health workers. However, most AYAs reported an instance when they used their phone in an emergency, with childbirth-related emergencies being the most common. Finally, most AYAs reported that they would like to use their phones for health purposes and specifically stated that they would like to use their mobile phones to access current HIV prevention information. Conclusions: This study demonstrates how mobile phones are related to income-generating practices in the region and communication with sexual partners but not access to health and HIV information. Our analysis offers some explanation for our previous study, which suggested an association between mobile phone ownership, having multiple sexual partners, and HIV risk. Mobile phones have untapped potential to serve as tools for health promotion and HIV prevention. ",
doi="10.2196/17837",
url="https://www.jmir.org/2021/2/e17837",
url="http://www.ncbi.nlm.nih.gov/pubmed/33528375"
}


@Article{info:doi/10.2196/19998,
author="Magnol, Marion
and Eleonore, Berard
and Claire, Rempenault
and Castagne, Benjamin
and Pugibet, Marine
and Lukas, C{\'e}dric
and Tournadre, Anne
and Vergne-Salle, Pascale
and Barnetche, Thomas
and Truchetet, Marie-Elise
and Ruyssen-Witrand, Adeline",
title="Use of eHealth by Patients With Rheumatoid Arthritis: Observational, Cross-sectional, Multicenter Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="29",
volume="23",
number="1",
pages="e19998",
keywords="eHealth",
keywords="internet",
keywords="mobile app",
keywords="rheumatoid arthritis",
keywords="patients' expectation",
abstract="Background: The use of eHealth tools (eg, the internet, mobile apps, and connected devices) in the management of chronic diseases and for rheumatoid arthritis is growing. eHealth may improve the overall quality of care provided to patients with chronic diseases. Objective: The primary objective of this study was to describe eHealth use by patients with rheumatoid arthritis in France. The secondary objectives were to identify associations between patient demographics and disease characteristics and the use of eHealth tools, and assess their expectations of eHealth. Methods: In this cross-sectional, multicenter study, patients with rheumatoid arthritis, according to the 2010 ACR/EULAR classification criteria, were recruited from 5 university hospitals (Bordeaux, Clermont-Ferrand, Limoges, Montpellier, and Toulouse). Patients completed an anonymous self-questionnaire, including demographic data, evaluating their eHealth use (ie, access, support, frequency of use, type of use, and reason for use). The rheumatologist in charge of each patient completed an independent medical questionnaire on disease characteristics, activity of rheumatoid arthritis, and treatments. Data were collected between December 2018 and July 2019. Results: Questionnaires were completed by 575 participants, with a mean age of 62 (SD 13) years, 447 (77.7\%) of whom were female. Overall, 82.2\% (473/575) of the participants had access to eHealth through a computer (402/467, 86.1\%), tablet (188/467, 40.2\%), or smartphone (221/467, 47.3\%). Of these, 36.4\% (170/467) of the participants used the internet for health in general, and 28.7\% (134/467) used it specifically for rheumatoid arthritis--related reasons. All these 134 patients used eHealth to learn about disease pathology, and 66.4\% (89/134) of them used it as a tool to help monitor rheumatoid arthritis. Most patients (87/125, 69.6\%) had a paper file, 19.2\% (24/125) used a digital tool (spreadsheets, 10/125, 8\%; mobile app, 9/125, 7.2\%; or website, 5/125, 4\%), and 24.8\% (31/125) did not use any tools for monitoring. Few patients (16/125, 12.8\%) used tools for treatment reminders. About 21.6\% (27/125) of the patients using eHealth used a specific app for rheumatoid arthritis. Univariate analysis showed that age, education level, employment status, treatment, comorbidities, membership of a patient association, and patient education program were associated with eHealth use for rheumatoid arthritis. Multivariate analysis showed that membership of a patient association (odds ratio [OR] 5.8, 95\% CI 3.0-11.2), use of biologic disease-modifying antirheumatic drugs (OR 0.6, 95\% CI 0.4-1.0), and comorbidities (OR 0.7, 95\% CI 0.6-0.8) remained associated with eHealth use for rheumatoid arthritis. Recommendation by a doctor (225/330, 68.2\%), ease of use (105/330, 31.8\%), and data security (69/330, 20.9\%) were factors favoring the use of eHealth. Conclusions: To date, few patients have used eHealth for disease management. The use of a reliable and validated eHealth tool for rheumatoid arthritis could therefore be promoted by rheumatologists and could optimize therapeutic adherence. ",
doi="10.2196/19998",
url="http://www.jmir.org/2021/1/e19998/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33512320"
}


@Article{info:doi/10.2196/17782,
author="Park, Jaeyoung
and Liang, Muxuan
and Alpert, M. Jordan
and Brown, F. Richard
and Zhong, Xiang",
title="The Causal Relationship Between Portal Usage and Self-Efficacious Health Information--Seeking Behaviors: Secondary Analysis of the Health Information National Trends Survey Data",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="27",
volume="23",
number="1",
pages="e17782",
keywords="causal inference",
keywords="instrumental variable",
keywords="directed acyclic graph",
keywords="patient portal",
keywords="self-efficacy",
abstract="Background: Patient portals have drawn much attention, as they are considered an important tool for health providers in facilitating patient engagement. However, little is known about whether the intensive use of patient portals contributes to improved management of patients' health in terms of their confidence in acquiring health information and exercising self-care. There is a lack of randomized trials with these outcomes measured both pre- and postadoption of patient portals. Objective: The aim of this study was to examine the causal relationship between the usage of patient portals and patients' self-efficacy toward obtaining health information and performing self-care. Methods: This study was a secondary data analysis that used data from a US national survey, the National Cancer Institute's Health Information National Trends Survey 5 Cycle 1. Patient portal usage frequency was used to define the treatment. Survey items measuring self-efficacy on a Likert-type scale were selected as the main outcomes, including patients' confidence in obtaining health information and performing self-care. To establish causality using survey data, we adopted the instrumental variables method. To determine the direction of the causal relationship in the presence of high-dimensional confounders, we further proposed a novel testing framework that employs conditional independence tests in a directed acyclic graph. The average causal effect was measured using the two-stage least squares regression method. Results: We showed that frequently using patient portals improves patients' confidence in obtaining health information. The estimand of the weighted average causal effect was 0.14 (95\% CI 0.06-0.23; P<.001). This means that when increasing the portal usage intensity, for instance, from 1-2 times to 3-5 times per year, the expected average increase in confidence level measured on a Likert-type scale would be 0.14. However, we could not conclusively determine the causal effect between patient portal usage and patients' confidence in exercising self-care. Conclusions: The results support the use of patient portals and encourage better support and education to patients. The proposed statistical method can be used to exploit the potential of national survey data for causal inference studies. ",
doi="10.2196/17782",
url="http://www.jmir.org/2021/1/e17782/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33502334"
}


@Article{info:doi/10.2196/14088,
author="Lee, Yun Hee
and Jin, Won Seok
and Henning-Smith, Carrie
and Lee, Jongwook
and Lee, Jaegoo",
title="Role of Health Literacy in Health-Related Information-Seeking Behavior Online: Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="27",
volume="23",
number="1",
pages="e14088",
keywords="digital divide",
keywords="health literacy",
keywords="internet",
keywords="technology",
keywords="access",
abstract="Background: The internet has emerged as a main venue of health information delivery and health-related activities. However, few studies have examined how health literacy determines online health-related behavior. Objective: The aim of this study was to investigate the current level of health-related information-seeking using the internet and how health literacy, access to technology, and sociodemographic characteristics impact health-related information-seeking behavior. Methods: We conducted a cross-sectional study through a survey with Minnesotan adults (N=614) to examine their health literacy, access to technology, and health-related information-seeking internet use. We used multivariate regression analysis to assess the relationship between health-related information-seeking on the internet and health literacy and access to technology, controlling for sociodemographic characteristics. Results: Better health literacy ($\beta$=.35, SE 0.12) and greater access to technological devices (eg, mobile phone and computer or tablet PC; $\beta$=.06, SE 0.19) were both associated with more health-related information-seeking behavior on the internet after adjusting for all other sociodemographic characteristics. Possession of a graduate degree ($\beta$=.28, SE 0.07), female gender ($\beta$=.15, SE 0.05), poor health ($\beta$=.22, SE 0.06), participation in social groups ($\beta$=.13, SE 0.05), and having an annual health exam ($\beta$=.35, SE 0.12) were all associated with online health-related information-seeking. Conclusions: Our findings indicate that access to online health-related information is not uniformly distributed throughout the population, which may exacerbate disparities in health and health care. Research, policy, and practice attention are needed to address the disparities in access to health information as well as to ensure the quality of the information and improve health literacy. ",
doi="10.2196/14088",
url="http://www.jmir.org/2021/1/e14088/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33502332"
}


@Article{info:doi/10.2196/25456,
author="Friis-Healy, A. Elsa
and Nagy, A. Gabriela
and Kollins, H. Scott",
title="It Is Time to REACT: Opportunities for Digital Mental Health Apps to Reduce Mental Health Disparities in Racially and Ethnically Minoritized Groups",
journal="JMIR Ment Health",
year="2021",
month="Jan",
day="26",
volume="8",
number="1",
pages="e25456",
keywords="digital health",
keywords="app",
keywords="public mental health",
keywords="health disparities",
keywords="COVID-19",
keywords="pandemic",
keywords="mental health",
keywords="disparity",
keywords="behavior",
doi="10.2196/25456",
url="http://mental.jmir.org/2021/1/e25456/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33406050"
}


@Article{info:doi/10.2196/20314,
author="Kola, Lola
and Abiona, Dolapo
and Adefolarin, Olufolake Adeyinka
and Ben-Zeev, Dror",
title="Mobile Phone Use and Acceptability for the Delivery of Mental Health Information Among Perinatal Adolescents in Nigeria: Survey Study",
journal="JMIR Ment Health",
year="2021",
month="Jan",
day="26",
volume="8",
number="1",
pages="e20314",
keywords="mHealth",
keywords="perinatal adolescent",
keywords="perinatal depression",
keywords="community",
keywords="low income",
abstract="Background: There are several barriers that may hamper adolescent mothers' utilization of available health interventions for perinatal depression. Innovative treatment approaches are needed to increase adolescent mothers' access to mental health care for improved maternal and child health outcomes. Mobile phones have the potential to serve as important conduits to mental health care in Africa. However, mobile phone use patterns and needs among young mothers in Nigeria are not well documented. Objective: This study sought to determine the prevalence of mobile phone use among perinatal adolescents and report patterns of use, as well as to assess the openness of young mothers to mobile health (mHealth) mental health interventions. Methods: We surveyed 260 adolescent mothers (ages 16-19 years) in their perinatal or postnatal periods of pregnancies in 33 primary health care clinics in Ibadan, Oyo State, Nigeria in 2020. Respondents were included if they were pregnant with a gestation age of greater than or equal to 4 weeks, or had babies (which they had birthed) that were younger than 12 months. Results: The total study sample consisted of 260 adolescent mothers with a mean age of 18.4 (SD 0.88) years. The majority of the respondents (233/260, 89.6\%) owned mobile phones (eg, keypad, keypad and internet, smartphones); 22 (8.5\%) of the 260 mothers had access to phones that belonged to relatives who lived in the same household, while 5 (1.9\%) had access only to public paid phones. Only 23\% (54/233) of phone owners (which is 20.5\% of the total study population) had smartphones. On average, respondents reported first using mobile phones at 15.5 (SD 2.06) years old.  The majority of respondents  (222/260, 85.4\%) reported using their phones for an average of 45 minutes daily for calls to family members. Facebook was the social media platform  that was most often used among respondents who had phones with internet access (122/146 minutes per day, 83.4\%). The majority of the sample responded as being ``interested'' and ``very interested'' in the use of mobile phones for preventive interventions (250/260, 96.2\%) and treatment (243/260, 93.5\%) information on mental illness such as depression and ``hearing voices.'' Half of the respondents (126/233, 50.4\%) preferred to receive such information in the form of text messages. Conclusions: Findings from this study suggest that the vast majority of perinatal adolescents in Nigeria own and use mobile phones and that they are interested in leveraging these devices for prevention, treatment, and informational campaigns focused on mental health. The use of smartphones in this population is relatively low, and health intervention through text messages were favored by the women. ",
doi="10.2196/20314",
url="http://mental.jmir.org/2021/1/e20314/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33496678"
}


@Article{info:doi/10.2196/17187,
author="Suarez-Lledo, Victor
and Alvarez-Galvez, Javier",
title="Prevalence of Health Misinformation on Social Media: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="20",
volume="23",
number="1",
pages="e17187",
keywords="social media",
keywords="health misinformation",
keywords="infodemiology",
keywords="infodemics",
keywords="social networks",
keywords="poor quality information",
keywords="social contagion",
abstract="Background: Although at present there is broad agreement among researchers, health professionals, and policy makers on the need to control and combat health misinformation, the magnitude of this problem is still unknown. Consequently, it is fundamental to discover both the most prevalent health topics and the social media platforms from which these topics are initially framed and subsequently disseminated. Objective: This systematic review aimed to identify the main health misinformation topics and their prevalence on different social media platforms, focusing on methodological quality and the diverse solutions that are being implemented to address this public health concern. Methods: We searched PubMed, MEDLINE, Scopus, and Web of Science for articles published in English before March 2019, with a focus on the study of health misinformation in social media. We defined health misinformation as a health-related claim that is based on anecdotal evidence, false, or misleading owing to the lack of existing scientific knowledge. We included (1) articles that focused on health misinformation in social media, including those in which the authors discussed the consequences or purposes of health misinformation and (2) studies that described empirical findings regarding the measurement of health misinformation on these platforms. Results: A total of 69 studies were identified as eligible, and they covered a wide range of health topics and social media platforms. The topics were articulated around the following six principal categories: vaccines (32\%), drugs or smoking (22\%), noncommunicable diseases (19\%), pandemics (10\%), eating disorders (9\%), and medical treatments (7\%). Studies were mainly based on the following five methodological approaches: social network analysis (28\%), evaluating content (26\%), evaluating quality (24\%), content/text analysis (16\%), and sentiment analysis (6\%). Health misinformation was most prevalent in studies related to smoking products and drugs such as opioids and marijuana. Posts with misinformation reached 87\% in some studies. Health misinformation about vaccines was also very common (43\%), with the human papilloma virus vaccine being the most affected. Health misinformation related to diets or pro--eating disorder arguments were moderate in comparison to the aforementioned topics (36\%). Studies focused on diseases (ie, noncommunicable diseases and pandemics) also reported moderate misinformation rates (40\%), especially in the case of cancer. Finally, the lowest levels of health misinformation were related to medical treatments (30\%). Conclusions: The prevalence of health misinformation was the highest on Twitter and on issues related to smoking products and drugs. However, misinformation on major public health issues, such as vaccines and diseases, was also high. Our study offers a comprehensive characterization of the dominant health misinformation topics and a comprehensive description of their prevalence on different social media platforms, which can guide future studies and help in the development of evidence-based digital policy action plans. ",
doi="10.2196/17187",
url="http://www.jmir.org/2021/1/e17187/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33470931"
}


@Article{info:doi/10.2196/22051,
author="Hunsaker, Amanda
and Hargittai, Eszter
and Micheli, Marina",
title="Relationship Between Internet Use and Change in Health Status: Panel Study of Young Adults",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="13",
volume="23",
number="1",
pages="e22051",
keywords="internet use",
keywords="health-related internet use",
keywords="health status",
keywords="panel data",
keywords="young adults",
keywords="internet",
keywords="healthy living",
abstract="Background: Using the internet for health information is a widespread phenomenon documented in considerable scholarship. Less common, however, is the analysis of panel data to examine how internet use may relate to change in health status over time. Objective: This study examines whether internet use and internet use related to health are associated with a change in health status among young adults. Methods: We used a unique panel survey data set collected about young adults' internet use in 2012 and 2016 (n=384). We applied logistic regression to examine the relationships between sociodemographics, internet experiences, frequency of health-related internet use, and sharing health content online with change in health status over time. We additionally examined the variables characterizing sharing health content online (via Facebook, Twitter, and email) in separate models. Results: In the second wave, over half (236/384, 61.5\%) of the sample used the internet for health at least weekly. Approximately one-third (141/384, 36.7\%) used Facebook for health-content sharing, while using Twitter and email for sharing health content were far less frequent (14/384, 3.6\%, and 55/384, 14.3\%, respectively). A change in health status occurred for 43.0\% (165/384) of the sample; 18.5\% (71/384) reported an improvement while 24.5\% (94/384) reported a decline. Greater frequency of internet use was associated with health decline over time (B=--0.58, P=.02). We also found that frequent health-related internet use was related to enhanced health or maintained health (B=0.58, P=.03). Sharing health content on social media or email, however, was not related to young adults' health changes. Conclusions: Young adults exhibit a pattern of using the internet for health that influences their health status. Our finding that frequent health-related internet use may promote improved or maintained health suggests that this type of online activity might also support healthy living. ",
doi="10.2196/22051",
url="https://www.jmir.org/2021/1/e22051",
url="http://www.ncbi.nlm.nih.gov/pubmed/33439134"
}


@Article{info:doi/10.2196/21244,
author="Doyle, M. Aoife
and Bandason, Tsitsi
and Dauya, Ethel
and McHugh, Grace
and Grundy, Chris
and Dringus, Stefanie
and Dziva Chikwari, Chido
and Ferrand, A. Rashida",
title="Mobile Phone Access and Implications for Digital Health Interventions Among Adolescents and Young Adults in Zimbabwe: Cross-Sectional Survey",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jan",
day="13",
volume="9",
number="1",
pages="e21244",
keywords="adolescent",
keywords="young adult",
keywords="young person",
keywords="young people",
keywords="cross-sectional studies",
keywords="humans",
keywords="female",
keywords="male",
keywords="mobile phone",
keywords="smartphone",
keywords="cell phones",
keywords="technology",
keywords="internet",
keywords="safety",
keywords="health-related internet use",
keywords="Zimbabwe",
abstract="Background: Mobile phones may help young people (YP) access health information and support health service engagement. However, in low-income settings there is limited knowledge on YP's phone and internet access to inform the feasibility of implementing digital health interventions. Objective: We investigated access to information and communication technologies among adolescents and young adults in Zimbabwe. Methods: A cross-sectional population-based survey was conducted from October to December 2018 among YP aged 13-24 years in 5 communities in urban and peri-urban Harare and Mashonaland East, Zimbabwe. Consenting YP completed a self-completed tablet-based questionnaire on mobile phone ownership and use, and use of the internet. The primary outcome was the proportion who reported owning a mobile phone. Secondary outcomes included phone and internet access and use behavior, and ownership and use of other technological devices. Multivariable logistic regression was used to investigate factors associated with mobile phone ownership and with internet access, with adjustment for the one-stage cluster sampling design. A priori exploratory variables were age, sex, marital status, and urban/peri-urban residence. Results: A total of 634/719 (88.2\%) eligible YP, mean age 18.0 years (SD 3.3) and 62.6\% (397/634) females, participated. Of the YP interviewed, 62.6\% (396/633; 95\% CI 58.5-66.5) reported owning a phone and a further 4.3\% (27/633) reported having access to a shared phone. Phone ownership increased with age: 27.0\% (43/159) of 13-15-year olds, 61.0\% (72/118) of 16-17-year olds, 71.5\% (103/144) of 18-19-year olds, and 84.7\% (171/202) of 20-24-year olds (odds ratio [OR] 1.4, 95\% CI 1.3-1.5) per year increase. Ownership was similar among females and males: 61.0\% (236/387; 95\% CI 55.6-66.1) versus 64.8\% (153/236; 95\% CI 57.8-71.2), age-adjusted OR 0.7 (95\% CI 0.5-1.1); higher in those with secondary level education compared to primary or no education: 67.1\% (346/516; 95\% CI 62.6-71.2) versus 26\% (21/82; 95\% CI 16.4-37.7), age-adjusted OR 2.3 (95\% CI 1.1-4.8); and similar across other sociodemographic factors. YP reported that 85.3\% (361/423) of phones, either owned or shared, were smartphones. Among phone owners, the most commonly used phone app was WhatsApp (71.2\%, 282/396), and 16.4\% (65/396) reported having ever used their phone to track their health. A total of 407/631 (64.5\%; 95\% CI 60.3-68.5) currently had access to the internet (used in last 3 months on any device) with access increasing with age (OR 1.2, 95\% CI 1.2-1.3 per year increase). In age-adjusted analysis, internet access was higher among males, the unmarried, those with a higher level of education, phone owners, and those who had lived in the community for more than 1 year. The aspect of the internet that YP most disliked was unwanted sexual (29.2\%, 136/465) and violent (13.1\%, 61/465) content. Conclusions: Mobile phone--based interventions may be feasible in this population; however, such interventions could increase inequity, especially if they require access to the internet. Internet-based interventions should consider potential risks for participants and incorporate skill-building sessions on safe internet and phone use. ",
doi="10.2196/21244",
url="https://mhealth.jmir.org/2021/1/e21244",
url="http://www.ncbi.nlm.nih.gov/pubmed/33439136"
}


@Article{info:doi/10.2196/20671,
author="Makowsky, J. Mark
and Jones, A. Charlotte
and Davachi, Shahnaz",
title="Prevalence and Predictors of Health-Related Internet and Digital Device Use in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Results From a 2014 Community-Based Survey",
journal="JMIR Public Health Surveill",
year="2021",
month="Jan",
day="8",
volume="7",
number="1",
pages="e20671",
keywords="consumer health information",
keywords="cardiovascular disease",
keywords="type 2 diabetes",
keywords="eHealth",
keywords="mobile phone",
keywords="ethnicity",
keywords="cross-sectional survey",
keywords="Canada",
abstract="Background: South Asian Canadians are at high risk of developing cardiovascular disease and diabetes. Consumer-oriented health information technology may help mitigate lifestyle risk factors and improve chronic disease self-management. Objective: This study aims to explore the prevalence, patterns, and predictors of the use of the internet, digital devices, and apps for health purposes as well as preferences for future use of eHealth support in South Asian Canadians. Methods: We conducted a cross-sectional, mixed-mode survey in a convenience sample of 831 South Asian adults recruited at faith-based gathering places, health care settings, and community events in Edmonton, Alberta, in 2014. The 706 responders (mean age 47.1, SD 17.6 years; n=356, 50.4\% female; n=509, 72.1\% Sikh) who provided complete sociodemographic information were included in the analysis, and the denominators varied based on the completeness of responses to each question. Multivariate logistic regression was used to determine sociodemographic and health status predictors of internet use, being a web-based health information seeker, smartphone or tablet ownership, health app use, and willingness to use various modes of eHealth support. Results: Of all respondents, 74.6\% (527/706) were internet users and 47.8\% (336/703) were web-based health information seekers. In addition, 74.9\% (527/704) of respondents owned a smartphone or tablet and 30.7\% (159/518) of these had a health and fitness app. Most internet users (441/527, 83.7\%) expressed interest in using ?1 mode of eHealth support. Older age, being female, having less than high school education, preferring written health information in languages other than English, and lacking confidence in completing medical forms predicted lack of internet use. Among internet users, factors that predicted web-based health information seeking were being female, use of the internet several times per day, being confident in completing medical forms, and preferring health information in English. Predictors of not owning a smartphone or tablet were being older, preferring health information in languages other than English, having less than high school education, living in Canada for <5 years, having a chronic health condition, and having diabetes. Increasing age was associated with lower odds of having a health app. Preferring health information in languages other than English consistently predicted lower interest in all modes of eHealth support. Conclusions: eHealth-based chronic disease prevention and management interventions are feasible for South Asian adults, but digital divides exist according to language preference, education, age, sex, confidence in completing medical forms, and number of years lived in Canada. Community-based, culturally tailored strategies targeting these factors are required to address existing divides and increase the uptake of credible web-based and app-based resources for health purposes. ",
doi="10.2196/20671",
url="https://publichealth.jmir.org/2021/1/e20671",
url="http://www.ncbi.nlm.nih.gov/pubmed/33416506"
}


@Article{info:doi/10.2196/19061,
author="Park, Sunhee
and Kim, Beomsoo",
title="Predictors of Internet Use Among Older Adults With Diabetes in South Korea: Survey Study",
journal="JMIR Med Inform",
year="2020",
month="Dec",
day="23",
volume="8",
number="12",
pages="e19061",
keywords="digital divide",
keywords="internet use",
keywords="older adults",
keywords="diabetes",
keywords="health",
keywords="internet",
keywords="Korea",
abstract="Background: Internet access in Korea has grown dramatically over the past two decades. However, disparities in internet use, referred to as the second level of the digital divide, persist. Objective: This study aims to examine opportunity, motivation, and health variables that indicate internet use among older adults with diabetes. Methods: Data were sourced from a nationally representative sample of people 65 years and older with diabetes (N=1919). Logistic regression was used to explore potential differences in predictor variables between internet users and nonusers. Results: Only 306 of the 1919 (15.95\%) participants in the sample used the internet. They were more likely to be younger (odds ratio [OR] 0.89, 95\% CI 0.87-0.92), well-educated (OR 1.20, 95\% CI 1.16-1.26), and able to afford leisure expenditures (OR 1.02, 95\% CI 1.01-1.04). Additionally, they had more information and communications technology (ICT) training experience, were motivated to learn, volunteered, and reported good physical and cognitive function. Participation in ICT education and better health more positively correlated with a higher rate of internet use than did years of education or economic standing in older adults with diabetes. Conclusions: To support older adults with diabetes in the internet age, policies and health care providers should focus on digital competency training as well as physical and cognitive function. ",
doi="10.2196/19061",
url="http://medinform.jmir.org/2020/12/e19061/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33277232"
}


@Article{info:doi/10.2196/24137,
author="Lin, Wen Annie
and Baik, H. Sharon
and Aaby, David
and Tello, Leslie
and Linville, Twila
and Alshurafa, Nabil
and Spring, Bonnie",
title="eHealth Practices in Cancer Survivors With BMI in Overweight or Obese Categories: Latent Class Analysis Study",
journal="JMIR Cancer",
year="2020",
month="Dec",
day="3",
volume="6",
number="2",
pages="e24137",
keywords="eHealth",
keywords="patient communication",
keywords="cancer survivorship",
keywords="obesity",
keywords="behavior",
abstract="Background: eHealth technologies have been found to facilitate health-promoting practices among cancer survivors with BMI in overweight or obese categories; however, little is known about their engagement with eHealth to promote weight management and facilitate patient-clinician communication. Objective: The objective of this study was to determine whether eHealth use was associated with sociodemographic characteristics, as well as medical history and experiences (ie, patient-related factors) among cancer survivors with BMI in overweight or obese categories. Methods: Data were analyzed from a nationally representative cross-sectional survey (National Cancer Institute's Health Information National Trends Survey). Latent class analysis was used to derive distinct classes among cancer survivors based on sociodemographic characteristics, medical attributes, and medical experiences. Logistic regression was used to examine whether class membership was associated with different eHealth practices. Results: Three distinct classes of cancer survivors with BMI in overweight or obese categories emerged: younger with no comorbidities, younger with comorbidities, and older with comorbidities. Compared to the other classes, the younger with comorbidities class had the highest probability of identifying as female (73\%) and Hispanic (46\%) and feeling that clinicians did not address their concerns (75\%). The older with comorbidities class was 6.5 times more likely than the younger with comorbidities class to share eHealth data with a clinician (odds ratio [OR] 6.53, 95\% CI 1.08-39.43). In contrast, the younger with no comorbidities class had a higher likelihood of using a computer to look for health information (OR 1.93, 95\% CI 1.10-3.38), using an electronic device to track progress toward a health-related goal (OR 2.02, 95\% CI 1.08-3.79), and using the internet to watch health-related YouTube videos (OR 2.70, 95\% CI 1.52-4.81) than the older with comorbidities class. Conclusions: Class membership was associated with different patterns of eHealth engagement, indicating the importance of tailored digital strategies for delivering effective care. Future eHealth weight loss interventions should investigate strategies to engage younger cancer survivors with comorbidities and address racial and ethnic disparities in eHealth use. ",
doi="10.2196/24137",
url="http://cancer.jmir.org/2020/2/e24137/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33156810"
}


@Article{info:doi/10.2196/23854,
author="Kavosi, Zahra
and Vahedian, Sara
and Montazeralfaraj, Razieh
and Dehghani Tafti, Arefeh
and Bahrami, Amin Mohammad",
title="The Correlation of Online Health Information--Seeking Experience With Health-Related Quality of Life: Cross-Sectional Study Among Non--English-Speaking Female Students in a Religious Community",
journal="JMIR Med Inform",
year="2020",
month="Dec",
day="2",
volume="8",
number="12",
pages="e23854",
keywords="general health",
keywords="SF-36",
keywords="information seeking behavior",
keywords="online health information",
keywords="high school students",
keywords="health literacy",
abstract="Background: Given the increasing availability of the internet, it has become a common source of health information. However, the effect of this increased access on health needs to be further studied. Objective: This study aimed to investigate the correlation between online health information--seeking behavior and general health dimensions in a sample of high school students in Iran. Methods: A cross-sectional study was conducted in 2019. A total of 295 female students participated in the study. The data were collected using two validated questionnaires: the e-Health Impact Questionnaire and the 36-Item Short Form Health Survey. The collected data were analyzed through descriptive statistics and Pearson correlation coefficients using SPSS version 23 (IBM Corp). Results: The participants moderately used online information in their health-related decisions, and they thought that the internet helped people in health-related decision making. They also thought that the internet could be used to share health experiences with others. Participants had moderate confidence in online health information and stated that the information provided by health websites was moderately understandable and reliable and moderately encouraged and motivated them to play an active role in their health promotion. Nevertheless, the results showed that online health information--seeking experience had no significant correlation with health-related quality of life. Conclusions: This study provides insights into the effect of using internet information on the health of adolescents. It has important implications for researchers and policy makers to build appropriate policies to maximize the benefit of internet access for health. ",
doi="10.2196/23854",
url="https://medinform.jmir.org/2020/12/e23854",
url="http://www.ncbi.nlm.nih.gov/pubmed/33263546"
}


@Article{info:doi/10.2196/15543,
author="Quittschalle, Janine
and Stein, Janine
and Luppa, Melanie
and Pabst, Alexander
and L{\"o}bner, Margrit
and Koenig, Hans-Helmut
and Riedel-Heller, G. Steffi",
title="Internet Use in Old Age: Results of a German Population-Representative Survey",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="23",
volume="22",
number="11",
pages="e15543",
keywords="internet use",
keywords="epidemiology",
keywords="old age",
keywords="health services",
keywords="eHealth",
abstract="Background: The internet has the potential to foster healthy lifestyles and to support chronic disease management. Older adults could benefit from using the internet and other information and communication technology to access health-related information and interventions available online. Objective: The aim of this study was to investigate factors influencing internet use in older and oldest age groups and to determine the frequency of internet use for health-related purposes. Methods: Using data from a nationally representative telephone survey of older adults aged 75 years and over, a sample of 999 people was assessed using structured clinical interviews. Descriptive and binary logistic regression analyses were performed. Results: Overall, 42.6\% (418/999) of participants used the internet. Among those, 55.7\% (233/417) searched the internet for health-related information. Regression analyses revealed that internet use was significantly associated with younger age (odds ratio [OR] 0.89, 95\% CI 0.85-0.92; P<.001), male gender (OR 2.84, 95\% CI 2.02-4.00; P<.001), higher education levels (OR 6.69, 95\% CI 4.48-9.99; P<.001), a wider social network (OR 1.04, 95\% CI 1.01-1.07; P=.01), higher health-related quality of life (OR 1.02, 95\% CI 1.00-1.03; P=.006), lower levels of depressive symptoms (OR 0.89, 95\% CI 0.80-0.99; P=.04), and higher rates of chronic illness (OR 1.12, 95\% CI 1.04-1.21; P<.004). Conclusions: This study provides population-representative data on internet use in old age in Germany. People in the older and oldest age groups participate in online activities. Understanding the factors that are associated with older adults internet use can contribute to developing tailored interventions and eHealth (electronic health) services to improve well-being in older adults. ",
doi="10.2196/15543",
url="https://www.jmir.org/2020/11/e15543",
url="http://www.ncbi.nlm.nih.gov/pubmed/33226351"
}


@Article{info:doi/10.2196/23922,
author="Mohamad, Emma
and Tham, Sern Jen
and Ayub, Hadi Suffian
and Hamzah, Rezal Mohammad
and Hashim, Hasrul
and Azlan, Anis Arina",
title="Relationship Between COVID-19 Information Sources and Attitudes in Battling the Pandemic Among the Malaysian Public: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="12",
volume="22",
number="11",
pages="e23922",
keywords="COVID-19",
keywords="information source",
keywords="confidence",
keywords="media",
keywords="social media",
keywords="government",
keywords="Malaysia",
keywords="online information",
keywords="survey",
abstract="Background: There are multiple media platforms and various resources available for information on COVID-19. Identifying people's preferences is key to building public confidence and planning for successful national health intervention strategies. Objective: This study examines the sources of information for COVID-19 used by the Malaysian public and identifies those that are associated with building public confidence and positive perceptions toward the Malaysian government. Methods: A cross-sectional online survey of 4850 Malaysian residents was conducted. Participant demographics, media use, information sources, and attitudes surrounding COVID-19 were assessed. Descriptive statistics and multiple logistic regression analyses were conducted to gauge the relationship between demographics, information sources, and attitudes toward COVID-19. Results: Malaysians primarily used television and internet news portals to access information on COVID-19. The Malaysian Ministry of Health was the most preferred source of COVID-19 information. Respondents who referred to the Ministry of Health, television, and the Malaysian National Security Council for information were more likely to believe that the country could win the battle against COVID-19 and that the government was handling the health crisis well compared to those who referred to other information sources. Those who used the World Health Organization, friends, YouTube, family, and radio as sources of information were less likely to harbor confidence and positive belief toward combating COVID-19. Conclusions: Managing information and sustaining public confidence is important during a pandemic. Health authorities should pay considerable attention to the use of appropriate media channels and sources to allow for more effective dissemination of critical information to the public. ",
doi="10.2196/23922",
url="http://www.jmir.org/2020/11/e23922/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33151897"
}


@Article{info:doi/10.2196/20453,
author="Park, Keeho",
title="Factors Related to the Behavior of People Who Have Never Used the Internet for Voluntary Reasons: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="11",
volume="22",
number="11",
pages="e20453",
keywords="internet",
keywords="use",
keywords="voluntary",
keywords="factor",
keywords="information and communications technology",
keywords="digital divide",
abstract="Background: If there are people who do not want to use the internet despite having the circumstances and conditions for using it, another policy consideration will be needed. Objective: The purpose of this study was to explore the factors related to the behavior of people who do not voluntarily use the internet. Methods: A cross-sectional survey was conducted in 2018. It used a proportional quota random sampling design to select a representative sample of Koreans. Accordingly, 6150 participants were included in the study. Multiple logistic regression methods were used to explore the predicting factors of the act of voluntarily not using the internet. Results: Age, education level, bonding and bridging social capitals, and daily life satisfaction for health status were found to be factors related to the behavior of not voluntarily using the internet. However, gender, household income, occupation, family size, and community type were not related to voluntary nonuse of the internet. Conclusions: It was found that sociodemographic factors, such as age and education level, which are difficult to modify, along with psychosocial factors located deeper than the visible living conditions, such as social capital and life satisfaction, are involved in voluntary internet nonuse. These results also suggest that it is not desirable to proceed with policies related to information and communications technology on a separate track, but rather that they should be comprehensively approached with other social policies that design various social interventions in order to enhance equity within the society. ",
doi="10.2196/20453",
url="http://www.jmir.org/2020/11/e20453/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33174848"
}


@Article{info:doi/10.2196/20528,
author="Mayer, Gwendolyn
and Alvarez, Simone
and Gronewold, Nadine
and Schultz, Jobst-Hendrik",
title="Expressions of Individualization on the Internet and Social Media: Multigenerational Focus Group Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="4",
volume="22",
number="11",
pages="e20528",
keywords="focus groups",
keywords="discussion",
keywords="qualitative research",
keywords="generation",
keywords="baby boomers",
keywords="generation x",
keywords="generation y",
keywords="digital natives",
keywords="identity",
keywords="self",
keywords="media use",
keywords="internet research",
keywords="social media",
abstract="Background: Growing individualization within the past decades has been described as a fundamental shift in society. Studies have reported how the digital age promotes new forms of individualism with self-tracking technologies and self-presentation in social networks. Potential harmful effects on the mental health of young adults have already been at the forefront of research. However, 2 questions that remain unanswered are how emotional experiences and expressions of self-relatedness differ among generations in their usage of the internet and social media, and if an increasing individualism can be observed by this. Objective: The aim of this study is to examine whether the use of the internet and social media has led people to be more concerned about themselves than former generations. The potential consequences of mental and emotional distress among different age groups are analyzed. Methods: A focus-group approach was chosen to study the following age groups: Baby Boomers (those born in 1950-1965), Generation X (those born in 1966-1980), and Digital Natives (those born in 1981-2000). We organized 6 focus groups with 36 participants who discussed their private usage of the internet and social media, different devices, platforms and functions, communication behavior, and self-tracking. We applied inductive category formation and followed the Standards for Reporting Qualitative Research (SRQR) checklist. Results: We found differences in the 3 studied generations regarding the reasons for their use of the internet and social media, the effects of this use, personal feelings and experiences, expressions of self-relatedness, and social relationships. The Baby Boomers voiced a wish to stay autonomous while being in contact with their personal network. Generation X included enthusiastic members who appreciate self-tracking for curiosity and fascination, as well as people who felt fears about data surveillance. The Digital Natives reported a wish to optimize their own body by self-tracking while being faced with norms and expectations that were communicated via the internet and social media. Conclusions: All generations expressed self-relatedness, yet by different means. The Baby Boomers expressed less individualism than Generation X and the Digital Natives, who felt the highest strain due to social comparisons. However, all generations reported specific, potentially problematic consequences for their mental health. Age-specific coping strategies are necessary to promote a mentally healthy way of using the internet and social media. ",
doi="10.2196/20528",
url="https://www.jmir.org/2020/11/e20528",
url="http://www.ncbi.nlm.nih.gov/pubmed/33146622"
}


@Article{info:doi/10.2196/18309,
author="Comulada, Scott Warren
and Step, Mary
and Fletcher, B. Jesse
and Tanner, E. Amanda
and Dowshen, L. Nadia
and Arayasirikul, Sean
and Keglovitz Baker, Kristin
and Zuniga, James
and Swendeman, Dallas
and Medich, Melissa
and Kao, H. Uyen
and Northrup, Adam
and Nieto, Omar
and Brooks, A. Ronald
and ",
title="Predictors of Internet Health Information--Seeking Behaviors Among Young Adults Living With HIV Across the United States: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="2",
volume="22",
number="11",
pages="e18309",
keywords="youth",
keywords="young adults",
keywords="HIV/AIDS",
keywords="digital technology",
keywords="health information seeking",
keywords="general health",
keywords="sexual and reproductive health",
keywords="HIV stigma",
abstract="Background: Consistent with young adults' penchant for digital communication, young adults living with HIV use digital communication media to seek out health information. Understanding the types of health information sought online and the characteristics of these information-seeking young adults is vital when designing digital health interventions for them. Objective: This study aims to describe characteristics of young adults living with HIV who seek health information through the internet. Results will be relevant to digital health interventions and patient education. Methods: Young adults with HIV (aged 18-34 years) self-reported internet use during an evaluation of digital HIV care interventions across 10 demonstration projects in the United States (N=716). Lasso (least absolute shrinkage and selection operator) models were used to select characteristics that predicted whether participants reported seeking general health and sexual and reproductive health (SRH) information on the internet during the past 6 months. Results: Almost a third (211/716, 29.5\%) and a fifth (155/716, 21.6\%) of participants reported searching for general health and SRH information, respectively; 26.7\% (36/135) of transgender young adults with HIV searched for gender-affirming care topics. Areas under the curve (>0.70) indicated success in building models to predict internet health information seeking. Consistent with prior studies, higher education and income predicted health information seeking. Higher self-reported antiretroviral therapy adherence, substance use, and not reporting transgender gender identity also predicted health information seeking. Reporting a sexual orientation other than gay, lesbian, bisexual, or straight predicted SRH information seeking. Conclusions: Young adults living with HIV commonly seek both general health and SRH information online, particularly those exploring their sexual identity. Providers should discuss the most commonly sought SRH topics and the use of digital technology and be open to discussing information found online to better assist young adults with HIV in finding accurate information. Characteristics associated with health information--seeking behavior may also be used to develop and tailor digital health interventions for these young adults. ",
doi="10.2196/18309",
url="https://www.jmir.org/2020/11/e18309",
url="http://www.ncbi.nlm.nih.gov/pubmed/33136057"
}


@Article{info:doi/10.2196/16835,
author="Casillas, Alejandra
and Abhat, Anshu
and Mahajan, Anish
and Moreno, Gerardo
and Brown, F. Arleen
and Simmons, Sara
and Szilagyi, Peter",
title="Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="23",
volume="22",
number="10",
pages="e16835",
keywords="patient portal",
keywords="safety net",
keywords="health disparities",
keywords="digital divide",
doi="10.2196/16835",
url="https://www.jmir.org/2020/10/e16835",
url="http://www.ncbi.nlm.nih.gov/pubmed/33094732"
}


@Article{info:doi/10.2196/20099,
author="Kirchberg, Johanna
and Fritzmann, Johannes
and Weitz, J{\"u}rgen
and Bork, Ulrich",
title="eHealth Literacy of German Physicians in the Pre--COVID-19 Era: Questionnaire Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="16",
volume="8",
number="10",
pages="e20099",
keywords="eHealth",
keywords="electronic health",
keywords="mobile health",
keywords="health apps",
keywords="mobile health apps",
keywords="eHealth literacy",
abstract="Background: Digitalization is a disruptive technology that changes the way we deliver diagnostic procedures and treatments in medicine. Different stakeholders have varying interests in and expectations of the digitalization of modern medicine. Many recent digital advances in the medical field, such as the implementation of electronic health records, telemedical services, and mobile health apps, are increasingly used by medical professionals and patients. During the current pandemic outbreak of a novel coronavirus-caused respiratory disease (COVID-19), many modern information and communication technologies (ICT) have been used to overcome the physical barriers and limitations caused by government-issued curfews and workforce shortages. Therefore, the COVID-19 pandemic has led to a surge in the usage of modern ICT in medicine. At the same time, the eHealth literacy of physicians working with these technologies has probably not improved since our study. Objective: This paper describes a representative cohort of German physicians before the COVID-19 pandemic and their eHealth literacy and attitude towards modern ICT. Methods: A structured, self-developed questionnaire about user behavior and attitudes towards eHealth applications was administered to a representative cohort of 93 German physicians. Results: Of the 93 German physicians who participated in the study, 97\% (90/93) use a mobile phone. Medical apps are used by 42\% (39/93). Half of the surveyed physicians (47/93, 50\%) use their private mobile phones for official purposes on a daily basis. Telemedicine is part of the daily routine for more than one-third (31/93, 33\%) of all participants. More than 80\% (76/93, 82\%) of the trial participants state that their knowledge regarding the legal aspects and data safety of medical apps and cloud computing is insufficient. Conclusions: Modern ICT is frequently used and mostly welcomed by German physicians. However, there is a tremendous lack of eHealth literacy and knowledge about the safe and secure implementation of these technologies in routine clinical practice. ",
doi="10.2196/20099",
url="http://mhealth.jmir.org/2020/10/e20099/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33064102"
}


@Article{info:doi/10.2196/22443,
author="Chandrasekaran, Ranganathan
and Katthula, Vipanchi
and Moustakas, Evangelos",
title="Patterns of Use and Key Predictors for the Use of Wearable Health Care Devices by US Adults: Insights from a National Survey",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="16",
volume="22",
number="10",
pages="e22443",
keywords="wearable healthcare devices",
keywords="mobile health",
keywords="HINTS",
keywords="health technology adoption and use",
keywords="smart wearables",
abstract="Background: Despite the growing popularity of wearable health care devices (from fitness trackes such as Fitbit to smartwatches such as Apple Watch and more sophisticated devices that can collect information on metrics such as blood pressure, glucose levels, and oxygen levels), we have a limited understanding about the actual use and key factors affecting the use of these devices by US adults. Objective: The main objective of this study was to examine the use of wearable health care devices and the key predictors of wearable use by US adults. Methods: Using a national survey of 4551 respondents, we examined the usage patterns of wearable health care devices (use of wearables, frequency of their use, and willingness to share health data from a wearable with a provider) and a set of predictors that pertain to personal demographics (age, gender, race, education, marital status, and household income), individual health (general health, presence of chronic conditions, weight perceptions, frequency of provider visits, and attitude towards exercise), and technology self-efficacy using logistic regression analysis. Results: About 30\% (1266/4551) of US adults use wearable health care devices. Among the users, nearly half (47.33\%) use the devices every day, with a majority (82.38\% weighted) willing to share the health data from wearables with their care providers. Women (16.25\%), White individuals (19.74\%), adults aged 18-50 years (19.52\%), those with some level of college education or college graduates (25.60\%), and those with annual household incomes greater than US \$75,000 (17.66\%) were most likely to report using wearable health care devices. We found that the use of wearables declines with age: Adults aged >50 years were less likely to use wearables compared to those aged 18-34 years (odds ratios [OR] 0.46-0.57). Women (OR 1.26, 95\% CI 0.96-1.65), White individuals (OR 1.65, 95\% CI 0.97-2.79), college graduates (OR 1.05, 95\% CI 0.31-3.51), and those with annual household incomes greater than US \$75,000 (OR 2.6, 95\% CI 1.39-4.86) were more likely to use wearables. US adults who reported feeling healthier (OR 1.17, 95\% CI 0.98-1.39), were overweight (OR 1.16, 95\% CI 1.06-1.27), enjoyed exercise (OR 1.23, 95\% CI 1.06-1.43), and reported higher levels of technology self-efficacy (OR 1.33, 95\% CI 1.21-1.46) were more likely to adopt and use wearables for tracking or monitoring their health. Conclusions: The potential of wearable health care devices is under-realized, with less than one-third of US adults actively using these devices. With only younger, healthier, wealthier, more educated, technoliterate adults using wearables, other groups have been left behind. More concentrated efforts by clinicians, device makers, and health care policy makers are needed to bridge this divide and improve the use of wearable devices among larger sections of American society. ",
doi="10.2196/22443",
url="http://www.jmir.org/2020/10/e22443/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33064083"
}


@Article{info:doi/10.2196/20529,
author="Zhao, Zhi Sheng
and Guo, Ningyuan
and Wang, Ping Man
and Fong, Tak Daniel Yee
and Lai, Kwan Agnes Yuen
and Chan, Siu-Chee Sophia
and Lam, Hing Tai
and Ho, Yin Daniel Sai",
title="The Association Between Electronic Device Use During Family Time and Family Well-Being: Population-Based Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="14",
volume="22",
number="10",
pages="e20529",
keywords="eDevice",
keywords="smartphone",
keywords="mobile phone",
keywords="well-being",
keywords="family dinner",
keywords="family communication",
keywords="public health",
abstract="Background: Electronic devices (eDevices) may have positive or negative influences on family communication and well-being depending on how they are used. Objective: We examined eDevice use during family time and its association with the quality of family communication and well-being in Hong Kong Chinese adults. Methods: In 2017, a probability-based 2-stage random sampling landline telephone survey collected data on eDevice use in daily life and during family time (eg, family dinner) and the presence of rules banning eDevice use during family dinner. Family communication quality was rated from 0 to 10 with higher scores being favorable. Family well-being was calculated as a composite mean score of 3 items each using the same scale from 0 to 10. The associations of family communication quality and well-being with eDevice use in daily life and during family time were estimated using beta-coefficient ($\beta$) adjusting for sociodemographics. The mediating role of family communication quality in the association between eDevice use and family well-being was analyzed. Results: Of the 2064 respondents (mean age 56.4 [SD 19.2] years, 1269/2064 [61.48\%] female), 1579/2059 (76.69\%) used an eDevice daily for a mean of 3.6 hours (SD 0.1) and 257/686 (37.5\%) used it for 30+ minutes before sleep. As much as 794/2046 (38.81\%) often or sometimes used an eDevice during family time including dinner (311/2017, 15.42\%); 713/2012 (35.44\%) reported use of an eDevice by family members during dinner. Lower family communication quality was associated with hours of eDevice use before sleep (adjusted $\beta$=--.25; 95\% CI --0.44 to --0.05), and often use (vs never use) of eDevice during family dinner by oneself (adjusted $\beta$=--.51; 95\% CI --0.91 to --0.10) and family members (adjusted $\beta$=--.54; 95\% CI --0.79 to --0.29). Similarly, lower family well-being was associated with eDevice use before sleep (adjusted $\beta$=--.26; 95\% CI --0.42 to --0.09), and often use during family dinner by oneself (adjusted $\beta$=--.48; 95\% CI --0.83 to --0.12) and family members (adjusted $\beta$=--.50; 95\% CI --0.72 to --0.28). Total ban of eDevice use during family dinner was negatively associated with often use by oneself (adjusted odds ratio 0.49; 95\% CI 0.29 to 0.85) and family members (adjusted odds ratio 0.41; 95\% CI 0.28, 0.60) but not with family communication and well-being. Lower family communication quality substantially mediated the total effect of the association of eDevice use time before sleep (61.2\%) and often use at family dinner by oneself (87.0\%) and by family members (67.8\%) with family well-being. Conclusions: eDevice use before sleep and during family dinner was associated with lower family well-being, and the association was substantially mediated by family communication quality. Our results suggest that interventions on smart use of eDevice may improve family communication and well-being. ",
doi="10.2196/20529",
url="http://www.jmir.org/2020/10/e20529/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33052120"
}


@Article{info:doi/10.2196/19684,
author="Li, Xiaojing
and Liu, Qinliang",
title="Social Media Use, eHealth Literacy, Disease Knowledge, and Preventive Behaviors in the COVID-19 Pandemic: Cross-Sectional Study on Chinese Netizens",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="9",
volume="22",
number="10",
pages="e19684",
keywords="social media",
keywords="media use",
keywords="COVID-19",
keywords="pandemic",
keywords="disease knowledge",
keywords="eHealth literacy",
keywords="public health",
keywords="preventive behaviors",
abstract="Background: Since its outbreak in January 2020, COVID-19 has quickly spread worldwide and has become a global pandemic. Social media platforms have been recognized as important tools for health-promoting practices in public health, and the use of social media is widespread among the public. However, little is known about the effects of social media use on health promotion during a pandemic such as COVID-19. Objective: In this study, we aimed to explore the predictive role of social media use on public preventive behaviors in China during the COVID-19 pandemic and how disease knowledge and eHealth literacy moderated the relationship between social media use and preventive behaviors. Methods: A national web-based cross-sectional survey was conducted by a proportionate probability sampling among 802 Chinese internet users (``netizens'') in February 2020. Descriptive statistics, Pearson correlations, and hierarchical multiple regressions were employed to examine and explore the relationships among all the variables. Results: Almost half the 802 study participants were male (416, 51.9\%), and the average age of the participants was 32.65 years. Most of the 802 participants had high education levels (624, 77.7\%), had high income >{\textyen}5000 (US \$736.29) (525, 65.3\%), were married (496, 61.8\%), and were in good health (486, 60.6\%). The average time of social media use was approximately 2 to 3 hours per day (mean 2.34 hours, SD 1.11), and the most frequently used media types were public social media (mean score 4.49/5, SD 0.78) and aggregated social media (mean score 4.07/5, SD 1.07). Social media use frequency ($\beta$=.20, P<.001) rather than time significantly predicted preventive behaviors for COVID-19. Respondents were also equipped with high levels of disease knowledge (mean score 8.15/10, SD 1.43) and eHealth literacy (mean score 3.79/5, SD 0.59). Disease knowledge ($\beta$=.11, P=.001) and eHealth literacy ($\beta$=.27, P<.001) were also significant predictors of preventive behaviors. Furthermore, eHealth literacy (P=.038) and disease knowledge (P=.03) positively moderated the relationship between social media use frequency and preventive behaviors, while eHealth literacy ($\beta$=.07) affected this relationship positively and disease knowledge ($\beta$=--.07) affected it negatively. Different social media types differed in predicting an individual's preventive behaviors for COVID-19. Aggregated social media ($\beta$=.22, P<.001) was the best predictor, followed by public social media ($\beta$=.14, P<.001) and professional social media ($\beta$=.11, P=.002). However, official social media ($\beta$=.02, P=.597) was an insignificant predictor. Conclusions: Social media is an effective tool to promote behaviors to prevent COVID-19 among the public. Health literacy is essential for promotion of individual health and influences the extent to which the public engages in preventive behaviors during a pandemic. Our results not only enrich the theoretical paradigm of public health management and health communication but also have practical implications in pandemic control for China and other countries. ",
doi="10.2196/19684",
url="http://www.jmir.org/2020/10/e19684/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33006940"
}


@Article{info:doi/10.2196/15352,
author="Yin, Rong
and Neyens, M. David",
title="Online Health Resource Use by Individuals With Inflammatory Bowel Disease: Analysis Using the National Health Interview Survey",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="24",
volume="22",
number="9",
pages="e15352",
keywords="internet",
keywords="searching behavior",
keywords="access to information",
keywords="inflammatory bowel disease",
keywords="logistic regression model",
keywords="National Health Interview Survey",
abstract="Background: The internet has enabled convenient and efficient health information searching which is valuable for individuals with chronic conditions requiring some level of self-management. However, there is little research evaluating what factors may impact the use of the internet for health-related tasks for specific clinical populations, such as individuals with inflammatory bowel diseases. Objective: Our goal was to investigate the factors that influence internet use in acquiring health information by individuals with inflammatory bowel diseases. Specifically, we identified factors associated with internet searching behavior and using the internet for completing health-related tasks. Methods: We used 2016 National Health Interview Survey weighted data to develop logistic regression models to predict the likelihood that individuals with inflammatory bowel diseases would use the internet for 2 types of tasks: seeking health information through online searches and using the internet to perform health-related tasks including scheduling appointments and emailing care providers. Results: 2016 National Health Interview Survey weighted data include more than 3 million weighted adult respondents with inflammatory bowel diseases (approximately 1.29\% of adults in the weighted data set). Our results suggest that approximately 66.3\% of those with inflammatory bowel diseases reported using the internet at least once a day, and approximately 14.7\% reported being dissatisfied with their current health care. About 62.3\% of those with inflammatory bowel diseases reported that they had looked up health information online, 16.3\% of those with inflammatory bowel diseases reported that they had scheduled an appointment with a health care provider online, and 21.6\% reported having used a computer to communicate with a health provider by email. We found that women who were self-regulating their care were more likely to look up health information online than others. Both middle-aged and older adults with inflammatory bowel diseases who were unsatisfied with their current health care were less likely to look up health information online. Frequent internet users who were worried about medical costs were more likely to look up health information online. Similarly, the results from our statistical models suggest that individuals with inflammatory bowel diseases who were frequent internet users were more likely to use the internet for specific health-related tasks. Additionally, women with inflammatory bowel diseases who reported being married were less likely to use the internet for specific health-related tasks. Conclusions: For those with inflammatory bowel diseases, there are additional socioeconomic and behavioral factors that impact the use of the internet for health information and health-related tasks. Future research should evaluate how these factors moderate the use of the internet and identify how online resources can support clinical populations in ways that improve access to information, support health self-management, and subsequently improve health outcomes. ",
doi="10.2196/15352",
url="http://www.jmir.org/2020/9/e15352/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32969831"
}


@Article{info:doi/10.2196/21012,
author="Ghaddar, Suad
and Vatcheva, P. Kristina
and Alvarado, G. Samantha
and Mykyta, Laryssa",
title="Understanding the Intention to Use Telehealth Services in Underserved Hispanic Border Communities: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="3",
volume="22",
number="9",
pages="e21012",
keywords="telehealth",
keywords="eHealth literacy",
keywords="health information technologies",
abstract="Background: Despite the United States having one of the leading health care systems in the world, underserved minority communities face significant access challenges. These communities can benefit from telehealth innovations that promise to improve health care access and, consequently, health outcomes. However, little is known about the attitudes toward telehealth in these communities, an essential first step toward effective adoption and use. Objective: The purpose of this study is to assess the factors that shape behavioral intention to use telehealth services in underserved Hispanic communities along the Texas-Mexico border and examine the role of electronic health (eHealth) literacy in telehealth use intention. Methods: We used cross-sectional design to collect data at a community health event along the Texas-Mexico border. The area is characterized by high poverty rates, low educational attainment, and health care access challenges. Trained bilingual students conducted 322 in-person interviews over a 1-week period. The survey instrument assessed sociodemographic information and telehealth-related variables. Attitudes toward telehealth were measured by asking participants to indicate their level of agreement with 9 statements reflecting different aspects of telehealth use. For eHealth literacy, we used the eHealth Literacy Scale (eHEALS), an 8-item scale designed to measure consumer confidence in finding, evaluating, and acting upon eHealth information. To assess the intention to use telehealth, we asked participants about the likelihood that they would use telehealth services if offered by a health care provider. We analyzed data using univariate, multivariate, and mediation statistical models. Results: Participants were primarily Hispanic (310/319, 97.2\%) and female (261/322, 81.1\%), with an average age of 43 years. Almost three-quarters (219/298) reported annual household incomes below \$20,000. Health-wise, 42.2\% (136/322) self-rated their health as fair or poor, and 79.7\% (255/320) were uninsured. The overwhelming majority (289/319, 90.6\%) had never heard of telehealth. Once we defined the term, participants exhibited positive attitudes toward telehealth, and 78.9\% (254/322) reported being somewhat likely or very likely to use telehealth services if offered by a health care provider. Based on multivariate proportional odds regression analysis, a 1-point increase in telehealth attitudes reduced the odds of lower versus higher response in the intention to use telehealth services by 23\% (OR 0.77, 95\% CI 0.73-0.81). Mediation analysis revealed that telehealth attitudes fully mediated the association between eHealth literacy and intention to use telehealth services. For a 1-point increase in eHEALS, the odds of lower telehealth use decreased by a factor of 0.95 (5\%; OR 0.95, 95\% CI 0.93-0.98; P<.001) via the increase in the score of telehealth attitudes. Conclusions: Telehealth promises to address many of the access challenges facing ethnic and racial minorities, rural communities, and low-income populations. Findings underscore the importance of raising awareness of telehealth and promoting eHealth literacy as a key step in fostering positive attitudes toward telehealth and furthering interest in its use. ",
doi="10.2196/21012",
url="https://www.jmir.org/2020/9/e21012",
url="http://www.ncbi.nlm.nih.gov/pubmed/32880579"
}


@Article{info:doi/10.2196/18481,
author="Ma, Qianqian
and Sun, Dongxu
and Cui, Fangfang
and Zhai, Yunkai
and Zhao, Jie
and He, Xianying
and Shi, Jinming
and Gao, Jinghong
and Li, Mingyuan
and Zhang, Wenjie",
title="Impact of the Internet on Medical Decisions of Chinese Adults: Longitudinal Data Analysis",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="3",
volume="22",
number="9",
pages="e18481",
keywords="internet",
keywords="medical decision",
keywords="health care provider choice",
keywords="adult",
keywords="longitudinal data analysis",
keywords="hierarchical medical policy",
abstract="Background: The internet has caused the explosive growth of medical information and has greatly improved the availability of medical knowledge. This makes the internet one of the main ways for residents to obtain medical information and knowledge before seeking medical treatment. However, little has been researched on how the internet affects medical decisions. Objective: The purpose of this study was to explore the associations between internet behaviors and medical decisions among Chinese adults aged 18 or over, including whether to go to the hospital and which level of medical institution to choose. Methods: With the adult residents (?18 years old) in 12 regions including urban and rural areas taken as the research objects, the differences in medical choices of adults with various characteristics were analyzed, and generalized linear mixed models were adopted to analyze the longitudinal data of the China Health Nutrition Survey from 2006 to 2015. Results: Adult groups with different ages, genders, education levels, regions, places of residence, severities of illness and injury, years of suffering from hypertension, and history of chronic diseases showed diverse medical decisions, and the differences were statistically significant (P<.05). After controlling for these potential confounding factors and taking self-care as the reference, the probability of Chinese adults who participated in online browsing activities selecting hospital care was 0.82 (95\% CI 0.69-0.98; P=.03) times that of residents who did not participate in online browsing activities. In terms of medical institution choices, adults who participated in online browsing activities were 1.86 (95\% CI 1.35-2.58; P<.001) times more likely to opt for municipal medical treatment than primary care. However, the effect of online browsing on the selection probability of county-level hospitals was not significant compared with primary hospitals (P=.59). Robust analysis verified that accessing the internet had a similar effect on Chinese adults' medical decisions. Conclusions: Chinese adults who use the internet are a little less likely to go to the hospital than self-care. The internet has broken down the barriers to obtain knowledge of common diseases and thus has a slight substitution effect of self-care on hospital care. Internet use may increase the probability of adults going to municipal hospitals. The rising tendency of visiting high-level medical institutions may be consequently exacerbated due to knowledge monopoly of severe and complicated diseases that is difficult to eliminate, and the increase in inconsistent and incomplete medical information online will blur the residents' cognitive boundary of common diseases and severe diseases. Exploring the substantive impact of the internet on medical decision making is of great significance for further rational planning and utilization of the internet, in order to guide patients to appropriate medical institution. ",
doi="10.2196/18481",
url="https://www.jmir.org/2020/9/e18481",
url="http://www.ncbi.nlm.nih.gov/pubmed/32880581"
}


@Article{info:doi/10.2196/19517,
author="Birkeland, F. S{\o}ren
and Haakonsson, K. Anders
and Pedersen, S. Susanne
and Rottmann, Nina
and Barry, J. Michael
and M{\"o}ller, S{\"o}ren",
title="Sociodemographic Representativeness in a Nationwide Web-Based Survey of the View of Men on Involvement in Health Care Decision-Making: Cross-Sectional Questionnaire Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="2",
volume="22",
number="9",
pages="e19517",
keywords="research methodology",
keywords="electronic data capture",
keywords="internet-based survey",
keywords="representativeness",
keywords="generalizability",
keywords="user involvement",
keywords="patient satisfaction",
keywords="bioethics",
keywords="medical law",
keywords="cancer",
abstract="Background: Being able to generalize research findings to a broader population outside of the study sample is an important goal in surveys on the internet. We conducted a nationwide, cross-sectional, web-based survey with vignettes illustrating different levels of patient involvement to investigate men's preferences regarding participation in health care decision-making. Following randomization into vignette variants, we distributed the survey among men aged 45 to 70 years through the state-authorized digital mailbox provided by the Danish authorities for secure communication with citizens. Objective: This study aimed to investigate the sociodemographic representativeness of our sample of men obtained in a nationwide web-based survey using the digital mailbox. Methods: Response rate estimates were established, and comparisons were made between responders and nonresponders in terms of age profiles (eg, average age) and municipality-level information on sociodemographic characteristics. Results: Among 22,288 men invited during two waves, a total of 6756 (30.31\%) participants responded to the survey. In adjusted analyses, responders' characteristics mostly resembled those of nonresponders. Response rates, however, were significantly higher in older men (odds ratio [OR] 2.83 for responses among those aged 65-70 years compared with those aged 45-49 years, 95\% CI 2.58-3.11; P<.001) and in rural areas (OR 1.10 compared with urban areas, 95\% CI 1.03-1.18; P=.005). Furthermore, response rates appeared lower in areas with a higher tax base (OR 0.89 in the highest tertile, 95\% CI 0.81-0.98; P=.02). Conclusions: Overall, the general population of men aged 45 to 70 years was represented very well by the responders to our web-based survey. However, the imbalances identified highlight the importance of supplementing survey findings with studies of the representativeness of other characteristics of the sample like trait and preference features, so that proper statistical corrections can be made in upcoming analyses of survey responses whenever needed. ",
doi="10.2196/19517",
url="https://www.jmir.org/2020/9/e19517",
url="http://www.ncbi.nlm.nih.gov/pubmed/32663149"
}


@Article{info:doi/10.2196/19350,
author="Fern{\'a}ndez, C{\'e}sar
and Vicente, Asunci{\'o}n Mar{\'i}a
and Carrillo, Irene
and Guilabert, Mercedes
and Mira, Joaqu{\'i}n Jos{\'e}",
title="Factors Influencing the Smartphone Usage Behavior of Pedestrians: Observational Study on ``Spanish Smombies''",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="14",
volume="22",
number="8",
pages="e19350",
keywords="smartphone addiction",
keywords="smartphone overuse",
keywords="smombies",
keywords="pedestrian safety",
keywords="mobile phone",
abstract="Background: Smartphone addiction has become a reality accepted by all. Some previous studies have shown that the use of smartphones on public roads while walking is very common among the young population. The term ``smombie'' or smartphone zombie has been coined for this behavior. Such behavior causes a reduction in the attention given to other pedestrians and drivers and may result in accidents or collisions. However, there are no precise data about how many people use the phone while they are walking on the street. Smartphone usage habits are evolving rapidly, and more in-depth information is required, particularly about how users interact with their devices while walking: traditional phone conversations (phone close to the ear), voice chats (phone in front of the head), waiting for notifications (phone in hand), text chats (user touching the screen), etc. This in-depth information may be useful for carrying out specific preventive actions in both the education field (raising awareness about the risks) and in the infrastructure field (redesigning the cities to increase safety). Objective: This study aimed to gather information about pedestrians' smartphone usage and to identify population groups wherein interventions should be focused to prevent accidents. The main hypothesis was that gender, age, and city area can significantly influence the smartphone usage of the pedestrians while walking. Methods: An observational study of pedestrians in the street was carried out in Elche, a medium-sized Spanish city of 230,000 inhabitants. The following data were gathered: gender, age group, location, and type of smartphone interaction. A specific smartphone app was developed to acquire data with high reliability. The statistical significance of each variable was evaluated using chi-squared tests, and Cram{\'e}r's V statistic was used to measure the effect sizes. Observer agreement was checked by the Cohen kappa analysis. Results: The behavior of 3301 pedestrians was analyzed, of which 1770 (53.6\%) were females. As expected, the effect of the main variables studied was statistically significant, although with a small effect size: gender (P<.001, V=0.12), age (P<.001, V=0.18), and city area (P<.001, V=0.16). The phone in hand or ``holding'' behavior was particularly dependent on gender for all age groups (P<.001, V=0.09) and to a greater extent in young people (P<.001, V=0.16). Approximately 39.7\% (222/559) of the young women observed showed ``holding'' or ``smombie'' behavior, and they comprised the highest proportion among all age and gender groups. Conclusions: An in-depth analysis of smartphone usage while walking revealed that certain population groups (especially young women) have a high risk of being involved in accidents due to smartphone usage. Interventions aimed at reducing the risk of falls and collisions should be focused in these groups. ",
doi="10.2196/19350",
url="http://www.jmir.org/2020/8/e19350/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32667896"
}


@Article{info:doi/10.2196/19661,
author="Knitza, Johannes
and Simon, David
and Lambrecht, Antonia
and Raab, Christina
and Tascilar, Koray
and Hagen, Melanie
and Kleyer, Arnd
and Bayat, Sara
and Derungs, Adrian
and Amft, Oliver
and Schett, Georg
and Hueber, J. Axel",
title="Mobile Health Usage, Preferences, Barriers, and eHealth Literacy in Rheumatology: Patient Survey Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="12",
volume="8",
number="8",
pages="e19661",
keywords="mobile applications",
keywords="eHealth",
keywords="rheumatology",
keywords="mHealth",
keywords="eHEALS",
keywords="telemedicine",
abstract="Background: Mobile health (mHealth) defines the support and practice of health care using mobile devices and promises to improve the current treatment situation of patients with chronic diseases. Little is known about mHealth usage and digital preferences of patients with chronic rheumatic diseases. Objective: The aim of the study was to explore mHealth usage, preferences, barriers, and eHealth literacy reported by German patients with rheumatic diseases. Methods: Between December 2018 and January 2019, patients (recruited consecutively) with rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis were asked to complete a paper-based survey. The survey included questions on sociodemographics, health characteristics, mHealth usage, eHealth literacy using eHealth Literacy Scale (eHEALS), and communication and information preferences. Results: Of the patients (N=193) who completed the survey, 176 patients (91.2\%) regularly used a smartphone, and 89 patients (46.1\%) regularly used social media. Patients (132/193, 68.4\%) believed that using medical apps could be beneficial for their own health. Out of 193 patients, only 8 (4.1\%) were currently using medical apps, and only 22 patients (11.4\%) stated that they knew useful rheumatology websites/mobile apps. Nearly all patients (188/193, 97.4\%) would agree to share their mobile app data for research purposes. Out of 193 patients, 129 (66.8\%) would regularly enter data using an app, and 146 patients (75.6\%) would welcome official mobile app recommendations from the national rheumatology society. The preferred duration for data entry was not more than 15 minutes (110/193, 57.0\%), and the preferred frequency was weekly (59/193, 30.6\%). Medication information was the most desired app feature (150/193, 77.7\%). Internet was the most frequently utilized source of information (144/193, 74.6\%). The mean eHealth literacy was low (26.3/40) and was positively correlated with younger age, app use, belief in benefit of using medical apps, and current internet use to obtain health information. Conclusions: Patients with rheumatic diseases are very eager to use mHealth technologies to better understand their chronic diseases. This open-mindedness is counterbalanced by low mHealth usage and competency. Personalized mHealth solutions and clear implementation recommendations are needed to realize the full potential of mHealth in rheumatology. ",
doi="10.2196/19661",
url="http://mhealth.jmir.org/2020/8/e19661/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32678796"
}


@Article{info:doi/10.2196/19531,
author="Langford, Aisha
and Orellana, Kerli
and Kalinowski, Jolaade
and Aird, Carolyn
and Buderer, Nancy",
title="Use of Tablets and Smartphones to Support Medical Decision Making in US Adults: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="12",
volume="8",
number="8",
pages="e19531",
keywords="smartphone",
keywords="mHealth",
keywords="eHealth",
keywords="mobile phone",
keywords="cell phone",
keywords="tablets",
keywords="ownership",
keywords="decision making",
keywords="health communication",
keywords="telemedicine",
keywords="monitoring",
keywords="physiologic",
keywords="surveys and questionnaires",
abstract="Background: Tablet and smartphone ownership have increased among US adults over the past decade. However, the degree to which people use mobile devices to help them make medical decisions remains unclear. Objective: The objective of this study is to explore factors associated with self-reported use of tablets or smartphones to support medical decision making in a nationally representative sample of US adults. Methods: Cross-sectional data from participants in the 2018 Health Information National Trends Survey (HINTS 5, Cycle 2) were evaluated. There were 3504 responses in the full HINTS 5 Cycle 2 data set; 2321 remained after eliminating respondents who did not have complete data for all the variables of interest. The primary outcome was use of a tablet or smartphone to help make a decision about how to treat an illness or condition. Sociodemographic factors including gender, race/ethnicity, and education were evaluated. Additionally, mobile health (mHealth)- and electronic health (eHealth)-related factors were evaluated including (1) the presence of health and wellness apps on a tablet or smartphone, (2) use of electronic devices other than tablets and smartphones to monitor health (eg, Fitbit, blood glucose monitor, and blood pressure monitor), and (3) whether people shared health information from an electronic monitoring device or smartphone with a health professional within the last 12 months. Descriptive and inferential statistics were conducted using SAS version 9.4. Weighted population estimates and standard errors, univariate odds ratios, and 95\% CIs were calculated, comparing respondents who used tablets or smartphones to help make medical decisions (n=944) with those who did not (n=1377), separately for each factor. Factors of interest with a P value of <.10 were included in a subsequent multivariable logistic regression model. Results: Compared with women, men had lower odds of reporting that a tablet or smartphone helped them make a medical decision. Respondents aged 75 and older also had lower odds of using a tablet or smartphone compared with younger respondents aged 18-34. By contrast, those who had health and wellness apps on tablets or smartphones, used other electronic devices to monitor health, and shared information from devices or smartphones with health care professionals had higher odds of reporting that tablets or smartphones helped them make a medical decision, compared with those who did not. Conclusions: A limitation of this research is that information was not available regarding the specific health condition for which a tablet or smartphone helped people make a decision or the type of decision made (eg, surgery, medication changes). In US adults, mHealth and eHealth use, and also certain sociodemographic factors are associated with using tablets or smartphones to support medical decision making. Findings from this study may inform future mHealth and other digital health interventions designed to support medical decision making. ",
doi="10.2196/19531",
url="https://mhealth.jmir.org/2020/8/e19531",
url="http://www.ncbi.nlm.nih.gov/pubmed/32784181"
}


@Article{info:doi/10.2196/16761,
author="Vargas Meza, Xanat
and Yamanaka, Toshimasa",
title="Food Communication and its Related Sentiment in Local and Organic Food Videos on YouTube",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="10",
volume="22",
number="8",
pages="e16761",
keywords="social networks",
keywords="framing",
keywords="semantic analysis",
keywords="sentiment analysis",
keywords="organic",
keywords="local",
keywords="food",
keywords="YouTube",
abstract="Background: Local and organic foods have shown increased importance and market size in recent years. However, attitudes, sentiment, and habits related to such foods in the context of video social networks have not been thoroughly researched. Given that such media have become some of the most important venues of internet traffic, it is relevant to investigate how sustainable food is communicated through such video social networks. Objective: This study aimed to explore the diffusion paths of local and organic foods on YouTube, providing a review of trends, coincidences, and differences among video discourses. Methods: A combined methodology involving webometric, framing, semantic, and sentiment analyses was employed. Results: We reported the results for the following two groups: organic and local organic videos. Although the content of 923 videos mostly included the ``Good Mother'' (organic and local organic: 282/808, 34.9\% and 311/866, 35.9\%, respectively), ``Natural Goodness'' (220/808, 27.2\% and 253/866, 29.2\%), and ``Undermining of Foundations'' (153/808, 18.9\% and 180/866, 20.7\%) frames, organic videos were more framed in terms of ``Frankenstein'' food (organic and local organic: 68/808, 8.4\% and 27/866, 3.1\%, respectively), with genetically modified organisms being a frequent topic among the comments. Organic videos (N=448) were better connected in terms of network metrics than local organic videos (N=475), which were slightly more framed regarding ``Responsibility'' (organic and local organic: 42/808, 5.1\% and 57/866, 6.5\%, respectively) and expressed more positive sentiment (M ranks for organic and local organic were 521.2 and 564.54, respectively, Z=2.15, P=.03). Conclusions: The results suggest that viewers considered sustainable food as part of a complex system and in a positive light and that food framed as artificial and dangerous sometimes functions as a counterpoint to promote organic food. ",
doi="10.2196/16761",
url="https://www.jmir.org/2020/8/e16761",
url="http://www.ncbi.nlm.nih.gov/pubmed/32773370"
}


@Article{info:doi/10.2196/17352,
author="Greenberg-Worisek, Alexandra
and Ferede, Liaa
and Balls-Berry, Joyce
and Marigi, Ian
and Valentin Mendez, Emily
and Bajwa, Numra
and Ouk, Melody
and Orellana, Minerva
and Enders, Felicity",
title="Differences in Electronic Personal Health Information Tool Use Between Rural and Urban Cancer Patients in the United States: Secondary Data Analysis",
journal="JMIR Cancer",
year="2020",
month="Aug",
day="10",
volume="6",
number="2",
pages="e17352",
keywords="cancer",
keywords="patient engagement",
keywords="health research",
keywords="digital divide",
keywords="disparities",
abstract="Background: Studies have previously shown that rural cancer patients are diagnosed at later stages of disease. This delay is felt throughout treatment and follow-up, reflected in the fact that rural patients often have poorer clinical outcomes compared with their urban counterparts. Objective: Few studies have explored whether there is a difference in cancer patients' current use of health information technology tools by residential location. Methods: Data from 7 cycles of the Health Information National Trends Survey (HINTS, 2003-2017) were merged and analyzed to examine whether differences exist in managing electronic personal health information (ePHI) and emailing health care providers among rural and urban cancer patients. Geographic location was categorized using Rural-Urban Continuum Codes (RUCCs). Bivariate analyses and multivariable logistic regression were used to determine whether associations existed between rural/urban residency and use of health information technology among cancer patients. Results: Of the 3031 cancer patients/survivors who responded across the 7 cycles of HINTS, 797 (26.9\%) resided in rural areas. No difference was found between rural and urban cancer patients in having managed ePHI in the past 12 months (OR 0.78, 95\% CI 0.43-1.40). Rural cancer patients were significantly less likely to email health care providers than their urban counterparts (OR 0.52, 95\% CI 0.32-0.84). Conclusions: The digital divide between rural and urban cancer residents does not extend to general ePHI management; however, electronic communication with providers is significantly lower among rural cancer patients than urban cancer patients. Further research is needed to determine whether such disparities extend to other health information technology tools that might benefit rural cancer patients as well as other chronic conditions. ",
doi="10.2196/17352",
url="http://cancer.jmir.org/2020/2/e17352/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32773369"
}


@Article{info:doi/10.2196/15683,
author="Lam, Man Sabrina Sze
and Jivraj, Stephen
and Scholes, Shaun",
title="Exploring the Relationship Between Internet Use and Mental Health Among Older Adults in England: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="28",
volume="22",
number="7",
pages="e15683",
keywords="internet",
keywords="socioeconomic factors",
keywords="mental health",
keywords="life satisfaction",
keywords="depression",
keywords="effect modifier",
abstract="Background: There is uncertainty about the impact of internet use on mental health in older adults. Moreover, there is very little known specifically about the impact of particular purposes of internet use. Objective: This study aims to investigate the longitudinal relationship between two distinct concepts of mental health with the frequency of internet use among older adults: the moderating role of socioeconomic position (SEP) and the association between specific purposes of internet use. Methods: Longitudinal fixed and random effects (27,507 person-years) models were fitted using waves 6-8 of the English Longitudinal Study of Ageing to examine the relationship between different aspects of internet use (frequency and purpose) and two mental health outcomes (depression and life satisfaction). The potential moderating effect of SEP on these associations was tested using interaction terms. Results: Infrequent internet use (monthly or less vs daily) was predictive of deteriorating life satisfaction ($\beta$=?0.512; P=.02) but not depression. Education and occupational class had a moderating effect on the association between frequency of internet use and mental health. The associations were stronger in the highest educational group in both depression (P=.09) and life satisfaction (P=.02), and in the highest occupational group in life satisfaction (P=.05) only. Using the internet for communication was associated with lower depression ($\beta$=?0.24; P=.002) and better life satisfaction ($\beta$=.97; P<.001), whereas those using the internet for information access had worse life satisfaction ($\beta$=?0.86; P<.001) compared with those who did not. Conclusions: Policies to improve mental health in older adults should encourage internet use, especially as a tool to aid communication. ",
doi="10.2196/15683",
url="https://www.jmir.org/2020/7/e15683",
url="http://www.ncbi.nlm.nih.gov/pubmed/32718913"
}


@Article{info:doi/10.2196/16473,
author="Ahmed, Tanvir
and Rizvi, Raza Syed Jafar
and Rasheed, Sabrina
and Iqbal, Mohammad
and Bhuiya, Abbas
and Standing, Hilary
and Bloom, Gerald
and Waldman, Linda",
title="Digital Health and Inequalities in Access to Health Services in Bangladesh: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="21",
volume="8",
number="7",
pages="e16473",
keywords="health equity",
keywords="eHealth",
keywords="mHealth",
keywords="digital health",
keywords="health technology",
keywords="Bangladesh",
keywords="developing countries",
abstract="Background: Globally, the rapid growth of technology and its use as a development solution has generated much interest in digital health. In line with global trends, Bangladesh is also integrating technology into its health system to address disparities. Strong political endorsement and uptake of digital platforms by the government has influenced the rapid proliferation of such initiatives in the country. This paper aims to examine the implications of digital health on access to health care in Bangladesh, considering who uses electronic devices to access health information and services and why. Objective: This study aims to understand how access to health care and related information through electronic means (digital health) is affected by sociodemographic determinants (ie, age, gender, education, socioeconomic status, and personal and household ownership of mobile phones) in a semiurban community in Bangladesh. Methods: A cross-sectional survey of 854 households (between October 2013 and February 2014) and 20 focus group discussions (between February 2017 and March 2017) were conducted to understand (1) who owns electronic devices; (2) who, among the owners, uses these to access health information and services and why; (3) the awareness of electronic sources of health information; and (4) the role of intermediaries (family members or peers who helped to look for health information using electronic devices). Results: A total of 90.3\% (771/854) of households (471/854, 55.2\% of respondents) owned electronic devices, mostly mobile phones. Among these, 7.2\% (34/471) used them to access health information or services. Middle-aged (35-54 years), female, less (or not) educated, and poorer people used these devices the least ($\alpha$=.05, $\alpha$ is the level of significance). The lack of awareness, discomfort, differences with regular care-seeking habits, lack of understanding and skills, and proximity to a health facility were the main reasons for not using devices to access digital health. Conclusions: Although influenced by sociodemographic traits, access to digital health is not merely related to device ownership and technical skill. Rather, it is a combination of general health literacy, phone ownership, material resources, and technical skill as well as social recognition of health needs and inequity. This study's findings should serve as a basis for better integrating technology within the health system and ensuring equitable access to health care. ",
doi="10.2196/16473",
url="http://mhealth.jmir.org/2020/7/e16473/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706736"
}


@Article{info:doi/10.2196/18095,
author="Xie, Jie Yao
and Cheung, SK Daphne
and Loke, Y. Alice
and Nogueira, L. Bernice
and Liu, M. Karry
and Leung, YM Angela
and Tsang, SM Alice
and Leong, SU Cindy
and Molassiotis, Alex",
title="Relationships Between the Usage of Televisions, Computers, and Mobile Phones and the Quality of Sleep in a Chinese Population: Community-Based Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="7",
volume="22",
number="7",
pages="e18095",
keywords="electronic device",
keywords="screen-based",
keywords="sleep",
keywords="Chinese",
keywords="digital",
keywords="mobile phone",
abstract="Background: No study has comprehensively investigated the association between the usage of typical screen-based electronic media devices and sleep quality in a Chinese population with individuals in a wide range of ages. Objective: This study aimed to understand the characteristics of television (TV) viewing, computer usage, and mobile phone usage in a representative Chinese population in Macau and to examine their roles in predicting the variations in sleep quality. Methods: This cross-sectional study was an analysis of 1500 Macau residents aged 15 to 90 years based on a community-based health needs assessment study entitled, ``Healthy Living, Longer Lives.'' Data collection was conducted in 7 districts of Macau from 2017 to 2018 through face-to-face interviews. The durations of daily TV viewing, computer usage, and mobile phone usage were recorded in a self-administered questionnaire. The Chinese version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality. Results: The prevalence of TV, computer, and mobile phone usage was 78.4\% (1176/1500), 51.6\% (769/1490), and 85.5\% (1276/1492), respectively. The average daily hours of usage were 1.75 (1.62), 1.53 (2.26), and 2.85 (2.47) hours, respectively. Females spent more time watching TV (P=.03) and using mobile phones (P=.02) and less time on the computer (P=.04) as compared to males. Older adults were more likely to watch TV while young people spent more time using the computer and mobile phones (P for all trends<.001). The mean PSQI global score was 4.79 (2.80) among the participants. Females exhibited significantly higher PSQI scores than males (5.04 vs 4.49, respectively; P<.001). No linear association was observed between the PSQI score and the amount of time spent on the 3 electronic devices (P=.58 for PSQI-TV, P=.05 for PSQI-computer, and P=.52 for PSQI-mobile phone). Curve estimation showed significant quadratic curvilinear associations in PSQI-TV (P=.003) and PSQI-computer (P<.001) among all the participants and in PSQI-mobile phone among youths (age, 15-24 years; P=.04). After adjustment of the gender, age, body mass index, demographics, and lifestyle factors, more than 3 hours of TV viewing and 4 hours of computer usage or mobile phone usage was associated with 85\% (95\% CI 1.04-1.87; P=.008), 72\% (95\% CI 1.01-2.92; P=.045), and 53\% (95\% CI 1.06-2.22; P=.03) greater odds of having poor sleep quality (PSQI score>5), respectively. Conclusions: The mobile phone was the most popular screen-based electronic device used in the Macau population, especially among young people. ``J'' shape associations were observed between sleep quality and the duration of TV viewing, computer usage, and mobile phone usage, indicating that the extreme use of screen-based electronic devices predicted poorer sleep status, whereas moderate use would be acceptable. ",
doi="10.2196/18095",
url="https://www.jmir.org/2020/7/e18095",
url="http://www.ncbi.nlm.nih.gov/pubmed/32369439"
}


@Article{info:doi/10.2196/17616,
author="Heponiemi, Tarja
and Jormanainen, Vesa
and Leemann, Lars
and Manderbacka, Kristiina
and Aalto, Anna-Mari
and Hypp{\"o}nen, Hannele",
title="Digital Divide in Perceived Benefits of Online Health Care and Social Welfare Services: National Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="7",
volume="22",
number="7",
pages="e17616",
keywords="digital divide",
keywords="online services",
keywords="benefits",
keywords="skills",
keywords="access",
keywords="sociodemographics",
keywords="participation",
keywords="Finland",
abstract="Background: The number of online services in health care is increasing rapidly in developed countries. Users are expected to take a more skilled and active role in taking care of their health and prevention of ill health. This induces risks that users (especially those who need the services the most) will drop out of digital services, resulting in a digital divide or exclusion. To ensure wide and equal use of online services, all users must experience them as beneficial. Objective: This study aimed to examine associations of (1) demographics (age, gender, and degree of urbanization), (2) self-rated health, (3) socioeconomic position (education, experienced financial hardship, labor market position, and living alone), (4) social participation (voting, satisfaction with relationships, and keeping in touch with friends and family members), and (5) access, skills, and extent of use of information and communication technologies (ICT) with perceived benefits of online health care and social welfare services. Associations were examined separately for perceived health, economic, and collaboration benefits. Methods: We used a large random sample representative of the Finnish population including 4495 (56.77\% women) respondents aged between 20 and 97 years. Analyses of covariance were used to examine the associations of independent variables with perceived benefits. Results: Access to online services, ICT skills, and extent of use were associated with all examined benefits of online services. ICT skills seemed to be the most important factor. Poor self-rated health was also consistently associated with lower levels of perceived benefits. Similarly, those who were keeping in touch with their friends and relatives at least once a week perceived online services more often beneficial in all the examined dimensions. Those who had experienced financial hardship perceived fewer health and economic benefits than others. Those who were satisfied with their relationships reported higher levels of health and collaboration benefits compared with their counterparts. Also age, education, and degree of urbanization had some statistically significant associations with benefits but they seemed to be at least partly explained by differences in access, skills, and extent of use of online services. Conclusions: According to our results, providing health care services online has the potential to reinforce existing social and health inequalities. Our findings suggest that access to online services, skills to use them, and extent of use play crucial roles in perceiving them as beneficial. Moreover, there is a risk of digital exclusion among those who are socioeconomically disadvantaged, in poor health, or socially isolated. In times when health and social services are increasingly offered online, this digital divide may predispose people with high needs for services to exclusion from them. ",
doi="10.2196/17616",
url="https://www.jmir.org/2020/7/e17616",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673218"
}


@Article{info:doi/10.2196/20472,
author="Campos-Castillo, Celeste
and Laestadius, I. Linnea",
title="Racial and Ethnic Digital Divides in Posting COVID-19 Content on Social Media Among US Adults: Secondary Survey Analysis",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="3",
volume="22",
number="7",
pages="e20472",
keywords="COVID-19",
keywords="digital divides",
keywords="user characteristics",
keywords="race",
keywords="ethnicity",
keywords="algorithm bias",
keywords="social media",
keywords="bias",
keywords="surveillance",
keywords="public health",
abstract="Background: Public health surveillance experts are leveraging user-generated content on social media to track the spread and effects of COVID-19. However, racial and ethnic digital divides, which are disparities among people who have internet access and post on social media, can bias inferences. This bias is particularly problematic in the context of the COVID-19 pandemic because due to structural inequalities, members of racial and ethnic minority groups are disproportionately vulnerable to contracting the virus and to the deleterious economic and social effects from mitigation efforts. Further, important demographic intersections with race and ethnicity, such as gender and age, are rarely investigated in work characterizing social media users; however, they reflect additional axes of inequality shaping differential exposure to COVID-19 and its effects. Objective: The aim of this study was to characterize how the race and ethnicity of US adults are associated with their odds of posting COVID-19 content on social media and how gender and age modify these odds. Methods: We performed a secondary analysis of a survey conducted by the Pew Research Center from March 19 to 24, 2020, using a national probability sample (N=10,510). Respondents were recruited from an online panel, where panelists without an internet-enabled device were given one to keep at no cost. The binary dependent variable was responses to an item asking whether respondents ``used social media to share or post information about the coronavirus.'' We used survey-weighted logistic regressions to estimate the odds of responding in the affirmative based on the race and ethnicity of respondents (white, black, Latino, other race/ethnicity), adjusted for covariates measuring sociodemographic background and COVID-19 experiences. We examined how gender (female, male) and age (18 to 30 years, 31 to 50 years, 51 to 64 years, and 65 years and older) intersected with race and ethnicity by estimating interactions. Results: Respondents who identified as black (odds ratio [OR] 1.29, 95\% CI 1.02-1.64; P=.03), Latino (OR 1.66, 95\% CI 1.36-2.04; P<.001), or other races/ethnicities (OR 1.33, 95\% CI 1.02-1.72; P=.03) had higher odds than respondents who identified as white of reporting that they posted COVID-19 content on social media. Women had higher odds of posting than men regardless of race and ethnicity (OR 1.58, 95\% CI 1.39-1.80; P<.001). Among men, respondents who identified as black, Latino, or members of other races/ethnicities were significantly more likely to post than respondents who identified as white. Older adults (65 years or older) had significantly lower odds (OR 0.73, 95\% CI 0.57-0.94; P=.01) of posting compared to younger adults (18-29 years), particularly among those identifying as other races/ethnicities. Latino respondents were the most likely to report posting across all age groups. Conclusions: In the United States, members of racial and ethnic minority groups are most likely to contribute to COVID-19 content on social media, particularly among groups traditionally less likely to use social media (older adults and men). The next step is to ensure that data collection procedures capture this diversity by encompassing a breadth of search criteria and social media platforms. ",
doi="10.2196/20472",
url="https://www.jmir.org/2020/7/e20472",
url="http://www.ncbi.nlm.nih.gov/pubmed/32568726"
}


@Article{info:doi/10.2196/14977,
author="Flitcroft, Leah
and Chen, Sun Won
and Meyer, Denny",
title="The Demographic Representativeness and Health Outcomes of Digital Health Station Users: Longitudinal Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="26",
volume="22",
number="6",
pages="e14977",
keywords="population health",
keywords="health behavior",
keywords="health technology",
keywords="eHealth",
keywords="health status",
abstract="Background: Digital health stations offer an affordable and accessible platform for people to monitor their health; however, there is limited information regarding the demographic profile of users and the health benefits of this technology. Objective: This study aimed to assess the demographic representativeness of health station users, identify the factors associated with repeat utilization of stations, and determine if the health status of repeat users changed between baseline and final health check. Methods: Data from 180,442 health station users in Australia, including 8441 repeat users, were compared with 2014-2015 Australian National Health Survey (NHS) participants on key demographic and health characteristics. Binary logistic regression analyses were used to compare demographic and health characteristics of repeat and one-time users. Baseline and final health checks of repeat users were compared using McNemar tests and Wilcoxon signed rank tests. The relationship between the number of checks and final health scores was investigated using generalized linear models. Results: The demographic profile of SiSU health station users differs from that of the general population. A larger proportion of SiSU users were female (100,814/180,442, 55.87\% vs 7807/15,393, 50.72\%), younger (86,387/180,442, 47.88\% vs 5309/15,393, 34.49\% aged less than 35 years), and socioeconomically advantaged (64,388/180,442, 35.68\% vs 3117/15,393, 20.25\%). Compared with NHS participants, a smaller proportion of SiSU health station users were overweight or obese, were smokers, had high blood pressure (BP), or had diabetes. When data were weighted for demographic differences, only rates of high BP were found to be lower for SiSU users compared with the NHS participants (odds ratio [OR] 1.26; P<.001). Repeat users were more likely to be female (OR 1.37; P<.001), younger (OR 0.99; P<.001), and from high socioeconomic status areas---those residing in socioeconomic index for areas quintiles 4 and 5 were significantly more likely to be repeat users compared with those residing in quintile 1 (OR 1.243; P<.001 and OR 1.151; P<.001, respectively). Repeat users were more likely to have a higher BMI (OR 1.02; P<.001), high BP (OR 1.15; P<.001), and less likely to be smokers (OR 0.77; P<.001). Significant improvements in health status were observed for repeat users. Mean BMI decreased by 0.97 kg/m2 from baseline to final check (z=?14.24; P<.001), whereas the proportion of people with high BP decreased from 15.77\% (1080/6848) to 12.90\% (885/6860; $\chi$21=38.2; P<.001). The proportion of smokers decreased from 11.91\% (1005/8438) to 10.13\% (853/8421; $\chi$21=48.4; P<.001). Number of repeat health checks was significantly associated with smoking status (OR 0.96; P<.048) but not with higher BP (P=.14) or BMI (P=.23). Conclusions: These findings provide valuable insight into the benefits of health stations for self-monitoring and partially support previous research regarding the effect of demographics and health status on self-management of health. ",
doi="10.2196/14977",
url="http://www.jmir.org/2020/6/e14977/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32589150"
}


@Article{info:doi/10.2196/14714,
author="Joshi, Ashish
and Malhotra, Bhavya
and Amadi, Chioma
and Loomba, Menka
and Misra, Archa
and Sharma, Shruti
and Arora, Arushi
and Amatya, Jaya",
title="Gender and the Digital Divide Across Urban Slums of New Delhi, India: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="22",
volume="22",
number="6",
pages="e14714",
keywords="gender",
keywords="digital divide",
keywords="mobile phone",
keywords="internet access",
keywords="text messaging",
keywords="slums",
abstract="Background: Disparities in access to specific technologies within gender groups have not been investigated. Slum settings provide an ideal population to investigate the contributing factors to these disparities. Objective: This study aimed to examine gender differences in mobile phone ownership, internet access, and knowledge of SMS text messaging among males and females living in urban slum settings. Methods: A convenience sampling approach was used in sample selection from 675 unnotified slums. A total of 38 slum sites were then selected across four geographic zones. Of these, 10\% of the households in each slum site was selected from each zone. One household member was interviewed based on their availability and fulfillment of the eligibility criteria. Eligible individuals included those aged 18 years and above, residing in these slums, and who provided voluntary consent to participate in the study. Individuals with mental or physical challenges were excluded from the study. Results: Our results showed that females were half as likely to own mobile phones compared with males (odds ratio [OR] 0.53, 95\% CI 0.37-0.76), less likely to have internet access (OR 0.79, 95\% CI 0.56-1.11), or know how to send text messages (OR 0.93, 95\% CI 0.66-1.31). The predictors of mobile phone ownership, internet access, and text messaging between males and females included age, individual education, housing type, and the number of earning members in a household in the adjusted analysis. Among males, the number of earning members was a predictor of both mobile phone ownership and text messaging, whereas household education was a predictor of both internet access and text messaging. Age and individual education only predicted internet access, whereas housing type only predicted text messaging. Among females, household education was a predictor of all the technology outcomes. Age and type of toilet facility only predicted mobile phone ownership; housing type only predicted internet access whereas television ownership with satellite service and smoking behavior only predicted text messaging. Conclusions: Our study findings showing disparate access to technology within gender groups lend support for further research to examine the causal mechanisms promoting these differences to proffer significant solutions. Specifically, our study findings suggest that improving household education is crucial to address the disparate access and usage of mobile phones, the internet, and text messaging among women in slum settings. This suggestion is due to the consistency in household educational level as a predictor across all these technology indicators. In addition, the mechanisms by which the number of household earning members influences the disparate access to technology among men call for further exploration. ",
doi="10.2196/14714",
url="https://www.jmir.org/2020/6/e14714",
url="http://www.ncbi.nlm.nih.gov/pubmed/32343670"
}


@Article{info:doi/10.2196/15450,
author="Baudin, Katarina
and Gustafsson, Christine
and Frennert, Susanne",
title="Views of Swedish Elder Care Personnel on Ongoing Digital Transformation:  Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="16",
volume="22",
number="6",
pages="e15450",
keywords="elder care",
keywords="welfare technology",
keywords="gender",
keywords="municipality",
keywords="participation",
keywords="digitalization",
keywords="age",
abstract="Background: Swedish municipalities are facing demographic challenges due to the growing number of older people and the resulting increased need for health care services. Welfare technologies are being launched as possible solutions for meeting some of these challenges. Objective: The aim of this study was to explore the perception, experimentation, evaluation, and procurement of welfare technology practices among professionals working in municipal elder care in relation to their gender, age, and profession. Methods: Data for this explorative cross-sectional study were collected from 393 responses to a web-based survey on municipal elder care in Sweden. Chi square tests were performed to determine the associations. Results: The results revealed gender, age, and professional differences in perspectives of municipal elder care workers. Differences were particularly evident in attitudes toward technology, both the use of technology in general and in the workplace, and involvement and participation in decision making regarding the procurement of new welfare technologies. Men (37/53, 70\%) expressed a more positive attitude toward and curiosity regarding new technologies than women (157/336, 46.7\%) (P=.03). Regarding age, the younger respondents (18-24 years old) perceived the digital transformation in the workplace as ``too slow'' (4/4, 100\%), whereas the majority of older respondents (65-74 years old) perceived it as happening at the ``right pace'' (4/7, 57\%). The elder care personnel felt encouraged by management to explore and experiment with new welfare technologies, but never did so either for management or with patients. Even though the majority of the respondents were women, more men (4/7, 57\%) were involved in the procurement process for welfare technology devices and solutions than women (98/336, 29.2\%) (P<.001). Conclusions: Personnel working within municipal elder care were generally very positive toward new technologies. However, both gender and age differences may influence these perspectives such as the personnel's resistance to welfare technology and patients' participation in welfare technology usage and deployment. Different levels of participation in the decision-making process regarding new technology deployment may negatively affect the overall digital transformation within municipal elder care. ",
doi="10.2196/15450",
url="http://www.jmir.org/2020/6/e15450/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32543444"
}


@Article{info:doi/10.2196/15099,
author="Weber, Winja
and Reinhardt, Anne
and Rossmann, Constanze",
title="Lifestyle Segmentation to Explain the Online Health Information--Seeking Behavior of Older Adults: Representative Telephone Survey",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="12",
volume="22",
number="6",
pages="e15099",
keywords="older adults",
keywords="online health information seeking",
keywords="lifestyle",
keywords="segmentation",
keywords="cluster analysis",
abstract="Background: As a result of demographic changes, the number of people aged 60 years and older has been increasing steadily. Therefore, older adults have become more important as a target group for health communication efforts. Various studies show that online health information sources have gained importance among younger adults, but we know little about the health-related internet use of senior citizens in general and in particular about the variables explaining their online health-related information--seeking behavior. Media use studies indicate that in addition to sociodemographic variables, lifestyle factors might play a role in this context. Objective: The aim of this study was to examine older people's health-related internet use. Our study focused on the explanatory potential of lifestyle types over and above sociodemographic variables to predict older adults' internet use for health information. Methods: A telephone survey was conducted with a random sample of German adults aged 60 years and older (n=701) that was quota-allocated by gender, age, educational status, and degree of urbanity of their place of residence. Results: The results revealed that participants used the internet infrequently (mean 1.82 [SD 1.07]), and medical personnel (mean 2.89 [SD 1.11]), family and friends (mean 2.86 [SD 1.21]), and health brochures (mean 2.85 [SD 1.21]) were their main sources of health information. A hierarchical cluster analysis based on values, interests, and leisure time activities revealed three different lifestyle types for adults aged over 60 years: the Sociable Adventurer, the Average Family Person, and the Uninterested Inactive. After adding these types as second-step predictors in a hierarchical regression model with sociodemographic variables (step 1), the explained variance increased significantly (R2=.02, P=.001), indicating that the Average Family Person and the Sociable Adventurer use the internet more often for health information than the Uninterested Inactive, over and above their sociodemographic attributes. Conclusions: Our findings indicate that the internet still plays only a minor role in the health information--seeking behavior of older German adults. Nevertheless, there are subgroups including younger, more active, down-to-earth and family-oriented males that may be reached with online health information. Our findings suggest that lifestyle types should be taken into account when predicting health-related internet use behavior. ",
doi="10.2196/15099",
url="http://www.jmir.org/2020/6/e15099/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32530433"
}


@Article{info:doi/10.2196/17640,
author="Hsu, Wan-Chen
and Chiang, Chia-Hsun",
title="Effect of BMI and Perceived Importance of Health on the Health Behavior of College Students: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="11",
volume="22",
number="6",
pages="e17640",
keywords="body mass index",
keywords="college students",
keywords="health behavior",
keywords="perceived importance of health",
abstract="Background: Both body mass index (BMI) and the perceived importance of health have received a lot of attention, but few studies have fully investigated the interaction of their effects on health behaviors. Objective: This study investigates the effects of BMI and the perceived importance of health on health behaviors (patterns of eating, sleeping, and exercising) among college students in Taiwan. Methods: A survey was conducted with 334 students to assess their perception of the importance of health (using indicators) and their health behavior (using the Health Behaviors Scale). Respondent BMI was calculated from self-reported body weight and height. Descriptive statistical analysis, independent t test analysis, two-way analysis of variance (ANOVA), and one-way ANOVA were conducted. Results: The results showed a significant difference between genders in health behaviors among college students (eating: t332=2.17, P=.03; exercise: t332=5.57, P<.001; sleep: t332=2.58, P=.01). Moreover, there was an interaction between BMI and perception (of the importance of health) for exercise behaviors (F2,328=3.50, P=.03), but not for eating behaviors (F2,328=0.12, P=.89) or sleep behaviors (F2,328=1.64, P=.20). Conclusions: This study establishes, for the first time, the interaction of BMI and the perceived importance of health on health behaviors. The perception of health was found to have a significant effect on exercise behaviors. Thus, the perception of health plays a significant role in the exercise behaviors of college students in Taiwan. This finding provides researchers, policy makers, and practitioners with evidence, and consequently, opportunities for focusing on preventive actions. The findings suggest that increasing the importance of health in the perception of college students, should be the focus of efforts to help students exercise more regularly. ",
doi="10.2196/17640",
url="https://www.jmir.org/2020/6/e17640",
url="http://www.ncbi.nlm.nih.gov/pubmed/32525487"
}


@Article{info:doi/10.2196/17221,
author="Li, Peiyi
and Luo, Yunmei
and Yu, Xuexin
and Wen, Jin
and Mason, Elizabeth
and Li, Weimin
and Jalali, S. Mohammad",
title="Patients' Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="11",
volume="22",
number="6",
pages="e17221",
keywords="innovation adoption",
keywords="e-hospital",
keywords="internet hospital",
keywords="eHealth",
keywords="barriers",
keywords="facilitators",
abstract="Background: As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users' acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. Objective: This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients' willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. Methods: We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients' sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. Results: Overall, it was found that 65.6\% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7\%) and accessibility to skilled medical experts (489/677, 72.2\%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7\%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75\%). Conclusions: We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries. ",
doi="10.2196/17221",
url="http://www.jmir.org/2020/6/e17221/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32525483"
}


@Article{info:doi/10.2196/17014,
author="Tariq, Amina
and Khan, R. Shanchita
and Basharat, Amna",
title="Internet Use, eHealth Literacy, and Dietary Supplement Use Among Young Adults in Pakistan: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="10",
volume="22",
number="6",
pages="e17014",
keywords="internet",
keywords="digital health",
keywords="eHealth",
keywords="eHealth literacy",
keywords="internet use",
keywords="physical activity",
keywords="university students",
keywords="Pakistan",
abstract="Background: Increased access to the internet has facilitated widespread availability of health information. Thus, electronic health (eHealth) literacy---the ability to seek, find, understand, and appraise health information from electronic resources and apply that knowledge in making a health-related decision---is a crucial skill. Despite the increasing use of the internet as a source of health information in developing countries, only a few studies have examined the eHealth literacy of young adults, who frequently use the internet to access health information in these developing countries. Objective: The aim of this study was to assess the patterns of internet use and eHealth literacy levels among university students pursuing a non--health-related degree in Pakistan. We also examined the association of the eHealth literacy levels of these young adults with their physical activity levels and dietary supplement intake. Methods: Students from 2 leading engineering universities in Pakistan were invited to participate in a cross-sectional anonymous web-based survey in order to collect data on their internet use, eHealth literacy, and dietary supplement intake. Of the 900 eligible university students who were invited to participate, 505 (56.1\%) students who completed the questionnaire were included in the analysis. The findings were converted to median values and frequency analyses were performed. The associations between the variables were determined using the chi-square test; P?.05 was considered significant. Results: In this study, the median eHealth literacy scale (eHEALS) score was 29, which did not vary across gender. The most common type of health-related information that was searched by the participants was that related to maintaining a healthy lifestyle (305/505, 60.4\%). Participants with high eHEALS scores were those who used the internet frequently for finding people with similar health issues (P<.001). The use of specific social media platforms was not associated with the perceived eHealth literacy levels. Neither the frequency of physical activity nor the dietary supplement use was associated with the eHealth literacy of the participants. Conclusions: University students in non--health-related disciplines in Pakistan expressed high confidence in their skills to find health-related information on the internet, as indicated by the aggregate eHEALS scores. However, the findings of our study show that the perceived eHealth literacy was not associated with health behaviors such as physical activity and dietary supplement intake. Further research is necessary to investigate the extent to which eHealth literacy can be considered as a panacea for solving public health challenges in developing countries. ",
doi="10.2196/17014",
url="http://www.jmir.org/2020/6/e17014/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32519974"
}


@Article{info:doi/10.2196/17849,
author="Turnbull, Sophie
and Cabral, Christie
and Hay, Alastair
and Lucas, J. Patricia",
title="Health Equity in the Effectiveness of Web-Based Health Interventions for the Self-Care of People With Chronic Health Conditions: Systematic Review",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="5",
volume="22",
number="6",
pages="e17849",
keywords="health equity",
keywords="self-care",
keywords="eHealth",
keywords="intervention",
keywords="diabetes",
keywords="asthma",
keywords="pulmonary disease, chronic obstructive",
keywords="osteoarthritis",
abstract="Background: Web-based self-care interventions have the potential to reduce health inequalities by removing barriers to access to health care. However, there is a lack of evidence about the equalizing effects of these interventions on chronic conditions. Objective: This study investigated the differences in the effectiveness of web-based behavioral change interventions for the self-care of high burden chronic health conditions (eg, asthma, chronic obstructive pulmonary disease [COPD], diabetes, and osteoarthritis) across socioeconomic and cultural groups. Methods: A systematic review was conducted, following Cochrane review guidelines. We conducted searches in Ovid Medical Literature Analysis and Retrieval System Online and Cumulative Index to Nursing and Allied Health Literature databases. Studies with any quantitative design were included (published between January 1, 2006, and February 20, 2019) if they investigated web-based self-care interventions targeting asthma, COPD, diabetes, and osteoarthritis; were conducted in any high-income country; and reported variations in health, behavior, or psychosocial outcomes across social groups. Study outcomes were investigated for heterogeneity, and the possibility of a meta-analysis was explored. A narrative synthesis was provided together with a novel figure that was developed for this review, displaying heterogeneous outcomes. Results: Overall, 7346 records were screened and 18 studies were included, most of which had a high or critical risk of bias. Important study features and essential data were often not reported. The meta-analysis was not possible due to the heterogeneity of outcomes. There was evidence that intervention effectiveness was modified by participants' social characteristics. Minority ethnic groups were found to benefit more from interventions than majority ethnic groups. Single studies with variable quality showed that those with higher education, who were employed, and adolescents with divorced parents benefited more from interventions. The evidence for differences by age, gender, and health literacy was conflicting (eg, in some instances, older people benefited more, and in others, younger people benefited more). There was no evidence of differences in income, numeracy, or household size. Conclusions: There was evidence that web-based self-care interventions for chronic conditions can be advantageous for some social groups (ie, minority ethnic groups, adolescents with divorced parents) and disadvantageous for other (ie, low education, unemployed) social groups who have historically experienced health inequity. However, these findings should be treated with caution as most of the evidence came from a small number of low-quality studies. The findings for gender and health literacy were mixed across studies on diabetes, and the findings for age were mixed across studies on asthma, COPD, and diabetes. There was no evidence that income, numeracy, or the number of people living in the household modified intervention effectiveness. We conclude that there appear to be interaction effects, which warrant exploration in future research, and recommend a priori consideration of the predicted interaction effects. Trial Registration: PROSPERO CRD42017056163; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=56163 ",
doi="10.2196/17849",
url="http://www.jmir.org/2020/6/e17849/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32459632"
}


@Article{info:doi/10.2196/17519,
author="Vollbrecht, Hanna
and Arora, Vineet
and Otero, Sebastian
and Carey, Kyle
and Meltzer, David
and Press, G. Valerie",
title="Evaluating the Need to Address Digital Literacy Among Hospitalized Patients: Cross-Sectional Observational Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="4",
volume="22",
number="6",
pages="e17519",
keywords="health literacy",
keywords="digital literacy",
keywords="hospitalization",
keywords="technology",
abstract="Background: Technology is a potentially powerful tool to assist patients with transitions of care during and after hospitalization. Patients with low health literacy who are predisposed to poor health outcomes are particularly poised to benefit from such interventions. However, this population may lack the ability to effectively engage with technology. Although prior research studied the role of health literacy in technology access/use among outpatients, hospitalized patient populations have not been investigated in this context. Further, with the rapid uptake of technology, access may no longer be pertinent, and differences in technological capabilities may drive the current digital divide. Thus, characterizing the digital literacy of hospitalized patients across health literacy levels is paramount. Objective: We sought to determine the relationship between health literacy level and technological access, use, and capability among hospitalized patients. Methods: Adult inpatients completed a technology survey that asked about technology access/use and online capabilities as part of an ongoing quality of care study. Participants' health literacy level was assessed utilizing the 3-question Brief Health Literacy Screen. Descriptive statistics, bivariate chi-squared analyses, and multivariate logistic regression analyses (adjusting for age, race, gender, and education level) were performed. Using Bonferroni correction for the 18 tests, the threshold P value for significance was <.003. Results: Among 502 enrolled participants, the mean age was 51 years, 71.3\% (358/502) were African American, half (265/502, 52.8\%) were female, and half (253/502, 50.4\%) had at least some college education. Over one-third (191/502, 38.0\%) of participants had low health literacy. The majority of participants owned devices (owned a smartphone: 116/173, 67.1\% low health literacy versus 235/300, 78.3\% adequate health literacy, P=.007) and had used the Internet previously (143/189, 75.7\% low health literacy versus 281/309, 90.9\% adequate health literacy, P<.001). Participants with low health literacy were more likely to report needing help performing online tasks (133/189, 70.4\% low health literacy versus 135/303, 44.6\% adequate health literacy, P<.001). In the multivariate analysis, when adjusting for age, race, gender, and education level, we found that low health literacy was not significantly associated with a lower likelihood of owning smartphones (OR: 0.8, 95\% CI 0.5-1.4; P=.52) or using the internet ever (OR: 0.5, 95\% CI 0.2-0.9; P=.02). However, low health literacy remained significantly associated with a higher likelihood of needing help performing any online task (OR: 2.2, 95\% CI 1.3-3.6; P=.002). Conclusions: The majority of participants with low health literacy had access to technological devices and had used the internet previously, but they were unable to perform online tasks without assistance. The barriers patients face in using online health information and other health information technology may be more related to online capabilities rather than to technology access. When designing and implementing technological tools for hospitalized patients, it is important to ensure that patients across digital literacy levels can both understand and use them. ",
doi="10.2196/17519",
url="https://www.jmir.org/2020/6/e17519",
url="http://www.ncbi.nlm.nih.gov/pubmed/32496196"
}


@Article{info:doi/10.2196/17294,
author="Choi, G. Namkee
and DiNitto, M. Diana
and Lee, EunKyoung Othelia
and Choi, Y. Bryan",
title="Internet and Health Information Technology Use and Psychological Distress Among Older Adults With Self-Reported Vision Impairment: Case-Control Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="3",
volume="22",
number="6",
pages="e17294",
keywords="older adults",
keywords="vision impairment",
keywords="HIT",
keywords="psychological distress",
keywords="digital divide",
keywords="mobile phone",
abstract="Background: The number of older adults with vision impairment (VI) is growing. As health care services increasingly call for patients to use technology, it is important to examine internet/health information technology (HIT) use among older adults with VI. Objective: This study aimed to examine (1) the rates of internet/HIT use among older adults with VI compared with a matched sample of their peers without VI, (2) associations of VI with internet/HIT use, and (3) association of HIT use with psychological distress, assessed with the Kessler-6 screen. Methods: Data were obtained from the 2013 to 2018 US National Health Interview Survey. Older adults (aged ?65 years) with self-reported VI were matched with older adults without VI, in a 1:1 ratio, based on age, sex, number of chronic medical conditions, and functional limitations (N=2866). Descriptive statistics and multivariable logistic regression models, with sociodemographic factors, health conditions, health insurance type, and health care service use as covariates, were used to examine the research questions. Results: In total, 3.28\% of older adults (compared with 0.84\% of those aged 18-64 years) reported VI, and 25.7\% of them were aged ?85 years. Those with VI were significantly more socioeconomically disadvantaged than those without VI and less likely to use the internet (adjusted odds ratio [aOR] 0.64, 95\% CI0.49-0.83) and HIT (aOR 0.74, 95\% CI 0.56-0.97). However, among internet users, VI was not associated with HIT use. HIT use was associated with lower odds of mild/moderate or serious psychological distress (aOR 0.62, 95\% CI 0.43-0.90), whereas VI was associated with greater odds of mild/moderate or serious distress (aOR 1.84, 95\% CI 1.36-2.49). Health care provider contacts were also associated with higher odds of internet or HIT use. Conclusions: Compared with their matched age peers without VI, older adults with VI are less likely to use HIT because they are less likely to use the internet. Socioeconomically disadvantaged older adults experiencing a digital divide need help to access information and communication technologies through a fee waiver or subsidy to cover internet equipment and subscription and ensure continuous connectivity. Older adults with VI who do not know how to use the internet/HIT but want to learn should be provided instruction, with special attention to accessibility features and adaptive devices. Older adults with a low income also need better access to preventive eye care and treatment of VI as well as other health care services. ",
doi="10.2196/17294",
url="https://www.jmir.org/2020/6/e17294",
url="http://www.ncbi.nlm.nih.gov/pubmed/32490851"
}


@Article{info:doi/10.2196/17253,
author="Guzman-Parra, Jose
and Barnestein-Fonseca, Pilar
and Guerrero-Perti{\~n}ez, Gloria
and Anderberg, Peter
and Jimenez-Fernandez, Luis
and Valero-Moreno, Esperanza
and Goodman-Casanova, Marian Jessica
and Cuesta-Vargas, Antonio
and Garolera, Maite
and Quintana, Maria
and Garc{\'i}a-Betances, I. Rebeca
and Lemmens, Evi
and Sanmartin Berglund, Johan
and Mayoral-Cleries, Fermin",
title="Attitudes and Use of Information and Communication Technologies in Older Adults With Mild Cognitive Impairment or Early Stages of Dementia and Their Caregivers: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="1",
volume="22",
number="6",
pages="e17253",
keywords="aging",
keywords="mild cognitive impairment",
keywords="dementia eHealth",
keywords="information and communication technology",
keywords="technophilia",
abstract="Background: Information and communication technologies are promising tools to increase the quality of life of people with dementia or mild cognitive impairment and that of their caregivers. However, there are barriers to their use associated with sociodemographic factors and negative attitudes, as well as inadequate knowledge about technologies. Objective: The aim of this study was to analyze technophilia (attitudes toward new technologies) and the use of smartphones and tablets along with associated factors in  people with dementia/mild cognitive impairment and their caregivers. Methods: Data from the first visit of the Support Monitoring and Reminder for Mild Dementia (SMART4MD) randomized multicenter clinical trial were used for this analysis. Data were obtained from two European countries, Spain and Sweden, and from three centers: Consorci Sanitari de Terrassa (Catalonia, Spain), Servicio Andaluz de Salud (Andalusia, Spain), and the Blekinge Institute of Technology (Sweden). Participants with a score between 20 and 28 in the Mini Mental State Examination, with  memory problems (for more than 6 months), and who were over the age of 55 years were included in the study, along with their caregivers. The bivariate Chi square and Mann-Whitney tests, and multivariate linear and logistic regression models were used for statistical analysis. Results: A total of 1086 dyads were included (N=2172). Overall, 299 (27.53\%) of people with dementia/mild cognitive impairment had a diagnosis of dementia. In addition, 588 (54.14\%) of people with dementia/mild cognitive impairment reported using a smartphone almost every day, and 106 (9.76\%) used specific apps or software to support their memory. Among the caregivers, 839 (77.26\%) used smartphones and tablets almost every day, and 181 (16.67\%) used specific apps or software to support their memory. The people with dementia/mild cognitive impairment showed a lower level of technophilia in comparison to that of their caregivers after adjusting for confounders (B=0.074, P=.02) with differences in technology enthusiasm (B=0.360, P<.001), but not in technology anxiety (B=--0.042, P=.37). Technophilia was associated with lower age (B=--0.009, P=.004), male gender (B=--0.160, P<.001), higher education level (P=.01), living arrangement (living with children vs single; B=--2.538, P=.01), country of residence (Sweden vs Spain; B=0.256, P<.001), lower depression (B=--0.046, P<.001), and better health status (B=0.004, P<.001) in people with dementia/mild cognitive impairment. Among caregivers, technophilia was associated with comparable sociodemographic factors (except for living arrangement), along with a lower caregiver burden (B=--0.005, P=.04) and better quality of life (B=0.348, P<.001). Conclusions: Technophilia was associated with a better quality of life and sociodemographic variables in people with dementia/mild cognitive impairment and caregivers, suggesting potential barriers for technological interventions. People with dementia/mild cognitive impairment frequently use smartphones and tablets, but the use of specific apps or software to support memory is limited. Interventions using these technologies are needed to overcome barriers in this population related to sociodemographic characteristics and the lack of enthusiasm for new technologies. Trial Registration: ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699 ",
doi="10.2196/17253",
url="https://www.jmir.org/2020/6/e17253",
url="http://www.ncbi.nlm.nih.gov/pubmed/32442136"
}


@Article{info:doi/10.2196/13470,
author="Clarke, A. Martina
and Fruhling, L. Ann
and Sitorius, Marilyn
and Windle, A. Thomas
and Bernard, L. Tamara
and Windle, R. John",
title="Impact of Age on Patients' Communication and Technology Preferences in the Era of Meaningful Use: Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="1",
volume="22",
number="6",
pages="e13470",
keywords="patients",
keywords="personal health record",
keywords="needs assessment",
keywords="data display",
keywords="communication",
keywords="age groups",
abstract="Background: Identifying effective means of communication between patients and their health care providers has a positive impact on patients' satisfaction, adherence, and health-related outcomes. Objective: This study aimed to identify the impact of patients' age on their communication and technology preferences when managing their health. We hypothesize that a patient's age affects their communication and technology preferences when interacting with clinicians and managing their health. Methods: A mixed methods study was conducted to identify the preferences of patients with cardiovascular diseases. Results were analyzed based on the patients' age. Grounded theory was used to analyze the qualitative data. Patients were recruited based on age, gender, ethnicity, and zip code. Results: A total of 104 patients were recruited: 34 young adults (19-39 years), 33 middle aged (40-64), and 37 senior citizens (>65). Young adults (mean 8.29, SD 1.66) reported higher computer self-efficacy than middle-aged participants (mean 5.56, SD 3.43; P<.05) and senior citizens (mean 47.55, SD 31.23; P<.05). Qualitative analysis identified the following three themes: (1) patient engagement (young adults favored mobile technologies and text messaging, middle-aged patients preferred phone calls, and senior citizens preferred direct interactions with the health care provider); (2) patient safety (young adults preferred electronic after-visit summaries [AVS] and medication reconciliation over the internet; middle-aged patients preferred paper-based or emailed AVS and medication reconciliation in person; senior citizens preferred paper-based summaries and in-person medication reconciliation); (3) technology (young adults preferred smartphones and middle-aged patients and senior citizens preferred tablets or PCs). Middle-aged patients were more concerned about computer security than any other group. A unique finding among senior citizens was the desire for caregivers to have access to their personal health record (PHR). Conclusions: Patients of different ages have different communication and technology preferences and different preferences with respect to how they would like information presented to them and how they wish to interact with their provider. The PHR is one approach to improving patient engagement, but nontechnological options need to be sustained to support all patients. ",
doi="10.2196/13470",
url="https://www.jmir.org/2020/6/e13470",
url="http://www.ncbi.nlm.nih.gov/pubmed/32478658"
}


@Article{info:doi/10.2196/14670,
author="Knapova, Lenka
and Klocek, Adam
and Elavsky, Steriani",
title="The Role of Psychological Factors in Older Adults' Readiness to Use eHealth Technology: Cross-Sectional Questionnaire Study",
journal="J Med Internet Res",
year="2020",
month="May",
day="28",
volume="22",
number="5",
pages="e14670",
keywords="eHealth",
keywords="information technology",
keywords="need for cognitive closure",
keywords="elderly",
abstract="Background: Information and communication technology (ICT) use among older adults has been on the rise in recent years. However, the predictors and mechanisms behind older adults' acceptance and use of ICT are not clear. Objective: This study aimed to systematically describe ICT usage among Czech older adults and to evaluate the factors influencing their ICT use and readiness to use digital technology to promote health (eHealth readiness). The primary focus was on psychological factors and the role of persons close to older adults. Methods: The research utilized cross-sectional survey data from a quota-based sample of Czech older adults (>50 years) and persons close to them further referred to as close persons (N=250 dyads). A structural equation modeling framework was used to evaluate relationships between psychological factors, ICT use, and eHealth readiness. Results: Czech older adults' use of ICT is low with the exception of cell phone usage (cell phone usage by 173/250, 69.2\%; other devices used by 50/250, 20.0\% of older adults or less). Apart from age ($\beta$=?.21; P<.001), eHealth readiness was predicted by ICT use ($\beta$=.65; P<.001). eHealth readiness was also indirectly affected by the need for cognitive closure (NFCC): individuals with a high need for closure perceived more barriers to ICT ($\beta$=.23; P=.01) and more reported barriers were linked to lower ICT usage ($\beta$=?.21; P=.001). The expected positive relationships between eHealth readiness of persons close to older adults and ICT use and eHealth readiness of older adults were not significant, but the total effect of eHealth readiness of persons close to older adults on eHealth readiness of older adults was positive and significant ($\beta$=.18; P=.01), indicating some level of influence of persons close to them on older adults' attitudes and behaviors. Conclusions: This study provided the first systematic examination of Czech older adults' ICT usage and eHealth readiness. Novel predictors (NFCC and close persons' variables) were evaluated and yielded actionable results. More research is needed to clarify the role of persons close to older adults. ",
doi="10.2196/14670",
url="http://www.jmir.org/2020/5/e14670/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32348251"
}


@Article{info:doi/10.2196/14825,
author="Too, San Lay
and Leach, Liana
and Butterworth, Peter",
title="Mental Health Problems and Internet Access: Results From an Australian National Household Survey",
journal="JMIR Ment Health",
year="2020",
month="May",
day="15",
volume="7",
number="5",
pages="e14825",
keywords="internet access",
keywords="mental health",
keywords="affordability, mobile phone",
abstract="Background: Mental health support and interventions are increasingly delivered on the web, and stepped care systems of mental health services are embracing the notion of a digital gateway through which individuals can have access to information, assessment, and services and can be connected with more intensive services if needed. Although concerns have been raised over whether people with mental health problems are disadvantaged in terms of their access to the internet, there is a lack of representative data on this topic. Objective: This study aimed to examine the relationship between mental health and internet access, particularly lack of access because of affordability issues. Methods: Data from wave 14 of the Household, Income, and Labour Dynamics in Australia survey were used (n=15,596) in the analyses. Sample weights available in the survey were used to calculate the proportion of those with or without internet access for those with and without mental health problems and more severe long-term mental health conditions. These proportions were also calculated for those with and without internet access due, specifically, to affordability issues. Multinomial logistic regression analyses assessed the relationship between mental health status and internet access/affordability issues, adjusting for a range of covariates. Results: Access to the internet was poorer for those with mental health problems (87.8\%) than those without mental health problems (92.2\%), and the difference was greater when a measure of more severe mental health conditions was used (81.3\% vs 92.2\%). The regression models showed that even after adjusting for a broad range of covariates, people with mental ill health were significantly more likely to have no internet access because of unaffordability than those without mental ill health (mental health problems: relative risk ratio [RRR] 1.68; 95\% CI 1.11-2.53 and severe mental health conditions: RRR 1.92; 95\% CI 1.16-3.19). Conclusions: As Australia and other nations increasingly deliver mental health services on the web, issues of equity and affordability need to be considered to ensure that those who most need support and assistance are not further disadvantaged. ",
doi="10.2196/14825",
url="http://mental.jmir.org/2020/5/e14825/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32410731"
}


@Article{info:doi/10.2196/16299,
author="Rising, J. Camella
and Jensen, E. Roxanne
and Moser, P. Richard
and Oh, April",
title="Characterizing the US Population by Patterns of Mobile Health Use for Health and Behavioral Tracking: Analysis of the National Cancer Institute's Health Information National Trends Survey Data",
journal="J Med Internet Res",
year="2020",
month="May",
day="14",
volume="22",
number="5",
pages="e16299",
keywords="mobile health",
keywords="population health",
keywords="health communication",
keywords="survey methodology",
keywords="mobile applications",
keywords="devices",
abstract="Background: Multiple types of mobile health (mHealth) technologies are available, such as smartphone health apps, fitness trackers, and digital medical devices. However, despite their availability, some individuals do not own, do not realize they own, or own but do not use these technologies. Others may use mHealth devices, but their use varies in tracking health, behaviors, and goals. Examining patterns of mHealth use at the population level can advance our understanding of technology use for health and behavioral tracking. Moreover, investigating sociodemographic and health-related correlates of these patterns can provide direction to researchers about how to target mHealth interventions for diverse audiences. Objective: The aim of this study was to identify patterns of mHealth use for health and behavioral tracking in the US adult population and to characterize the population according to those patterns. Methods: We combined data from the 2017 and 2018 National Cancer Institute Health Information National Trends Survey (N=6789) to characterize respondents according to 5 mutually exclusive reported patterns of mHealth use for health and behavioral tracking: (1) mHealth nonowners and nonusers report not owning or using devices to track health, behaviors, or goals; (2) supertrackers track health or behaviors and goals using a smartphone or tablet plus other devices (eg, Fitbit); (3) app trackers use only a smartphone or tablet; (4) device trackers use only nonsmartphone or nontablet devices and do not track goals; and (5) nontrackers report having smartphone or tablet health apps but do not track health, behaviors, or goals. Results: Being in the mHealth nonowners and nonusers category (vs all mHealth owners and users) is associated with males, older age, lower income, and not being a health information seeker. Among mHealth owners and users, characteristics of device trackers and supertrackers were most distinctive. Compared with supertrackers, device trackers have higher odds of being male (odds ratio [OR] 2.22, 95\% CI 1.55-3.19), older age (vs 18-34 years; 50-64 years: OR 2.83, 95\% CI 1.52-5.30; 65+ years: OR 6.28, 95\% CI 3.35-11.79), have an annual household income of US \$20,000 to US \$49,999 (vs US \$75,000+: OR 2.31, 95\% CI 1.36-3.91), and have a chronic condition (OR 1.69, 95\% CI 1.14-2.49). Device trackers also have higher odds of not being health information seekers than supertrackers (OR 2.98, 95\% CI 1.66-5.33). Conclusions: Findings revealed distinctive sociodemographic and health-related characteristics of the population by pattern of mHealth use, with notable contrasts between those who do and do not use devices to track goals. Several characteristics of individuals who track health or behaviors but not goals (device trackers) are similar to those of mHealth nonowners and nonusers. Our results suggest patterns of mHealth use may inform how to target mHealth interventions to enhance reach and facilitate healthy behaviors. ",
doi="10.2196/16299",
url="https://www.jmir.org/2020/5/e16299",
url="http://www.ncbi.nlm.nih.gov/pubmed/32406865"
}


@Article{info:doi/10.2196/15282,
author="Hsiang, Elaine
and Offer, Claudine
and Prescott, Maximo
and Rodriguez, Amy
and Behar, Emily
and Matheson, Tim
and Santa Maria, Diane
and Santos, Glenn-Milo",
title="Bridging the Digital Divide Among Racial and Ethnic Minority Men Who Have Sex With Men to Reduce Substance Use and HIV Risk: Mixed Methods Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="29",
volume="8",
number="4",
pages="e15282",
keywords="ecological momentary assessment",
keywords="men who have sex with men",
keywords="text messaging",
keywords="substance use",
keywords="HIV",
keywords="digital divide",
keywords="focus group",
abstract="Background: Ecological momentary assessment (EMA) is a promising data collection tool for mobile health interventions targeting episodic health behaviors. For substance-using men who have sex with men (SUMSM), EMA is becoming more widely utilized in efforts to characterize substance use and sexual risk factors for HIV transmission. However, recent literature demonstrates emerging concerns over compliance and lower EMA engagement and data concordance among racial and ethnic minority SUMSM. Objective: This study aimed to provide a qualitative evaluation of the barriers and facilitators of EMA as a data collection tool among racial and ethnic minority SUMSM. Methods: Between October and November 2017, 45 racial and ethnic minority SUMSM were recruited from a list of prior research participants at the San Francisco Department of Public Health to participate in daily EMA surveys on their substance use and sexual health behaviors for 1 week, followed by in-person focus groups (FGs). A total of 4 FGs explored the participants' experiences with the surveys, issues regarding privacy and confidentiality, and suggestions for improvement. Qualitative analysis was performed using content analysis. Descriptive statistics and Fisher exact tests were used to assess the associations between demographics or substance use behaviors and EMA completion. Results: Overall, 93.9\% (295/314) of all delivered surveys were initiated, and of those, 98.0\% (289/295) were completed. Neither participant demographics, including race (P=.65) or age (P=.43), nor substance use behaviors, including the frequency of alcohol (P=.40) or methamphetamine (P=.91) use or any cocaine (P=.28), crack (P=.99), or polysubstance use (P=.24), were found to be associated with survey completion. Overall, participants were receptive to the text message--based EMA surveys. Facilitators included survey timing, user-friendly survey design, survey-stimulated self-reflection, coding of sensitive phrases, and other privacy benefits of a mobile survey. Barriers included an inability to correct texting errors and participants' perception of judgment or stigmatization related to questions about condomless sex. To improve EMA compliance and uptake, participants suggested adding response confirmations, clarifying survey language, and continuing to diversify the study audience. Conclusions: EMA appears to be feasible and acceptable among this sample of racial and ethnic minority SUMSM. Close attention to EMA study design and the development of nonjudgmental, contextualized questions regarding stigmatized health behaviors may be critical to further improve EMA compliance. ",
doi="10.2196/15282",
url="http://mhealth.jmir.org/2020/4/e15282/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32347807"
}


@Article{info:doi/10.2196/15906,
author="Sedrak, S. Mina
and Soto-Perez-De-Celis, Enrique
and Nelson, A. Rebecca
and Liu, Jennifer
and Waring, E. Molly
and Lane, S. Dorothy
and Paskett, D. Electra
and Chlebowski, T. Rowan",
title="Online Health Information--Seeking Among Older Women With Chronic Illness: Analysis of the Women's Health Initiative",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="9",
volume="22",
number="4",
pages="e15906",
keywords="online health information--seeking",
keywords="digital health",
keywords="technology",
keywords="chronic disease",
keywords="internet",
abstract="Background: Understanding how older patients with chronic illnesses use the internet to obtain health information is relevant for the design of digital interventions aimed at improving the health and well-being of adults aged 65 years and older; this cohort represents the sickest, most expensive, and fastest-growing segment of the US population. Objective: The objective of our study was to describe online health information--seeking behavior among older patients with chronic illnesses and to compare the characteristics of patients who report using the internet to obtain health information with those who do not. Methods: The study population included 72,806 women aged 65 years and older enrolled in the Women's Health Initiative (WHI), a national cohort study, who completed a 2014 supplemental questionnaire assessing everyday technology use and internet use for researching health conditions. Comparisons were made between participants with and without a history of chronic illness and between users and nonusers of online sources for health information. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95\% CIs. Results: Of the total, 59\% (42,887/72,806) of older women used the internet for health information. Compared with women who did not use the internet to obtain health information, those who used the internet were younger (median age: 76 vs 81 years), more likely to be non-Hispanic white (90\% [38,481/42,887] vs 87\% [26,017/29,919]), earned a higher income (over \$US 50,000: 55\% [23,410/42,887] vs 33\% [9991/29,919]), achieved a higher educational level (more than high school: 87\% [37,493/42,887] vs 75\% [22,377/29,919]), and were more likely to live with a partner (52\% [22,457/42,887] vs 36\% [10,759/29,919]) (all P<.001). Women with Alzheimer disease were least likely to report online health information--seeking compared to those without the disease (OR 0.41, 95\% CI 0.38-0.43). In contrast, women with a recent diagnosis of cancer, within the previous 2 years (OR 1.23, 95\% CI 1.11-1.36) or 2-5 years ago (OR 1.09, 95\% CI 1.00-1.19), were most likely to use the internet for health information. Conclusions: Nearly 6 in 10 older women participating in the WHI reported using the internet to obtain health information. Patients recently diagnosed with cancer are more likely to be looking for health information online, even after adjustment for age, suggesting that these patients may have a greater need for digital health resources. ",
doi="10.2196/15906",
url="http://www.jmir.org/2020/4/e15906/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32271152"
}


@Article{info:doi/10.2196/16951,
author="Khoong, C. Elaine
and Rivadeneira, A. Natalie
and Hiatt, A. Robert
and Sarkar, Urmimala",
title="The Use of Technology for Communicating With Clinicians or Seeking Health Information in a Multilingual Urban Cohort: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="6",
volume="22",
number="4",
pages="e16951",
keywords="vulnerable populations",
keywords="health information technology",
keywords="physician patient relations",
keywords="consumer health information",
keywords="digital divide",
keywords="social media",
keywords="internet",
abstract="Background: Technology is being increasingly used to communicate health information, but there is limited knowledge on whether these strategies are effective for vulnerable populations, including non--English speaking or low-income individuals. Objective: This study assessed how language preferences (eg, English, Spanish, or Chinese), smartphone ownership, and the type of clinic for usual source of care (eg, no usual source of care, nonintegrated safety net, integrated safety net, private or community clinic, academic tertiary medical center, or integrated payer-provider) affect technology use for health-related communication. Methods: From May to September 2017, we administered a nonrandom, targeted survey to 1027 English-, Spanish-, and Chinese-speaking San Francisco residents and used weighted multivariable logistic regression analyses to assess predictors of five technology use outcomes. The three primary predictors of interest---language preference, smartphone ownership, and type of clinic for usual care---were adjusted for age, gender, race or ethnicity, limited English proficiency, educational attainment, health literacy, and health status. Three outcomes focused on use of email, SMS text message, or phone apps to communicate with clinicians. The two other outcomes were use of Web-based health videos or online health support groups. Results: Nearly one-third of participants watched Web-based health videos (367/1027, 35.74\%) or used emails to communicate with their clinician (318/1027, 30.96\%). In adjusted analyses, individuals without smartphones had significantly lower odds of texting their clinician (adjusted odds ratio [aOR] 0.27, 95\% CI 0.13-0.56), using online health support groups (aOR 0.14, 95\% CI 0.04-0.55), or watching Web-based health videos (aOR 0.31, 95\% CI 0.15-0.64). Relative to English-speaking survey respondents, individuals who preferred Chinese had lower odds of texting their clinician (aOR 0.25, 95\% CI 0.08-0.79), whereas Spanish-speaking survey respondents had lower odds of using apps to communicate with clinicians (aOR 0.34, 95\% CI 0.16-0.75) or joining an online support group (aOR 0.30, 95\% CI 0.10-0.92). Respondents who received care from a clinic affiliated with the integrated safety net, academic tertiary medical center, or integrated payer-provider systems had higher odds than individuals without a usual source of care at using emails, SMS text messages, or apps to communicate with clinicians. Conclusions: In vulnerable populations, smartphone ownership increases the use of many forms of technology for health purposes, but device ownership itself is not sufficient to increase the use of all technologies for communicating with clinicians. Language preference impacts the use of technology for health purposes even after considering English proficiency. Health system factors impact patients' use of technology-enabled approaches for communicating with clinicians. No single factor was associated with higher odds of using technology for all health purposes; therefore, existing disparities in the use of digital health tools among diverse and vulnerable populations can only be addressed using a multipronged approach. ",
doi="10.2196/16951",
url="https://www.jmir.org/2020/4/e16951",
url="http://www.ncbi.nlm.nih.gov/pubmed/32250280"
}


@Article{info:doi/10.2196/16680,
author="Alcaraz, I. Kassandra
and Vereen, N. Rhyan
and Burnham, Donna",
title="Use of Telephone and Digital Channels to Engage Socioeconomically Disadvantaged Adults in Health Disparities Research Within a Social Service Setting: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="1",
volume="22",
number="4",
pages="e16680",
keywords="cross-sectional studies",
keywords="electronic mail",
keywords="health status disparities",
keywords="health care disparities",
keywords="internet",
keywords="mobile phone",
keywords="telephone",
keywords="text messaging",
keywords="social services",
abstract="Background: Engaging socioeconomically disadvantaged populations in health research is vital to understanding and, ultimately, eliminating health-related disparities. Digital communication channels are increasingly used to recruit study participants, and recent trends indicate a growing need to partner with the social service sector to improve population health. However, few studies have recruited participants from social service settings using multiple digital channels. Objective: This study aimed to recruit and survey 3791 adult clients of a social service organization via telephone and digital channels. This paper aimed to describe recruitment outcomes across five channels and compare participant characteristics by recruitment channel type. Methods: The Cancer Communication Channels in Context Study recruited and surveyed adult clients of 2-1-1, a social service--focused information and referral system, using five channels: telephone, website, text message, web-based live chat, and email. Participants completed surveys administered either by phone (if recruited by phone) or on the web (if recruited from digital channels, ie, website, text message, Web-based live chat, or email). Measures for the current analysis included demographic and health characteristics. Results: A total of 3293 participants were recruited, with 1907 recruited by phone and 1386 recruited from digital channels. Those recruited by phone had a moderate study eligibility rate (42.23\%) and the highest survey completion rate (91.24\%) of all channels. Individuals recruited by text message had a high study eligibility rate (94.14\%) yet the lowest survey completion rate (74.0\%) of all channels. Sample accrual goals were achieved for phone, text message, and website recruitment. Multivariable analyses found differences in participant characteristics by recruitment channel type. Compared with participants recruited by phone, those recruited from digital channels were younger (adjusted odds ratio [aOR] 0.96, 95\% CI 0.96-0.97) and more likely to be female (aOR 1.52, 95\% CI 1.23-1.88), married (aOR 1.52, 95\% CI 1.22-1.89), and other than non-Hispanic black (aOR 1.48, 95\% CI 1.22-1.79). Those recruited via phone also were more likely to have more than a high school education (aOR 2.17, 95\% CI 1.67-2.82), have a household income ?US \$25,000 a year (aOR 2.02, 95\% CI 1.56-2.61), and have children living in the home (aOR 1.26, 95\% CI 1.06-1.51). Additionally, participants recruited from digital channels were less likely than those recruited by phone to have public health insurance (aOR 0.75, 95\% CI 0.62-0.90) and more likely to report better overall health (aOR 1.52, 95\% CI 1.27-1.83 for good-to-excellent health). Conclusions: Findings indicate the feasibility and utility of recruiting socioeconomically disadvantaged adults from the social service sector using multiple communication channels, including digital channels. As social service--based health research evolves, strategic recruitment using a combination of traditional and digital channels may be warranted to avoid underrepresentation of highly medically vulnerable individuals, which could exacerbate disparities in health. ",
doi="10.2196/16680",
url="https://www.jmir.org/2020/4/e16680",
url="http://www.ncbi.nlm.nih.gov/pubmed/32234699"
}


@Article{info:doi/10.2196/15875,
author="Ratanjee-Vanmali, Husmita
and Swanepoel, Wet De
and Laplante-L{\'e}vesque, Ariane",
title="Patient Uptake, Experience, and Satisfaction Using Web-Based and Face-to-Face Hearing Health Services: Process Evaluation Study",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="20",
volume="22",
number="3",
pages="e15875",
keywords="audiology",
keywords="hearing loss",
keywords="internet-based intervention",
keywords="patient outcome assessment",
keywords="patient satisfaction",
keywords="telemedicine",
keywords="text messaging",
keywords="eHealth",
keywords="mHealth",
keywords="social media",
keywords="patient-centered care",
abstract="Background: Globally, access to hearing health care is a growing concern with 900 million people estimated to suffer from disabling hearing loss by 2050. Hearing loss is one of the most common chronic health conditions, yet access to hearing health care is limited. Incorporating Web-based (voice calling, messaging, or emailing) service delivery into current treatment pathways could improve access and allow for better scalability of services. Current electronic health studies in audiology have focused on technical feasibility, sensitivity, and specificity of diagnostic hearing testing and not on patient satisfaction, experiences, and sustainable models along the entire patient journey. Objective: This study aimed to investigate a hybrid (Web-based and face-to-face) hearing health service in terms of uptake, experience, and satisfaction in adult patients with hearing loss. Methods: A nonprofit hearing research clinic using online and face-to-face services was implemented in Durban, South Africa, using online recruitment from the clinic's Facebook page and Google AdWords, which directed persons to an online Web-based hearing screening test. Web-based and face-to-face care pathways included assessment, treatment, and rehabilitation. To evaluate the service, an online survey comprising (1) a validated satisfaction measurement tool (Short Assessment of Patient Satisfaction), (2) a process evaluation of all the 5 steps completed, and (3) personal preferences of communication methods used vs methods preferred was conducted, which was sent to 46 patients who used clinic services. Results: Of the patients invited, 67\% (31/46) completed the survey with mean age 66 years, (SD 16). Almost all patients, 92\% (30/31) reported that the online screening test assisted them in seeking hearing health care. Approximately 60\% (18/31) of the patients accessed the online hearing screening test from an Android device. Patients stayed in contact with the audiologist mostly through WhatsApp instant messaging (27/31, 87\%), and most patients (25/31, 81\%) preferred to use this method of communication. The patients continuing with hearing health care were significantly older and had significantly poorer speech recognition abilities compared with the patients who discontinued seeking hearing health care. A statistically significant positive result (P=.007) was found between age and the number of appointments per patient. Around 61\% (19/31) of patients previously completed diagnostic testing at other practices, with 95\% (18/19) rating the services at the hybrid clinic as better. The net promoter score was 87, indicating that patients were highly likely to recommend the hybrid clinic to friends and family. Conclusions: This study applied Web-based and face-to-face components into a hybrid clinic and measured an overall positive experience with high patient satisfaction through a process evaluation. The findings support the potential of a hybrid clinic with synchronous and asynchronous modes of communication to be a scalable hearing health care model, addressing the needs of adults with hearing loss globally. ",
doi="10.2196/15875",
url="http://www.jmir.org/2020/3/e15875/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32196459"
}


@Article{info:doi/10.2196/13116,
author="Marco-Ruiz, Luis
and Wynn, Rolf
and Oyeyemi, Oluwafemi Sunday
and Budrionis, Andrius
and Yigzaw, Yitbarek Kassaye
and Bellika, Gustav Johan",
title="Impact of Illness on Electronic Health Use (The Seventh Troms{\o} Study - Part 2): Population-Based Questionnaire Study",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="5",
volume="22",
number="3",
pages="e13116",
keywords="eHealth",
keywords="internet",
keywords="search engines",
keywords="mobile apps",
keywords="social media",
abstract="Background: Patients who suffer from different diseases may use different electronic health (eHealth) resources. Thus, those who plan eHealth interventions should take into account which eHealth resources are used most frequently by patients that suffer from different diseases. Objective: The aim of this study was to understand the associations between different groups of chronic diseases and the use of different eHealth resources. Methods: Data from the seventh survey of the Troms{\o} Study (Troms{\o} 7) were analyzed to determine how different diseases influence the use of different eHealth resources. Specifically, the eHealth resources considered were use of apps, search engines, video services, and social media. The analysis contained data from 21,083 participants in the age group older than 40 years. A total of 15,585 (15,585/21,083; 73.92\%) participants reported to have suffered some disease, 10,604 (10,604/21,083; 50.29\%) participants reported to have used some kind of eHealth resource in the last year, and 7854 (7854/21,083; 37.25\%) participants reported to have used some kind of eHealth resource in the last year and suffered (or had suffered) from some kind of specified disease. Logistic regression was used to determine which diseases significantly predicted the use of each eHealth resource. Results: The use of apps was increased among those individuals that (had) suffered from psychological problems (odds ratio [OR] 1.39, 95\% CI 1.23-1.56) and cardiovascular diseases (OR 1.12, 95\% CI 1.01-1.24) and those part-time workers that (had) suffered from any of the diseases classified as others (OR 2.08, 95\% CI 1.35-3.32). The use of search engines for accessing health information increased among individuals who suffered from psychological problems (OR 1.39, 95\% CI 1.25-1.55), cancer (OR 1.26, 95\% CI 1.11-1.44), or any of the diseases classified as other diseases (OR 1.27, 95\% CI 1.13-1.42). Regarding video services, their use for accessing health information was more likely when the participant was a man (OR 1.31, 95\% CI 1.13-1.53), (had) suffered from psychological problems (OR 1.70, 95\% CI 1.43-2.01), or (had) suffered from other diseases (OR 1.43, 95\% CI 1.20-1.71). The factors associated with an increase in the use of social media for accessing health information were as follows: (had) suffered from psychological problems (OR 1.65, 95\% CI 1.42-1.91), working part time (OR 1.35, 95\% CI 0.62-2.63), receiving disability benefits (OR 1.42, 95\% CI 1.14-1.76), having received an upper secondary school education (OR 1.20, 95\% CI 1.03-1.38), being a man with a high household income (OR 1.67, 95\% CI 1.07-2.60), suffering from cardiovascular diseases and having a high household income (OR 3.39, 95\% CI 1.62-8.16), and suffering from respiratory diseases while being retired (OR 1.95, 95\% CI 1.28-2.97). Conclusions: Our findings show that different diseases are currently associated with the use of different eHealth resources. This knowledge is useful for those who plan eHealth interventions as they can take into account which type of eHealth resource may be used for gaining the attention of the different user groups. ",
doi="10.2196/13116",
url="https://www.jmir.org/2020/3/e13116",
url="http://www.ncbi.nlm.nih.gov/pubmed/32134390"
}


@Article{info:doi/10.2196/13120,
author="Yigzaw, Yitbarek Kassaye
and Wynn, Rolf
and Marco-Ruiz, Luis
and Budrionis, Andrius
and Oyeyemi, Oluwafemi Sunday
and Fagerlund, Johansen Asbj{\o}rn
and Bellika, Gustav Johan",
title="The Association Between Health Information Seeking on the Internet and Physician Visits (The Seventh Troms{\o} Study - Part 4): Population-Based Questionnaire Study",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="5",
volume="22",
number="3",
pages="e13120",
keywords="eHealth",
keywords="internet",
keywords="health care service",
keywords="physician visit",
keywords="Troms{\o} study",
keywords="health information seeking",
keywords="Web search engine",
keywords="health app",
keywords="social media",
keywords="video search engine",
abstract="Background: The internet is being widely used for seeking health information. However, there is no consensus on the association between health information seeking on the internet and the use of health care services. Objective: We examined the association between health information seeking via the internet and physician visits. In addition, we investigated the association between online health information seeking and the decisions to visit and not to visit a physician. Methods: We used the cross-sectional electronic health (eHealth) data of 18,197 participants from the seventh survey of the Troms{\o} Study (Troms{\o} 7). The participants were aged ?40 years and living in Troms{\o}, Norway. We used logistic regression models to examine the association between online health information seeking and physician visits, the decision to visit a physician, and the decision not to visit a physician, with adjustment for the demographic status, socioeconomic status, and health status of the participants. Results: The use of Web search engines was associated with a physician visit. However, the association was moderated by age, and the OR decreased as age increased. The ORs for the use of Web search engines were 1.99 (95\% CI 1.94-2.02) and 1.07 (95\% CI 1.03-1.12) at ages 40 and 80 years, respectively. The decision to visit a physician was associated with the use of Web search engines (OR 2.95, 95\% CI 2.03-4.46), video search engines (OR 1.43, 95\% CI 1.21-1.70), and health apps (OR 1.26, 95\% CI 1.13-1.42). The association between social media use and the decision to visit a physician was moderated by gender. Women who used social media had 1.42 (95\% CI 1.31-1.55) times higher odds of deciding to visit a physician, whereas the decision to visit a physician was not different between men who used social media and those who did not use social media. Conversely, the decision not to visit a physician was associated with the use of Web search engines (OR 2.78, 95\% CI 1.92-4.18), video search engines (OR 1.27, 95\% CI 1.07-1.51), social media (OR 1.28, 95\% CI 1.10-1.49), and health apps (OR 1.20, 95\% CI 1.07-1.35). Conclusions: Health information found on the internet was positively associated with both the decision to visit a physician and the decision not to visit a physician. However, the association of health information seeking with the decision to visit a physician was slightly stronger than the association with the decision not to visit a physician. This could imply that the use of eHealth services is associated with a resultant increase in physician visits. In summary, our findings suggest that the internet serves as a supplement to health care services rather than as a replacement. ",
doi="10.2196/13120",
url="https://www.jmir.org/2020/3/e13120",
url="http://www.ncbi.nlm.nih.gov/pubmed/32134387"
}


@Article{info:doi/10.2196/13118,
author="Budrionis, Andrius
and Wynn, Rolf
and Marco-Ruiz, Luis
and Yigzaw, Yitbarek Kassaye
and Bergvik, Svein
and Oyeyemi, Oluwafemi Sunday
and Bellika, Gustav Johan",
title="Impact of the Use of Electronic Health Tools on the Psychological and Emotional Well-Being of Electronic Health Service Users (The Seventh Troms{\o} Study - Part 3): Population-Based Questionnaire Study",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="5",
volume="22",
number="3",
pages="e13118",
keywords="eHealth",
keywords="telemedicine",
keywords="health information",
keywords="Troms{\o} study",
keywords="health-related internet use",
keywords="emotions",
keywords="effect",
keywords="anxious",
keywords="confused",
keywords="knowledgeable",
keywords="reassured",
abstract="Background: Electronic health (eHealth) has been described as a silver bullet for addressing how challenges of the current health care system may be solved by technological solutions in future strategies and visions for modern health care. However, the evidence of its effects on service quality and cost effectiveness remains unclear. In addition, patients' psychological and emotional reactions to using eHealth tools are rarely addressed by the scientific literature. Objective: This study aimed to assess how the psychological and emotional well-being of eHealth service users is affected by the use of eHealth tools. Methods: We analyzed data from a population-based survey in Norway, conducted in the years 2015-2016 and representing 10,604 eHealth users aged over 40 years, to identify how the use of eHealth tools was associated with feeling anxious, confused, knowledgeable, or reassured. Associations between these four emotional outcomes and the use of four types of eHealth services (Web search engines, video search engines, health apps, and social media) were analyzed using logistic regression models. Results: The use of eHealth tools made 72.41\% (6740/9308) of the participants feel more knowledgeable and 47.49\% (4421/9308) of the participants feel more reassured about their health status. However, 25.69\% (2392/9308) reported feeling more anxious and 27.88\% (2595/9308) reported feeling more confused using eHealth tools. A high level of education and not having a full-time job were associated with positive reactions and emotions (feeling more knowledgeable and reassured), whereas low self-reported health status and not having enough friends who could provide help and support predicted negative reactions and emotions (ie, feeling anxious and confused). Overall, the positive emotional effects of eHealth use (feeling knowledgeable and reassured) were relatively more prevalent among users aged over 40 years than the negative emotional effects (ie, feeling anxious and confused). About one-fourth of eHealth users reported being more confused and anxious after using eHealth services. Conclusions: The search for health information on the internet can be motivated by a range of factors and needs (not studied in this study), and people may experience a range of reactions and feelings following health information searching on the Web. Drawing on prior studies, we categorized reactions as positive and negative reactions. Some participants had negative reactions, which is challenging to resolve and should be taken into consideration by eHealth service providers when designing services (ie, including concrete information about how users can get more help and support). There is a need for more studies examining a greater range of reactions to online health information and factors that might predict negative reactions to health information on the Web. ",
doi="10.2196/13118",
url="https://www.jmir.org/2020/3/e13118",
url="http://www.ncbi.nlm.nih.gov/pubmed/32134396"
}


@Article{info:doi/10.2196/16286,
author="Munsell, Michael
and De Oliveira, Emily
and Saxena, Sadhvi
and Godlove, Jason
and Kiran, Swathi",
title="Closing the Digital Divide in Speech, Language, and Cognitive Therapy: Cohort Study of the Factors Associated With Technology Usage for Rehabilitation",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="11",
volume="22",
number="2",
pages="e16286",
keywords="aphasia",
keywords="stroke",
keywords="traumatic brain injury",
keywords="technology",
abstract="Background: For stroke, traumatic brain injury (TBI), and other neurologic conditions associated with speech-language disorders, speech and language therapy is the standard of care for promoting recovery. However, barriers such as clinician time constraints and insurance reimbursement can inhibit a patient's ability to receive the support needed to optimize functional gain. Although digital rehabilitation has the potential to increase access to therapy by allowing patients to practice at home, the clinical and demographic characteristics that impact a patient's level of engagement with technology-based therapy are currently unknown. Objective: This study aimed to evaluate whether the level of engagement with digital therapy differs by various patient characteristics, including age, gender, diagnosis, time from disease onset, and geographic location (urban vs rural). Methods: Data for patients with stroke or TBI that initiated the use of Constant Therapy, a remotely delivered, cloud-based rehabilitation program for patients with speech-language disorders, were retrospectively analyzed. Only data from therapeutic sessions completed at home were included. The following three activity metrics were evaluated: (1) the number of active weeks of therapy, (2) the average number of active therapy days per week, and (3) the total number of therapeutic sessions completed during the first 20 weeks of program access. An active day or week was defined as having at least one completed therapeutic session. Separate multiple linear regression models were performed with each activity measure as the dependent variable and all available patient demographics as model covariates. Results: Data for 2850 patients with stroke or TBI were analyzed, with the average patient completing 8.6 weeks of therapy at a frequency of 1.5 days per week. Contrary to known barriers to technological adoption, older patients were more active during their first 20 weeks of program access, with those aged 51 to 70 years completing 5.01 more sessions than patients aged 50 years or younger (P=.04). Similarly, patients living in a rural area, who face greater barriers to clinic access, were more digitally engaged than their urban counterparts, with rural patients completing 11.54 more (P=.001) sessions during their first 20 weeks of access, after controlling for other model covariates. Conclusions: An evaluation of real-world data demonstrated that patients with stroke and TBI use digital therapy frequently for cognitive and language rehabilitation at home. Usage was higher in areas with limited access to clinical services and was unaffected by typical barriers to technological adoption, such as age. These findings will help guide the direction of future research in digital rehabilitation therapy, including the impact of demographics on recovery outcomes and the design of large, randomized controlled trials. ",
doi="10.2196/16286",
url="https://www.jmir.org/2020/2/e16286"
}


@Article{info:doi/10.2196/11551,
author="Wong, Gordon Kwok Tung
and Liu, Dennis
and Balzan, Ryan
and King, Daniel
and Galletly, Cherrie",
title="Smartphone and Internet Access and Utilization by People With Schizophrenia in South Australia: Quantitative Survey Study",
journal="JMIR Ment Health",
year="2020",
month="Jan",
day="28",
volume="7",
number="1",
pages="e11551",
keywords="schizophrenia",
keywords="schizoaffective disorder",
keywords="internet",
keywords="technology",
keywords="computer",
keywords="smartphone",
abstract="Background: Web-based information and interventions for mental illness are increasingly being provided. There is an expectation that citizens have access to the internet and are competent in using technology. People with schizophrenia are often excluded from social engagement, have cognitive impairment, and have very limited income, all of which may reduce their use of technology. Objective: This study aimed to investigate technology access, use of digital technology, and confidence in using technology among people with schizophrenia living in the community. Methods: Face-to-face structured interviews with 50 people with schizophrenia (aged 18-65 years) living in the northern suburbs of Adelaide, South Australia, were conducted using an instrument designed to assess technology access and utilization. Results: Most participants (42/50, 84\%) owned a mobile phone, but only 58\% (29/50) owned a smartphone. Two-thirds of participants (33/50, 66\%) had access to the internet at home, using a smartphone or computer. Moreover, 40\% (20/50) of participants used the internet at least daily, but 30\% (15/50) of participants had never accessed the internet from any device. Approximately half of the participants (24/50, 48\%) had never used Facebook. Participants rarely used community facilities (eg, libraries and cafes) to access the internet. There were no significant differences (P values ranged from .14 to .70) between younger participants (aged 18-34 years) and older participants (aged 35-64 years) in internet or smartphone access or confidence in using technology. Conclusions: Although the sample size of this study is small, it shows limited technology access, use of digital technology, and confidence in using technology among the participants. This could be a barrier to the online delivery of information and interventions for people with schizophrenia. To better understand the impacts of such technological disadvantage and potential disparities in access and use of online resources, prospective studies should recruit a larger sample size and include control subjects matched for socioeconomic disadvantage. ",
doi="10.2196/11551",
url="https://mental.jmir.org/2020/1/e11551",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012068"
}


@Article{info:doi/10.2196/14241,
author="Bender, L. Jacqueline
and Feldman-Stewart, Deb
and Tong, Christine
and Lee, Karen
and Brundage, Michael
and Pai, Howard
and Robinson, John
and Panzarella, Tony",
title="Health-Related Internet Use Among Men With Prostate Cancer in Canada: Cancer Registry Survey Study",
journal="J Med Internet Res",
year="2019",
month="Nov",
day="19",
volume="21",
number="11",
pages="e14241",
keywords="prostate cancer",
keywords="internet",
keywords="health decision making",
keywords="digital divide",
abstract="Background: After a prostate cancer diagnosis, men want information about their disease and treatment options. The internet offers a convenient means to deliver health information to patients with prostate cancer. However, there are concerns about the use of the internet among this largely senior population. Objective: This study aimed to determine the patterns and factors associated with the use of the internet as a source of health information among Canadian men with prostate cancer and the features and information required in a website. Methods: Population surveys were conducted in four Canadian provinces (British Columbia, Alberta, Saskatchewan, and Ontario) in 2014-2015. Data analyses included descriptive, bivariable, and multivariable analyses. The Pearson Chi-square and univariable regression were used to examine associations between independent variables and health-related internet use. Correlates of health-related internet use were analyzed using multivariable logistic regression. Results: A total of 1362 patients responded across the four provinces. The mean age of respondents was 69 years (SD 8.2). In addition, 82\% (n=1071) were internet users and 71\% (n=910) used the internet daily. Further, 65\% (n=784) used the internet as a source of prostate cancer information, and 40\% (n=521) were confident about using information obtained from the internet to make health decisions. Men who used the internet to obtain prostate cancer information were more likely to be active information seekers (odds ratio [OR]: 4.5, 95\% CI 2.6-7.8), be confident using information from the internet to make health decisions (OR: 3.6, 95\% CI 2.3-5.7), have broadband internet access (OR: 1.8, 95\% CI 1.2-2.7), and have more unmet supportive care needs (OR: 1.05, 95\% CI 1.0-1.1). Top features wanted in a website, reported by more than 50\% of respondents, were a library of resources (n=893, 65.6\%), tools to support treatment decision making (n=815, 59.8\%), and tools to help navigate the prostate cancer journey (n=698, 51.2\%). Top three topics of information wanted in such a website were treatment options (n=916, 67.3\%), disease progression (n=904, 66.4\%), and management of side effects (n=858, 63\%). Conclusions: Over two-thirds of Canadian patients with prostate cancer surveyed use the internet as a source of health information about prostate cancer, but over half did not feel confident using information from the internet to make health decisions. Being an active information seeker, having confidence in using information from the internet to make health decisions, having broadband internet, and having more unmet supportive care needs were significantly associated with health-related internet use. Future work should examine electronic health literacy interventions as a means to boost men's confidence in using information from the internet and design websites that include information and features that help men navigate the prostate cancer journey and support treatment decision making and management of side effects. ",
doi="10.2196/14241",
url="http://www.jmir.org/2019/11/e14241/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31742561"
}


@Article{info:doi/10.2196/14203,
author="Maar, A. Marion
and Beaudin, Valerie
and Yeates, Karen
and Boesch, Lisa
and Liu, Peter
and Madjedi, Kian
and Perkins, Nancy
and Hua-Stewart, Diane
and Beaudin, Faith
and Wabano, Jo Mary
and Tobe, W. Sheldon",
title="Wise Practices for Cultural Safety in Electronic Health Research and Clinical Trials With Indigenous People: Secondary Analysis of a Randomized Clinical Trial",
journal="J Med Internet Res",
year="2019",
month="Nov",
day="4",
volume="21",
number="11",
pages="e14203",
keywords="mobile health",
keywords="process evaluation",
keywords="implementation science",
keywords="Indigenous peoples",
keywords="health care texting",
keywords="SMS",
keywords="hypertension",
keywords="task shifting",
keywords="community-based participatory research",
keywords="DREAM-GLOBAL",
abstract="Background: There is a paucity of controlled clinical trial data based on research with Indigenous peoples. A lack of data specific to Indigenous peoples means that new therapeutic methods, such as those involving electronic health (eHealth), will be extrapolated to these groups based on research with other populations. Rigorous, ethical research can be undertaken in collaboration with Indigenous communities but requires careful attention to culturally safe research practices. Literature on how to involve Indigenous peoples in the development and evaluation of eHealth or mobile health apps that responds to the needs of Indigenous patients, providers, and communities is still scarce; however, the need for community-based participatory research to develop culturally safe technologies is emerging as an essential focus in Indigenous eHealth research. To be effective, researchers must first gain an in-depth understanding of Indigenous determinants of health, including the harmful consequences of colonialism. Second, researchers need to learn how colonialism affects the research process. The challenge then for eHealth researchers is to braid Indigenous ethical values with the requirements of good research methodologies into a culturally safe research protocol. Objective: A recent systematic review showed that Indigenous peoples are underrepresented in randomized controlled trials (RCTs), primarily due to a lack of attention to providing space for Indigenous perspectives within the study frameworks of RCTs. Given the lack of guidelines for conducting RCTs with Indigenous communities, we conducted an analysis of our large evaluation data set collected in the Diagnosing Hypertension-Engaging Action and Management in Getting Lower Blood Pressure in Indigenous Peoples and Low- and Middle- Income Countries (DREAM-GLOBAL) trial over a period of five years. Our goal is to identify wise practices for culturally safe, collaborative eHealth and RCT research with Indigenous communities. Methods: We thematically analyzed survey responses and qualitative interview/focus group data that we collected over five years in six culturally diverse Indigenous communities in Canada during the evaluation of the clinical trial DREAM-GLOBAL. We established themes that reflect culturally safe approaches to research and then developed wise practices for culturally safe research in pragmatic eHealth research. Results: Based on our analysis, successful eHealth research in collaboration with Indigenous communities requires a focus on cultural safety that includes: (1) building a respectful relationship; (2) maintaining a respectful relationship; (3) good communication and support for the local team during the RCT; (4) commitment to co-designing the innovation; (5) supporting task shifting with the local team; and (6) reflecting on our mistakes and lessons learned or areas for improvement that support learning and cultural safety. Conclusions: Based on evaluation data collected in the DREAM-GLOBAL RCT, we found that there are important cultural safety considerations in Indigenous eHealth research. Building on the perspectives of Indigenous staff and patients, we gleaned wise practices for RCTs in Indigenous communities. Trial Registration: ClinicalTrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226 ",
doi="10.2196/14203",
url="https://www.jmir.org/2019/11/e14203",
url="http://www.ncbi.nlm.nih.gov/pubmed/31682574"
}


@Article{info:doi/10.2196/14327,
author="Ashkanani, Hasan
and Asery, Rabab
and Bokubar, Fajer
and AlAli, Noor
and Mubarak, Shahad
and Buabbas, Ali
and Almajran, Abdullah",
title="Web-Based Health Information Seeking Among Students at Kuwait University: Cross-Sectional Survey Study",
journal="JMIR Form Res",
year="2019",
month="Oct",
day="31",
volume="3",
number="4",
pages="e14327",
keywords="Kuwait",
keywords="online",
keywords="health care",
abstract="Background: Owing to the revolution in technology, the internet has become an important aspect of people's lives. Modern technology is enabling people from diverse educational backgrounds to use the internet for several purposes, one of which is health information seeking. Recently, Web-based health information has become more popular among patients all over the world and among the general public. Objective: This study aimed to investigate the use of Web-based health resources among undergraduate students from different faculties at Kuwait University. Methods: The study employed a cross-sectional design with students selected from 8 faculties of Kuwait University, 4 faculties of Literature and 4 faculties of Science. Data were collected using structured questionnaires, and analysis was done using a chi-square test and binary logistic regression to determine the factors associated with seeking health information on the Web. Results: The sample size obtained was 1132 with a response rate of 90.27\% (1132/1254). Overall, the prevalence of students seeking Web-based health information was 92.66\%. (1049/1132) The most significant factors associated with seeking health information on the Web were age, gender, faculty, year of study, primary source of internet, and level of experience with internet use. In total, 90.0\% (325/361) of students who were aged older than 21 years used Web-based health information compared with 82.8\% (275/332) of those who were aged 18 years. In addition, female students showed a higher prevalence (829/934, 88.8\%) of Web-based health information seeking than males (210/270, 77.8\%). Students who majored in faculties of Science were more likely to seek health information than those who majored in faculties of Literature. All the differences found in the study were statistically significant (P<.05). Conclusions: The study concluded that many people use the internet for seeking health information. Sociodemographic factors have a significant association with Web-based health information seeking. Therefore, doctors must educate the public about the health information websites that can be trusted. ",
doi="10.2196/14327",
url="http://formative.jmir.org/2019/4/e14327/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31473592"
}


@Article{info:doi/10.2196/15035,
author="Gerido, Hammond Lynette
and Tang, Xiang
and Ernst, Brittany
and Langford, Aisha
and He, Zhe",
title="Patient Engagement in Medical Research Among Older Adults: Analysis of the Health Information National Trends Survey",
journal="J Med Internet Res",
year="2019",
month="Oct",
day="29",
volume="21",
number="10",
pages="e15035",
keywords="aging",
keywords="health care disparities",
keywords="patient participation",
keywords="medical informatics",
abstract="Background: By 2035, it is expected that older adults (aged 65 years and older) will outnumber children and will represent 78 million people in the US population. As the aging population continues to grow, it is critical to reduce disparities in their representation in medical research. Objective: This study aimed to describe sociodemographic characteristics and health and information behaviors as factors that influence US adults' interest in engaging in medical research, beyond participation as study subjects. Methods: Nationally representative cross-sectional data from the 2014 Health Information National Trends Survey (N=3677) were analyzed. Descriptive statistics and weighted multivariable logistic regression analyses were performed to assess predictors of one's interest in patient engagement in medical research. The independent variables included age, general health, income, race and ethnicity, education level, insurance status, marital status, and health information behaviors. Results: We examined the association between the independent variables and patient interest in engaging in medical research (PTEngage\_Interested). Patient interest in engaging in medical research has a statistically significant association with age (adjusted P<.01). Younger adults (aged 18-34 years), lower middle-aged adults (aged 35-49 years), and higher middle-aged adults (aged 50-64 years) indicated interest at relatively the same frequency (29.08\%, 29.56\%, and 25.12\%, respectively), but older adults (aged ?65 years) expressed less interest (17.10\%) than the other age groups. After the multivariate model was run, older adults (odds ratio 0.738, 95\% CI 0.500-1.088) were found to be significantly less likely to be interested in engaging in medical research than adults aged 50 to 64 years. Regardless of age, the strongest correlation was found between interest in engaging in medical research and actively looking for health information (P<.001). Respondents who did not seek health information were significantly less likely than those who did seek health information to be interested in engaging in medical research. Conclusions: Patients' interest in engaging in medical research vary by age and information-seeking behaviors. As the aging population continues to grow, it is critical to reduce disparities in their representation in medical research. Interest in participatory research methods may reflect an opportunity for consumer health informatics technologies to improve the representation of older adults in future medical research. ",
doi="10.2196/15035",
url="http://www.jmir.org/2019/10/e15035/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31663860"
}


@Article{info:doi/10.2196/14445,
author="Ukoha, P. Erinma
and Feinglass, Joe
and Yee, M. Lynn",
title="Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2019",
month="Sep",
day="23",
volume="21",
number="9",
pages="e14445",
keywords="patient portals",
keywords="socioeconomic factors",
keywords="pregnancy",
keywords="cohort studies",
abstract="Background: Electronic patient portals are websites that provide individuals access to their personal health records and allow them to engage through a secure Web-based platform. These portals are becoming increasingly popular in contemporary health care systems. Patient portal use has been found to be beneficial in multiple specialties, especially in the management of chronic disease. However, disparities have been identified in portal use in which racial and ethnic minorities and individuals with lower socioeconomic status have been shown to be less likely to enroll and use patient portals than non-Hispanic white persons and individuals with higher socioeconomic status. Electronic patient portal use by childbearing women has not been well studied, and data on portal use during pregnancy are limited. Objective: This study aimed to quantify the use of an electronic patient portal during pregnancy and examine whether disparities related to patients' demographics or clinical characteristics exist. Methods: This was a retrospective cohort study of women who received prenatal care at an academic medical center from 2014 to 2016. Clinical records were reviewed for portal use and patient data. Patients were considered enrolled in the portal if they had an account at the time of delivery, and enrollees were compared with nonenrollees. Enrollees were further categorized based on the number of secure messages sent during pregnancy as active (?1) or inactive (0) users. Bivariable chi-square and multivariable Poisson regression models were used to calculate the incidence rate ratio of portal enrollment and, if enrolled, of active use based on patients' characteristics. Results: Of the 3450 women eligible for inclusion, 2530 (73.33\%) enrolled in the portal. Of these enrollees, 72.09\% (1824/2530) were active users. There was no difference in portal enrollment by maternal race and ethnicity on multivariable models. Women with public insurance (adjusted incidence rate ratio; aIRR 0.60, 95\% CI 0.49-0.84), late enrollment in prenatal care (aIRR 0.78, 95\% CI 0.69-0.89 for second trimester and aIRR 0.50, 95\% CI 0.39-0.64 for third trimester), and high-risk pregnancies (aIRR 0.82, 95\% CI 0.75-0.89) were significantly less likely to enroll. Conversely, nulliparity (aIRR 1.10, 95\% CI 1.02-1.20) and having more than 8 prescription medications at prenatal care initiation (aIRR 1.19, 95\% CI 1.06-1.32) were associated with greater likelihood of enrollment. Among portal enrollees, the only factor significantly associated with active portal use (ie, secure messaging) was nulliparity (aIRR 1.11, 95\% CI 1.01-1.23). Conclusions: Among an obstetric population, multiple clinical and socioeconomic factors were associated with electronic portal enrollment, but not subsequent active use. As portals become more integrated as tools to promote health, efforts should be made to ensure that already vulnerable populations are not further disadvantaged with regard to electronic-based care. ",
doi="10.2196/14445",
url="https://www.jmir.org/2019/9/e14445",
url="http://www.ncbi.nlm.nih.gov/pubmed/31586367"
}


@Article{info:doi/10.2196/11998,
author="Tatara, Naoe
and Hammer, Lewi Hugo
and Mirkovic, Jelena
and Kj{\o}llesdal, R{\aa}berg Marte Karoline
and Andreassen, Kristin Hege",
title="Associations Between Immigration-Related User Factors and eHealth Activities for Self-Care: Case of First-Generation Immigrants From Pakistan in the Oslo Area, Norway",
journal="JMIR Public Health Surveill",
year="2019",
month="Aug",
day="16",
volume="5",
number="3",
pages="e11998",
keywords="immigrants",
keywords="type 2 diabetes",
keywords="self-care",
keywords="information-seeking behavior",
keywords="literacy",
keywords="language",
abstract="Background: Immigrant populations are often disproportionally affected by chronic diseases, such as type 2 diabetes mellitus (T2DM). Use of information and communication technology (ICT) is one promising approach for better self-care of T2DM to mitigate the social health inequalities, if designed for a wider population. However, knowledge is scarce about immigrant populations' diverse electronic health (eHealth) activities for self-care, especially in European countries. Objective: With a target group of first-generation immigrants from Pakistan in the Oslo area, Norway, we aimed to understand their diverse eHealth activities for T2DM self-care in relation to immigration-related user factors specific to this target group: proficiency in relevant languages (Urdu, Norwegian, English), length of residence in Norway, and diagnosis of T2DM compared with general user factors (age, gender, education and digital skills, and self-rated health status). Methods: Data were from a survey among the target population (N=176) conducted in 2015-2016. Using logistic regression, we analyzed associations between user factors and experiences of each of the following eHealth activities for T2DM self-care in the last 12 months: first, information seeking by (1) search engines and (2) Web portals or email subscriptions; second, communication and consultation (1) by closed conversation with a few acquaintances using ICT and (2) on social network services; and third, active decision making by using apps for (1) tracking health information and (2) self-assessment of health status. Using Poisson regression, we also assessed the relationship between user factors and variety of eHealth activities experienced. The Bonferroni correction was used to address the multiple testing problem. Results: Regression analyses yielded the following significantly positive associations: between Urdu literacy and (1) information seeking by Web portals or email subscriptions (odds ratio [OR] 2.155, 95\% CI 1.388-3.344), (2) communication and consultation on social network services (OR 5.697, 95\% CI 2.487-13.053), and (3) variety (estimate=0.350, 95\% CI 0.148-0.552); between length of residence in Norway and (1) communication and consultation by closed conversation with a few acquaintances using ICT (OR 1.728, 95\% CI 1.193-2.503), (2) communication and consultation on social network services (OR 2.098, 95\% CI 1.265-3.480), and (3) variety (estimate=0.270, 95\% CI 0.117-0.424); between Norwegian language proficiency and active decision making by using apps for self-assessment of health status (OR 2.285, 95\% CI 1.294-4.036); between education and digital skills and active decision making by using apps for tracking health information (OR 3.930, 95\% CI 1.627-9.492); and between being a female and communication and consultation by closed conversation with a few acquaintances using ICT (OR 2.883, 95\% CI 1.335-6.227). Conclusions: This study implies immigration-related factors may confound associations between general user factors and eHealth activities. Further studies are needed to explore the influence of immigration-related user factors for eHealth activities in other immigrant groups and countries. International Registered Report: RR2-DOI 10.2196/resprot.5468 ",
doi="10.2196/11998",
url="http://publichealth.jmir.org/2019/3/e11998/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31420957"
}


@Article{info:doi/10.2196/13939,
author="L{\'o}pez Segu{\'i}, Francesc
and de San Pedro, Marc
and Aumatell Verges, Eva
and Sim{\'o} Algado, Salvador
and Garcia Cuy{\`a}s, Francesc",
title="An Intergenerational Information and Communications Technology Learning Project to Improve Digital Skills: User Satisfaction Evaluation",
journal="JMIR Aging",
year="2019",
month="Aug",
day="09",
volume="2",
number="2",
pages="e13939",
keywords="active aging",
keywords="digital inclusion",
keywords="ICT program",
keywords="intergenerational relationships",
keywords="civic participation",
keywords="community service",
abstract="Background: ``Digital Partners'' is an intergenerational information and communications technology learning project carried out in the municipalities of Vic and Centelles (Catalonia) from April to May 2018. Within the framework of the introduction of community service as a subject in secondary education, the Centre for Health and Social Studies (University of Vic) created a training space with 38 intergenerational partners (aged 14-15 years and >65 years), with the aim of improving the senior users' digital skills in terms of use of smartphones and tablets, thus helping reduce the digital divide in the territory. Objective: The aim of this paper is to evaluate the satisfaction of both junior and senior participants toward the intervention and to explore its main drivers. Methods: Participants who volunteered to participate in the study were interviewed. Quantitative and qualitative data gathered in paper-based ad hoc surveys were used to assess participants' satisfaction. Results: The experience shows a broad satisfaction of both junior and senior users. The project's strengths include the format of working in couples; randomly pairing individuals by operating system; the ability to practice with the device itself; individuals' free choice to decide what they wish to learn, develop, or practice; and the availability of voluntary practice material that facilitates communication and learning. With regard to aspects that could be improved, there is a need to review the timetabling flexibility of meetings to avoid hurrying the elderly and to extend the project's duration, if necessary. Conclusions: This activity can serve to create mutual learning through the use of mobile devices and generate security and motivation on the part of the seniors, thus reducing the digital divide and improving social inclusion. ",
doi="10.2196/13939",
url="http://aging.jmir.org/2019/2/e13939/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518276"
}


@Article{info:doi/10.2196/14210,
author="Jin, Yinzi
and Jing, Mingxia
and Ma, Xiaochen",
title="Effects of Digital Device Ownership on Cognitive Decline in a Middle-Aged and Elderly Population: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2019",
month="Jul",
day="29",
volume="21",
number="7",
pages="e14210",
keywords="digital access",
keywords="cognitive decline",
keywords="China",
abstract="Background: Cognitive decline is a major risk factor for disability and death and may serve as a precursor of dementia. Digital devices can provide a platform of cognitively stimulating activities which might help to slow cognitive decline during the process of normal aging. Objective: This longitudinal study aimed to examine the independent protective factors of desktop and cellphone ownership against cognitive decline in mid-life and older adulthood and to examine the combined effect of desktop and cellphone ownership on the same outcome. Methods: Data was obtained from a China Health and Retirement Longitudinal Studies (CHARLS) cohort made up of 13,457 community-dwelling adults aged 45 years or above in 2011-2012. They were followed for 4 years, with baseline measurements taken as well as 2 two-year follow-up visits. Cognitive function was tested during the baseline test and follow-up visits. A global cognition z-score was calculated based on two domains: word recall and mental intactness. The key independent variables were defined as: whether one had desktops with internet connection at home and whether one had a cellphone. An additional categorical variable of three values was constructed as: 0 (no desktop or cellphone), 1 (desktop or cellphone alone), and 2 (desktop and cellphone both). Mixed-effects regression was adjusted for demographic and health behavior as well as health condition risk factors. Results: Adjusted for demographic and health behavior as well as health condition risk factors, desktop and cellphone ownership were independently associated with subsequent decreased cognitive decline over the four-year period. Participants without a desktop at home had an adjusted cognitive decline of --0.16 standard deviations (95\% CI --0.18 to --0.15), while participants with a desktop at home had an adjusted cognitive decline of --0.10 standard deviations (95\% CI --0.14 to --0.07; difference of --0.06 standard deviations; P=.003). A similar pattern of significantly protective association of 0.06 standard deviations (95\% CI 0.03-0.10; P<.001) between cellphone ownership and cognitive function was observed over the four-year period. Additionally, a larger longitudinal protective association on cognitive decline was observed among those with both of the digital devices, although the 95\% CIs for the coefficients overlapped with those with a single digital device alone. Conclusions: Findings from this study underscored the importance of digital devices as platforms for cognitively stimulating activities to delay cognitive decline. Future studies focusing on use of digital devices are warranted to investigate their longitudinal protective factors against cognitive decline at mid- and later life. ",
doi="10.2196/14210",
url="http://www.jmir.org/2019/7/e14210/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31359864"
}


@Article{info:doi/10.2196/12546,
author="Stawarz, Katarzyna
and Preist, Chris
and Coyle, David",
title="Use of Smartphone Apps, Social Media, and Web-Based Resources to Support Mental Health and Well-Being: Online Survey",
journal="JMIR Ment Health",
year="2019",
month="Jul",
day="12",
volume="6",
number="7",
pages="e12546",
keywords="mental health",
keywords="mobile apps",
keywords="mHealth",
keywords="social media",
keywords="self-instruction programs, computerized",
abstract="Background: Technology can play an important role in supporting mental health. Many studies have explored the effectiveness, acceptability, or context of use of different types of mental health technologies. However, existing research has tended to investigate single types of technology at a time rather than exploring a wider ecosystem that people may use. This narrow focus can limit our understanding of how we could best design mental health technologies. Objective: The aim of this study was to investigate which technologies (smartphone apps, discussion forums and social media, and websites and Web-based programs) people use to support their mental health and why, whether they combine and use more than one technology, what purpose each technology serves, and which features people find the most valuable. Methods: We conducted an online survey to gather responses from members of the public who use technology to support their mental health and well-being. The survey was advertised on social media and via posters at a university. It explored usage patterns, frequently used features, and engagement with technology. To gain deeper insights into users' preferences, we also thematically analyzed open-ended comments about each technology type and suggestions for improvements provided by the respondents. Results: In total, 81 eligible participants completed the survey. Smartphone apps were the most commonly used technology, with 78\% of the participants (63/81) using them, either alone (40\%) or in combination with other technologies (38\%). Each type of technology was used for specific purposes: apps provided guided activities, relaxation, and enabled tracking; social media and discussion forums allowed participants to learn from the experiences of others and use that knowledge to understand their own situation; and Web-based programs and websites helped to find out how to deal on a day-to-day basis with stress and anxiety. The analysis of open-ended responses showed that although many people valued technology and felt it could support targeted activities, it was not seen as a substitute for traditional face-to-face therapy. Participants wanted technology to be more sophisticated and nuanced, supporting personalized and actionable recommendations. There was evidence that participants mistrusted technology, irrespective of the type, and had broader concerns regarding the impact of overuse of technology. Conclusions: People use different types of technology to support their mental health. Each can serve a specific purpose. Although apps are the most widely used technology, mixing and matching different types of technology is also common. Technology should not be seen as a replacement for traditional psychotherapy, rather it offers new opportunities to support mental health as part of an overall ecosystem. People want technology to be more nuanced and personalized to help them plan informed actions. Future interventions should explore the use of multiple technologies and their combined effects on mental health support. ",
doi="10.2196/12546",
url="http://mental.jmir.org/2019/7/e12546/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31301126"
}


@Article{info:doi/10.2196/13300,
author="Greenberg-Worisek, J. Alexandra
and Kurani, Shaheen
and Finney Rutten, J. Lila
and Blake, D. Kelly
and Moser, P. Richard
and Hesse, W. Bradford",
title="Tracking Healthy People 2020 Internet, Broadband, and Mobile Device Access Goals: An Update Using Data From the Health Information National Trends Survey",
journal="J Med Internet Res",
year="2019",
month="Jun",
day="24",
volume="21",
number="6",
pages="e13300",
keywords="Healthy People 2020",
keywords="digital divide",
keywords="internet",
abstract="Background: As the year 2020 approaches, there is a need to evaluate progress toward the United States government's Healthy People 2020 (HP2020) health information technology and communication objectives to establish baselines upon which Healthy People 2030 objectives can be based. Objective: The aim of this study was to use the National Cancer Institute's (NCI) Health Information National Trends Survey (HINTS) to benchmark progress toward HP2020 goals related to increasing internet access using broadband, and to assess the state of the digital divide for various sociodemographic groups. Methods: We merged and analyzed data from 8 administrations of HINTS (2003-2017). Descriptive statistics were generated, and predicted marginals were calculated using interaction terms between survey year and selected sociodemographic variables of interest, including age, sex, race and ethnicity, income, education, and geography (rural versus urban), to test for differential change over time. Results: The number of users having access to the internet increased between 2003 and 2014 (63.15\% [3982/6358] to 83.41\% [2802/3629]); it remained relatively steady from 2014 to 2017 (81.15\% [2533/3283]). Broadband access increased between 2003 and 2011 (from 32.83\% [1031/3352] to 77.87\% [3375/4405]), but has been declining since (55.93\% [1364/2487] in 2017). Access via cellular network increased between 2008 and 2017 (from 6.86\% [240/4405] to 65.43\% [1436/2489]). Statistically significant disparities in overall internet access were noted in the predicted marginals for age, sex, race and ethnicity, income, and education; for age, sex, income, and geography for broadband access; and for age and sex for cellular network. Conclusions: The targets set forth in HP2020 were met for overall internet access and for internet access via cellular network; however, the target was not met for internet access via broadband. Furthermore, although the digital divide persisted by sociodemographic characteristics, the magnitude of many disparities in access decreased over time. ",
doi="10.2196/13300",
url="http://www.jmir.org/2019/6/e13300/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31237238"
}


@Article{info:doi/10.2196/12693,
author="Li, HongMin
and Xu, Jin
and Li, Lingui
and Meng, Qingyue",
title="Health-Related Internet Use in Hard-to-Reach Populations: Empirical Findings From a Survey in a Remote and Mountainous Province in China",
journal="J Med Internet Res",
year="2019",
month="May",
day="31",
volume="21",
number="5",
pages="e12693",
keywords="eHealth",
keywords="rural population",
keywords="cross-sectional survey",
keywords="China",
abstract="Background: The expanding use of the internet contributes to more effective searches for health-related information and opens up opportunities for direct Web-based communication with health care professionals. However, little is known about how users' characteristics on the demand side influence health-related internet use, especially in remote and rural areas within developing countries. The absence of accurate estimates of users' characteristics and their impact on adaptations of health care services in developing countries constrains focused policy-centered discussions and the design of appropriate policies. Objective: The aim of this study was to assess the prevalence of health-related internet use and to identify its determinants in a remote province in China. Methods: We conducted a cross-sectional survey in June and July of 2018 in Ningxia, located in northwestern China. Rural households were selected by multistage random sampling, and households' key members were interviewed face-to-face at the respondents' home. Dependent variables were whether the households use Web health services or not. Independent variables were chosen based on the Andersen behavioral model. Sociodemographic characteristics were compared between households that used health-related Web services with nonusers. We applied logistic regression models to evaluate multivariate associations between respondents' characteristics and their usage of Web-based health services and obtained odds ratios with 95\% CI. Results: A total of 1354 respondents from rural households were interviewed, of whom 707 (52.22\%) were men. The mean age of the respondents was 44.54 years (SD 10.22). Almost half of the surveyed households (640/1354, 47.27\%) reported using 1 or more Web-based health care services, whereas 37.8\% (502/1354) reported using the internet to obtain health-related information, 15.51\% (210/1354) used the internet to communicate with professionals about health issues, and 7.24\% (98/1354) had engaged in Web-based consultations in the last year. After controlling for potential confounders, households engaged in health-related internet use were found to be wealthier, have higher health demands, and have less geographic access to high-quality health care compared with other households. Conclusions: The internet has become a major health information resource in rural Ningxia. Social structures, family enabling factors, health needs, and characteristics relating to health care access were significant predictors of households' health-related internet use in rural and remote areas in China. Those who belong to older age groups, have low income, and whose education levels do not extend beyond primary school education are significantly less likely to use Web-based health care services and to benefit from Web-based health care programs. A need for continued collaborative efforts involving multiple stakeholders, including communities, Web-based and other health care providers, family members, and the government is needed. ",
doi="10.2196/12693",
url="http://www.jmir.org/2019/5/e12693/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31152526"
}


@Article{info:doi/10.2196/13615,
author="Hansen, Helen Anne
and Bradway, Meghan
and Broz, Jan
and Claudi, Tor
and Henriksen, {\O}ystein
and Wangberg, C. Silje
and {\AA}rsand, Eirik",
title="Inequalities in the Use of eHealth Between Socioeconomic Groups Among Patients With Type 1 and Type 2 Diabetes: Cross-Sectional Study",
journal="J Med Internet Res",
year="2019",
month="May",
day="29",
volume="21",
number="5",
pages="e13615",
keywords="inequalities",
keywords="eHealth",
keywords="internet",
keywords="health care utilization",
keywords="cross-sectional study",
keywords="diabetes mellitus, type 1",
keywords="diabetes mellitus, type 2",
keywords="education",
keywords="income",
keywords="Norway",
abstract="Background: The prevalence of diabetes and the use of electronic health (eHealth) are increasing. People with diabetes need frequent monitoring and follow-up of health parameters, and eHealth services can be highly valuable. However, little is known about the use of eHealth in different socioeconomic groups among people with diabetes. Objective: The aim of this study was to investigate the use of 4 different eHealth platforms (apps, search engines, video services, and social media sites) and the association with socioeconomic status (SES) among people diagnosed with type 1 and type 2 diabetes mellitus (T1D and T2D, respectively). Methods: We used email survey data from 1250 members of the Norwegian Diabetes Association (aged 18-89 years), collected in 2018. Eligible for analyses were the 1063 respondents having T1D (n=523) and T2D (n=545). 5 respondents reported having both diabetes types and thus entered into both groups. Using descriptive statistics, we estimated the use of the different types of eHealth. By logistic regressions, we studied the associations between the use of these types of eHealth and SES (education and household income), adjusted for gender, age, and self-rated health. Results: We found that 87.0\% (447/514) of people with T1D and 77.7\% (421/542) of people with T2D had used 1 or more forms of eHealth sometimes or often during the previous year. The proportion of people using search engines was the largest in both diagnostic groups, followed by apps, social media, and video services. We found a strong association between a high level of education and the use of search engines, whereas there were no educational differences for the use of apps, social media, or video services. In both diagnostic groups, high income was associated with the use of apps. In people with T1D, lower income was associated with the use of video services. Conclusions: This paper indicates a digital divide among people with diabetes in Norway, with consequences that may contribute to sustaining and shaping inequalities in health outcomes. The strong relationship between higher education and the use of search engines, along with the finding that the use of apps, social media, and video services was not associated with education, indicates that adequate communication strategies for audiences with varying education levels should be a focus in future efforts to reduce inequalities in health outcomes. ",
doi="10.2196/13615",
url="http://www.jmir.org/2019/5/e13615/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31144669"
}


@Article{info:doi/10.2196/13951,
author="Anderberg, Peter
and Eivazzadeh, Shahryar
and Berglund, Sanmartin Johan",
title="A Novel Instrument for Measuring Older People's Attitudes Toward Technology (TechPH): Development and Validation",
journal="J Med Internet Res",
year="2019",
month="May",
day="23",
volume="21",
number="5",
pages="e13951",
keywords="technophilia",
keywords="aging",
keywords="internet",
keywords="health technology",
keywords="eHealth",
abstract="Background: The use of health technology by older people is coming increasingly in focus with the demographic changes. Health information technology is generally perceived as an important factor in enabling increased quality of life and reducing the cost of care for this group. Age-appropriate design and facilitation of technology adoption are important to ensure functionality and removal of various barriers to usage. Development of assessment tools and instruments for evaluating older persons' technology adoption and usage as well as measuring the effects of the interventions are of high priority. Both usability and acceptance of a specific technology or service are important factors in evaluating the impact of a health information technology intervention. Psychometric measures are seldom included in evaluations of health technology. However, basic attitudes and sentiments toward technology (eg, technophilia) could be argued to influence both the level of satisfaction with the technology itself as well as the perception of the health intervention outcome. Objective: The purpose of this study is to develop a reduced and refined instrument for measuring older people's attitudes and enthusiasm for technology based on relevant existing instruments for measuring technophilia. A requirement of the new instrument is that it should be short and simple to make it usable for evaluation of health technology for older people. Methods: Initial items for the TechPH questionnaire were drawn from a content analysis of relevant existing technophilia measure instruments. An exploratory factor analysis was conducted in a random selection of persons aged 65 years or older (N=374) on eight initial items. The scale was reduced to six items, and the internal consistency and reliability of the scale were examined. Further validation was made by a confirmatory factor analysis (CFA). Results: The exploratory factor analysis resulted in two factors. These factors were analyzed and labeled techEnthusiasm and techAnxiety. They demonstrated relatively good internal consistency (Cronbach alpha=.72 and .68, respectively). The factors were confirmed in the CFA and showed good model fit ($\chi$28=21.2, $\chi$2/df=2.65, comparative fit index=0.97, adjusted goodness-of-fit index=0.95, root mean square error of approximation=0.067, standardized root mean square residual=0.036). Conclusions: The construed TechPH score showed expected relations to external real-world criteria, and the two factors showed interesting internal relations. Different technophilia personality traits distinguish clusters with different behaviors of adaptation as well as usage of new technology. Whether there is an independent association with the TechPH score against outcomes in health technology projects needs to be shown in further studies. The instrument must also be validated in different contexts, such as other countries. ",
doi="10.2196/13951",
url="http://www.jmir.org/2019/5/e13951/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31124467"
}


@Article{info:doi/10.2196/13679,
author="Guan, Lu
and Peng, Tai-Quan
and Zhu, JH Jonathan",
title="Who is Tracking Health on Mobile Devices: Behavioral Logfile Analysis in Hong Kong",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="23",
volume="7",
number="5",
pages="e13679",
keywords="mobile apps",
keywords="mHealth",
keywords="circadian rhythm",
abstract="Background: Health apps on mobile devices provide an unprecedented opportunity for ordinary people to develop social connections revolving around health issues. With increasing penetration of mobile devices and well-recorded behavioral data on such devices, it is desirable to employ digital traces on mobile devices rather than self-reported measures to capture the behavioral patterns underlying the use of mobile health (mHealth) apps in a more direct and valid way. Objective: The objectives of this study were to (1) assess the demographic predictors of the adoption of mHealth apps; (2) investigate the temporal pattern underlying the use of mHealth apps; and (3) explore the impacts of demographic variables, temporal features, and app genres on the use of mHealth apps. Methods: Logfile data of mobile devices were collected from a representative panel of about 2500 users in Hong Kong. Users' mHealth app activities were analyzed. We first conducted a binary logistic regression analysis to uncover demographic predictors of users' adoption status. Then we utilized a multilevel negative binomial regression to examine the impacts of demographic characteristics, temporal features, and app genres on mHealth app use. Results: It was found that 27.5\% of mobile device users in Hong Kong adopt at least one genre of mHealth app. Adopters of mHealth apps tend to be female and better educated. However, demographic characteristics did not showcase the predictive powers on the use of mHealth apps, except for the gender effect (Bfemale vs Bmale=--0.18; P=.006). The use of mHealth apps demonstrates a significant temporal pattern, which is found to be moderately active during daytime and intensifying at weekends and at night. Such temporal patterns in mHealth apps use are moderated by individuals' demographic characteristics. Finally, demographic characteristics were also found to condition the use of different genres of mHealth apps. Conclusions: Our findings suggest the importance of dynamic perspective in understanding users' mHealth app activities. mHealth app developers should consider more the demographic differences in temporal patterns of mHealth apps in the development of mHealth apps. Furthermore, our research also contributes to the promotion of mHealth apps by emphasizing the differences of usage needs for various groups of users. ",
doi="10.2196/13679",
url="http://mhealth.jmir.org/2019/5/e13679/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31120429"
}


@Article{info:doi/10.2196/12416,
author="Paslakis, Georgios
and Fischer-Jacobs, Josefine
and Pape, Lars
and Schiffer, Mario
and Gertges, Raoul
and Tegtbur, Uwe
and Zimmermann, Tanja
and N{\"o}hre, Mariel
and de Zwaan, Martina",
title="Assessment of Use and Preferences Regarding Internet-Based Health Care Delivery: Cross-Sectional Questionnaire Study",
journal="J Med Internet Res",
year="2019",
month="May",
day="16",
volume="21",
number="5",
pages="e12416",
keywords="telemedicine",
keywords="health care delivery",
keywords="internet",
keywords="eHealth",
keywords="teleconference",
keywords="electronic medical records",
keywords="online psychotherapy",
abstract="Background: There has been an incremental increase in the use of technology in health care delivery. Feasibility, acceptability, and efficacy of interventions based on internet technologies are supported by a growing body of evidence. Objective: The aim of this study was to investigate use and preferences in the general adult population in Germany for remote, internet-based interaction (eg, email, videoconferencing, electronic medical records, apps). Methods: A nationwide cross-sectional questionnaire survey in adults that was representative in terms of age, sex and educational level was carried out. Results: A total of 22.16\% (538/2428) of survey participants reported not using the internet for work or private use. The nonuser phenotype can be described as being older, having lower educational and income status, and living in less populated areas. The majority of participants within the cohort of internet users reported that they would not consider using electronic medical records (973/1849, 52.62\%), apps (988/1854, 53.29\%), or emails to report symptoms (1040/1838, 56.58\%); teleconference with one (1185/1852, 63.98\%) or more experts (1239/1853, 66.86\%); or participate in video psychotherapy (1476/1853, 79.65\%) for the purpose of medical consultation or treatment. Older age and lower educational level were the most robust predictors of assumed future denial of use. Conclusions: Our results point toward low use and preference rates among the general population for the use of telemedicine. It also seems that those who might benefit from telemedical interventions the most, are, in fact, those who are most hesitating. These low use and preference rates of eHealth should be considered prior to designing and providing future telemedical care, supporting the need for easy-to-use, data secure solutions. ",
doi="10.2196/12416",
url="http://www.jmir.org/2019/5/e12416/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31099338"
}


@Article{info:doi/10.2196/13864,
author="Wang, Jing
and Du, Yan
and Coleman, Deidra
and Peck, Michelle
and Myneni, Sahiti
and Kang, Hong
and Gong, Yang",
title="Mobile and Connected Health Technology Needs for Older Adults Aging in Place: Cross-Sectional Survey Study",
journal="JMIR Aging",
year="2019",
month="May",
day="15",
volume="2",
number="1",
pages="e13864",
keywords="mobile health",
keywords="connected health",
keywords="wearable technology",
keywords="remote monitoring",
keywords="independent living",
keywords="aging in place",
abstract="Background: An increasing number of mobile and wearable devices are available in the market. However, the extent to which these devices can be used to assist older adults to age in place remains unclear. Objective: This study aimed to assess older adults' perceptions of using mobile and connected health technologies. Methods: Using a cross-sectional design, a total of 51 participants were recruited from a senior community center. Demographics and usage of mobile or wearable devices and online health communities were collected using a survey questionnaire. Descriptive statistics assessed usage of devices and online health communities. The Fisher exact test was used to examine the relationship between technology usage and having access to a smartphone. Results: The sample was primarily comprised non-Hispanic white (35/51, 69\%), educated (39/51, 76\% any college), and female (36/51, 71\%) participants, with an average age of 70 (SD 8) years. All participants were insured and nearly all lived at home (49/51, 94\%). A total of 86\% (44/51) of the participants had heard of wearable health devices, but only 18 out of 51 (35\%) had ever used them. Over 80\% (42/51) expressed interest in using such devices and were interested in tracking exercise and physical activity (46/51, 90\%), sleep (38/51, 75\%), blood pressure (34/51, 67\%), diet (31/51, 61\%), blood sugar (28/51, 55\%), weight (26/51, 51\%), and fall risk (23/51, 45\%). The greatest concerns about using wearable devices were cost (31/51, 61\%), safety (14/51, 28\%), and privacy (13/51, 26\%); one-fourth (12/51) reported having no concerns. They were mostly interested in sharing data from mobile and connected devices with their health care providers followed by family, online communities, friends, and no one. About 41\% (21/51) of the older adults surveyed reported having ever heard of an online health community, and roughly 40\% (20/51) of the participants reported being interested in joining such a community. Most participants reported having access to a smartphone (38/51, 74\%), and those with such access were significantly more likely to show interest in using a wearable health device (P<.001) and joining an online health community (P=.05). Conclusions: Our findings suggest that, although few older adults are currently using mobile and wearable devices and connected health technologies for managing health, they are open to this idea and are mostly interested in sharing such data with their health care providers. Further studies are warranted to explore strategies to balance the data sharing preference of older adults and how to best integrate mobile and wearable device data with clinical workflow for health care providers to promote healthy aging in place. ",
doi="10.2196/13864",
url="http://aging.jmir.org/2019/1/e13864/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518283"
}


@Article{info:doi/10.2196/11931,
author="Din, Naz Hena
and McDaniels-Davidson, Corinne
and Nodora, Jesse
and Madanat, Hala",
title="Profiles of a Health Information--Seeking Population and the Current Digital Divide: Cross-Sectional Analysis of the 2015-2016 California Health Interview Survey",
journal="J Med Internet Res",
year="2019",
month="May",
day="14",
volume="21",
number="5",
pages="e11931",
keywords="internet",
keywords="digital divide",
keywords="health information",
keywords="patient portals",
keywords="online health information seeking",
keywords="eHealth",
abstract="Background: Internet use for health information is important, given the rise of electronic health (eHealth) that integrates technology into health care. Despite the perceived widespread use of the internet, a persistent ``digital divide'' exists in which many individuals have ready access to the internet and others do not. To date, most published reports have compared characteristics of internet users seeking health information vs nonusers. However, there is little understanding of the differences between internet users seeking health information online and users who do not seek such information online. Understanding these differences could enable targeted outreach for health interventions and promotion of eHealth technologies. Objective: This study aims to assess population-level characteristics associated with different types of internet use, particularly for seeking online health information. Methods: The 2015-2016 California Health Interview Survey datasets were used for this study. Internet use was classified as never used the internet (Never use), ever used the internet but not to search for health information in the last 12 months (Use not for health), and ever used the internet and have used it to search for health information in the last 12 months (Use for health). Weighted multinomial logistic regression was used to assess sociodemographic and health characteristics associated with types of internet use. Findings are reported as odds ratios (ORs) with 95\% CIs. Results: Among 42,087 participants (weighted sample of 29,236,426), 19\% reported Never Use of the internet, 27.9\% reported Use not for health, and 53.1\% reported Use for health. Compared to Never Use individuals, Use for health individuals were more likely to be younger (OR: 0.1, 95\% CI 0.1-0.2 for ?60 years vs <60 years), female (OR: 1.6, 95\% CI 1.3-1.9 compared to males), and non-Hispanic white (OR: 0.54, 95\% CI 0.4-0.7 for Latinos and OR: 0.2, 95\% CI 0.2-0.4 for African Americans) and have a higher socioeconomic status (>400\% of Federal Poverty Guidelines; OR: 1.3, 95\% CI 1.4-2.4). Overall, characteristics for the Use not for health and Use for health groups were similar, except for those with lower levels of education and respondents not having visited a physician in the last year. For these two characteristics, the Use not for health group was more similar to the Never Use group. Conclusions: Our findings indicate that a digital divide characterized by sociodemographic and health information exists across three types of users. Our results are in line with those of previous studies on the divide, specifically with regard to disparities in use and access related to age, race/ethnicity, and socioeconomic status. Disparities in online health-seeking behavior may reflect existing disparities in health care access extending into a new era of health technology. These findings support the need for interventions to target internet access and health literacy among Never Use and Use not for health groups. ",
doi="10.2196/11931",
url="https://www.jmir.org/2019/5/e11931/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094350"
}


@Article{info:doi/10.2196/11364,
author="Mowforth, Daniel Oliver
and Davies, Marshall Benjamin
and Kotter, Reinhard Mark",
title="The Use of Smart Technology in an Online Community of Patients With Degenerative Cervical Myelopathy",
journal="JMIR Form Res",
year="2019",
month="May",
day="09",
volume="3",
number="2",
pages="e11364",
keywords="spinal cord diseases",
keywords="cervical vertebrae",
keywords="spinal osteophytosis",
keywords="spondylosis",
keywords="biomedical technology",
keywords="chronic disease",
keywords="follow-up studies",
abstract="Background: Degenerative cervical myelopathy (DCM) is a prevalent and progressively disabling neurological condition. Treatment is currently limited to surgery, the timing of which is not without controversy. New international guidelines recommend that all patients should undergo lifelong surveillance and those with moderate-to-severe or progressive disease should be offered surgery. Long-term surveillance will place substantial burden on health services and short clinic assessments may risk misrepresenting disease severity. The use of smart technology to monitor disease progression could provide an invaluable opportunity to lessen this burden and improve patient care. However, given the older demographic of DCM, the feasibility of smart technology use is unclear. Objective: The aim of this study was to investigate current usage of smart technology in patients with self-reported DCM to inform design of smart technology apps targeted at monitoring DCM disease progression. Methods: Google Analytics from the patient section of Myelopathy.org, an international DCM charity with a large online patient community, was analyzed over a 1-year period. A total of 15,761 sessions were analyzed. Results: In total, 39.6\% (295/744) of visitors accessed the website using a desktop computer, 35.1\% (261/744) using mobile, and 25.3\% (188/744) using a tablet. Of the mobile and tablet visitors, 98.2\% (441/449) utilized a touchscreen device. A total of 51.3\% (141/275) of mobile and tablet visitors used iPhone Operating System (iOS) and 45.8\% (126/275) used an Android operating system. Apple and Samsung were the most popular smart devices, utilized by 53.6\% (241/449) and 25.8\% (116/449) of visitors, respectively. The overall visitor age was representative of DCM trials. Smart technology was widely used by older visitors: 58.8\% (113/192) of mobile visitors and 84.2\% (96/114) of tablet visitors were aged 45 years or older. Conclusions: Smart technology is commonly used by DCM patients. DCM apps need to be iOS and Android compatible to be accessible to all patients. ",
doi="10.2196/11364",
url="http://formative.jmir.org/2019/2/e11364/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094330"
}


@Article{info:doi/10.2196/13241,
author="Turner, M. Caitlin
and Arayasirikul, Sean
and Trujillo, Dillon
and L{\^e}, Victory
and Wilson, C. Erin",
title="Social Inequity and Structural Barriers to Completion of Ecological Momentary Assessments for Young Men Who Have Sex With Men and Trans Women Living With HIV in San Francisco",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="08",
volume="7",
number="5",
pages="e13241",
keywords="ecological momentary assessment",
keywords="EMA",
keywords="MSM",
keywords="trans women",
keywords="people living with HIV",
keywords="feasibility",
keywords="acceptability",
abstract="Background: Ecological momentary assessments (EMAs) administered via text messaging facilitate real-time data collection. With widespread cell phone access, EMAs are becoming more available to even the most disenfranchised communities, such as those living with HIV. However, structural barriers disproportionately burden young men who have sex with men (MSM) and trans women (TW) living with HIV and threaten participation in HIV research. Objective: We aim to identify structural barriers to completing EMA text surveys nested within a digital HIV care intervention for young MSM and TW living with HIV in San Francisco. Methods: A total of 10,800 EMA text messages were delivered daily over 90 days to 120 participants enrolled in the Health eNav intervention (2017-2018) at the San Francisco Department of Public Health. EMA surveys inquired about participants' daily affect, sexual behaviors, substance use, and treatment adherence. Survey completion was calculated after 30, 60, and 90 days of follow-up. We described characteristics of nonstarters (those who provided less than four complete responses to the first seven EMA surveys) and analyzed structural correlates of days to first weeklong or more EMA survey noncompletion using multivariable Cox proportional hazards regression. Qualitative interviews were used to evaluate the acceptability of EMA surveys. Results: Participants completed 4384 of 10,800 (40.59\%) EMA surveys. Completion of 70\% or more of EMA surveys was attained by 56 of 120 participants (46.7\%) at 30 days of follow-up, 40/120 (33.3\%) at 60 days of follow-up, and 30/120 (25.0\%) by the end of the 90-day study period. Twenty-eight participants (23.3\%) were identified as nonstarters, and were more likely to be recently incarcerated (prevalence ratio [PR] 2.3, 95\% CI 1.3-4.4), forego basic needs for HIV medications (PR 2.4, 95\% CI 1.3-4.5), and be diagnosed with HIV in the last year (PR 2.2, 95\% CI 1.1-4.1). Adjusting for nonstarters, young MSM and TW living in temporary/transitional housing (adjusted hazard ratio [aHR] 1.8, 95\% CI 1.1-3.0), foregoing HIV medications to afford basic needs (aHR 1.7, 95\% CI 1.1-2.7), and having less than a college education (aHR 3.5, 95\% CI 1.4-9.0) had greater hazard of weeklong or more EMA survey noncompletion. Overall, there was high acceptability of the EMA surveys. Conclusions: Although access to and use of technology is increasingly ubiquitous, this analysis demonstrates persisting gaps in EMA completion by socioeconomic factors such as incarceration, education level, housing, and competing needs for young MSM and TW living with HIV in San Francisco. Moreover, those recently diagnosed with HIV were more likely to experience an immediate drop-off in completing EMA surveys. EMAs are feasible for individuals not experiencing social inequity and structural barriers. HIV prevention technologies addressing these barriers and leveraging similar methodology may prove effective for young MSM and TW living with HIV. ",
doi="10.2196/13241",
url="https://mhealth.jmir.org/2019/5/e13241/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31066714"
}


@Article{info:doi/10.2196/10256,
author="Tarver, L. Will
and Haggstrom, A. David",
title="The Use of Cancer-Specific Patient-Centered Technologies Among Underserved Populations in the United States: Systematic Review",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="23",
volume="21",
number="4",
pages="e10256",
keywords="underserved populations",
keywords="medical informatics",
keywords="cancer",
abstract="Background: In the United States, more than 1.6 million new cases of cancer are estimated to be diagnosed each year. However, the burden of cancer among the US population is not shared equally, with racial and ethnic minorities and lower-income populations having a higher cancer burden compared with their counterparts. For example, African Americans have the highest mortality rates and shortest survival rates for most cancers compared with other racial or ethnic groups in the United States. A wide range of technologies (eg, internet-based [electronic health, eHealth] technologies, mobile [mobile health, mHealth] apps, and telemedicine) available to patients are designed to improve their access to care and empower them to participate actively in their care, providing a means to reduce health care disparities; however, little is known of their use among underserved populations. Objective: The aim of this study was to systematically review the current evidence on the use of cancer-specific patient-centered technologies among various underserved populations. Methods: Computer-based search was conducted in the following academic databases: (1) PubMed (cancer subset), (2) MEDLINE, (3) PsycINFO, and (4) CINAHL. We included studies that were peer-reviewed, published in the English language, and conducted in the United States. Each study was individually assessed for relevance, with any disagreements being reconciled by consensus. We used a 3-step inclusion process in which we examined study titles, abstracts, and full-text papers for assessment of inclusion criteria. We systematically extracted information from each paper meeting our inclusion criteria. Results: This review includes 71 papers that use patient-centered technologies that primarily targeted African Americans (n=31), rural populations (n=14), and Hispanics (n=12). A majority of studies used eHealth technologies (n=41) finding them to be leading sources of cancer-related health information and significantly improving outcomes such as screening among nonadherent individuals and increasing knowledge about cancer and cancer screening. Studies on mHealth found that participants reported overall favorable responses to receiving health information via short message service (SMS) text message; however, challenges were experienced with respect to lack of knowledge of how to text among some participants. More complex mobile technologies (eg, a tablet-based risk assessment tool) were also found favorable to use and acceptable among underserved populations; however, they also resulted in more significant barriers, for example, participants expressed concerns regarding security and unfamiliarity with the technology and preferred further instruction and assistance in its use. Conclusions: There is a growing body of literature exploring patient-centered technology and its influence on care of underserved populations. In this review, we find that these technologies seem to be effective, especially when tailored, in improving patient and care-related outcomes. Despite the potential of patient-centered technologies and the receptivity of underserved populations, challenges still exist with respect to their effective use and usability. ",
doi="10.2196/10256",
url="http://www.jmir.org/2019/4/e10256/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31012855"
}


@Article{info:doi/10.2196/11864,
author="Wedd, Joel
and Basu, Mohua
and Curtis, M. Laura
and Smith, Kayla
and Lo, J. Denise
and Serper, Marina
and Wolf, S. Michael
and Parker, Ruth
and Patzer, E. Rachel",
title="Racial, Ethnic, and Socioeconomic Disparities in Web-Based Patient Portal Usage Among Kidney and Liver Transplant Recipients: Cross-Sectional Study",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="22",
volume="21",
number="4",
pages="e11864",
keywords="kidney transplantation",
keywords="liver transplantation",
keywords="patient portal",
keywords="patient engagement",
keywords="healthcare disparities",
abstract="Background: Kidney and liver transplant recipients must manage a complex care regimen after kidney transplant. Although the use of Web-based patient portals is known to improve patient-provider communication and health outcomes in chronic disease populations by helping patients manage posttransplant care, disparities in access to and use of portals have been reported. Little is known about portal usage and disparities among kidney and liver transplant recipients. Objective: The aim of this study was to examine patient racial/ethnic, socioeconomic, and clinical characteristics associated with portal usage among kidney and liver transplant recipients. Methods: The study included all adult kidney and liver transplant recipients (n=710) at a large academic transplant center in the Southeastern United States between March 2014 and November 2016. Electronic medical record data were linked with Cerner portal usage data. Patient portal use was defined as any portal activity (vs no activity) recorded in the Cerner Web-based portal, including viewing of health records, lab results, medication lists, and the use of secure messaging. Multivariable log-binomial regression was used to determine the patient demographic, clinical, and socioeconomic characteristics associated with portal usage, stratified by organ. Results: Among 710 transplant recipients (n=455 kidney, n=255 liver), 55.4\% (252/455) of kidney recipients and 48.2\% (123/255) of liver recipients used the patient portal. Black patients were less likely to use the portal versus white patients among both kidney (57\% black vs 74\% white) and liver (28\% black vs 55\% white) transplant recipients. In adjusted multivariable analyses, kidney transplant recipients were more likely to use the portal if they had higher education; among liver recipients, patients who were white versus black and had higher education were more likely to use the portal. Conclusions: Despite studies showing that patient portals have the potential to benefit transplant recipients as a tool for health management, racial and socioeconomic disparities should be considered before widespread implementation. Transplant centers should include portal training and support to all patients to encourage use, given its potential to improve outcomes. ",
doi="10.2196/11864",
url="https://www.jmir.org/2019/4/e11864/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31008707"
}


@Article{info:doi/10.2196/13050,
author="Curtis, L. Brenda
and Ashford, D. Robert
and Magnuson, I. Katherine
and Ryan-Pettes, R. Stacy",
title="Comparison of Smartphone Ownership, Social Media Use, and Willingness to Use Digital Interventions Between Generation Z and Millennials in the Treatment of Substance Use: Cross-Sectional Questionnaire Study",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="17",
volume="21",
number="4",
pages="e13050",
keywords="social media, mHealth, substance use treatment, digital health, recovery",
keywords="social networking sites",
keywords="substance use disorder",
abstract="Background: Problematic substance use in adolescence and emerging adulthood is a significant public health concern in the United States due to high recurrence of use rates and unmet treatment needs coupled with increased use. Consequently, there is a need for both improved service utilization and availability of recovery supports. Given the ubiquitous use of the internet and social media via smartphones, a viable option is to design digital treatments and recovery support services to include internet and social media platforms. Objective: Although digital treatments delivered through social media and the internet are a possibility, it is unclear how interventions using these tools should be tailored for groups with problematic substance use. There is limited research comparing consumer trends of use of social media platforms, use of platform features, and vulnerability of exposure to drug cues online. The goal of this study was to compare digital platforms used among adolescents (Generation Zs, age 13-17) and emerging adults (Millennials, age 18-35) attending outpatient substance use treatment and to examine receptiveness toward these platforms in order to support substance use treatment and recovery. Methods: Generation Zs and Millennials enrolled in outpatient substance use treatment (n=164) completed a survey examining social media use, digital intervention acceptability, frequency of substance exposure, and substance use experiences. Generation Zs (n=53) completed the survey in July 2018. Millennials (n=111) completed the survey in May 2016. Results: Generation Zs had an average age of 15.66 (SD 1.18) years and primarily identified as male (50.9\%). Millennials had an average age of 27.66 (SD 5.12) years and also primarily identified as male (75.7\%). Most participants owned a social media account (Millennials: 82.0\%, Generation Zs: 94.3\%) and used it daily (Millennials: 67.6\%, Generation Zs: 79.2\%); however, Generation Zs were more likely to use Instagram and Snapchat, whereas Millennials were more likely to use Facebook. Further, Generation Zs were more likely to use the features within social media platforms (eg, instant messaging: Millennials: 55.0\%, Generation Zs: 79.2\%; watching videos: Millennials: 56.8\%, Generation Zs: 81.1\%). Many participants observed drug cues on social media (Millennials: 67.5\%, Generation Zs: 71.7\%). However, fewer observed recovery information on social media (Millennials: 30.6\%, Generation Zs: 34.0\%). Participants felt that social media (Millennials: 55.0\%, Generation Zs: 49.1\%), a mobile phone app (Millennials: 36.9\%, Generation Zs: 45.3\%), texting (Millennials: 28.8\%, Generation Zs: 45.3\%), or a website (Millennials: 39.6\%, Generation Zs: 32.1\%) would be useful in delivering recovery support. Conclusions: Given the high rates of exposure to drug cues on social media, disseminating recovery support within a social media platform may be the ideal just-in-time intervention needed to decrease the rates of recurrent drug use. However, our results suggest that cross-platform solutions capable of transcending generational preferences are necessary and one-size-fits-all digital interventions should be avoided. ",
doi="10.2196/13050",
url="http://www.jmir.org/2019/4/e13050/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30994464"
}


@Article{info:doi/10.2196/10389,
author="Gonzalez, Mariaelena
and Sanders-Jackson, Ashley
and Wright, Tashelle",
title="Web-Based Health Information Technology: Access Among Latinos Varies by Subgroup Affiliation",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="16",
volume="21",
number="4",
pages="e10389",
keywords="information seeking behavior",
keywords="health information technology",
keywords="Hispanic Americans",
keywords="minority health",
abstract="Background: There are significant health technology gaps between Latinos and non-Hispanic whites and between first- and second-generation Latinos. Objective: This study aimed to examine disparities in Web-based health information--seeking behavior (HISB) and patient portal use among Latinos, taking into account nativity and subethnic affiliation. Methods: We analyzed US-born, non-Hispanic whites and Latinos adults (N=49,259) and adult internet users (N=36,214) in the 2015 to 2016 National Health Interview Survey using a binary logistic regression controlling for individual difference level variables. Outcomes were internet use, HISB (health information-seeking online and using a chat group for health information), and patient portal use (using a computer to schedule an appointment, filling a prescription, and communicating with a provider). Results: We found that US-born Mexicans (odds ratio [OR] 0.81, 95\% CI 0.66-0.99), foreign-born Mexicans (OR 0.35, 95\% CI 0.29-0.42), foreign-born Puerto Ricans (OR 0.62, 95\% CI 0.44-0.87), foreign-born Central and South Americans (OR 0.42, 95\% CI 0.33-0.53), and foreign-born other Latinos (OR 0.34, 95\% CI 0.24-0.49) had lower odds of using the internet than US-born non-Hispanic whites. The relationship between subgroup affiliation and Web-based HISB varied by type of technology. US-born Mexicans (OR 0.77, 95\% CI 0.66-0.9), foreign-born Mexicans (OR 0.51, 95\% CI 0.43-0.61), foreign-born Central and South Americans (OR 0.53, 95\% CI 0.43-0.64), and foreign-born other Latinos (OR 0.56, 95\% CI 0.4-0.79) had lower odds of looking up health information online than US-born non-Hispanic whites. Controlling for age, sex, education, income to federal poverty level, and region, foreign-born Central and South Americans (OR 0.61, 95\% CI 0.41-0.92) and foreign-born other Latinos (OR 0.26, 95\% CI 0.1-0.68) had lower odds of filling a prescription using a computer than US-born non-Hispanic whites. Foreign-born Mexicans (OR 0.51, 95\% CI 0.36-0.72) and foreign-born Central and South Americans (OR 0.7, 95\% CI 0.5-0.99) have lower odds of emailing a health care provider than US-born non-Hispanic whites. Posthoc analyses were conducted among Mexican-Americans to see if age was significant in predicting Web-based HISB or other patient portal use. We found individuals aged 18 to 30 years had higher odds of using the internet (OR 3.46, 95\% CI 2.61-4.59) and lower odds of looking up health information online (OR 0.75, 95\% CI 0.58-0.96). A posthoc analysis was conducted among Mexican-Americans to see if nativity predicted Web-based HISB and patient portal use. We found that US-born individuals had higher odds (OR 52.9, 95\% CI 1.2-1.93) of looking up health information online compared with foreign-born individuals. Conclusions: We found Latino subgroups do not use health information channels equally, and attempts to target Latinos should take ethnicity and nativity into account. ",
doi="10.2196/10389",
url="https://www.jmir.org/2019/4/e10389/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30990462"
}


@Article{info:doi/10.2196/11824,
author="Fern{\'a}ndez-Sotos, Patricia
and Fern{\'a}ndez-Caballero, Antonio
and Gonz{\'a}lez, Pascual
and Aparicio, Isabel Ana
and Mart{\'i}nez-Gras, Isabel
and Torio, Iosune
and Dompablo, M{\'o}nica
and Garc{\'i}a-Fern{\'a}ndez, Lorena
and Santos, Luis Jos{\'e}
and Rodriguez-Jimenez, Roberto",
title="Digital Technology for Internet Access by Patients With Early-Stage Schizophrenia in Spain: Multicenter Research Study",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="05",
volume="21",
number="4",
pages="e11824",
keywords="information technology",
keywords="computers",
keywords="internet",
keywords="schizophrenia",
abstract="Background: Digital technology and social networks are part of everyday life in the current internet age, especially among young people. To date, few studies have been published worldwide on the pattern of use of digital technology devices and applications in patients with early-stage schizophrenia and even fewer comparing them with healthy participants (not using data from general population surveys) from the same demographic areas. In Spain, no such study has been carried out. Objective: The aim of this study was to analyze how patients with early-stage schizophrenia use internet and social networks compared with healthy participants matched by age and gender and also to examine which devices are utilized to access internet resources. Methods: A cross-sectional, multicentric study was carried out through a semistructured interview asking about the use of digital technology devices and internet. The sample comprised 90 patients and 90 healthy participants. The semistructured interview was conducted on 30 outpatients and 30 healthy subjects in each of the 3 different cities (Madrid, Alicante, and Cuenca). Student t test was used for continuous variables and chi-square test for categorical variables. In the case of ordinal variables, nonparametric Mann-Whitney U and Kruskal-Wallis H tests for independent samples were performed to compare groups. Results: The results indicated that a large proportion of patients with early-stage schizophrenia have access to different digital devices and use them frequently. In addition, both groups coincide in the order of preference and the purpose for which they use the devices. However, a lower frequency of use of most digital technology devices was detected in patients compared with healthy participants. In the case of some devices, this was due to the impossibility of access and not a lack of interest. Conclusions: To our knowledge, this is the first study to analyze patterns of internet access and use of digital technology devices and applications in Spanish patients with early-stage schizophrenia compared with healthy participants from the same demographic areas. The results on significant access and use of digital technology and internet shown in this cross-sectional study will allow enhanced and more efficient treatment strategies to be planned, utilizing digital technology devices, for patients with early-stage schizophrenia. ",
doi="10.2196/11824",
url="https://www.jmir.org/2019/4/e11824/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30950798"
}


@Article{info:doi/10.2196/10189,
author="Almenara, A. Carlos
and Machackova, Hana
and Smahel, David",
title="Sociodemographic, Attitudinal, and Behavioral Correlates of Using Nutrition, Weight Loss, and Fitness Websites: An Online Survey",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="04",
volume="21",
number="4",
pages="e10189",
keywords="body image",
keywords="compulsive behavior",
keywords="diet",
keywords="feeding and eating disorders",
keywords="individuality",
keywords="internet",
keywords="user-computer interface",
keywords="weight loss",
keywords="social support",
abstract="Background: Nutrition, diet, and fitness are among the most searched health topics by internet users. Besides that, health-related internet users are diverse in their motivations and individual characteristics. However, little is known about the individual characteristics associated with the usage of nutrition, weight loss, and fitness websites. Objective: The aim of this study was to examine the individual factors associated with the usage of nutrition, weight loss, and fitness websites. Methods: An invitation to an online survey was published on 65 websites and discussion forums. In total, we employed data from 623 participants (aged 13 to 39 years, mean 24.11 [SD 5.26]). The measures included frequency of usage of nutrition, weight loss and fitness websites, excessive exercise, eating disorder symptomatology, internalization of the beauty ideal, weight status, and perceived online social support. Participants' data were used as predictors in a base linear regression model. Results: The final model had an acceptable fit ($\chi$210 =14.1; P=.17; root mean square error of approximation=0.03; comparative fit index=0.99; Tucker-Lewis index=0.99). Positive associations were found between usage of (1) nutrition websites and being female, higher levels of excessive exercise, and perceived online social support; (2) weight loss websites and excessive exercise, internalization, being female, eating disorder symptomatology, and being overweight or obese; and (3) fitness websites and levels of excessive exercise, internalization, and frequency of internet use. Conclusions: The results highlighted the importance of individual differences in the usage of health-related websites. ",
doi="10.2196/10189",
url="https://www.jmir.org/2019/4/e10189/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30946018"
}


@Article{info:doi/10.2196/12179,
author="Ernsting, Clemens
and St{\"u}hmann, Mareike Lena
and Dombrowski, U. Stephan
and Voigt-Antons, Jan-Niklas
and Kuhlmey, Adelheid
and Gellert, Paul",
title="Associations of Health App Use and Perceived Effectiveness in People With Cardiovascular Diseases and Diabetes: Population-Based Survey",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Mar",
day="28",
volume="7",
number="3",
pages="e12179",
keywords="mHealth",
keywords="eHealth",
keywords="smartphone",
keywords="telemedicine",
keywords="health literacy",
keywords="chronic disease",
keywords="comorbidity",
keywords="multimorbidity",
abstract="Background: Mobile health apps can help to change health-related behaviors and manage chronic conditions in patients with cardiovascular diseases (CVDs) and diabetes mellitus, but a certain level of health literacy and electronic health (eHealth) literacy may be needed. Objective: The aim of this study was to identify factors associated with mobile health app use in individuals with CVD or diabetes and detect relations with the perceived effectiveness of health apps among app users. Methods: The study used population-based Web-based survey (N=1500) among Germans, aged 35 years and older, with CVD, diabetes, or both. A total of 3 subgroups were examined: (1) Individuals with CVD (n=1325), (2) Individuals with diabetes (n=681), and (3) Individuals with CVD and diabetes (n=524). Sociodemographics, health behaviors, CVD, diabetes, health and eHealth literacy, characteristics of health app use, and characteristics of apps themselves were assessed by questionnaires. Linear and logistic regression models were applied. Results: Overall, patterns of factors associated with health app use were comparable in individuals with CVD or diabetes or both. Across subgroups, about every fourth patient reported using apps for health-related purposes, with physical activity and weight loss being the most prominent target behaviors. Health app users were younger, more likely to be female (except in those with CVD and diabetes combined), better educated, and reported more physical activity. App users had higher eHealth literacy than nonusers. Those users who perceived the app to have a greater effectiveness on their health behaviors tended to be more health and eHealth literate and rated the app to use more behavior change techniques (BCTs). Conclusions: There are health- and literacy-related disparities in the access to health app use among patients with CVD, diabetes, or both, which are relevant to specific health care professionals such as endocrinologists, dieticians, cardiologists, or general practitioners. Apps containing more BCTs had a higher perceived effect on people's health, and app developers should take the complexity of needs into account. Furthermore, eHealth literacy appears to be a requirement to use health apps successfully, which should be considered in health education strategies to improve health in patients with CVD and diabetes. ",
doi="10.2196/12179",
url="http://mhealth.jmir.org/2019/3/e12179/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30920383"
}


@Article{info:doi/10.2196/11726,
author="Oliveira, Pedro
and Zejnilovic, Leid
and Azevedo, Salom{\'e}
and Rodrigues, Maria Ana
and Canh{\~a}o, Helena",
title="Peer Adoption and Development of Health Innovations by Patients: National Representative Study of 6204 Citizens",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="26",
volume="21",
number="3",
pages="e11726",
keywords="citizen",
keywords="patient",
keywords="innovation",
keywords="therapeutics",
keywords="health",
keywords="development",
keywords="adoption",
keywords="physician-patient relations",
keywords="social interactions",
keywords="search engine",
abstract="Background: There is growing evidence that many patients and caregivers innovate by developing new solutions to cope with their health disorders. Given the easy access to vast internet resources and peers globally, it is increasingly important to understand what may influence user innovation and its adoption in health for improving individual well-being and ensuring their safety, in particular, how interactions with peers and physicians or search behavior, along with sociodemographics, may influence the decision to develop a solution or adopt one developed by a peer. Objective: The aim of this paper was to study the development and peer-to-peer adoption of user innovations in health care and identify individual-level factors associated with these processes. Methods: Data were collected via computer-assisted phone survey from a large, random, and representative sample of adult residents in Portugal (N=6204). User innovation questions were added to 1 wave of an ongoing observational, longitudinal, population-based epidemiological study. By asking about individual innovation activity, the sample was split into 3 groups: (1) the developers of health-related solutions for own use (developers), (2) the adopters of solutions developed by other patients or caregivers (peer-to-peer adopters), and (3) the rest of the population. Within the last group, intention to adopt was measured and used as a proxy of future behavior. Regression analysis is used to test the associations. Results: In the population considered in this paper, an estimated 1.3\% (75/6008) reported having developed a solution for own use and 3.3\% reported to have adopted a solution developed by peers. The 3 groups (developers, adopters, and remaining population) have distinctive characteristics. Gender plays an important role in the solution development, as women are less likely to develop one (odds ratio [OR] 0.4, 95\% CI 0.20-0.81; P<.05). Education is positively associated with the development activity (OR 1.13, 95\% CI 1.03-1.24; P<.05) but also with the intentions to adopt a peer-developed solution. Search for health-related information is positively associated with the development, adoption, and the intentions to adopt a solution. Interactions with peers over the internet are rare, but in-person interactions are frequent and have a positive association with the dependent variables in all 3 groups. The results also suggest that trust in doctors represents an important dimension that shapes the attitudes of the population toward peer-developed solutions. Conclusions: This paper demonstrates the importance of the peer community, doctor-patient relationship, citizen's search for information on innovation, and individual attitudes toward peer-to-peer adoption in health care. It stresses the need for a reliable Web-based health-related information and the necessity to deeper understand complex relationships between the need to improve health and fulfill the need and the perception of the health care system. ",
doi="10.2196/11726",
url="http://www.jmir.org/2019/3/e11726/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30912748"
}


@Article{info:doi/10.2196/11421,
author="Sadasivaiah, Shobha
and Lyles, R. Courtney
and Kiyoi, Stephen
and Wong, Piera
and Ratanawongsa, Neda",
title="Disparities in Patient-Reported Interest in Web-Based Patient Portals: Survey at an Urban Academic Safety-Net Hospital",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="26",
volume="21",
number="3",
pages="e11421",
keywords="patient portals",
keywords="vulnerable populations",
keywords="health care disparities",
keywords="safety net hospitals",
keywords="health information technology",
abstract="Background: Offering hospitalized patients' enrollment into a health system's patient portal may improve patient experience and engagement throughout the care continuum, especially across care transitions, but this process is less studied than portal engagement in the ambulatory setting. Patient portal disparities exist and may lead to differences in access or outcomes. As such, it is important to study upstream factors in a typical hospital workflow that could lead to those disparities in safety-net settings. Objective: The objective of this study was to evaluate sociodemographic characteristics associated with interest in a health care system's portal among hospitalized patients and reasons for no interest. Methods: Nurses assessed interest in a Web-based patient portal, expressed by the patient as ``yes'' or ``no,'' as part of the admission nursing assessment among patients at an academic urban safety-net hospital and recorded responses in the electronic health record (EHR), including reasons for no interest. We extracted patient responses from the EHR. Results: Among 23,994 hospitalizations over a 2-year period, 35.90\% (8614/ 23,994) reported an interest in a Web-based portal. Reasons for no interest included the following: not interested/other reason 41.68\% (6410/15,380), no ability to use/access computers/internet 29.59\% (4551/15,380), doesn't speak English 11.15\% (1715/15,380), physically or mentally unable 8.70\% (1338/15,380), does not want to say 8.70\% (1338/15,380), security concerns 0.03\% (4/15,380), and not useful 0.16\% (24/15,380). Among the 16,507 unique patients included in this sample, portal interest was lower in older, African American, non-English speaking, and homeless patient populations. Conclusions: In a safety-net system, patient interest at the time of hospitalization in a Web-based enterprise portal---a required step before enrollment---is low with significant disparities by sociodemographic characteristics. To avoid worsening the digital divide, new strategies are needed and should be embedded within routine workflows to engage vulnerable safety-net patients in the use of Web-based health technologies. ",
doi="10.2196/11421",
url="http://www.jmir.org/2019/3/e11421/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30912747"
}


@Article{info:doi/10.2196/11451,
author="Crouch, Elizabeth
and Gordon, P. Nancy",
title="Prevalence and Factors Influencing Use of Internet and Electronic Health Resources by Middle-Aged and Older Adults in a US Health Plan Population: Cross-Sectional Survey Study",
journal="JMIR Aging",
year="2019",
month="Mar",
day="26",
volume="2",
number="1",
pages="e11451",
keywords="digital divide",
keywords="patient portal",
keywords="information-seeking behavior",
keywords="health education",
keywords="patient preference",
keywords="patient surveys",
abstract="Background: Health care organizations are increasingly using electronic health (eHealth) platforms to provide and exchange health information and advice (HIA). There is limited information about how factors beyond internet access affect use of eHealth resources by middle-aged and older adults. Objective: We aimed to estimate prevalence of use of the internet, health plan patient portal, and Web-based HIA among middle-aged and older adults; investigate whether similar sociodemographic-related disparities in eHealth resource use are found among middle-aged and older adults; and examine how sociodemographic and internet access factors drive disparities in eHealth resource use among adults who use the internet. Methods: We analyzed cross-sectional survey data for 10,920 Northern California health plan members aged 45 to 85 years who responded to a mailed and Web-based health survey (2014-2015). We used bivariate and multivariable analyses with weighted data to estimate prevalence of and identify factors associated with internet use and self-reported past year use of the health plan's patient portal and Web-based HIA resources by middle-aged adults (aged 45 to 65 years; n=5520), younger seniors (aged 65 to 75 years; n=3014), and older seniors (aged 76 to 85 years; n=2389). Results: Although approximately 96\% of middle-aged adults, 92\% of younger seniors, and 76\% of older seniors use the internet to obtain information, about 4\%, 9\%, and 16\%, respectively, require someone's help to do so. The percentages who used the patient portal and Web-based HIA resources were similar for middle-aged adults and younger seniors but lower among older seniors (59.6\%, 61.4\%, and 45.0\% and 47.9\%, 48.4\%, and 37.5\%, respectively). Disparities in use of the internet, patient portal, and Web-based HIA across levels of education and between low and higher income were observed in all age groups, with wider disparities between low and high levels of education and income among seniors. Multivariable analyses showed that for all 3 age groups, educational attainment, ability to use the internet without help, and having 1 or more chronic condition were significant predictors of patient portal and Web-based HIA use after controlling for gender, race/ethnicity, and internet use. Conclusions: Internet use, and especially use without help, significantly declines with age, even within a middle-aged group. Educational attainment is significantly associated with internet use, ability to use the internet without help, and use of patient portal and Web-based HIA resources by middle-aged and older adults. Even among middle-aged and older adult internet users, higher educational attainment and ability to use the internet without help are positively associated with patient portal and Web-based HIA use. Organizations serving middle-aged and older adults should take into account target population characteristics when developing and evaluating uptake of eHealth resources and should consider offering instruction and support services to boost patient engagement. ",
doi="10.2196/11451",
url="http://aging.jmir.org/2019/1/e11451/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518256"
}


@Article{info:doi/10.2196/10019,
author="Cosco, D. Theodore
and Firth, Joseph
and Vahia, Ipsit
and Sixsmith, Andrew
and Torous, John",
title="Mobilizing mHealth Data Collection in Older Adults: Challenges and Opportunities",
journal="JMIR Aging",
year="2019",
month="Mar",
day="19",
volume="2",
number="1",
pages="e10019",
keywords="mHealth",
keywords="older adults",
keywords="data collection",
keywords="digital divide",
doi="10.2196/10019",
url="http://aging.jmir.org/2019/1/e10019/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518253"
}


@Article{info:doi/10.2196/11224,
author="Smail-Crevier, Rachel
and Powers, Gabrielle
and Noel, Chelsea
and Wang, JianLi",
title="Health-Related Internet Usage and Design Feature Preference for E-Mental Health Programs Among Men and Women",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="18",
volume="21",
number="3",
pages="e11224",
keywords="occupational health",
keywords="workplace",
keywords="mental health",
keywords="preventive health program",
keywords="depression",
keywords="internet",
abstract="Background: Major depressive episodes (MDEs) are prevalent in the workplace and affect workers' health and productivity. Therefore, there is a pressing need for innovation in the prevention of MDEs in the workplace. Electronic mental (e-mental) health programs are a cost-effective approach toward the self-management of stress and emotional issues. E-mental health dropout rate, MDE prevalence, and symptoms greatly vary by sex and age. Thus, the development and implementation of e-mental health programs for the prevention of MDEs need to be examined through a sex and age lens to enhance program use and effectiveness. Objective: This study aimed to examine design feature preferences based on sex and age for an e-mental health program targeted toward depression prevention. Methods: Household residents across Canada were contacted using the random digit dialing method. 500 women and 511 men who were 18 years and older and who were at high risk of having MDEs were interviewed. Internet use was assessed using questions from the 2012 Canadian Internet Use Survey conducted by Statistics Canada, and preferred design features of e-mental health program questions were developed by the BroMatters team members. The proportions of likely use of specific features of e-mental health programs in women were estimated and compared with those in men using chi-square tests. The comparisons were made overall and by age groups. Results: Men (181/511, 35.4\%) and women (211/500, 42.2\%) differed significantly in their likelihood of using an e-mental health program. Compared with men (307/489, 62.8\%), women (408/479, 85.2\%) were more likely to use the internet for medical or health-related information. Women were more likely to use the following design features: practices and exercises to help reduce symptoms of stress and depression (350/500, 70.7\%), a self-help interactive program that provides information about stress and work problems (302/500, 61.8\%), the ability to ask questions and receive answers from mental health professionals via email or text message (294/500, 59.9\%), and to receive printed materials by mail (215/500, 43.4\%). Men preferred to receive information in a video game format (156/511, 30.7\%). Younger men (46/73, 63\%) and younger women (49/60, 81\%) were more likely to access a program through a mobile phone or an app, and younger men preferred having access to information in a video game format. Conclusions: Factors such as sex and age influenced design feature preferences for an e-mental health program. Working women who are at high risk for MDEs preferred interactive programs incorporating practice and exercise for reducing stress, quality information about work stress, and some guidance from professionals. This suggests that sex and age should be taken into account when designing e-mental health programs to meet the needs of individuals seeking help via Web-based mental health programs and to enhance their use. ",
doi="10.2196/11224",
url="http://www.jmir.org/2019/3/e11224/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30882361"
}


@Article{info:doi/10.2196/10348,
author="George, C. Goldy
and Iwuanyanwu, C. Eucharia
and Buford, S. Adrianna
and Piha-Paul, A. Sarina
and Subbiah, Vivek
and Fu, Siqing
and Karp, D. Daniel
and Pant, Shubham
and Hinojosa, O. Christina
and Hess, R. Kenneth
and Cleeland, S. Charles
and Bernstam, V. Elmer
and Meric-Bernstam, Funda
and Hong, S. David",
title="Cancer-Related Internet Use and Its Association With Patient Decision Making and Trust in Physicians Among Patients in an Early Drug Development Clinic: A Questionnaire-Based Cross-Sectional Observational Study",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="14",
volume="21",
number="3",
pages="e10348",
keywords="cancer",
keywords="clinical trial",
keywords="doctor",
keywords="early-phase clinical trial",
keywords="internet",
keywords="patient",
keywords="physician",
keywords="patient-physician relationship",
keywords="symptoms",
abstract="Background: The role of cancer-related internet use on the patient-physician relationship has not been adequately explored among patients who are cancer-related internet users (CIUs) in early-phase clinical trial clinics. Objective: We examined the association between cancer-related internet use and the patient-physician relationship and decision making among CIUs in an early drug development clinic. Methods: Of 291 Phase I clinic patients who completed a questionnaire on internet use, 179 were CIUs. Generations were defined by the year of patient's birth: ``millennials'' (after 1990) and ``Generation X/Y'' (1965-1990) grouped as ``Millennials or Generation X/Y''; ``Baby Boomers'' (1946-1964); and ``Greatest or Silent Generation'' (1945 and earlier). Statistical analyses included the Wilcoxon matched-pairs signed-rank test and the Mann-Whitney U test. Results: CIUs were 52\% (94/179) female, 44\% (78/179) were older than 60 years, and 60\% (108/179) had household incomes exceeding US \$60,000. The sources of information on cancer and clinical trials included physicians (171/179, 96\%), the internet (159/179, 89\%), and other clinical trial personnel (121/179, 68\%). For the overall sample and each generation, the median values for trust in referring and Phase I clinical trial physicians among early drug development clinic CIUs were 5 on a 0-5 scale, with 5 indicating ``complete trust.'' CIUs' trust in their referring (5) and phase 1 (5) physicians was higher than CIUs' trust in Web-based cancer-related information (3; P<.001 for both). CIUs who reported visiting the National Cancer Institute (NCI) website, NCI.org, to learn about cancer reported higher levels of trust in Web-based cancer-related information than CIUs who did not use the NCI website (P=.02). Approximately half of CIUs discussed internet information with their doctor. Only 14\% (23/165) of CIUs had asked their physician to recommend cancer-related websites, and 24\% (35/144) of CIUs reported at least occasional conflict between their physician's advice and Web-based information. Conclusions: Despite the plethora of websites related to cancer and cancer clinical trials, patients in early-phase clinical trial settings trust their physicians more than Web-based information. Cancer-related organizations should provide regularly updated links to trustworthy websites with cancer and clinical trial information for patients and providers and educate providers on reliable cancer websites so that they can better direct their patients to appropriate internet content. ",
doi="10.2196/10348",
url="https://www.jmir.org/2019/3/e10348/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30869638"
}


@Article{info:doi/10.2196/11386,
author="Abbott-Garner, Philip
and Richardson, Janet
and Jones, B. Ray",
title="The Impact of Superfast Broadband, Tailored Booklets for Households, and Discussions With General Practitioners on Personal Electronic Health Readiness: Cluster Factorial Quasi-Randomized Control Trial",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="11",
volume="21",
number="3",
pages="e11386",
keywords="eHealth",
keywords="randomized controlled trial",
keywords="digital divide",
keywords="broadband implementation",
keywords="eHealth readiness",
keywords="eHealth inequalities",
keywords="tailored booklet",
keywords="cluster trial",
abstract="Background: Electronic health (eHealth) may improve health outcomes, but many people remain digitally excluded. Personal readiness to use the internet for health may be limited by lack of internet infrastructure, personal skills, social support, service provision, and cost. The impact of interventions to reduce these barriers is unknown. From 2011, the British Government supported the implementation of ``superfast'' broadband (Superfast) across the rural county of Cornwall. This provided the opportunity to assess the impact of interventions at regional, practice, and household levels. Objective: This study aimed to assess the impact of 3 interventions on personal eHealth readiness: (1) regional-level implementation of Superfast, (2) practice-level discussions with general practitioners to encourage greater internet use in health service provision, and (3) household-level tailored booklets providing information to help improve personal skills in eHealth. Methods: This was a cluster quasi-randomized factorial controlled trial. Implementation of Superfast was monitored, and postcodes were classified as having early or late availability. An algorithm selected 78 from 16,385 eligible postcodes to minimize the possibility of overlap between general practices and ensure a balance of urban and rural areas; 1388 households were randomly selected from the 78 postcodes and allocated to the 8 (2 {\texttimes} 2 {\texttimes} 2) study arms. A modified version of the Personal eHealth Readiness Questionnaire was used to compare scores (0 to 10) and 4 components (personal, provision, support, and economic) from baseline (August 2013) to the 18-month follow-up between the 8 arms, to assess the impact of interventions. We compared SDs of scores to assess changes in eHealth inequalities. Results: eHealth readiness improved over 18 months from 4.36 out of 10 to 4.59 out of 10 (t235=4.18; P<.001; CI=0.13 to 0.35), resulting from increases in personal and provision components of the score (t255=3.191; P=.002 and t258=3.410; P=.001). However, there were no significant differences between the 3 interventions, either singly or in combination using intention-to-treat analysis. The proportion of internet users did not significantly increase (79.2\%, 205/259 to 81.5\%, 211/259) and mobile use was significantly greater (50.5\%, 101/199 to 64.8\%, 129/199). There was no change in eHealth inequality. Conclusions: People in Cornwall became more ready to adopt eHealth services, increasing both their personal ability to use eHealth and their methods of access. The implementation of Superfast may have contributed to this; we are certain that our other 2 interventions did not. This increased eHealth readiness did not cause a larger digital divide. The study illustrates the complexity of conducting a randomized controlled trial to assess the impact of interventions at regional, practice, and household levels. Our method may be of use to others. Trial Registration: ClinicalTrials.gov NCT00102401; https://clinicaltrials.gov/ct2/show/NCT02355808 (Archived by WebCite at http://www.webcitation.org/75oEz0E1x) ",
doi="10.2196/11386",
url="http://www.jmir.org/2019/3/e11386/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30855234"
}


@Article{info:doi/10.2196/11279,
author="Powell, John
and Deetjen, Ulrike",
title="Characterizing the Digital Health Citizen: Mixed-Methods Study Deriving a New Typology",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="05",
volume="21",
number="3",
pages="e11279",
keywords="eHealth",
keywords="health information seeking",
keywords="perceived health",
keywords="health service use",
keywords="health outcomes",
keywords="digital divide",
keywords="digital inequalities",
abstract="Background: A key challenge for health systems harnessing digital tools and services is that of digital inclusion. Typically, digital inequalities are conceptualized in relation to unequal access or usage. However, these differences do not fully explain differences in health behavior as a result of health-related internet use. Objective: Our objective was to derive a new typology of health internet users based on their antecedent motivations and enablers, to explain how individuals' different orientations influence their health behavior. Methods: We used a mixed-methods design using (1) qualitative data from 43 semistructured interviews about individuals' general and health-related internet use, and how this influenced their health perception and their help-seeking decisions, and (2) quantitative data from the Oxford Internet Surveys (OxIS), a household survey of 2150 adults in England about their internet use and other characteristics. We used the interview data to identify constructs that described motivations and enablers affecting how internet use shaped respondents' health perception and health service use. We then used these constructs to identify variables in OxIS, which provided a quantitative measure of these constructs. We then undertook a hierarchical cluster analysis of these constructs, using the numerical variables, to derive a proposed typology of health information seekers. Results: Both the qualitative findings and the subsequent cluster analysis suggested the existence of 6 types of individuals, categorized as learners, pragmatists, skeptics, worriers, delegators, and adigitals. Learners had a strong desire to understand health better. They used the internet to make decisions about whether they needed to see a professional and to learn about their and others' health. Pragmatists primarily used the internet to decide whether seeing a doctor was worthwhile. Skeptics were skeptical of physicians and the medical system and valued the internet for solving health problems that doctors may not be able to deal with. Worriers found it difficult to interpret health information online, described health information seeking online as frightening, and reported a critical attitude toward online health information despite seeking it frequently. Delegators comprised nonusers and users valuing the internet as an information source, but not necessarily wanting or being able to use the internet themselves. Adigitals comprised many nonusers, but also users, who did not see the internet as a useful information tool and presented strong views on its low suitability for health care. Conclusions: This research supports a shift in the understanding of the digital divide in health, away from only access and usage issues, toward also conceptualizing an outcomes divide, whereby different types of health behavior result from the differing orientations of internet users accessing online health information. This new typology can be used to inform digital inclusion policies in health systems. ",
doi="10.2196/11279",
url="https://www.jmir.org/2019/3/e11279/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30835238"
}


@Article{info:doi/10.2196/11240,
author="Madrigal, Lillian
and Escoffery, Cam",
title="Electronic Health Behaviors Among US Adults With Chronic Disease: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="05",
volume="21",
number="3",
pages="e11240",
keywords="information seeking behavior",
keywords="chronic disease",
keywords="health promotion",
keywords="eHealth",
keywords="mobile apps",
keywords="patient portals",
abstract="Background: With increased access to technology and the internet, there are many opportunities for utilizing electronic health (eHealth), internet, or technology-delivered health services and information for the prevention and management of chronic diseases. Objective: The aim of this paper was to explore (1) the differences in technology use, (2) Web-based health information seeking and use behaviors, (3) attitudes toward seeking health information on the Web, and (4) the level of eHealth literacy between adults aged 18 and 64 years with and without chronic disease. Methods: A cross-sectional internet survey was conducted in March 2017 with 401 US adults. Participant responses were examined to understand associations between chronic disease status and eHealth behaviors such as internet health-seeking behaviors and Web-based behaviors related to health, tracking health indicators with a mobile app, patient portal use, and preferences for health information. Results: About 1 in 3 (252/401, 37.2\%) participants reported at least 1 chronic disease diagnosis. Seventy-five percent (301/401) of all participants reported having ever searched for health information on the Web. Participants with a chronic disease reported significantly higher instances of visiting and talking to a health care provider based on health information found on the Web (40.0\% [48/120] vs 25.8\% [46/178], $\chi$22=6.7; P=.01; 43.3\% [52/120] vs 27.9\% [50/179]; $\chi$22=7.6; P=.006). The uses of health information found on the Web also significantly differed between participants with and without chronic diseases in affecting a decision about how to treat an illness or condition (49.2\% [59/120] vs 35.0\% [63/180], $\chi$23=6.7; P=.04), changing the way they cope with a chronic condition or manage pain (40.8\% [49/120] vs 19.4\% [35/180], $\chi$22=16.3; P<.001), and leading them to ask a doctor new questions or get a second opinion (37.5\% [45/120] vs 19.6\% [35/179], $\chi$22=11.8; P<.001). Chronic disease participants were significantly more likely to be tracking health indicators (43.9\% [65/148] vs 28.3\%, [71/251] $\chi$22=10.4; P=.006). In addition, participants with chronic disease diagnosis reported significantly higher rates of patient portal access (55.0\% [82/149] vs 42.1\% [106/252], $\chi$22=6.3; P=.01) and use (40.9\% [61/149] vs 21.0\% [53/252], $\chi$22=18.2; P<.001). Finally, both groups reported similar perceived skills in using the internet for health information on the eHealth Literacy Scale (eHEALS). The majority of participants responded positively when asked about the usefulness of health information and importance of accessing health resources on the Web. Conclusions: The high rates of reported information seeking and use of internet-based health technology among participants with chronic disease may reflect the uptake in eHealth to help manage chronic disease conditions. Health care providers and educators should continue to seek ways to interact and support patients in their management of chronic disease through eHealth platforms, including capitalizing on Web-based resources, patient portals, and mobile phone apps for disease education and monitoring. ",
doi="10.2196/11240",
url="https://www.jmir.org/2019/3/e11240/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30835242"
}


@Article{info:doi/10.2196/11404,
author="Leary, P. Miriam
and Clegg, N. Emily
and Santella, E. Madison
and Murray, J. Pamela
and Downs, S. Julie
and Olfert, D. Melissa",
title="Consumption of Health-Related Content on Social Media Among Adolescent Girls: Mixed-Methods Pilot Study",
journal="JMIR Form Res",
year="2019",
month="Mar",
day="01",
volume="3",
number="1",
pages="e11404",
keywords="adolescent",
keywords="female",
keywords="social media",
keywords="health information",
keywords="health behaviors",
abstract="Background: Consumption of health- and fitness-related social media content is a predominant behavior among teenage girls, which puts them at risk for consuming unreliable health-related information. Objective: This mixed-methods study (qualitative and quantitative) assessed health behavior attitudes and practices as well as social media use among adolescent girls. Additionally, similar practices and behaviors of adults who regularly interact with this population were studied. Methods: Girls aged 12-18 years were recruited to complete a 28-item survey and participate in a 45- to 60-minute focus group. Adults who regularly interact with adolescent girls, including parents, teachers, and healthcare professionals, were recruited from the local community and given a link to provide online consent and complete a survey. Results: A total of 27 adolescent girls participated in one of nine focus groups. Participants included 18 high school (age: mean 16.1 years; SD 1.3 years) and 9 middle school (age: mean 12.4 years; SD 0.7 years) girls. Eleven adults completed the online survey. Adolescents used social media to communicate and connect with friends, rather than as a source of health information. Although adolescents may see health-related content, most do not follow health-related pages or share such pages themselves, and fewer are actively searching for this information. Adolescents tend to trust information from familiar sources, and the participants reported that they do not follow official news accounts. Adults considered modeling and discussing healthy behaviors important and reportedly expected adolescents to see some level of health-related, especially fitness-related, content on social media. Conclusions: Education interventions are warranted for both adolescents and adults with whom adolescent girls regularly interact, in the areas of sedentary behavior to guide them to access reliable online health-related information and be judicious consumers of online health information. ",
doi="10.2196/11404",
url="http://formative.jmir.org/2019/1/e11404/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30821696"
}


@Article{info:doi/10.2196/11146,
author="Potemkowski, Andrzej
and Brola, Waldemar
and Ratajczak, Anna
and Ratajczak, Marcin
and Zaborski, Jacek
and Jasi?ska, El?bieta
and Pokryszko-Dragan, Anna
and Gruszka, Ewa
and Dubik-Jezierza?ska, Marta
and Podlecka-Pi?towska, Aleksandra
and Nojszewska, Monika
and Gospodarczyk-Szot, Krystyna
and St?pie?, Adam
and Gocy?a-Dudar, Katarzyna
and Maci?gowska-Terela, Marzena
and Wencel, Jacek
and Ka?mierski, Rados?aw
and Ku?akowska, Alina
and Kapica-Topczewska, Katarzyna
and Pawe?czak, Witold
and Bartosik-Psujek, Halina",
title="Internet Usage by Polish Patients With Multiple Sclerosis: A Multicenter Questionnaire Study",
journal="Interact J Med Res",
year="2019",
month="Feb",
day="01",
volume="8",
number="1",
pages="e11146",
keywords="multiple sclerosis",
keywords="internet",
keywords="information seeking",
keywords="doctor-patient relationship",
abstract="Background: The internet is a source of knowledge and medium widely used in services that facilitate access to information and networking. Multiple sclerosis (MS) patients find the possibility of acquiring information relating to their condition particularly rewarding. Objective: We aimed to identify Polish MS patients' preferences by analyzing a percentage of internet users and determining the most common search subjects and patients' approach to information on the internet. Disability connected with the condition, its duration, and other factors that influence patients' internet use were examined along with instances of relations established through the internet and their durability. Methods: The study examined 1045 patients (731 women, 314 men) treated in 10 Polish MS centers, of whom 932 (89.19\%) declared to be internet users. Their average age was 40.65 (SD 11.06) and average MS duration was 9.08 (SD 6.97) years. The study used a proprietary survey on information seeking, the range of searched subjects, and internet usage frequency. Results: The majority of the patients (494/932, 53.0\%) used the internet 6-7 times per week and 4.3\% (40/932) declared they spent minimum 2 hours per day. The most commonly searched subjects were world news (604/932, 72.9\% of patients using the internet); 60.8\% (504/932) searched for information on their condition, particularly for new treatment methods (562/932, 67.8\%) and the course of illness (520/932, 62.7\%). One's sex had no impact on internet usage (female vs male, odds ratio [OR] 1.13, 95\% CI 0.72-1.77), although a patient's age might, at varying degrees. We found several significant associations using a .05 significance level: a patient with higher education used the internet 9 times more often than one with primary education (OR 8.64, 95\% CI 3.31-22.57); lasting relationships increased chances of internet usage by 10-fold compared to widowers (OR 0.12, 95\% CI 0.05-0.31); living in a city with a population over 100,000 increased chances by nearly 6 times compared with the countryside (OR 5.59, 95\% CI 2.72-11.48); the relapsing-remitting MS type saw a 2-fold increase compared with the primary progressive MS type (OR 0.47, 95\% CI 0.29-0.75); and those needing assistance were 2 times less likely to use the internet than patients who could move independently (OR 0.53, 95\% CI 0.31-0.89). More than half  of the patients (489/932, 52.5\%) did not discuss the information found on the internet with their neurologists; 15.9\% (148/932) believed that relationships established through the internet can be stable. Conclusions: The majority of Polish patients use the internet as a crucial information source on their condition and innovative treatment methods. The internet can be helpful in establishing new relationships, which are usually short-lived. Polish patients do not frequently discuss the information gathered on the internet with their doctors. ",
doi="10.2196/11146",
url="https://www.i-jmr.org/2019/1/e11146/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30707107"
}


@Article{info:doi/10.2196/11280,
author="Jin, Yinzi
and Jing, Mingxia
and Zhang, Luyu
and Song, Suhang
and Ma, Xiaochen",
title="Internet Access and Hypertension Management Among the Elderly Population: A Nationally Representative Cross-Sectional Survey in China",
journal="J Med Internet Res",
year="2019",
month="Jan",
day="31",
volume="21",
number="1",
pages="e11280",
keywords="China",
keywords="health disparity",
keywords="hypertension",
keywords="internet",
abstract="Background: Hypertension is a rapidly growing epidemic in China. Yet, it remains inadequately controlled, especially in rural areas. The internet has shown potential for better health management in different settings; however, few studies have investigated its role in hypertension management in China. Objective: This study aims to examine the association between internet access and hypertension awareness, treatment, and control among elderly Chinese adults and to investigate whether the association between internet access and hypertension management differed between those living in urban and rural areas. Methods: We obtained data from the nationally representative survey of the China Health and Retirement Longitudinal Study in 2011. Hypertension was defined as (1) average systolic blood pressure of ?140 mm Hg or average diastolic blood pressure of ?90 mm Hg or (2) currently taking antihypertensive medications. The outcome assessed included hypertension awareness, treatment, and control. The key independent variable was defined as whether one had internet access at home. We performed multivariate logistic regressions for each of the 3 outcomes. Results: Among 5135 hypertensive respondents (age 62.4 [SD 9.9] years; 2351/5135, 45.78\% men), 12.89\% (662/5135) had internet access at home. Compared with those who had no internet access, internet access was positively associated with hypertension awareness (odds ratio [OR] 1.36, 95\% CI 1.07-1.73) and treatment (OR 1.38, 95\% CI 1.09-1.75), but not with control (OR 1.19, 95\% CI 0.90-1.58). Internet access reduced urban-rural disparity in hypertension awareness by 9.6\% (P=.02), treatment by 8.3\% (P=.05), but not in control. In addition, the moderating effect of internet access on urban-rural disparities in hypertension management was larger among females. The decreased urban-rural disparities were primarily driven by that internet access improved the management level in rural areas. Conclusions: Despite the low rate of internet access among the elderly population, the internet shows its potential as a platform for achieving better hypertension management in China. Strategies for reducing the disparities in hypertension management and overall disease burden of hypertension among the elderly population might consider the internet as a platform. ",
doi="10.2196/11280",
url="http://www.jmir.org/2019/1/e11280/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30702439"
}


@Article{info:doi/10.2196/11898,
author="Strain, Tessa
and Wijndaele, Katrien
and Brage, S{\o}ren",
title="Physical Activity Surveillance Through Smartphone Apps and Wearable Trackers: Examining the UK Potential for Nationally Representative Sampling",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="29",
volume="7",
number="1",
pages="e11898",
keywords="adult",
keywords="exercise",
keywords="fitness trackers",
keywords="health surveys",
keywords="smartphone",
keywords="surveys and questionnaires",
keywords="United Kingdom",
keywords="mobile phone",
abstract="Background: Smartphones and wearable activity trackers present opportunities for large-scale physical activity (PA) surveillance that overcome some limitations of questionnaires or researcher-administered devices. However, it remains unknown whether current users of such technologies are representative of the UK population. Objective: The objective of this study was to investigate potential sociodemographic biases in individuals using, or with the potential to use, smartphone apps or wearable activity trackers for PA surveillance in the United Kingdom. Methods: We used data of adults (aged ?16 years) from two nationally representative surveys. Using the UK-wide 2018 Ofcom Technology Tracker (unweighted N=3688), we derived mutually adjusted odds ratios (ORs; 95\% CI) of personal use or household ownership of a smartwatch or fitness tracker and personal use of a smartphone by age, sex, social grade, activity- or work-limiting disability, urban or rural, and home nation. Using the 2016 Health Survey for England (unweighted N=4539), we derived mutually adjusted ORs of the use of wearable trackers or websites or smartphone apps for weight management. The explanatory variables were age, sex, PA, deprivation, and body mass index (BMI). Furthermore, we stratified these analyses by BMI, as these questions were asked in the context of weight management. Results: Smartphone use was the most prevalent of all technology outcomes, with 79.01\% (weighted 2085/2639) of the Technology Tracker sample responding affirmatively. All other outcomes were <30\% prevalent. Age ?65 years was the strongest inverse correlate of all outcomes (eg, OR 0.03, 95\% CI 0.02-0.05 for smartphone use compared with those aged 16-44 years). In addition, lower social grade and activity- or work-limiting disability were inversely associated with all Technology Tracker outcomes. Physical inactivity and male sex were inversely associated with both outcomes assessed in the Health Survey for England; higher levels of deprivation were only inversely associated with websites or phone apps used for weight management. The conclusions did not differ meaningfully in the BMI-stratified analyses, except for deprivation that showed stronger inverse associations with website or phone app use in the obese. Conclusions: The sole use of PA data from wearable trackers or smartphone apps for UK national surveillance is premature, as those using these technologies are more active, younger, and more affluent than those who do not. ",
doi="10.2196/11898",
url="http://mhealth.jmir.org/2019/1/e11898/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30694198"
}


@Article{info:doi/10.2196/11481,
author="Lupton, Deborah
and Maslen, Sarah",
title="How Women Use Digital Technologies for Health: Qualitative Interview and Focus Group Study",
journal="J Med Internet Res",
year="2019",
month="Jan",
day="25",
volume="21",
number="1",
pages="e11481",
keywords="digital health",
keywords="websites",
keywords="online forums",
keywords="social media",
keywords="apps",
keywords="wearable devices",
keywords="women",
keywords="Australia",
keywords="feminist new materialism",
keywords="qualitative research",
abstract="Background: A range of digital technologies are available to lay people to find, share, and generate health-related information. Few studies have directed attention specifically to how women are using these technologies from the diverse array available to them. Even fewer have focused on Australian women's use of digital health. Objective: The Australian Women and Digital Health Project aimed to investigate which types of digital technologies women used regularly for health-related purposes and which they found most helpful and useful. Qualitative methods---semistructured interviews and focus groups---were employed to shed light on the situated complexities of the participants' enactments of digital health technologies. The project adopted a feminist new materialism theoretical perspective, focusing on the affordances, relational connections, and affective forces that came together to open up or close off the agential capacities generated with and through these enactments. Methods: The project comprised two separate studies including a total of 66 women. In study 1, 36 women living in the city of Canberra took part in face-to-face interviews and focus groups, while study 2 involved telephone interviews with 30 women from other areas of Australia. Results: The affordances of search engines to locate health information and websites and social media platforms for providing information and peer support were highly used and valued. Affective forces such as the desire for trust, motivation, empowerment, reassurance, control, care, and connection emerged in the participants' accounts. Agential capacities generated with and through digital health technologies included the capacity to seek and generate information and create a better sense of knowledge and expertise about bodies, illness, and health care, including the women's own bodies and health, that of their families and friends, and that of their often anonymous online social networks. The participants referred time and again to appreciating the feelings of agency and control that using digital health technologies afforded them. When the technologies failed to work as expected, these agential capacities were not realized. Women responded with feelings of frustration, disappointment, and annoyance, leading them to become disenchanted with the possibilities of the digital technologies they had tried. Conclusions: The findings demonstrate the nuanced and complex ways in which the participants were engaging with and contributing to online sources of information and using these sources together with face-to-face encounters with doctors and other health care professionals and friends and family members. They highlight the lay forms of expertise that the women had developed in finding, assessing, and creating health knowledges. The study also emphasized the key role that many women play in providing advice and health care for family members not only as digitally engaged patients but also as digitally engaged carers. ",
doi="10.2196/11481",
url="http://www.jmir.org/2019/1/e11481/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30681963"
}


@Article{info:doi/10.2196/11454,
author="Laws, Rachel
and Walsh, D. Adam
and Hesketh, D. Kylie
and Downing, L. Katherine
and Kuswara, Konsita
and Campbell, J. Karen",
title="Differences Between Mothers and Fathers of Young Children in Their Use of the Internet to Support Healthy Family Lifestyle Behaviors: Cross-Sectional Study",
journal="J Med Internet Res",
year="2019",
month="Jan",
day="23",
volume="21",
number="1",
pages="e11454",
keywords="child",
keywords="family",
keywords="healthy lifestyle",
keywords="infant",
keywords="internet",
keywords="obesity",
keywords="parents",
abstract="Background: In early life, both mothers and fathers are important influences on their children's diet, active play, and obesity risk. Parents are increasingly relying on the internet and social media as a source of information on all aspects of parenting. However, little is known about the use of Web-based sources of information relevant to family lifestyle behaviors and, in particular, differences between mothers' and fathers' use and sociodemographic predictors. Objective: The objective of this study was to examine if mothers and fathers differ in their use of the internet for information on their own health and their child's health, feeding, and playing and to examine sociodemographic predictors of the use of the internet for information on these topics. Methods: We conducted a secondary analysis on data collected from mothers (n=297) and fathers (n=207) participating in the extended Infant Feeding, Activity and Nutrition Trial (InFANT Extend) when their children were 36 months of age. The main outcome variables were the use of the internet for information gathering for parents' own health and child health, feeding, and playing. Binary logistic regression was used to examine the sociodemographic predictors of outcomes. Results: Compared with fathers (n=296), a higher proportion of mothers (n=198) used the internet for information on their own health (230, 78.5\% vs 93, 46.5\%), child health (226, 77.1\% vs 84, 42.4\%), child feeding (136, 46.3\% vs 35, 17.5\%), and child play (123, 42.1\% vs 28, 14.0\%) and intended to use Facebook to connect with other parents (200, 74.9\% vs 43, 30.5\%). Despite the high use of the internet to support family health behaviors, only 15.9\% (47/296) of mothers reported consulting health practitioners for advice and help for their own or their child's weight, diet, or physical activity. Sociodemographic predictors of internet use differed between mothers and fathers and explained only a small proportion of the variance in internet use to support healthy family lifestyle behaviors. Conclusions: Our findings support the use of the internet and Facebook as an important potential avenue for reaching mothers with information relevant to their own health, child health, child diet, and active play. However, further research is required to understand the best avenues for engaging fathers with information on healthy family lifestyle behaviors to support this important role in their child's life. Trial Registration: ISRCTN Registry ISRCTN81847050; http://www.isrctn.com/ISRCTN81847050 ",
doi="10.2196/11454",
url="http://www.jmir.org/2019/1/e11454/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30674450"
}


@Article{info:doi/10.2196/10242,
author="Mosconi, Paola
and Radrezza, Silvia
and Lettieri, Emanuele
and Santoro, Eugenio",
title="Use of Health Apps and Wearable Devices: Survey Among Italian Associations for Patient Advocacy",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="15",
volume="7",
number="1",
pages="e10242",
keywords="health apps",
keywords="mobile phone",
keywords="Web-based survey",
keywords="patients' health care advocacy associations",
keywords="wearable devices",
abstract="Background: Technological tools such as Web-based social networks, telemedicine, apps, or wearable devices are becoming more widespread in health care like elsewhere. Although patients are the main users, for example, to monitor symptoms and clinical parameters or to communicate with the doctor, their perspective is seldom analyzed, and to the best of our knowledge, no one has focused on the patients' health care advocacy associations' point of view. Objective: The objective of this study was to assess patients' health care advocacy associations' opinions about the use, usefulness, obstacles, negative aspects, and impact of health apps and wearable devices through a Web-based survey. Methods: We conducted a Web-based survey through SurveyMonkey over nearly 3 months. Participants were contacted via an email explaining the aims of the survey and providing a link to complete the Web-based questionnaire. All the 20 items were mandatory, and the anonymized data were collected automatically into a database. Only fully completed questionnaires were considered for analysis. Results: We contacted 1998 patients' health care advocacy associations; a total of 258 questionnaires were received back (response rate 12.91\%), and 227 of the received questionnaires were fully completed (completion rate 88.0\%). Informative apps, hospital apps for viewing medical reports or booking visits, and those for monitoring physical activity are the most used. They are considered especially useful to improve patients' engagement and compliance with treatment. Wearable devices to check physical activity and glycemia are the most widespread considering, again, their benefits in increasing patients' involvement and treatment compliance. For health apps and wearable devices, the main obstacles to their use are personal and technical reasons; the risk of overmedicalization is considered the most negative aspect of their constant use, while privacy and confidentiality of data are not rated a limitation. No statistical difference was found on stratifying the answers by responders' technological level (P=.30), age (P=.10), and the composition of the association's advisory board (P=.15). Conclusions: According to responders, health apps and wearable devices are sufficiently known and used and are considered potential supports for greater involvement in health management. However, there are still obstacles to their adoption, and the developers need to work to make them more accessible and more useful. The involvement of patients and their associations in planning services and products based on these technologies (as well as others) would be desirable to overcome these barriers and boost awareness about privacy and the confidentiality of data. ",
doi="10.2196/10242",
url="http://mhealth.jmir.org/2019/1/e10242/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30664455"
}


@Article{info:doi/10.2196/12228,
author="Langford, T. Aisha
and Solid, A. Craig
and Scott, Ebony
and Lad, Meeki
and Maayan, Eli
and Williams, K. Stephen
and Seixas, A. Azizi",
title="Mobile Phone Ownership, Health Apps, and Tablet Use in US Adults With a Self-Reported History of Hypertension: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="14",
volume="7",
number="1",
pages="e12228",
keywords="smartphone",
keywords="text messaging",
keywords="health communication",
keywords="ownership",
keywords="goals",
keywords="cell phone",
keywords="telemedicine",
keywords="hypertension",
keywords="tablets",
keywords="chronic disease",
abstract="Background: Mobile phone and tablet ownership have increased in the United States over the last decade, contributing to the growing use of mobile health (mHealth) interventions to help patients manage chronic health conditions like diabetes. However, few studies have characterized mobile device ownership and the presence of health-related apps on mobile devices in people with a self-reported history of hypertension. Objective: This study aimed to describe the prevalence of smartphone, tablet, and basic mobile phone ownership and the presence of health apps by sociodemographic factors and self-reported hypertension status (ie, history) in a nationally representative sample of US adults, and to describe whether mobile devices are associated with health goal achievement, medical decision making, and patient-provider communication. Methods: Data from 3285 respondents from the 2017 Health Information National Trends Survey were analyzed. Participants were asked if they owned a smartphone, tablet, or basic mobile phone and if they had health apps on a smartphone or tablet. Participants were also asked if their smartphones or tablets helped them achieve a health-related goal like losing weight, make a decision about how to treat an illness, or talk with their health care providers. Chi-square analyses were conducted to test for differences in mobile device ownership, health app presence, and app helpfulness by patient characteristics. Results: Approximately 1460 (37.6\% weighted prevalence) participants reported a history of hypertension. Tablet and smartphone ownership were lower in participants with a history of hypertension than in those without a history of hypertension (55\% vs 66\%, P=.001, and 86\% vs 68\%, P<.001, respectively). Participants with a history of hypertension were more likely to own a basic mobile phone only as compared to those without a history of hypertension (16\% vs 9\%, P<.001). Among those with a history of hypertension exclusively, basic mobile phone, smartphone, and tablet ownership were associated with age and education, but not race or sex. Older adults were more likely to report having a basic mobile phone only, whereas those with higher education were more likely to report owning a tablet or smartphone. Compared to those without a history of hypertension, participants with a history of hypertension were less likely to have health-related apps on their smartphones or tablets (45\% vs 30\%, P<.001) and report that mobile devices helped them achieve a health-related goal (72\% vs 63\%, P=.01). Conclusions: Despite the increasing use of smartphones, tablets, and health-related apps, these tools are used less among people with a self-reported history of hypertension. To reach the widest cross-section of patients, a mix of novel mHealth interventions and traditional health communication strategies (eg, print, web based, and in person) are needed to support the diverse needs of people with a history of hypertension. ",
doi="10.2196/12228",
url="http://mhealth.jmir.org/2019/1/e12228/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31344667"
}


@Article{info:doi/10.2196/11696,
author="Greer, Ben
and Robotham, Dan
and Simblett, Sara
and Curtis, Hannah
and Griffiths, Helena
and Wykes, Til",
title="Digital Exclusion Among Mental Health Service Users: Qualitative Investigation",
journal="J Med Internet Res",
year="2019",
month="Jan",
day="09",
volume="21",
number="1",
pages="e11696",
keywords="digital exclusion",
keywords="digital divide",
keywords="digital inequality",
keywords="technology",
keywords="eHealth",
keywords="mental health",
keywords="social exclusion",
keywords="mobile phone",
abstract="Background: Access to internet-enabled technology and Web-based services has grown exponentially in recent decades. This growth potentially excludes some communities and individuals with mental health difficulties, who face a heightened risk of digital exclusion. However, it is unclear what factors may contribute to digital exclusion in this population. Objective: To explore in detail the problems of digital exclusion in mental health service users and potential facilitators to overcome them. Methods: We conducted semistructured interviews with 20 mental health service users who were deemed digitally excluded. We recruited the participants from a large secondary mental health provider in South London, United Kingdom. We employed thematic analysis to identify themes and subthemes relating to historical and extant reasons for digital exclusion and methods of overcoming it. Results: There were three major themes that appeared to maintain digital exclusion: a perceived lack of knowledge, being unable to access the necessary technology and services owing to personal circumstances, and the barriers presented by mental health difficulties. Specific facilitators for overcoming digital exclusion included intrinsic motivation and a personalized learning format that reflects the individual's unique needs and preferences. Conclusions: Multiple factors contribute to digital exclusion among mental health service users, including material deprivation and mental health difficulties. This means that efforts to overcome digital exclusion must address the multiple deprivations individuals may face in the offline world in addition to their individual mental health needs. Additional facilitators include fostering an intrinsic motivation to overcome digital exclusion and providing a personalized learning format tailored to the individual's knowledge gaps and preferred learning style. ",
doi="10.2196/11696",
url="http://www.jmir.org/2019/1/e11696/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30626564"
}


@Article{info:doi/10.2196/11051,
author="Shaffer, M. Kelly
and Chow, I. Philip
and Cohn, F. Wendy
and Ingersoll, S. Karen
and Ritterband, M. Lee",
title="Informal Caregivers' Use of Internet-Based Health Resources: An Analysis of the Health Information National Trends Survey",
journal="JMIR Aging",
year="2018",
month="Dec",
day="18",
volume="1",
number="2",
pages="e11051",
keywords="caregivers",
keywords="health education",
keywords="internet",
keywords="information dissemination",
keywords="mobile phone",
keywords="uncompensated care",
abstract="Background: Informal caregivers express strong interest in technology innovations to help them in their caregiving role; however, divides across sociodemographic characteristics in internet and technology access may preclude the most vulnerable caregivers from accessing such resources. Objective: This study aims to examine caregivers' internet use, both generally and for seeking health-related information, and whether usage differs as a function of caregivers' characteristics. Methods: Data were analyzed from the Health Information National Trends Survey 5 Cycle 1. Participants were included in analyses if they self-identified as providing uncompensated care to a close individual. Caregivers reported internet use factors, age, education, rurality, general health, distress, and objective caregiving burden. We used chi-square tests of independence with jackknife variance estimation to compare whether internet use factors differed by caregivers' characteristics. Results: A total of 77.5\% (303/391) caregivers surveyed reported ever using the internet. Of internet users, 88.1\% (267/303) accessed from a home computer and 83.2\% (252/303) from a mobile device. Most caregivers accessed health information for themselves (286/391, 73.1\%) or others (264/391, 67.5\%); fewer communicated with a doctor over the Web (148/391, 37.9\%) or had a wellness app (171/391, 43.7\%). Caregivers reporting younger age, more education, and good health were more likely to endorse any of these activities. Furthermore, two-thirds of caregivers (258/391, 66.0\%) endorsed trust in health information from the internet. Conclusions: Computers and mobile devices are practical platforms for disseminating caregiving-related information and supportive services to informal caregivers; these modalities may, however, have a more limited reach to caregivers who are older, have less education, and are in poorer health. ",
doi="10.2196/11051",
url="http://aging.jmir.org/2018/2/e11051/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518244"
}


@Article{info:doi/10.2196/11682,
author="Xie, Bo
and Champion, Dimmitt Jane
and Kwak, Jung
and Fleischmann, R. Kenneth",
title="Mobile Health, Information Preferences, and Surrogate Decision-Making Preferences of Family Caregivers of People With Dementia in Rural Hispanic Communities: Cross-Sectional Questionnaire Study",
journal="J Med Internet Res",
year="2018",
month="Dec",
day="10",
volume="20",
number="12",
pages="e11682",
keywords="mHealth",
keywords="dementia",
keywords="caregivers",
keywords="rural communities",
abstract="Background: Mobile health (mHealth) technology holds promise for promoting health education and reducing health disparities and inequalities in underserved populations. However, little research has been done to develop mHealth interventions for family caregivers of people with dementia, particularly those in rural Hispanic communities, who often serve as surrogate decision makers for their relatives with dementia. Objective: As part of a larger project to develop and test a novel, affordable, and easy-to-use mHealth intervention to deliver individually tailored materials in rural Hispanic communities, in this pilot study, we aimed to examine (1) characteristics of people with dementia and their family caregivers in rural Hispanic communities, (2) caregivers' preferences for types and amounts of health information and participation in surrogate decision making, and (3) caregivers' mobile device usage and their desire for receiving information via mobile devices. Methods: This was a cross-sectional survey. A convenience sample of 50 caregivers of people with dementia was recruited from rural health care facilities in Southwest Texas during 3 weeks of April 2017 to May 2017 via word-of-mouth and flyers posted at the facilities. Results: More women than men were in the patient group ($\chi$21=17.2, P<.001) and in the caregiver group ($\chi$21=22.2, P<.001). More patients were on Medicare and Medicaid; more caregivers had private insurance (P<.001 in all cases). Overall, 42\% of patients did not have a power of attorney for their health care; 40\% did not have a living will or advance directive. Caregivers were interested in receiving all types of information and participating in all types of decisions, although on subscales for diagnosis, treatment, laboratory tests, self-care, and complementary and alternative medicine, their levels of interest for decision-making participation were significantly lower than those for receiving information. On the psychosocial subscale, caregivers' desire was greater for surrogate decision-making participation than for information. Caregivers did not differ in their interests in information and participation in decision making on the health care provider subscale. All but 1 caregiver (98\%) owned a mobile phone and 84\% had a smartphone. Two-thirds wanted to receive at least a little dementia-related information via a smartphone or tablet. The amount of dementia-related information caregivers wanted to receive via a mobile device was significantly greater for women than for men (U=84.50, P=.029). Caregivers who owned a tablet were more likely to want to receive dementia-related information via a mobile device than those who did not own a tablet (U=152.0, P=.006). Conclusions: Caregivers in rural Hispanic communities were interested in receiving a wide range of information as well as participating in making decisions for their relatives with dementia. There is much need for effective mHealth interventions that can provide information tailored to the needs and preferences of these caregivers. ",
doi="10.2196/11682",
url="https://www.jmir.org/2018/12/e11682/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30530450"
}


@Article{info:doi/10.2196/10049,
author="Raven, C. Maria
and Kaplan, M. Lauren
and Rosenberg, Marina
and Tieu, Lina
and Guzman, David
and Kushel, Margot",
title="Mobile Phone, Computer, and Internet Use Among Older Homeless Adults: Results from the HOPE HOME Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Dec",
day="10",
volume="6",
number="12",
pages="e10049",
keywords="homelessness",
keywords="internet",
keywords="cell phone",
keywords="smartphone",
keywords="aged and middle aged",
abstract="Background: The median age of single homeless adults is approximately 50 years. Older homeless adults have poor social support and experience a high prevalence of chronic disease, depression, and substance use disorders. Access to mobile phones and the internet could help lower the barriers to social support, social services, and medical care; however, little is known about access to and use of these by older homeless adults. Objective: This study aimed to describe the access to and use of mobile phones, computers, and internet among a cohort of 350 homeless adults over the age of 50 years. Methods: We recruited 350 participants who were homeless and older than 50 years in Oakland, California. We interviewed participants at 6-month intervals about their health status, residential history, social support, substance use, depressive symptomology, and activities of daily living (ADLs) using validated tools. We performed clinical assessments of cognitive function. During the 6-month follow-up interview, study staff administered questions about internet and mobile technology use. We assessed participants' comfort with and use of multiple functions associated with these technologies. Results: Of the 343 participants alive at the 6-month follow-up, 87.5\% (300/343) completed the mobile phone and internet questionnaire. The median age of participants was 57.5 years (interquartile range 54-61). Of these, 74.7\% (224/300) were male, and 81.0\% (243/300) were black. Approximately one-fourth (24.3\%, 73/300) of the participants had cognitive impairment and slightly over one-third (33.6\%, 100/300) had impairments in executive function. Most (72.3\%, 217/300) participants currently owned or had access to a mobile phone. Of those, most had feature phones, rather than smartphones (89, 32.1\%), and did not hold annual contracts (261, 94.2\%). Just over half (164, 55\%) had ever accessed the internet. Participants used phones and internet to communicate with medical personnel (179, 64.6\%), search for housing and employment (85, 30.7\%), and to contact their families (228, 82.3\%). Those who regained housing were significantly more likely to have mobile phone access (adjusted odds ratio [AOR] 3.81, 95\% CI 1.77-8.21). Those with ADL (AOR 0.53, 95\% CI 0.31-0.92) and executive function impairment (AOR 0.49; 95\% CI 0.28-0.86) were significantly less likely to have mobile phones. Moderate to high risk amphetamine use was associated with reduced access to mobile phones (AOR 0.27, 95\% CI 0.10-0.72). Conclusions: Older homeless adults could benefit from portable internet and phone access. However, participants had a lower prevalence of smartphone and internet access than adults aged over 65 years in the general public or low-income adults. Participants faced barriers to mobile phone and internet use, including financial barriers and functional and cognitive impairments. Expanding access to these basic technologies could result in improved outcomes. ",
doi="10.2196/10049",
url="http://mhealth.jmir.org/2018/12/e10049/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30530464"
}


@Article{info:doi/10.2196/10925,
author="Poduval, Shoba
and Ahmed, Saddif
and Marston, Louise
and Hamilton, Fiona
and Murray, Elizabeth",
title="Crossing the Digital Divide in Online Self-Management Support: Analysis of Usage Data From HeLP-Diabetes",
journal="JMIR Diabetes",
year="2018",
month="Dec",
day="06",
volume="3",
number="4",
pages="e10925",
keywords="type 2 diabetes mellitus",
keywords="self-management",
keywords="patient education",
keywords="internet",
keywords="digital divide",
keywords="social class",
keywords="health literacy",
keywords="computer literacy",
abstract="Background: Digital health is increasingly recognized as a cost-effective means to support patient self-care. However, there are concerns about whether the ``digital divide,'' defined as the gap between those who do and do not make regular use of digital technologies, will lead to increased health inequalities. Access to the internet, computer literacy, motivation to use digital health interventions, and fears about internet security are barriers to use of digital health interventions. Some of these barriers disproportionately affect people of older age, black or minority ethnic background, and low socioeconomic status. HeLP-Diabetes (Healthy Living for People with type 2 Diabetes), a theoretically informed online self-management program for adults with type 2 diabetes, was developed to meet the needs of people from a broad demographic background. Objective: This study aimed to determine whether there was evidence of a digital divide when HeLP-Diabetes was integrated into routine care. This was achieved by (1) comparing the characteristics of people who registered for the program against the target population (people with type 2 diabetes in inner London), (2) comparing the characteristics of people who registered for the program and used it with those who did not use it, and (3) comparing sections of the website visited by different demographic groups. Methods: A retrospective analysis of data on the use of HeLP-Diabetes in routine clinical practice in 4 inner London clinical commissioning groups was undertaken. Data were collected from patients who registered for the program as part of routine health services.. Data on gender, age, ethnicity, and educational attainment were collected at registration, and data on webpage visits (user identification number, date, time, and page visited) were collected automatically by software on the server side of the website. Results: The characteristics of people who registered for the program were found to reflect those of the target population. The mean age was 58.4 years (SD=28.0), over 50.0\% were from black and minority ethnic backgrounds, and nearly a third (29.8\%) had no qualifications beyond school leaving age. There was no association between demographic characteristics and use of the program, apart from weak evidence of less use by the mixed ethnicity group. There was no evidence of the differential use of the program by any demographic group, apart from weak evidence for people with degrees and school leavers being more likely to use the ``Living and working with diabetes'' (P=.03) and ``Treating diabetes'' (P=.04) sections of the website. Conclusions: This study is one of the first to provide evidence that a digital health intervention can be integrated into routine health services without widening health inequalities. The relative success of the intervention may be attributed to integration into routine health care, and careful design with extensive user input and consideration of literacy levels. Developers of digital health interventions need to acknowledge barriers to access and use, and collect data on the demographic profile of users, to address inequalities. ",
doi="10.2196/10925",
url="http://diabetes.jmir.org/2018/4/e10925/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30522988"
}


@Article{info:doi/10.2196/11715,
author="Torous, John
and Wisniewski, Hannah
and Liu, Gang
and Keshavan, Matcheri",
title="Mental Health Mobile Phone App Usage, Concerns, and Benefits Among Psychiatric Outpatients: Comparative Survey Study",
journal="JMIR Ment Health",
year="2018",
month="Nov",
day="16",
volume="5",
number="4",
pages="e11715",
keywords="smartphone",
keywords="digital health",
keywords="mobile phone",
keywords="mental health",
keywords="schizophrenia",
keywords="depression",
keywords="psychiatry",
keywords="apps",
abstract="Background: Despite the popularity of mental health apps, it is unknown if they are actually used by those with mental illness. This study assessed whether differences in clinic setting may influence the use of mental health apps and which factors influence patient perception of apps. Objective: The objective of this study was to gain an understanding of how individuals with mental illness use their mobile phones by exploring their access to mobile phones and their use of mental health apps. Methods: A single time point survey study was conducted over a 2-week period in February 2018 at two nearby outpatient psychiatry clinics: one serving largely mood and anxiety disorder patients with private insurance staffed by both faculty and residents and the other serving largely psychotic disorder patients in a state Department of Mental Health (DMH) setting. A total of 25 patients at the state DMH clinic also consented for a single time point observation of apps currently installed on their personal mobile phone. Results: A total of 113 patients at the private insurance clinic and 73 at the state DMH clinic completed the survey. Those in the private insurance clinic were more likely to download a mental health app compared to the state DMH clinic, but actual rates of reported current app usage were comparable at each clinic, approximately 10\%. Verifying current apps on patients' mobile phones at the state DMH clinic confirmed that approximately 10\% had mental health apps installed. Patients at both clinics were most concerned about privacy of mental health apps, although those at the state DMH clinic viewed cost savings as the greatest benefit while those at the private clinic reported time as the greatest benefit. Conclusions: High interest in mental health apps does not automatically translate into high use. Our results of low but similar rates of mental health app use at diverse clinics suggests DMH patients with largely psychotic disorders are as interested and engaged with apps as those in a private insurance clinic treating largely mood and anxiety disorders. Results from our study also highlight the importance of understanding how actual patients are using apps instead of relying on internet-based samples, which often yield higher results due to their likelihood of being selected. ",
doi="10.2196/11715",
url="http://mental.jmir.org/2018/4/e11715/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30446484"
}


@Article{info:doi/10.2196/10763,
author="Liu, Darren
and Yamashita, Takashi
and Burston, Betty",
title="Identifying Consumers Who Search for Long-Term Care on the Web: Latent Class Analysis",
journal="JMIR Aging",
year="2018",
month="Nov",
day="02",
volume="1",
number="2",
pages="e10763",
keywords="internet",
keywords="information seeking behavior",
keywords="consumer health information",
keywords="marketing of health services",
keywords="public reporting",
abstract="Background: Because the internet has become a primary means of communication in the long-term care (LTC) and health care industry, an elevated understanding of market segmentation among LTC consumers is an indispensable step to responding to the informational needs of consumers. Objective: This exploratory study was designed to identify underlying market segments of the LTC consumers who seek Web-based information. Methods: Data on US adult internet users (n=2018) were derived from 2010 Pew Internet and America Life Project. Latent class analysis was employed to identify underlying market segments of LTC Web-based information seekers. Results: Web-based LTC information seekers were classified into the following 2 subgroups: heavy and light Web-based information seekers. Overall, 1 in 4 heavy Web-based information seekers used the internet for LTC information, whereas only 2\% of the light information seekers did so. The heavy information seekers were also significantly more likely than light users to search the internet for all other health information, such as a specific disease and treatment and medical facilities. The heavy Web-based information seekers were more likely to be younger, female, highly educated, chronic disease patients, caregivers, and frequent internet users in general than the light Web-based information seekers. Conclusions: To effectively communicate with their consumers, providers who target Web-based LTC information seekers can more carefully align their informational offerings with the specific needs of each subsegment of LTC markets. ",
doi="10.2196/10763",
url="https://aging.jmir.org/2018/2/e10763/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518237"
}


@Article{info:doi/10.2196/11006,
author="Collado-Borrell, Roberto
and Escudero-Vilaplana, Vicente
and Calles, Antonio
and Garcia-Martin, Estela
and Marzal-Alfaro, Belen
and Gonzalez-Haba, Eva
and Herranz-Alonso, Ana
and Sanjurjo-Saez, Maria",
title="Oncology Patient Interest in the Use of New Technologies to Manage Their Disease: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2018",
month="Oct",
day="23",
volume="20",
number="10",
pages="e11006",
keywords="eHealth",
keywords="app",
keywords="information and communication technologies",
keywords="oncology patient",
abstract="Background: Information and communication technologies (ICTs) in oncology can revolutionize the medical care of cancer patients. ICTs can promote patients' empowerment and real-time disease monitoring. There is limited information about the impact of ICTs in cancer patients or their level of interest in using these tools for greater management of their condition. Objective: This study aimed to understand the ICT usage profile in hematology-oncology patients to identify their needs and determine their level of interest in these technologies as a means of managing their disease. Methods: A 28-item questionnaire was drawn up by a multidisciplinary team including pharmacists and oncologists. The questions were organized into 3 blocks, which were as follows: block A---sociodemographic characteristics; block B---use of ICTs when searching for health-related information; and block C---usage preferences for health apps. Hematology-oncology patients receiving treatment between May and July 2017 were included. A paper copy of the questionnaire was handed over to patients in either the day hospital or the pharmaceutical care consultancy in pharmacy services. Results: A total of 650 questionnaires were handed out, with a participation of 94.0\% (611/650). Patient sociodemographic characteristics were as follows: mean age was 57.8 years (age range: 19-91). Of 611 participants, 40.7\% (249/611) had a university education, and 45.1\% (276/611) of participants reported their overall state of health to be good. Results from use of ICTs when searching for health-related information were as follows: 87.1\% (532/611) of participants were interested in being informed about health-related matters. Of all participants, 75.5\% (532/611) sought information from health professionals and 61.3\% (375/611) on the internet. Before going to their doctor's appointment, 21.8\% (133/611) of patients looked up information about their disease or treatment on the internet. This access to the internet rose to 50.9\% (311/611) after their first medical appointment with their oncologist. Usage preferences for health apps were as follows: 82.7\% (505/611) had a smartphone, whereas 20.3\% (124/611) had a health app installed. Overall, 81.5\% (498/611) would use an app if their health professional recommended it to them, but 39.6\% (242/611) were not willing to pay for it. Conclusions: The hematology-oncology patients showed a great deal of interest in searching for health-related information by means of ICTs, especially using smartphones and apps. The issues that drew the most interest in terms of apps were appointment management, advice on disease management, and communication with health professionals. Free access to these features and the recommendation by a health professional are important factors when it comes to their use. Therefore, the health care provider is a key element in the recommendation of ICTs, providing their knowledge and experience concerning their correct usage. ",
doi="10.2196/11006",
url="http://www.jmir.org/2018/10/e11006/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30355554"
}


@Article{info:doi/10.2196/jmir.9253,
author="Torrent-Sellens, Joan
and D{\'i}az-Chao, {\'A}ngel
and Soler-Ramos, Ivan
and Saig{\'i}-Rubi{\'o}, Francesc",
title="Modeling and Predicting Outcomes of eHealth Usage by European Physicians: Multidimensional Approach from a Survey of 9196 General Practitioners",
journal="J Med Internet Res",
year="2018",
month="Oct",
day="22",
volume="20",
number="10",
pages="e279",
keywords="internet",
keywords="eHealth",
keywords="health care",
keywords="health drivers",
keywords="health barriers",
keywords="health attitude",
keywords="health information",
keywords="health empowerment",
keywords="information and communication technologies",
keywords="structural equation modeling",
keywords="Europe",
abstract="Background: The literature has noted the need to use more advanced methods and models to evaluate physicians' outcomes in the shared health care model that electronic health (eHealth) proposes. Objective: The goal of our study was to design and evaluate a predictive multidimensional model of the outcomes of eHealth usage by European physicians. Methods: We used 2012-2013 survey data from a sample of 9196 European physicians (general practitioners). We proposed and tested two composite indicators of eHealth usage outcomes (internal practices and practices with patients) through 2-stage structural equation modeling. Logistic regression (odds ratios, ORs) to model the predictors of eHealth usage outcomes indicators were also calculated. Results: European general practitioners who were female (internal practices OR 1.15, 95\% CI 1.10-1.20; practices with patients OR 1.19, 95\% CI 1.14-1.24) and younger---aged <35 years (internal practices OR 1.14, 95\% CI 1.02-1.26; practices with patients OR 1.32, 95\% CI 1.13-1.54) and aged 36-45 years (internal practices OR 1.16, 95\% CI 1.06-1.28; practices with patients OR 1.21, 95\% CI 1.10-1.33)---had a greater propensity toward favorable eHealth usage outcomes in internal practices and practices with patients. European general practitioners who positively valued information and communication technology (ICT) impact on their personal working processes (internal practices OR 5.30, 95\% CI 4.73-5.93; practices with patients OR 4.83, 95\% CI 4.32-5.40), teamwork processes (internal practices OR 4.19, 95\% CI 3.78-4.65; practices with patients OR 3.38, 95\% CI 3.05-3.74), and the doctor-patient relationship (internal practices OR 3.97, 95\% CI 3.60-4.37; practices with patients OR 6.02, 95\% CI 5.43-6.67) had a high propensity toward favorable effects of eHealth usage on internal practices and practices with patients. More favorable eHealth outcomes were also observed for self-employed European general practitioners (internal practices OR 1.33, 95\% CI 1.22-1.45; practices with patients OR 1.10, 95\% CI 1.03-1.28). Finally, general practitioners who reported that the number of patients treated in the last 2 years had remained constant (internal practices OR 1.08, 95\% CI 1.01-1.17) or increased (practices with patients OR 1.12, 95\% CI 1.03-1.22) had a higher propensity toward favorable eHealth usage outcomes. Conclusions: We provide new evidence of predictors (sociodemographic issues, attitudes toward ICT impacts, and working conditions) that explain favorable eHealth usage outcomes. The results highlight the need to develop more specific policies for eHealth usage to address different realities. ",
doi="10.2196/jmir.9253",
url="http://www.jmir.org/2018/10/e279/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30348628"
}


@Article{info:doi/10.2196/jmir.9436,
author="Asan, Onur
and Cooper II, Farion
and Nagavally, Sneha
and Walker, J. Rebekah
and Williams, S. Joni
and Ozieh, N. Mukoso
and Egede, E. Leonard",
title="Preferences for Health Information Technologies Among US Adults: Analysis of the Health Information National Trends Survey",
journal="J Med Internet Res",
year="2018",
month="Oct",
day="18",
volume="20",
number="10",
pages="e277",
keywords="chronic conditions",
keywords="eHealth",
keywords="health information exchange",
keywords="health information technology",
keywords="internet",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Emerging health technologies are increasingly being used in health care for communication, data collection, patient monitoring, education, and facilitating adherence to chronic disease management. However, there is a lack of studies on differences in the preference for using information exchange technologies between patients with chronic and nonchronic diseases and factors affecting these differences. Objective: The purpose of this paper is to understand the preferences and use of information technology for information exchange among a nationally representative sample of adults with and without 3 chronic disease conditions (ie, cardiovascular disease [CVD], diabetes, and hypertension) and to assess whether these preferences differ according to varying demographic variables. Methods: We utilized data from the 2012 and 2014 iteration of the Health Information National Trends Survey (N=7307). We used multiple logistic regressions, adjusting for relevant demographic covariates, to identify the independent factors associated with lower odds of using health information technology (HIT), thus, identifying targets for awareness. Analyses were weighted for the US population and adjusted for the sociodemographic variables of age, gender, race, and US census region. Results: Of 7307 participants, 3529 reported CVD, diabetes, or hypertension. In the unadjusted models, individuals with diabetes, CVD, or hypertension were more likely to report using email to exchange medical information with their provider and less likely to not use any of the technology in health information exchange, as well as more likely to say it was not important for them to access personal medical information electronically. In the unadjusted model, additional significant odds ratio (OR) values were observed. However, after adjustment, most relationships regarding the use and interest in exchanging information with the provider were no longer significant. In the adjusted model, individuals with CVD, diabetes, or hypertension were more likely to access Web-based personal health information through a website or app. Furthermore, we assessed adjusted ORs for demographic variables. Those aged >65 years and Hispanic people were more likely to report no use of email to exchange medical information with their provider. Minorities (Hispanic, non-Hispanic black, and Asian people) were less likely to indicate they had no interest in exchanging general health tips with a provider electronically. Conclusions: The analysis did not show any significant association among those with comorbidities and their proclivity toward health information, possibly implying that HIT-related interventions, particularly design of information technologies, should focus more on demographic factors, including race, age, and region, than on comorbidities or chronic disease status to increase the likelihood of use. Future research is needed to understand and explore more patient-friendly use and design of information technologies, which can be utilized by diverse age, race, and education or health literacy groups efficiently to further bridge the patient-provider communication gap. ",
doi="10.2196/jmir.9436",
url="http://www.jmir.org/2018/10/e277/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30341048"
}


@Article{info:doi/10.2196/jmir.8784,
author="Sandefer, H. Ryan
and Westra, L. Bonnie
and Khairat, S. Saif
and Pieczkiewicz, S. David
and Speedie, M. Stuart",
title="Assessment of Personal Health Care Management and Chronic Disease Prevalence: Comparative Analysis of Demographic, Socioeconomic, and Health-Related Variables",
journal="J Med Internet Res",
year="2018",
month="Oct",
day="18",
volume="20",
number="10",
pages="e276",
keywords="personal health information",
keywords="consumer participation",
keywords="social determinants of health",
keywords="personal health records",
abstract="Background: The use of personal health care management (PHM) is increasing rapidly within the United States because of implementation of health technology across the health care continuum and increased regulatory requirements for health care providers and organizations promoting the use of PHM, particularly the use of text messaging (short message service), Web-based scheduling, and Web-based requests for prescription renewals. Limited research has been conducted comparing PHM use across groups based on chronic conditions. Objective: This study aimed to describe the overall utilization of PHM and compare individual characteristics associated with PHM in groups with no reported chronic conditions, with 1 chronic condition, and with 2 or more such conditions. Methods: Datasets drawn from the National Health Interview Survey were analyzed using multiple logistic regression to determine the level of PHM use in relation to demographic, socioeconomic, or health-related factors. Data from 47,814 individuals were analyzed using logistic regression. Results: Approximately 12.19\% (5737/47,814) of respondents reported using PHM, but higher rates of use were reported by individuals with higher levels of education and income. The overall rate of PHM remained stable between 2009 and 2014, despite increased focus on the promotion of patient engagement initiatives. Demographic factors predictive of PHM use included people who were younger, non-Hispanic, and who lived in the western region of the United States. There were also differences in PHM use based on socioeconomic factors. Respondents with college-level education were over 2.5 times more likely to use PHM than respondents without college-level education. Health-related factors were also predictive of PHM use. Individuals with health insurance and a usual place for health care were more likely to use PHM than individuals with no health insurance and no usual place for health care. Individuals reporting a single chronic condition or multiple chronic conditions reported slightly higher levels of PHM use than individuals reporting no chronic conditions. Individuals with no chronic conditions who did not experience barriers to accessing health care were more likely to use PHM than individuals with 1 or more chronic conditions. Conclusions: The findings of this study illustrated the disparities in PHM use based on the number of chronic conditions and that multiple factors influence the use of PHM, including economics and education. These findings provide evidence of the challenge associated with engaging patients using electronic health information as the health care industry continues to evolve. ",
doi="10.2196/jmir.8784",
url="http://www.jmir.org/2018/10/e276/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30341046"
}


@Article{info:doi/10.2196/11667,
author="Gesser-Edelsburg, Anat
and Abed Elhadi Arabia, Munawar",
title="Discourse on Exposure to Pornography Content Online Between Arab Adolescents and Parents: Qualitative Study on its Impact on Sexual Education and Behavior",
journal="J Med Internet Res",
year="2018",
month="Oct",
day="09",
volume="20",
number="10",
pages="e11667",
keywords="internet",
keywords="pornography",
keywords="porn viewing",
keywords="sexuality",
keywords="taboo",
keywords="Israeli Arab adolescents",
keywords="discourse",
keywords="sexual education and behavior",
keywords="sexual double standard",
abstract="Background: The internet revolution of the 21st century has made sexual content available and accessible on a scale that has never existed before. Many studies have indicated that the use of pornography was associated with more permissive sexual attitudes and tended to be linked with stronger gender-stereotypical sexual beliefs. It also seemed to be associated with other risky behaviors and sexual promiscuity. Pornography exposure in conservative societies leads to conflicts with religious and cultural taboos. Objective: The aim of this study was to characterize the barriers and difficulties that prevent sexual discourse in the Arab society and enable pornography viewing according to the perceptions of adolescents and mothers. Methods: This study involved qualitative research methods and in-depth interviews with 40 participants. This study included 20 Arab adolescents, sampled by 2 age groups (14-16 years and 16-18 years), and 20 mothers of adolescents from both sexes. Results: The findings indicate that mothers ``turn a blind eye'' to porn viewing and sexual activity by boys; however, they show a sweeping prohibition and denial of such behavior by girls. Boys reported viewing porn routinely, whereas girls denied doing so, but admitted that their female friends watched porn. The study also found that boys experienced guilt during and after viewing porn as a result of the clash between modernity and traditional values. The mothers and adolescents emphasized the need for an open sexual discourse to reduce violent behaviors such as Web-based sexual harassment, including sending videos and pictures of naked girls, often accompanied by threats and blackmail. Conclusions: It is necessary to find a way to encourage a significant sexual discourse to prevent the violent consequences of its absence in the Arab society. A controlled, transparent, and critical sexual discourse could help youth make more informed decisions concerning the search for sexual content, porn viewing, and sexual behavior. ",
doi="10.2196/11667",
url="http://www.jmir.org/2018/10/e11667/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30305264"
}


@Article{info:doi/10.2196/10748,
author="Connolly, L. Samantha
and Miller, J. Christopher
and Koenig, J. Christopher
and Zamora, A. Kara
and Wright, B. Patricia
and Stanley, L. Regina
and Pyne, M. Jeffrey",
title="Veterans' Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Aug",
day="22",
volume="6",
number="8",
pages="e10748",
keywords="smartphone apps",
keywords="mobile phone",
keywords="mhealth",
keywords="mental health",
keywords="qualitative analysis",
keywords="rurality",
keywords="age",
keywords="veterans",
keywords="depression",
keywords="anxiety disorders",
keywords="posttraumatic stress disorder",
keywords="PTSD",
keywords="alcohol abuse",
abstract="Background: Mental health smartphone apps provide support, skills, and symptom tracking on demand and come at minimal to no additional cost to patients. Although the Department of Veterans Affairs has established itself as a national leader in the creation of mental health apps, veterans' attitudes regarding the use of these innovations are largely unknown, particularly among rural and aging populations who may benefit from increased access to care. Objective: The objective of our study was to examine veterans' attitudes toward smartphone apps and to assess whether openness toward this technology varies by age or rurality. Methods: We conducted semistructured qualitative interviews with 66 veterans from rural and urban areas in Maine, Arkansas, and California. Eligible veterans aged 18 to 70 years had screened positive for postraumatic stress disorder (PTSD), alcohol use disorder, or major depressive disorder, but a history of mental health service utilization was not required. Interviews were digitally recorded, professionally transcribed, and coded by a research team using an established codebook. We then conducted a thematic analysis of segments pertaining to smartphone use, informed by existing theories of technology adoption. Results: Interviews revealed a marked division regarding openness to mental health smartphone apps, such that veterans either expressed strongly positive or negative views about their usage, with few participants sharing ambivalent or neutral opinions. Differences emerged between rural and urban veterans' attitudes, with rural veterans tending to oppose app usage, describe smartphones as hard to navigate, and cite barriers such as financial limitations and connectivity issues, more so than urban populations. Moreover, rural veterans more often described smartphones as being opposed to their values. Differences did not emerge between younger and older (?50) veterans regarding beliefs that apps could be effective or compatible with their culture and identity. However, compared with younger veterans, older veterans more often reported not owning a smartphone and described this technology as being difficult to use. Conclusions: Openness toward the use of smartphone apps in mental health treatment may vary based on rurality, and further exploration of the barriers cited by rural veterans is needed to improve access to care. In addition, findings indicate that older patients may be more open to integrating technology into their mental health care than providers might assume, although such patients may have more trouble navigating these devices and may benefit from simplified app designs or smartphone training. Given the strong opinions expressed either for or against smartphone apps, our findings suggest that apps may not be an ideal adjunctive treatment for all patients, but it is important to identify those who are open to and may greatly benefit from this technology. ",
doi="10.2196/10748",
url="http://mhealth.jmir.org/2018/8/e10748/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30135050"
}


@Article{info:doi/10.2196/jmir.9962,
author="Jabour, M. Sarah
and Page, Alexis
and Hall, F. Seventy
and Rodriguez, Lycinda
and Shields, C. Wendy
and Alvanzo, AH Anika",
title="Information and Communication Technologies Interest, Access, and Use: Cross-Sectional Survey of a Community Sample of Urban, Predominantly Black Women",
journal="J Med Internet Res",
year="2018",
month="Aug",
day="14",
volume="20",
number="8",
pages="e248",
keywords="women",
keywords="internet communication technology",
keywords="urban",
keywords="alcohol",
keywords="stress",
keywords="smartphones",
abstract="Background: Information and communication technologies (ICT) offer the potential for delivering health care interventions to low socioeconomic populations who often face barriers in accessing health care. However, most studies on ICT for health education and interventions have been conducted in clinical settings. Objective: The aim of this study was to examine access to and use of mobile phones and computers, as well as interest in, using ICT for receipt of behavioral health information among a community sample of urban, predominately black, women with low socioeconomic status. Methods: Participants (N=220) were recruited from hair salons and social service centers and completed audio-computer assisted self-interviews. Results: The majority of the participants (212/220, 96.3\%) reported use of a cell phone at least weekly, of which 89.1\% (189/212) used smartphones and 62.3\% (137/220) reported computer use at least weekly. Of the women included in the study, 51.9\% (107/206) reported using a cell phone and 39.4\% (74/188) reported using a computer to access health and/or safety information at least weekly. Approximately half of the women expressed an interest in receiving information about stress management (51\%-56\%) or alcohol and health (45\%-46\%) via ICT. Smartphone ownership was associated with younger age (odds ratio [OR] 0.92, 95\% CI 0.87-0.97) and employment (OR 5.12, 95\% CI 1.05-24.95). Accessing health and safety information weekly by phone was associated with younger age (OR 0.96, 95\% CI 0.94-0.99) and inversely associated with higher income (OR 0.42, 95\% CI 0.20-0.92). Conclusions: Our findings suggest that ICT use, particularly smartphone use, is pervasive among predominantly black women with low socioeconomic status in urban, nonclinical settings. These results show that ICT is a promising modality for delivering health information to this population. Further exploration of the acceptability, feasibility, and effectiveness of using ICT to disseminate behavioral health education and intervention is warranted. ",
doi="10.2196/jmir.9962",
url="http://www.jmir.org/2018/8/e248/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30108036"
}


@Article{info:doi/10.2196/mental.9950,
author="Bonet, Lucia
and Ll{\'a}cer, Blanca
and Hernandez-Viadel, Miguel
and Arce, David
and Blanquer, Ignacio
and Ca{\~n}ete, Carlos
and Escart{\'i}, Maria
and Gonz{\'a}lez-Pinto, M. Ana
and Sanju{\'a}n, Julio",
title="Differences in the Use and Opinions About New eHealth Technologies Among Patients With Psychosis: Structured Questionnaire",
journal="JMIR Ment Health",
year="2018",
month="Jul",
day="25",
volume="5",
number="3",
pages="e51",
keywords="eHealth",
keywords="internet",
keywords="mobile phone",
keywords="viability",
keywords="acceptability",
keywords="psychosis",
keywords="schizophrenia",
abstract="Background: Despite a growing interest in the use of technology in order to support the treatment of psychotic disorders, limited knowledge exists about the viability and acceptability of these eHealth interventions in relation to the clinical characteristics of patients. Objective: The objective of this study was to assess the access and use of, as well as experiences and interest in, new technologies using a survey of patients diagnosed with early psychosis compared with a survey of patients diagnosed with chronic psychotic disorders. Methods: We designed a structured questionnaire. This questionnaire was divided into five parts: (1) clinical and demographic information, (2) access and use of the internet, (3) use of the internet in relation to mental health, (4) experiences with technology, and (5) patients' interest in eHealth services. In total, 105 patients were recruited from early psychosis units (n=65) and recovery units (n=40). Results: In this study, 84.8\% (89/105) of the patients had access to the internet and 88.6\% (93/105) owned an electronic internet device. In total, 71.3\% (57/80) of patients who owned a mobile phone were interested in eHealth systems and 38.2\% (37/97) reported negative experiences related to the internet usage. We observed differences between the groups in terms of device ownership (P=.02), the frequency of internet access (P<.001), the use of social media (P=.01), and seeking health information (P=.04); the differences were found to be higher in the early psychosis group. No differences were found between the groups in terms of the use of internet in relation to mental health, experiences and opinions about the internet, or interest in eHealth interventions (P=.43). Conclusions: The availability and use of technology for the participants in our survey were equivalent to those for the general population. The differences found between the groups in relation to the access or use of technology seemed to due to age-related factors. The use of technology involving mental health and the interest in eHealth interventions were mainly positive and equivalent between the groups. Accordingly, this group of patients is a potential target for the emerging eHealth interventions, regardless of their clinical status. However, 28.7\% (23/80) of the studied patients rejected the use of internet interventions and 38.2\% (37/97) had unpleasant experiences related to its usage; thus, more in-depth studies are needed to better define the profile of patients with psychosis who may benefit from eHealth treatments. ",
doi="10.2196/mental.9950",
url="http://mental.jmir.org/2018/3/e51/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30045835"
}


@Article{info:doi/10.2196/10434,
author="Paige, R. Samantha
and Miller, David M.
and Krieger, L. Janice
and Stellefson, Michael
and Cheong, JeeWon",
title="Electronic Health Literacy Across the Lifespan: Measurement Invariance Study",
journal="J Med Internet Res",
year="2018",
month="Jul",
day="09",
volume="20",
number="7",
pages="e10434",
keywords="eHealth literacy",
keywords="eHealth",
keywords="aging",
keywords="measurement invariance",
abstract="Background: Electronic health (eHealth) information is ingrained in the healthcare experience to engage patients across the lifespan. Both eHealth accessibility and optimization are influenced by lifespan development, as older adults experience greater challenges accessing and using eHealth tools as compared to their younger counterparts. The eHealth Literacy Scale (eHEALS) is the most popular measure used to assess patient confidence locating, understanding, evaluating, and acting upon online health information. Currently, however, the factor structure of the eHEALS across discrete age groups is not well understood, which limits its usefulness as a measure of eHealth literacy across the lifespan. Objective: The purpose of this study was to examine the structure of eHEALS scores and the degree of measurement invariance among US adults representing the following generations: Millennials (18-35-year-olds), Generation X (36-51-year-olds), Baby Boomers (52-70-year-olds), and the Silent Generation (71-84-year-olds). Methods: Millennials (N=281, mean 26.64 years, SD 5.14), Generation X (N=164, mean 42.97 years, SD 5.01), and Baby Boomers/Silent Generation (N=384, mean 62.80 years, SD 6.66) members completed the eHEALS. The 3-factor (root mean square error of approximation, RMSEA=.06, comparative fit index, CFI=.99, Tucker-Lewis index, TLI=.98) and 4-factor (RMSEA=.06, CFI=.99, TLI=.98) models showed the best global fit, as compared to the 1- and 2-factor models. However, the 4-factor model did not have statistically significant factor loadings on the 4th factor, which led to the acceptance of the 3-factor eHEALS model. The 3-factor model included eHealth Information Awareness, Search, and Engagement. Pattern invariance for this 3-factor structure was supported with acceptable model fit (RMSEA=.07, $\Delta$$\chi$2=P>.05, $\Delta$CFI=0). Compared to Millennials and members of Generation X, those in the Baby Boomer and Silent Generations reported less confidence in their awareness of eHealth resources (P<.001), information seeking skills (P=.003), and ability to evaluate and act on health information found on the Internet (P<.001). Results: Young (18-48-year olds, N=411) and old (49-84-year olds, N=419) adults completed the survey. A 3-factor model had the best fit (RMSEA=.06, CFI=.99, TLI=.98), as compared to the 1-factor, 2-factor, and 4-factor models. These 3-factors included eHealth Information Awareness (2 items), Information Seeking (2 items), and Information and Evaluation (4 items). Pattern invariance was supported with the acceptable model fit (RMSEA=.06, $\Delta$$\chi$2=P>.05, $\Delta$CFI=0). Compared with younger adults, older adults had less confidence in eHealth resource awareness (P<.001), information seeking skills (P<.01), and ability to evaluate and act upon online health information (P<.001). Conclusions: The eHEALS can be used to assess, monitor uniquely, and evaluate Internet users' awareness of eHealth resources, information seeking skills, and engagement abilities. Configural and pattern invariance was observed across all generation groups in the 3-factor eHEALS model. To meet gold the standards for factor interpretation (ie, 3 items or indicators per factor), future research is needed to create and assess additional eHEALS items. Future research is also necessary to identify and test items for a fourth factor, one that captures the social nature of eHealth. ",
doi="10.2196/10434",
url="http://www.jmir.org/2018/7/e10434/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29986848"
}


@Article{info:doi/10.2196/jmir.9829,
author="Zhao, Jingsong
and Mir, Nageen
and Ackermann, Nicole
and Kaphingst, A. Kimberly
and Politi, C. Mary",
title="Dissemination of a Web-Based Tool for Supporting Health Insurance Plan Decisions (Show Me Health Plans): Cross-Sectional Observational Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="20",
volume="20",
number="6",
pages="e209",
keywords="Affordable Care Act",
keywords="health insurance decision aid",
keywords="health literacy",
keywords="public health",
abstract="Background: The rate of uninsured people has decreased dramatically since the Affordable Care Act was passed. To make an informed decision, consumers need assistance to understand the advantages and disadvantages of health insurance plans. The Show Me Health Plans Web-based decision support tool was developed to improve the quality of health insurance selection. In response to the promising effectiveness of Show Me Health Plans in a randomized controlled trial (RCT) and the growing need for Web-based health insurance decision support, the study team used expert recommendations for dissemination and implementation, engaged external stakeholders, and made the Show Me Health Plans tool available to the public. Objective: The purpose of this study was to implement the public dissemination of the Show Me Health Plans tool in the state of Missouri and to evaluate its impact compared to the RCT. Methods: This study used a cross-sectional observational design. Dissemination phase users were compared with users in the RCT study across the same outcome measures. Time spent using the Show Me Health Plans tool, knowledge, importance rating of 9 health insurance features, and intended plan choice match with algorithm predictions were examined. Results: During the dissemination phase (November 2016 to January 2017), 10,180 individuals visited the SMHP website, and the 1069 users who stayed on the tool for more than one second were included in our analyses. Dissemination phase users were more likely to live outside St. Louis City or County (P<.001), were less likely to be below the federal poverty level (P<.001), and had a higher income (P=.03). Overall, Show Me Health Plans users from St. Louis City or County spent more time on the Show Me Health Plans tool than those from other Missouri counties (P=.04); this association was not observed in the RCT. Total time spent on the tool was not correlated with knowledge scores, which were associated with lower poverty levels (P=.009). The users from the RCT phase were more likely to select an insurance plan that matched the tool's recommendations (P<.001) compared with the dissemination phase users. Conclusions: The study suggests that a higher income population may be more likely to seek information and online help when making a health insurance plan decision. We found that Show Me Health Plans users in the dissemination phase were more selective in the information they reviewed. This study illustrates one way of disseminating and implementing an empirically tested Web-based decision aid tool. Distributing Web-based tools is feasible and may attract a large number of potential users, educate them on basic health insurance information, and make recommendations based on personal information and preference. However, using Web-based tools may differ according to the demographics of the general public compared to research study participants. ",
doi="10.2196/jmir.9829",
url="http://www.jmir.org/2018/6/e209/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29925498"
}


@Article{info:doi/10.2196/mhealth.8383,
author="Anderson-Lewis, Charkarra
and Darville, Gabrielle
and Mercado, Eve Rebeccah
and Howell, Savannah
and Di Maggio, Samantha",
title="mHealth Technology Use and Implications in Historically Underserved and Minority Populations in the United States: Systematic Literature Review",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jun",
day="18",
volume="6",
number="6",
pages="e128",
keywords="mHealth",
keywords="mobile health",
keywords="digital health",
keywords="smartphone",
keywords="text messaging",
keywords="minority",
keywords="ethnic group",
keywords="health disparity",
keywords="underserved population",
abstract="Background: The proportion of people in the United States who are members of at least two ethnic groups is projected to increase to 10\% by the year 2050. This makes addressing health disparities and health inequities in minority populations increasingly more difficult. Minority populations, including those who classify themselves as African American and Hispanic, are using mobile phones to access health information via the internet more frequently than those who classify themselves as white, providing unique opportunities for those in public health and health education to reach these traditionally underserved populations using mobile health (mHealth) interventions. Objective: The objective of this review was to assess studies conducted in the United States that have used mHealth tools and strategies to develop and implement interventions in underserved populations. This review also examines the ways in which mHealth strategies are being employed in public health interventions to these priority population groups, as mobile phone capabilities include text messaging, mobile apps, internet access, emails, video streaming, social media, instant messaging, and more. Methods: A systematic literature review was conducted using key search phrases, the matrix method, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart diagram to identify key studies conducted between the years of 2009-2016 in the United States. These studies were reviewed for their use of mHealth interventions in historically underserved and minority populations. Results: A total of 16,270 articles were initially identified using key search phrases in three databases. Titles were reviewed and articles not meeting criteria were excluded, leaving 156 articles for further review. After additional review for relevance and inclusion criteria, 16 articles were qualified and analyzed. Conclusions: mHealth is a promising area of development for public health and health education. While successful research has been done using text messaging (short message service, SMS) and other mHealth strategies, there is a need for more research using mobile phones and tablet applications. This literature review demonstrates mHealth technology has the ability to increase prevention and health education in health disparate communities and concludes that more specified research is needed. ",
doi="10.2196/mhealth.8383",
url="http://mhealth.jmir.org/2018/6/e128/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29914860"
}


@Article{info:doi/10.2196/ijmr.9554,
author="Bosak, Kelly
and Park, Hye Shin",
title="Characteristics of Adults' Use of Facebook and the Potential Impact on Health Behavior: Secondary Data Analysis",
journal="Interact J Med Res",
year="2018",
month="Jun",
day="14",
volume="7",
number="1",
pages="e11",
keywords="social media",
keywords="health promotion",
keywords="health behavior",
keywords="adults",
abstract="Background: Social influences are a primary factor in the adoption of health behaviors. Social media platforms, such as Facebook, disseminate information, raise awareness, and provide motivation and support for positive health behaviors. Facebook has evolved rapidly and is now a part of many individuals' daily routine. The high degree of individual engagement and low attrition rate of this platform necessitate consideration for a potentially positive impact on health behavior. Objective: The aim of this paper is to investigate the use of Facebook by adults. Knowledge is limited to the unique characteristics of Facebook users, including time spent on Facebook by adults of various age groups. Characteristics of Facebook users are important to understand to direct efforts to engage adults in future health behavior interventions. Methods: Institutional Review Board approval was obtained for this secondary analysis of existing de-identified survey data collected for the Pew Research Center. The sample included adults age 18-65 years and above. Binomial logistic regression was performed for the model of age group and Facebook use, controlling for other demographics. A multinomial logistic regression model was used for the variable of time spent on Facebook. Based on the regression models, we computed and reported the marginal effects on Facebook use and time spent of adults age groups, including age groups 18-29, 30-49, 50-64, and 65 and over. We discuss these findings in the context of the implications for promoting positive health behaviors. Results: The demographics of the final sample (N=730) included adults age 18-65 years and above (mean 48.2 yrs, SD 18.3 yrs). The majority of the participants were female (372/730, 50.9\%), white (591/730, 80.9\%) and non-Hispanic (671/730, 91.9\%). Bivariate analysis indicated that Facebook users and nonusers differed significantly by age group ($\chi$2=76.71, P<.001) and sex ($\chi$2=9.04, P=.003). Among subjects aged 50 and above, the predicted probability was 66\% for spending the same amount of time, 10\% with increased time, and 24\% with decreased time. Conclusions: The key findings of this study were Facebook use among midlife and older adults was more likely to stay the same over time, compared to the other age groups. Interestingly, the young adult age group 18-29 years was more likely to decrease their time on Facebook over time. Specifically, younger females were most likely to decrease time spent on Facebook. In general, male participants were most likely to spend the same amount of time on Facebook. These findings have implications for future health intervention research, and ultimately, for translation to the clinic setting to improve health outcomes. ",
doi="10.2196/ijmr.9554",
url="http://www.i-jmr.org/2018/1/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29903698"
}


@Article{info:doi/10.2196/10141,
author="Schueller, M. Stephen
and Neary, Martha
and O'Loughlin, Kristen
and Adkins, C. Elizabeth",
title="Discovery of and Interest in Health Apps Among Those With Mental Health Needs: Survey and Focus Group Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="11",
volume="20",
number="6",
pages="e10141",
keywords="mHealth",
keywords="mental health",
keywords="mobile apps",
keywords="consumer preference",
keywords="focus groups",
abstract="Background: A large number of health apps are available directly to consumers through app marketplaces. Little information is known, however, about how consumers search for these apps and which factors influence their uptake, adoption, and long-term use. Objective: The aim of this study was to understand what people look for when they search for health apps and the aspects and features of those apps that consumers find appealing. Methods: Participants were recruited from Northwestern University's Center for Behavioral Intervention Technologies' research registry of individuals with mental health needs. Most participants (n=811) completed a survey asking about their use and interest in health and mental health apps. Local participants were also invited to participate in focus groups. A total of 7 focus groups were conducted with 30 participants that collected more detailed information about their use and interest in health and mental health apps. Results: Survey participants commonly found health apps through social media (45.1\%, 366/811), personal searches (42.7\%, 346/811), or word of mouth (36.9\%, 299/811), as opposed to professional sources such as medical providers (24.6\%, 200/811). From the focus groups, common themes related to uptake and use of health apps included the importance of personal use before adoption, specific features that users found desirable, and trusted sources either developing or promoting the apps. Conclusions: As the number of mental health and health apps continue to increase, it is imperative to better understand the factors that impact people's adoption and use of such technologies. Our findings indicated that a number of factors---ease of use, aesthetics, and individual experience---drove adoption and use and highlighted areas of focus for app developers and disseminators. ",
doi="10.2196/10141",
url="http://www.jmir.org/2018/6/e10141/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29891468"
}


@Article{info:doi/10.2196/jmir.8203,
author="Shim, Hyunju
and Ailshire, Jennifer
and Zelinski, Elizabeth
and Crimmins, Eileen",
title="The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points",
journal="J Med Internet Res",
year="2018",
month="May",
day="25",
volume="20",
number="5",
pages="e200",
keywords="health information technology",
keywords="health services",
keywords="disease management",
keywords="chronic disease",
keywords="geriatrics",
abstract="Background: The use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known. Objective: This study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions. Methods: The study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested. Results: A total of 48.0\% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times. Conclusions: The use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions. ",
doi="10.2196/jmir.8203",
url="http://www.jmir.org/2018/5/e200/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29802088"
}


@Article{info:doi/10.2196/jmir.9196,
author="Gerard, Macda
and Chimowitz, Hannah
and Fossa, Alan
and Bourgeois, Fabienne
and Fernandez, Leonor
and Bell, K. Sigall",
title="The Importance of Visit Notes on Patient Portals for Engaging Less Educated or Nonwhite Patients: Survey Study",
journal="J Med Internet Res",
year="2018",
month="May",
day="24",
volume="20",
number="5",
pages="e191",
keywords="patient engagement",
keywords="vulnerable populations",
keywords="patient portals",
keywords="electronic health record",
abstract="Background: OpenNotes, a national initiative to share clinicians' visit notes with patients, can improve patient engagement, but effects on vulnerable populations are not known very well. Objective: Our aim is to examine the importance of visit notes to nonwhite and less educated patients. Methods: Patients at an urban academic medical center with an active patient portal account and ?1 available ambulatory visit note over the prior year were surveyed during June 2016 until September 2016. The survey was designed with patients and families and assessed importance of reading notes (scale 0-10) for (1) understanding health conditions, (2) feeling informed about care, (3) understanding the provider's thought process, (4) remembering the plan of care, and (5) making decisions about care. We compared the proportion of patients reporting 9-10 (extremely important) for each item stratified by education level, race/ethnicity, and self-reported health. Principal component analysis and correlation measures supported a summary score for the 5 items (Cronbach alpha=.93). We examined factors associated with rating notes as extremely important to engage in care using logistic regression. Results: Of 24,722 patients, 6913 (27.96\%) completed the survey. The majority (6736/6913, 97.44\%) read at least one note. Among note readers, 74.0\% (727/982) of patients with ?high school education, 70.7\% (130/184) of black patients, and 69.9\% (153/219) of Hispanic/Latino patients reported that notes are extremely important to feel informed about their care. The majority of less educated and nonwhite patients reported notes as extremely important to remember the care plan (62.4\%, 613/982 ?high school education; 62.0\%, 114/184 black patients; and 61.6\%, 135/219 Hispanic/Latino patients) and to make care decisions (62.3\%, 612/982; 59.8\%, 110/184; and 58.5\%, 128/219, respectively, and P<.003 for all comparisons to more educated and white patients, respectively). Among patients with the poorest self-reported health, 65.9\% (499/757) found notes extremely important to be informed and to understand the provider. On multivariable modeling, less educated patients were nearly three times as likely to report notes were extremely important to engage in care compared with the most educated patients (odds ratio [OR] 2.9, 95\% CI 2.4-3.3). Nonwhite patients were twice as likely to report the same compared with white patients (OR 2.0, 95\% CI 1.5-2.7 [black] and OR 2.2, 95\% CI 1.6-2.9 [Hispanic/Latino and Asian], P<.001 for each comparison). Healthier patients, women, older patients, and those who read more notes were more likely to find notes extremely important to engage in care. Conclusions: Less educated and nonwhite patients using the portal each assigned higher importance to reading notes for several health behaviors than highly educated and white patients, and may find transparent notes especially valuable for understanding their health and engaging in their care. Facilitating access to notes may improve engagement in health care for some vulnerable populations who have historically been more challenging to reach. ",
doi="10.2196/jmir.9196",
url="http://www.jmir.org/2018/5/e191/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29793900"
}


@Article{info:doi/10.2196/jmir.9306,
author="VonHoltz, Houdek Lauren A.
and Frasso, Rosemary
and Golinkoff, M. Jesse
and Lozano, J. Alicia
and Hanlon, Alexandra
and Dowshen, Nadia",
title="Internet and Social Media Access Among Youth Experiencing Homelessness: Mixed-Methods Study",
journal="J Med Internet Res",
year="2018",
month="May",
day="22",
volume="20",
number="5",
pages="e184",
keywords="adolescent",
keywords="homeless youth",
keywords="internet",
keywords="social media",
keywords="smartphone",
keywords="health",
abstract="Background: Youth experiencing homelessness are at a risk for a variety of adverse outcomes. Given the widespread use of the internet and social media, these new technologies may be used to address their needs and for outreach purposes. However, little is known about how this group uses these resources. Objective: This study investigated how homeless adolescents use these technologies for general and health-related purposes, whether the scope of their use changes with housing status, and their interest in a website dedicated to youth experiencing homelessness. Methods: A convenience sample of youth aged 18 to 21 years was recruited from a youth-specific homeless shelter. All participants completed a 47-item survey, with 10 individuals completing a semistructured interview. Descriptive statistics, exact testing, logistic regression, and generalized estimating equation modeling was performed for quantitative data analysis. Interviews were transcribed verbatim, and NVivo 10 (QSR International) was employed to facilitate double coding and thematic analysis. Results: A total of 87 participants completed the survey with a mean age of 19.4 (SD 1.1) years. While experiencing homelessness, 56\% (49/87) accessed the internet at least once a day, with 86\% (75/87) accessing once a week. Access to a smartphone was associated with a 3.03 greater odds of accessing the internet and was the most frequently used device (66\% of participants, 57/87). While experiencing homelessness, subjects reported a 68\% decreased odds in internet access frequency (odds ratio [OR] 0.32, P<.001), 75\% decreased odds in spending greater amounts of time on the internet (OR 0.25, P<.001), and an 87\% decreased odds of social media use (OR 0.13, P=.01). Ten participants completed the semistructured interview. Several themes were identified, including (1) changes in internet behaviors while experiencing homelessness, (2) health status as a major concern and reason for Internet use, and (3) interest in a website dedicated to youth experiencing homelessness. While experiencing homelessness, participants indicated their behaviors were more goal-oriented and less focused on leisure or entertainment activities. Conclusions: While homeless youth experience changes in the frequency, amount of time, and specific uses of the internet and social media, study participants were able to access the internet regularly. The internet was used to search health-related topics. Given the importance of smartphones in accessing the internet, mobile-optimized websites may be an effective method for reaching this group. ",
doi="10.2196/jmir.9306",
url="http://www.jmir.org/2018/5/e184/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29789281"
}


@Article{info:doi/10.2196/mhealth.7657,
author="Saez, Laura
and Langlois, Johanne
and Legrand, Karine
and Quinet, Marie-H{\'e}l{\`e}ne
and Lecomte, Edith
and Omorou, Y. Abdou
and Brian{\c{c}}on, Serge
and ",
title="Reach and Acceptability of a Mobile Reminder Strategy and Facebook Group Intervention for Weight Management in Less Advantaged Adolescents: Insights From the PRALIMAP-IN{\`E}S Trial",
journal="JMIR Mhealth Uhealth",
year="2018",
month="May",
day="18",
volume="6",
number="5",
pages="e110",
keywords="adolescent",
keywords="social media",
keywords="text messaging",
keywords="overweight",
keywords="socioeconomic factors",
keywords="weight loss",
abstract="Background: Although information and communication technology interventions appear to be a promising means of reducing the health inequality gap in overweight and obesity prevention, research on information and communication technology interventions is lacking outside the Anglo-Saxon world. Objective: The aim of this study was to assess the reach and acceptability of 2 information and communication technology interventions delivered as part of a French nutritional program: an SMS text messaging (short message service, SMS) attendance-reminder for collective sessions strategy and a Facebook challenge group. Methods: This study sample comprised 262 socially less advantaged overweight adolescents aged between 13 and 18 years. The information and communication technology interventions were carried out during the 2013-2014 academic year in 33 French state-run schools. For the SMS attendance-reminder for collective sessions strategy, at the start of the academic year, adolescents were asked to give their mobile number. SMS attendance-reminders were sent shortly before each of the 5 collective sessions. For the Facebook challenge group, adolescents were invited to join a closed Facebook group in which challenges on physical activity and on diet were posted weekly. Process data and 2 sets of face-to-face interviews were also used to interpret participation rates and access to Facebook. Appreciation for both interventions was evaluated by a questionnaire at the end of the academic year. Results: Of the recruited adolescents, 79.0\% (207/262) gave their mobile number, reflecting high access to a mobile phone. Giving a number was significantly more likely for girls (odds ratio [OR] 2.1, 95\% CI 1.1-3.9; P=.02) and adolescents in a vocational or general high school as opposed to middle school (OR 1.0, 95\% CI 0.4-2.7; OR 0.2, 95\% CI 0.1-0.5; P<.001). Indicating a mobile number at the start of the year was not significantly associated with participation in collective sessions. Of the adolescents seen at the start-of-year face-to-face interviews, 78.1\% (153/196) declared an interest in the Facebook challenge group, which implies having a Facebook account or being able to have access to one. However, only 21 adolescents went through the process of joining the group. Although there was satisfaction with the Facebook group among the participants, the low participation rate in the Facebook group does not allow conclusions to be drawn with confidence. Conclusions: The results are in line with the claim that using information and communication technologies in health programs is unlikely to widen health inequalities. However, in this population of French adolescents, mobile phone strategies seem more adapted to a high school context, and caution should be exercised with a younger audience. Although there is positive appreciation of the SMS attendance-reminders and a Facebook intervention is initially highly appealing to less advantaged adolescents, no evidence of impact could be demonstrated. These results highlight the difficulty in assessing the impact of specific interventions in complex health programs. Trial Registration: Clinicaltrials.gov NCT01688453; https://clinicaltrials.gov/ct2/show/NCT01688453 (Archived by WebCite at http://www.webcitation.org/6yy6EQ0SM) ",
doi="10.2196/mhealth.7657",
url="http://mhealth.jmir.org/2018/5/e110/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29776897"
}


@Article{info:doi/10.2196/jmir.9434,
author="Grande, W. Stuart
and Sherman, D. Ledric",
title="Too Important to Ignore: Leveraging Digital Technology to Improve Chronic Illness Management Among Black Men",
journal="J Med Internet Res",
year="2018",
month="May",
day="14",
volume="20",
number="5",
pages="e182",
keywords="black men",
keywords="digital health",
keywords="chronic illness",
doi="10.2196/jmir.9434",
url="http://www.jmir.org/2018/5/e182/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29759956"
}


@Article{info:doi/10.2196/jmir.7299,
author="Lupi{\'a}{\~n}ez-Villanueva, Francisco
and Anastasiadou, Dimitra
and Codagnone, Cristiano
and Nu{\~n}o-Solin{\'i}s, Roberto
and Garcia-Zapirain Soto, Begona Maria",
title="Electronic Health Use in the European Union and the Effect of Multimorbidity: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2018",
month="May",
day="03",
volume="20",
number="5",
pages="e165",
keywords="multimorbidity",
keywords="eHealth",
keywords="adoption",
keywords="Europe",
abstract="Background: Multimorbidity is becoming increasingly common and is a leading challenge currently faced by societies with aging populations. The presence of multimorbidity requires patients to coordinate, understand, and use the information obtained from different health care professionals, while simultaneously striving to distinguish the symptoms of different diseases and self-manage their sometimes conflicting health problems. Electronic health (eHealth) tools provide a means to disseminate health information and education for both patients and health professionals and hold promise for more efficient and cost-effective care processes. Objective: The aim of this study was to analyze the use of eHealth tools, taking into account the citizens' sociodemographic and clinical characteristics, and above all, the presence of multimorbidity. Methods: Cross-sectional and exploratory research was conducted using online survey data from July 2011 to August 2011. Participants included a total of 14,000 citizens from 14 European countries aged 16 to 74 years, who had used an eHealth tool in the past 3 months. The variables studied were sociodemographic variables of the participants, the questionnaire items assessing the frequency of using eHealth tools, the degree of morbidity, and the eHealth adoption gradient. Chi-square tests were conducted to examine the relationship between the sociodemographic and clinical variables of participants and the group the participants were assigned to according to their frequency of eHealth use (eHealth user group). A one-way analysis of variance (ANOVA) allowed for assessing the differences in the eHealth adoption gradient average between different groups of individuals according to their morbidity level. A two-way between-groups ANOVA was performed to explore the effects of multimorbidity and age group on the eHealth adoption gradient. Results: According to the eHealth adoption gradient, most participants (68.15\%, 9541/14,000) were labeled as rare users, with the majority of them (55.1\%, 508/921) being in the age range of 25 to 54 years, with upper secondary education (50.3\%, 464/921), currently employed (49.3\%, 454/921), and living in medium-sized cities (40.7\%, 375/921). Results of the one-way ANOVA showed that the number of health problems significantly affected the use of eHealth tools (F2,13996=11.584; P<.001). The two-way ANOVA demonstrated that there was a statistically significant interaction between the effects of age and number of health problems on the eHealth adoption gradient (F4,11991=7.936; P<.001). Conclusions: The eHealth adoption gradient has proven to be a reliable way to measure different aspects of eHealth use. Multimorbidity is associated with a more intense use of eHealth, with younger Internet users using new technologies for health purposes more frequently than older groups with the same level of morbidity. These findings suggest the need to consider different strategies aimed at making eHealth tools more sensitive to the characteristics of older populations to reduce digital disadvantages. ",
doi="10.2196/jmir.7299",
url="http://www.jmir.org/2018/5/e165/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29724702"
}


@Article{info:doi/10.2196/mhealth.9002,
author="Xie, Zhenzhen
and Nacioglu, Ahmet
and Or, Calvin",
title="Prevalence, Demographic Correlates, and Perceived Impacts of Mobile Health App Use Amongst Chinese Adults: Cross-Sectional Survey Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Apr",
day="26",
volume="6",
number="4",
pages="e103",
keywords="mHealth",
keywords="mobile health apps",
keywords="prevalence",
keywords="demographic correlates",
keywords="health behavior",
abstract="Background: Mobile health apps have changed the way people obtain health information and services and advance their understanding and management of their health. Although many health apps are available, little is known about the prevalence of their use for different purposes, whether such use is associated with demographic characteristics, and the impacts of their use on health knowledge and management. Objective: The main objectives of this study were to examine the prevalence, extent, and demographic correlates of health app use and the perceived impacts of health app use on increased health knowledge and improved health condition management. Methods: We conducted a cross-sectional questionnaire survey of 633 Chinese adults randomly drawn from the general population in Hong Kong. Results: Of the 633 participants, 612 (96.7\%) reported using mobile devices. Of them, 235 (38.4\%) reported using multiple types of health apps. The most-used type of health app was about healthy living information (197/612, 32.2\%), followed by measuring/recording vital signs (80/612, 13.1\%), health and medical reminders (64/612, 10.5\%), recovery and rehabilitation information (42/612, 6.9\%), diagnosis assistance (28/612, 4.6\%), emergency services (16/612, 2.6\%), telehealth (11/612, 1.8\%), and ``other'' (19/612, 3.1\%). Multivariate logistic regression analysis found that health app users were more likely to be women (odds ratio [OR] 1.68, 95\% CI 1.14-2.48, P=.01) of a higher self-rated social class (OR 3.66, 95\% CI 1.11-12.11, P=.03). Participants who worked in education/culture/academia (OR 2.31, 95\% CI 1.16-4.59, P=.02) or disciplinary forces (OR 5.07, 95\% CI 1.25-20.62, P=.02) were more likely to believe that using health apps could increase their health knowledge; participants working in education/culture/academia were also more likely to believe that using health apps could improve the effectiveness of health condition management (OR 2.18, 95\% CI 1.10-4.34, P=.03). Conclusions: Effort should be made to promote health app use, especially to demographic groups that are currently less likely to use health apps (eg, males, individuals from lower social classes). From the public health perspective, guidelines could be developed to help individuals identify quality health apps that meet their needs. Moreover, app developers could improve the usability of health apps to promote health app use. ",
doi="10.2196/mhealth.9002",
url="http://mhealth.jmir.org/2018/4/e103/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29699971"
}


@Article{info:doi/10.2196/jmir.8819,
author="Senecal, Conor
and Widmer, Jay R.
and Bailey, Kent
and Lerman, O. Lilach
and Lerman, Amir",
title="Usage of a Digital Health Workplace Intervention Based on Socioeconomic Environment and Race: Retrospective Secondary Cross-Sectional Study",
journal="J Med Internet Res",
year="2018",
month="Apr",
day="23",
volume="20",
number="4",
pages="e145",
keywords="race and ethnicity",
keywords="socioeconomic position",
keywords="computers",
keywords="health services research",
keywords="health disparities",
abstract="Background: Digital health tools have been associated with improvement of cardiovascular disease (CVD) risk factors and outcomes; however, the differential use of these technologies among various ethnic and economic classes is not well known. Objective: To identify the effect of socioeconomic environment on usage of a digital health intervention. Methods: A retrospective secondary cross-sectional analysis of a workplace digital health tool use, in association with a change in intermediate markers of CVD, was undertaken over the course of one year in 26,188 participants in a work health program across 81 organizations in 42 American states between 2011 and 2014. Baseline demographic data for participants included age, sex, race, home zip code, weight, height, blood pressure, glucose, lipids, and hemoglobin A1c. Follow-up data was then obtained in 90-day increments for up to one year. Using publicly available data from the American Community Survey, we obtained the median income for each zip code as a marker for socioeconomic status via median household income. Digital health intervention usage was analyzed based on socioeconomic status as well as age, gender, and race. Results: The cohort was found to represent a wide sample of socioeconomic environments from a median income of US \$11,000 to \$171,000. As a whole, doubling of income was associated with 7.6\% increase in log-in frequency. However, there were marked differences between races. Black participants showed a 40.5\% increase and Hispanic participants showed a 57.8\% increase in use with a doubling of income, compared to 3\% for Caucasian participants. Conclusions: The current study demonstrated that socioeconomic data confirms no relevant relationship between socioeconomic environment and digital health intervention usage for Caucasian users. However, a strong relationship is present for black and Hispanic users. Thus, socioeconomic environment plays a prominent role only in minority groups that represent a high-risk group for CVD. This finding identifies a need for digital health apps that are effective in these high-risk groups. ",
doi="10.2196/jmir.8819",
url="http://www.jmir.org/2018/4/e145/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29685862"
}


@Article{info:doi/10.2196/jmir.9391,
author="Kim, Sujin
and Sinn, Donghee
and Syn, Yeon Sue",
title="Analysis of College Students' Personal Health Information Activities: Online Survey",
journal="J Med Internet Res",
year="2018",
month="Apr",
day="20",
volume="20",
number="4",
pages="e132",
keywords="health records, personal",
keywords="health information management",
keywords="student health services",
abstract="Background: With abundant personal health information at hand, individuals are faced with a critical challenge in evaluating the informational value of health care records to keep useful information and discard that which is determined useless. Young, healthy college students who were previously dependents of adult parents or caregivers are less likely to be concerned with disease management. Personal health information management (PHIM) is a special case of personal information management (PIM) that is associated with multiple interactions among varying stakeholders and systems. However, there has been limited evidence to understand informational or behavioral underpinning of the college students' PHIM activities, which can influence their health in general throughout their lifetime. Objective: This study aimed to investigate demographic and academic profiles of college students with relevance to PHIM activities. Next, we sought to construct major PHIM-related activity components and perceptions among college students. Finally, we sought to discover major factors predicting core PHIM activities among college students we sampled. Methods: A Web survey was administered to collect responses about PHIM behaviors and perceptions among college students from the University of Kentucky from January through March 2017. A total of 1408 college students were included in the analysis. PHIM perceptions, demographics, and academic variations were used as independent variables to predict diverse PHIM activities using a principal component analysis (PCA) and hierarchical regression analyses (SPSS v.24, IBM Corp, Armonk, NY, USA). Results: Majority of the participants were female (956/1408, 67.90\%), and the age distribution of this population included an adequate representation of college students of all ages. The most preferred health information resources were family (612/1408, 43.47\%), health care professionals (366/1408, 26.00\%), friends (27/1408, 1.91\%), and the internet (157/1408, 11.15\%). Organizational or curatorial activities such as Arranging, Labeling, Categorizing, and Discarding were rated low (average=3.21, average=3.02, average=2.52, and average=2.42, respectively). The PCA results suggested 3 components from perception factors labeled as follows: Assistance (alpha=.85), Awareness (alpha=.716), and Difficulty (alpha=.558). Overall, the Demographics and Academics variables were not significant in predicting dependent variables such as Labeling, Categorizing, Health Education Materials, and Discarding, whereas they were significant for other outcome variables such as Sharing, Collecting, Knowing, Insurance Information, Using, and Owning. Conclusions: College years are a significant time for students to learn decision-making skills for maintaining information, a key aspect of health records, as well as for educators to provide appropriate educational and decision aids in the environment of learning as independent adults. Our study will contribute to better understand knowledge about specific skills and perceptions for college students' practice of effective PHIM throughout their lives. ",
doi="10.2196/jmir.9391",
url="http://www.jmir.org/2018/4/e132/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29678798"
}


@Article{info:doi/10.2196/mhealth.9189,
author="R{\'e}gnier, Faustine
and Chauvel, Louis",
title="Digital Inequalities in the Use of Self-Tracking Diet and Fitness Apps: Interview Study on the Influence of Social, Economic, and Cultural Factors",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Apr",
day="20",
volume="6",
number="4",
pages="e101",
keywords="diet",
keywords="digital divide",
keywords="fitness trackers",
keywords="France",
keywords="healthy diet",
keywords="physical activity",
keywords="social networking",
keywords="social participation",
keywords="weight loss",
abstract="Background: Digital devices are driving economic and social transformations, but assessing the uses, perceptions, and impact of these new technologies on diet and physical activity remains a major societal challenge. Objective: We aimed to determine under which social, economic, and cultural conditions individuals in France were more likely to be actively invested in the use of self-tracking diet and fitness apps for better health behaviors. Methods: Existing users of 3 diet and fitness self-tracking apps (Weight Watchers, MyFitnessPal, and sport apps) were recruited from 3 regions of France. We interviewed 79 individuals (Weight Watchers, n=37; MyFitnessPal, n=20; sport apps, n=22). In-depth semistructured interviews were conducted with each participant, using open-ended questions about their use of diet and fitness apps. A triangulation of methods (content, textual, and quantitative analyses) was performed. Results: We found 3 clusters of interviewees who differed by social background and curative goal linked to use under constraint versus preventive goal linked to chosen use, and intensity of their self-quantification efforts and participation in social networks. Interviewees used the apps for a diversity of uses, including measurement, tracking, quantification, and participation in digital communities. A digital divide was highlighted, comprising a major social gap. Social conditions for appropriation of self-tracking devices included sociodemographic factors, life course stages, and cross-cutting factors of heterogeneity. Conclusions: Individuals from affluent or intermediate social milieus were most likely to use the apps and to participate in the associated online social networks. These interviewees also demonstrated a preventive approach to a healthy lifestyle. Individuals from lower milieus were more reluctant to use digital devices relating to diet and physical activity or to participate in self-quantification. The results of the study have major implications for public health: the digital self-quantification device is intrinsically less important than the way the individual uses it, in terms of adoption of successful health behaviors. ",
doi="10.2196/mhealth.9189",
url="http://mhealth.jmir.org/2018/4/e101/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29678807"
}


@Article{info:doi/10.2196/jmir.7766,
author="Featherall, Joseph
and Lapin, Brittany
and Chaitoff, Alexander
and Havele, A. Sonia
and Thompson, Nicolas
and Katzan, Irene",
title="Characterization of Patient Interest in Provider-Based Consumer Health Information Technology: Survey Study",
journal="J Med Internet Res",
year="2018",
month="Apr",
day="19",
volume="20",
number="4",
pages="e128",
keywords="consumer health informatics",
keywords="medical informatics",
keywords="self efficacy",
keywords="self-management",
keywords="telemedicine",
keywords="patient-centered care",
abstract="Background: Consumer health information technology can improve patient engagement in their health care and assist in navigating the complexities of health care delivery. However, the consumer health information technology offerings of health systems are often driven by provider rather than patient perspectives and inadequately address patient needs, thus limiting their adoption by patients. Consideration given to patients as stakeholders in the development of such technologies may improve adoption, efficacy, and consumer health information technology resource allocation. Objective: The aims of this paper were to measure patient interest in different health system consumer health information technology apps and determine the influence of patient characteristics on consumer health information technology interest. Methods: Patients seen at the Cleveland Clinic Neurological Institute were electronically surveyed on their interest in using different consumer health information technology apps. A self-efficacy scale, Patient Health Questionnaire-9 depression screen, and EuroQol 5 dimensions health-related quality of life scale were also completed by patients. Logistic regression was used to determine the influence of patient characteristics on interest in consumer health information technology in the categories of self-management, education, and communication. Results: The majority of 3852 patient respondents had an interest in all technology categories assessed in the survey. The highest interest was in apps that allow patients to ask questions of providers (3476/3852, 90.24\%) and to schedule appointments (3211/3839, 83.64\%). Patient interest in consumer health information technology was significantly associated with greater depression symptoms, worse quality of life, greater health self-efficacy, and smartphone ownership (P<.001 for all listed). Conclusions: Patients should be viewed as active stakeholders in consumer health information technology development and their perspectives should consistently guide development efforts. Health systems should consider focusing on consumer health information technologies that assist patients in scheduling appointments and asking questions of providers. Patients with depression should also be considered for targeted consumer health information technology implementation. Health self-efficacy is a valid predictor of consumer health information technology interest and may play a role in the utilization of consumer health information technologies. Health systems, broadly, should put forth greater effort to understand the needs and interests of patients in the consumer health information technology development process. Consumer health information technology design and implementation may be improved by understanding which technologies patients want. ",
doi="10.2196/jmir.7766",
url="http://www.jmir.org/2018/4/e128/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29674312"
}


@Article{info:doi/10.2196/jmir.7731,
author="Park, Eunhee
and Kwon, Misol",
title="Health-Related Internet Use by Children and Adolescents: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Apr",
day="03",
volume="20",
number="4",
pages="e120",
keywords="Internet",
keywords="child",
keywords="adolescent",
keywords="health information",
keywords="health-related Internet use",
keywords="eHealth",
abstract="Background: The internet is widely used by children and adolescents, who generally have a high level of competency with technology. Thus, the internet has become a great resource for supporting youth self-care and health-related services. However, few studies have explored adolescents' internet use for health-related matters. Objective: The objective of this systematic literature review was to examine the phenomenon of children and adolescents' health-related internet use and to identify gaps in the research. Methods: A total of 19 studies were selected from a search of major electronic databases: PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO using the following search terms: ``health-related internet use,'' ``eHealth,'' ``Internet use for health-related purpose,'' ``Web-based resource,'' ``health information seeking,'' and ``online resource,'' combined with ``child,'' ``adolescent,'' ``student,'' ``youth,'' and ``teen.'' The children's and adolescents' ages were limited to 24 years and younger. The search was conducted from September 2015 to October 2017. The studies identified to contain youth (<24 years) health-related internet use were all published in peer-reviewed journals in the past 10 years; these studies examined general internet use seeking health care services, resources, information, or using the internet for health promotion and self-care. Studies were excluded if they explored the role of the internet as a modality for surveys, recruitment, or searching for relevant literature without specifically aiming to study participants' health-related internet use; focused solely on quality assurance for specific websites; or were designed to test a specific internet-based intervention. Results: Interesting patterns in adolescents' health-related internet use, such as seeking preventative health care and specific information about medical issues, were identified. Quantitative studies reported rates of the internet use and access among youth, and the purpose and patterns of health-related internet use among youth were identified. A major objective of health-related internet use is to gain information, but there are inconsistencies in adolescents' perceptions of health-related internet use. Conclusions: This study's findings provide important information on how youth seek information and related support systems for their health care on the internet. The conceptual and methodological limitations of the identified studies, such as the lack of a theoretical background and unrepresentative samples, are discussed, and gaps within the studies are identified for future research. This review also suggests important features for potential Web-based health interventions for children and adolescents. ",
doi="10.2196/jmir.7731",
url="http://www.jmir.org/2018/4/e120/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29615385"
}


@Article{info:doi/10.2196/jmir.7851,
author="Tarver, L. Will
and Menser, Terri
and Hesse, W. Bradford
and Johnson, J. Tyler
and Beckjord, Ellen
and Ford, W. Eric
and Huerta, R. Timothy",
title="Growth Dynamics of Patient-Provider Internet Communication: Trend Analysis Using the Health Information National Trends Survey (2003 to 2013)",
journal="J Med Internet Res",
year="2018",
month="Mar",
day="29",
volume="20",
number="3",
pages="e109",
keywords="internet",
keywords="health communication",
abstract="Background: Communication is key in chronic disease management, and the internet has altered the manner in which patients and providers can exchange information. Adoption of secure messaging differs among patients due to the digital divide that keeps some populations from having effective access to online resources. Objective: This study aimed to examine the current state of online patient-provider communication, exploring trends over time in the use of online patient-provider communication tools. Methods: A 3-part analytic process was used to study the following: (1) reanalysis, (2) close replication across years, and (3) trend analysis extension. During the reanalysis stage, the publicly available Health Information National Trends Survey (HINTS) 1 and 2 data were used with the goal of identifying the precise analytic methodology used in a prior study, published in 2007. The original analysis was extended to add 3 additional data years (ie, 2008, 2011, and 2013) using the original analytical approach with the purpose of identifying trends over time. Multivariate logistic regression was used to analyze pooled data across all years, with year as an added predictor, in addition to a model for each individual data year. Results: The odds of internet users to communicate online with health care providers was significantly and increasingly higher year-over-year, starting in 2003 (2005: odds ratio [OR] 1.31, 95\% CI 1.03-1.68; 2008: OR 2.14, 95\% CI 1.76-2.59; 2011: OR 2.92, 95\% CI 2.33-3.66; and 2013: OR 5.77; 95\% CI 4.62-7.20). Statistically significant socio-economic factors found to be associated with internet users communicating online with providers included age, having health insurance, having a history of cancer, and living in an urban area of residence. Conclusions: The proportion of internet users communicating online with their health care providers has significantly increased since 2003. Although these trends are encouraging, access challenges still exist for some groups, potentially giving rise to a new set of health disparities related to communication. ",
doi="10.2196/jmir.7851",
url="http://www.jmir.org/2018/3/e109/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29599107"
}


@Article{info:doi/10.2196/rehab.8783,
author="Kim, Ji Eun
and Yuan, Yiyang
and Liebschutz, Jane
and Cabral, Howard
and Kazis, Lewis",
title="Understanding the Digital Gap Among US Adults With Disability: Cross-Sectional Analysis of the Health Information National Trends Survey 2013",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Mar",
day="16",
volume="5",
number="1",
pages="e3",
keywords="disability",
keywords="health information",
keywords="Internet",
keywords="health care provider",
keywords="trust",
keywords="psychosocial factors",
abstract="Background: Disabilities affect more than 1 in 5 US adults, and those with disabilities face multiple barriers in accessing health care. A digital gap, defined as the disparity caused by differences in the ability to use advanced technologies, is assumed to be prevalent among individuals with disabilities. Objective: This study examined the associations between disability and use of information technology (IT) in obtaining health information and between trust factors and IT use. We hypothesized that compared to US adults without disabilities, those with disabilities are less likely to refer to the internet for health information, more likely to refer to a health care provider to obtain health information, and less likely to use IT to exchange medical information with a provider. Additionally, we hypothesized that trust factors, such as trust toward health information source and willingness to exchange health information, are associated with IT use. Methods: The primary database was the 2013 Health Information National Trends Survey 4 Cycle 3 (N=3185). Disability status, the primary study covariate, was based on 6 questions that encompassed a wide spectrum of conditions, including impairments in mobility, cognition, independent living, vision, hearing, and self-care. Study covariates included sociodemographic factors, respondents' trust toward the internet and provider as information sources, and willingness to exchange medical information via IT with providers. Study outcomes were the use of the internet as the primary health information source, use of health care providers as the primary health information source, and use of IT to exchange medical information with providers. We conducted multivariate logistic regressions to examine the association between disability and study outcomes controlling for study covariates. Multiple imputations with fully conditional specification were used to impute missing values. Results: We found presence of any disability was associated with decreased odds (adjusted odds ratio [AOR] 0.65, 95\% CI 0.43-0.98) of obtaining health information from the internet, in particular for those with vision disability (AOR 0.27, 95\% CI 0.11-0.65) and those with mobility disability (AOR 0.51, 95\% CI 0.30-0.88). Compared to those without disabilities, those with disabilities were significantly more likely to consult a health care provider for health information in both actual (OR 2.21, 95\% CI 1.54-3.18) and hypothetical situations (OR 1.80, 95\% CI 1.24-2.60). Trust toward health information from the internet (AOR 3.62, 95\% CI 2.07-6.33), and willingness to exchange via IT medical information with a provider (AOR 1.88, 95\% CI 1.57-2.24) were significant predictors for seeking and exchanging such information, respectively. Conclusions: A potential digital gap may exist among US adults with disabilities in terms of their recent use of the internet for health information. Trust toward health information sources and willingness play an important role in people's engagement in use of the internet for health information. Future studies should focus on addressing trust factors associated with IT use and developing tools to improve access to care for those with disabilities. ",
doi="10.2196/rehab.8783",
url="http://rehab.jmir.org/2018/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29549074"
}


@Article{info:doi/10.2196/mhealth.9131,
author="Montagni, Ilaria
and Cariou, Tanguy
and Feuillet, Tiphaine
and Langlois, Emmanuel
and Tzourio, Christophe",
title="Exploring Digital Health Use and Opinions of University Students: Field Survey Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Mar",
day="15",
volume="6",
number="3",
pages="e65",
keywords="eHealth",
keywords="mHealth",
keywords="students",
keywords="mobile application",
keywords="surveys",
keywords="Internet",
abstract="Background: During university, students face some potentially serious health risks, and their lifestyle can have a direct effect on health and health behaviors later in life. Concurrently, university students are digital natives having easy access to the internet and new technologies. Digital health interventions offer promising new opportunities for health promotion, disease prevention, and care in this specific population. The description of the current use of and opinions on digital health among university students can inform future digital health strategies and interventions within university settings. Objective: The aim of this exploratory study was to report on university students' use and opinions regarding information and communication technologies for health and well-being, taking into account sociodemographic and self-rated general and mental health correlates. Methods: This field survey was conducted from March to April 2017. An informed consent form and a paper questionnaire were given to students aged 18 to 24 years in 4 university campuses in Bordeaux, France. The survey was formulated in 3 sections: (1) sociodemographic characteristics and self-rated general and mental health, (2) information about the use of digital health, and (3) opinions about digital health. Data were analyzed using descriptive statistics and tests of independence. Results: A total of 59.8\% (303/507 females) students completed the questionnaire. Concerning digital health use, 34.9\% (174/498) had at least 1 health app mostly for physical activity (49.4\%, 86/174) and general health monitoring (41.4\%, 72/174,), but only 3.9\% (20/507) of students had a wearable device. Almost all (94.8\%, 450/476) had searched for Web-based health-related information at least once in the last 12 months. The most sought health-related topics were nutrition (68.1\%, 324/476); pain and illnesses (64.5\%, 307/476); and stress, anxiety, or depression (51.1\%, 243/476). Although Wikipedia (79.7\%, 357/448) and general health websites (349/448, 77.9\%) were the most consulted sources, students considered institutional or official websites as the most credible sources (309/335, 92.2\%). There were significant differences in digital health use by gender, field, and year of study. No statistically significant association was found between digital health use and self-rated general and mental health status. Concerning opinions on digital health, although 94.1\% (475/505) of students estimated that today's digital health cannot replace traditional health services and medical consultations, 44.6\% (207/464) of students declared that this could be possible in the future, provided that digital health interventions are promoted by institutional or official entities. Conclusions: University students are largely using the internet for health information seeking, but using less mobile health apps and very few wearable devices. Our data suggest that digital health has the potential for improving health and well-being at the university, especially if digital health interventions take into account students' profiles, interests, and needs. ",
doi="10.2196/mhealth.9131",
url="http://mhealth.jmir.org/2018/3/e65/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29549071"
}


@Article{info:doi/10.2196/jmir.9172,
author="Ashford, D. Robert
and Lynch, Kevin
and Curtis, Brenda",
title="Technology and Social Media Use Among Patients Enrolled in Outpatient Addiction Treatment Programs: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2018",
month="Mar",
day="06",
volume="20",
number="3",
pages="e84",
keywords="digital divide",
keywords="behavioral health",
keywords="social media",
keywords="addiction",
keywords="recovery",
keywords="relapse",
abstract="Background: Substance use disorder research and practice have not yet taken advantage of emerging changes in communication patterns. While internet and social media use is widespread in the general population, little is known about how these mediums are used in substance use disorder treatment. Objective: The aims of this paper were to provide data on patients' with substance use disorders mobile phone ownership rates, usage patterns on multiple digital platforms (social media, internet, computer, and mobile apps), and their interest in the use of these platforms to monitor personal recovery. Methods: We conducted a cross-sectional survey of patients in 4 intensive outpatient substance use disorder treatment facilities in Philadelphia, PA, USA. Logistic regressions were used to examine associations among variables. Results: Survey participants (N=259) were mostly male (72.9\%, 188/259), African American (62.9\%, 163/259), with annual incomes less than US \$10,000 (62.5\%, 161/259), and averaged 39 (SD 12.24) years of age. The vast majority of participants (93.8\%, 243/259) owned a mobile phone and about 64.1\% (166/259) owned a mobile phone with app capabilities, of which 85.1\% (207/243) accessed the internet mainly through their mobile phone. There were no significant differences in age, gender, ethnicity, or socio-economic status by computer usage, internet usage, number of times participants changed their phone, type of mobile phone contract, or whether participants had unlimited calling plans. The sample was grouped into 3 age groups (Millennials, Generation Xers, and Baby Boomers). The rates of having a social media account differed across these 3 age groups with significant differences between Baby Boomers and both Generation Xers and Millennials (P<.001 in each case). Among participants with a social media account (73.6\%, 190/259), most (76.1\%, 144/190) reported using it daily and nearly all (98.2\%, 186/190) used Facebook. Nearly half of participants (47.4\%, 90/190) reported viewing content on social media that triggered substance cravings and an equal percentage reported being exposed to recovery information on social media. There was a significant difference in rates of reporting viewing recovery information on social media across the 3 age groups with Baby Boomers reporting higher rates than Millennials (P<.001). The majority of respondents (70.1\%, 181/259) said they would prefer to use a relapse prevention app on their phone or receive SMS (short message service) relapse prevention text messages (72.3\%, 186/259), and nearly half (49.1\%, 127/259) expressed an interest in receiving support by allowing social media accounts to be monitored as a relapse prevention technique. Conclusions: To our knowledge, this is the first and largest study examining the online behavior and preferences regarding technology-based substance use disorder treatment interventions in a population of patients enrolled in community outpatient treatment programs. Patients were generally receptive to using relapse prevention apps and text messaging interventions and a substantial proportion supported social media surveillance tools. However, the design of technology-based interventions remains as many participants have monthly telephone plans which may limit continuity. ",
doi="10.2196/jmir.9172",
url="http://www.jmir.org/2018/3/e84/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29510968"
}


@Article{info:doi/10.2196/jmir.8485,
author="Cherrez Ojeda, Ivan
and Vanegas, Emanuel
and Torres, Michell
and Calder{\'o}n, Carlos Juan
and Calero, Erick
and Cherrez, Annia
and Felix, Miguel
and Mata, Valeria
and Cherrez, Sofia
and Simancas, Daniel",
title="Ecuadorian Cancer Patients' Preference for Information and Communication Technologies: Cross-Sectional Study",
journal="J Med Internet Res",
year="2018",
month="Feb",
day="20",
volume="20",
number="2",
pages="e50",
keywords="social media",
keywords="telemedicine",
keywords="cancer",
keywords="Web 2.0",
keywords="mHealth",
abstract="Background: The instantaneous spread of information, low costs, and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, patient communication, and medical interventions in cancer treatment. There is little information available in Latin America about the level of usage of ICTs for and by cancer patients. Our study attempts to fill this gap. Objective: The aim of this study was to assess the level of ICT use and patterns of preferences among cancer patients. Methods: We conducted an anonymous cross-sectional survey study in 500 Ecuadorian cancer patients. This questionnaire consisted of 22 items about demographic and clinical data, together with the preferences of people who use ICTs. Chi-square, crude, and adjusted logistic regressions were performed. Results: Of the total, 43.2\% (216/500) of participants reported that they had access to the Internet, and 25.4\% (127/500) reported that they neither owned a cell phone nor did they have access to the Internet. The Internet constituted the highest usage rate as a source of information about malignant diseases (74.3\%, 162/218) regardless of age (P<.001). With regard to the preferences on how patients would like to use ICTs to receive information about diseases, WhatsApp (66.5\%, 145/218) and short message service (SMS) text messaging (61.0\%, 133/218) were widely reported as interesting communication channels. Similarly, WhatsApp (72.0\%, 157/218) followed by SMS (63.8\%, 139/218) were reported as the preferred ICTs through which patients would like to ask physicians about diseases. Adjusted regression analysis showed that patients aged between 40 and 64 years were more likely to be interested in receiving information through SMS (odds ratio, OR 5.09, 95\% CI 1.92-13.32), as well as for asking questions to physicians through this same media (OR 9.78, CI 3.45-27.67) than the oldest group. Conclusions: WhatsApp, SMS, and email are effective and widely used ICTs that can promote communication between cancer patients and physicians. According to age range, new ICTs such as Facebook are still emerging. Future studies should investigate how to develop and promote ICT-based resources more effectively to engage the outcomes of cancer patients. The widespread use of ICTs narrows the gap between cancer patients with restricted socioeconomic conditions and those with wealth and easily available technological means, thereby opening up new possibilities in low-income countries. ",
doi="10.2196/jmir.8485",
url="http://www.jmir.org/2018/2/e50/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29463492"
}


@Article{info:doi/10.2196/jmir.8892,
author="Wallace, M. Anne
and Bogard, T. Matthew
and Zbikowski, M. Susan",
title="Intrapersonal Variation in Goal Setting and Achievement in Health Coaching: Cross-Sectional Retrospective Analysis",
journal="J Med Internet Res",
year="2018",
month="Jan",
day="26",
volume="20",
number="1",
pages="e32",
keywords="health coaching",
keywords="health risks",
keywords="chronic conditions",
keywords="behavior change",
abstract="Background: Chronic conditions in the United States are among the most costly and preventable of all health problems. Research suggests health coaching is an effective strategy for reducing health risks including decreases in weight, blood pressure, lipids, and blood glucose. Much less is known about how and when coaching works. Objective: The aim of this study was to conduct an analysis of intrapersonal variations in participants' progression in health coaching, examining gender and age-related differences. Methods: This was a cross-sectional, retrospective analysis of 35,333 health coaching participants between 2012 and 2016. Differences in number of goals and activities set and completed, and number of interactions were assessed using negative binomial models. Differences in goal type were assessed using logistic regression for gender and using the Welch test for age to account for unequal variances. Results: Participants choosing online coaching were more likely to be younger and female (P<.001). Gender and age differences were found for the types of goals set by participants. Regarding program activity, women set and completed 12\% more action steps than men (P<.001), averaging 21\% more interactions than men (P<.001); no gender differences were found in number of goals completed (P=.12), although the percentage of males and females completing goals was significantly different at 60 and 120 days postenrollment (P<.001). Results indicated significant age-related differences in all aspects of program activity: number of interactions, goals set and completed, action steps set and completed (all P values <.01), as well as significant differences in percentage of individuals completing initial goals within 30 days, with older individuals completing more than younger individuals did (all P values <.001). Conclusions: This study found significant intrapersonal variation in how people participate in and progress through a coaching program. Age-related variations were found in all aspects of coaching activity, from modality preference and initial choice of goal type (eg, weight management, tobacco cessation) to goal completion, whereas gender-related differences were demonstrated for all program activities except number of goals set and completed. These findings indicate that to maximize behavior change, coaches need to personalize the coaching experience to the individual. ",
doi="10.2196/jmir.8892",
url="http://www.jmir.org/2018/1/e32/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29374005"
}


@Article{info:doi/10.2196/jmir.8947,
author="Balo?lu, Mustafa
and {\"O}zteke Kozan, ?rem Hatice
and Kesici, ?ahin",
title="Gender Differences in and the Relationships Between Social Anxiety and Problematic Internet Use: Canonical Analysis",
journal="J Med Internet Res",
year="2018",
month="Jan",
day="24",
volume="20",
number="1",
pages="e33",
keywords="anxiety",
keywords="Internet",
keywords="sex characteristics",
keywords="social anxiety disorder",
keywords="addictive behavior",
abstract="Background: The cognitive-behavioral model of problematic Internet use (PIU) proposes that psychological well-being is associated with specific thoughts and behaviors on the Internet. Hence, there is growing concern that PIU is associated with psychological impairments. Objective: Given the proposal of gender schema theory and social role theory, men and women are predisposed to experience social anxiety and engage in Internet use differently. Thus, an investigation of gender differences in these areas is warranted. According to the cognitive-behavioral model of PIU, social anxiety is associated with specific cognitions and behaviors on the Internet. Thus, an investigation of the association between social anxiety and PIU is essential. In addition, research that takes into account the multidimensional nature of social anxiety and PIU is lacking. Therefore, this study aimed to explore multivariate gender differences in and the relationships between social anxiety and PIU. Methods: Participants included 505 college students, of whom 241 (47.7\%) were women and 264 (52.3\%) were men. Participants' ages ranged from 18 to 22 years, with a mean age of 20.34 (SD=1.16). The Social Anxiety Scale and Problematic Internet Use Scale were used in data collection. Multivariate analysis of variance (MANOVA) and canonical correlation analysis were used. Results: Mean differences between men and women were not statistically significant in social anxiety ($\lambda$=.02, F3,501=2.47, P=.06). In all three PIU dimensions, men scored higher than women, and MANOVA shows that multivariate difference was statistically significant ($\lambda$=.94, F3,501=10.69, P<.001). Of the canonical correlation functions computed for men, only the first was significant (Rc=.43, $\lambda$=.78, $\chi$29=64.7, P<.001) and accounted for 19\% of the overlapping variance. Similarly, only the first canonical function was significant for women (Rc=.36, $\lambda$=.87, $\chi$29=33.9, P<.001), which accounted for 13\% of the overlapping variance. Conclusions: On the basis of the findings, we conclude that enhanced educational opportunities for women and their increasing role in the society have led women to become more active and thus closed the gap in social anxiety levels between men and women. We found that men showed more difficulties than women in terms of running away from personal problems (ie, social benefit), used the Internet more excessively, and experienced more interpersonal problems with significant others due to Internet use. We conclude that men are under a greater risk of social impairments due to PIU. Our overall conclusion is that there is a substantial amount of association between social anxiety and PIU and the association is stronger for men than it is for women. We advise that future research continue to investigate PIU and social anxiety as multidimensional constructs. ",
doi="10.2196/jmir.8947",
url="http://www.jmir.org/2018/1/e33/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29367182"
}


@Article{info:doi/10.2196/mhealth.8619,
author="Rasche, Peter
and Wille, Matthias
and Br{\"o}hl, Christina
and Theis, Sabine
and Sch{\"a}fer, Katharina
and Knobe, Matthias
and Mertens, Alexander",
title="Prevalence of Health App Use Among Older Adults in Germany: National Survey",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jan",
day="23",
volume="6",
number="1",
pages="e26",
keywords="telemedicine",
keywords="Germany",
keywords="mobile applications",
keywords="smartphone",
keywords="aged",
abstract="Background: Health apps are increasingly becoming an integral part of health care. Especially in older adults, the self-management of chronic diseases by health apps might become an integral part of health care services. Objective: The aim of this explorative study was to investigate the prevalence of health app use and related demographic factors, as well as health status among older adults in Germany. Methods: A nationwide postal survey was conducted. Of the 5000 individuals contacted, a total of 576 participants completed this survey. On the basis of their self-indicated assignment to one of the three predefined user groups (health app users, general app users, and nonusers of apps), participants answered various questions regarding app and health app use, including frequency of use and number of installed apps, demographic factors, and health status. Results: In total, 16.5\% (95/576) used health apps, whereas 37.5\% (216/576) indicated only using general apps, and 46.0\% (265/576) reported using no apps at all. The number of installed health apps was most frequently reported as between 1 and 5 apps per participant, which were usually used on a weekly basis. The most frequently cited type of health apps were exercise-related ones. Individuals using health apps were found to be younger (MeanmHealth 66.6, SD 4.7) and to have a higher level of technical readiness compared with general app users and nonusers of apps (adjusted odds ratio, AOR=4.02 [95\% CI 2.23-7.25] for technical readiness, and AOR=0.905 [95\% CI 0.85-0.97] for age). The most frequently mentioned sources of information about apps within the group of health and general app users were family and friends. Identified barriers against the use of health apps were a lack of trust, data privacy concerns, and fear of misdiagnosis. Conclusions: Health apps are already used by older adults in Germany. The main type of apps used are exercise-related ones. Barriers to and incentives for the use of health apps and associations with health status and users' demographics were revealed. ",
doi="10.2196/mhealth.8619",
url="http://mhealth.jmir.org/2018/1/e26/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29362211"
}


@Article{info:doi/10.2196/humanfactors.8246,
author="Bosak, Kelly
and Park, Hye Shin",
title="Characteristics of Adults Seeking Health Care Provider Support Facilitated by Mobile Technology: Secondary Data Analysis",
journal="JMIR Hum Factors",
year="2017",
month="Dec",
day="21",
volume="4",
number="4",
pages="e33",
keywords="health technology",
keywords="health behavior",
keywords="health care provider",
keywords="cohort analysis",
abstract="Background: Mobile health technology is rapidly evolving with the potential to transform health care. Self-management of health facilitated by mobile technology can maximize long-term health trajectories of adults. Little is known about the characteristics of adults seeking Web-based support from health care providers facilitated by mobile technology. Objective: This study aimed to examine the following: (1) the characteristics of adults who seek human support from health care providers for health concerns using mobile technology rather than from family members and friends or others with similar health conditions and (2) the use of mobile health technology among adults with chronic health conditions. Findings of this study were interpreted in the context of the Efficiency Model of Support. Methods: We first described characteristics of adults seeking Web-based support from health care providers. Using chi-square tests for categorical variables and t test for the continuous variable of age, we compared adults seeking Web-based and conventional support by demographics. The primary aim was analyzed using multivariate logistic regression to examine whether chronic health conditions and demographic factors (eg, sex, income, employment status, race, ethnicity, education, and age) were associated with seeking Web-based support from health care providers. Results: The sample included adults (N=1453), the majority of whom were female 57.60\% (837/1453), white 75.02\% (1090/1453), and non-Hispanic 89.13\% (1295/1453). The age of the participants ranged from 18 to 92 years (mean 48.6, standard deviation [SD] 16.8). The majority 76.05\% (1105/1453) of participants reported college or higher level of education. A disparity was found in access to health care providers via mobile technology based on socioeconomic status. Adults with annual income of US \$30,000 to US \$100,000 were 1.72 times more likely to use Web-based methods to contact a health care provider, and adults with an annual income above US \$100,000 were 2.41 to 2.46 times more likely to access health care provider support on the Web, compared with those with an annual income below US \$30,000. After adjusting for other demographic covariates and chronic conditions, age was not a significant factor in Web-based support seeking. Conclusions: In this study, the likelihood of seeking Web-based support increased when adults had any or multiple chronic health conditions. A higher level of income and education than the general population was found to be related to the use of mobile health technology among adults in this survey. Future study is needed to better understand the disparity in Web-based support seeking for health issues and the clinicians' role in promoting access to and use of mobile health technology. ",
doi="10.2196/humanfactors.8246",
url="http://humanfactors.jmir.org/2017/4/e33/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29269337"
}


@Article{info:doi/10.2196/mhealth.7832,
author="Robbins, Rebecca
and Krebs, Paul
and Jagannathan, Ram
and Jean-Louis, Girardin
and Duncan, T. Dustin",
title="Health App Use Among US Mobile Phone Users: Analysis of Trends by Chronic Disease Status",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Dec",
day="19",
volume="5",
number="12",
pages="e197",
keywords="smartphone",
keywords="telemedicine",
keywords="chronic disease",
abstract="Background: Mobile apps hold promise for serving as a lifestyle intervention in public health to promote wellness and attenuate chronic conditions, yet little is known about how individuals with chronic illness use or perceive mobile apps. Objective: The objective of this study was to explore behaviors and perceptions about mobile phone--based apps for health among individuals with chronic conditions. Methods: Data were collected from a national cross-sectional survey of 1604 mobile phone users in the United States that assessed mHealth use, beliefs, and preferences. This study examined health app use, reason for download, and perceived efficacy by chronic condition. Results: Among participants, having between 1 and 5 apps was reported by 38.9\% (314/807) of respondents without a condition and by 6.6\% (24/364) of respondents with hypertension. Use of health apps was reported 2 times or more per day by 21.3\% (172/807) of respondents without a condition, 2.7\% (10/364) with hypertension, 13.1\% (26/198) with obesity, 12.3\% (20/163) with diabetes, 12.0\% (32/267) with depression, and 16.6\% (53/319) with high cholesterol. Results of the logistic regression did not indicate a significant difference in health app download between individuals with and without chronic conditions (P>.05). Compared with individuals with poor health, health app download was more likely among those with self-reported very good health (odds ratio [OR] 3.80, 95\% CI 2.38-6.09, P<.001) and excellent health (OR 4.77, 95\% CI 2.70-8.42, P<.001). Similarly, compared with individuals who report never or rarely engaging in physical activity, health app download was more likely among those who report exercise 1 day per week (OR 2.47, 95\% CI 1.6-3.83, P<.001), 2 days per week (OR 4.77, 95\% CI 3.27-6.94, P<.001), 3 to 4 days per week (OR 5.00, 95\% CI 3.52-7.10, P<.001), and 5 to 7 days per week (OR 4.64, 95\% CI 3.11-6.92, P<.001). All logistic regression results controlled for age, sex, and race or ethnicity. Conclusions: Results from this study suggest that individuals with poor self-reported health and low rates of physical activity, arguably those who stand to benefit most from health apps, were least likely to report download and use these health tools. ",
doi="10.2196/mhealth.7832",
url="http://mhealth.jmir.org/2017/12/e197/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29258981"
}


@Article{info:doi/10.2196/jmir.8328,
author="Nguyen, Linh Hoang Thuy
and Nakamura, Keiko
and Seino, Kaoruko
and Vo, Thang Van",
title="Association Between a Wider Availability of Health Information and Health Care Utilization in Vietnam: Cross-Sectional Study",
journal="J Med Internet Res",
year="2017",
month="Dec",
day="18",
volume="19",
number="12",
pages="e405",
keywords="health care utilization",
keywords="health information",
keywords="mass media",
keywords="Internet",
abstract="Background: The rapid and widespread development of mass media sources including the Internet is occurring worldwide. Users are being confronted with a flood of health information through a wide availability of sources. Studies on how the availability of health information has triggered users' interest in utilizing health care services remain limited within the Vietnamese population. Objective: This study examined the associations between the wider availability of sources for health information and health care utilization in Vietnam after adjusting for potential confounding variables. Methods: The data for this study were drawn from a cross-sectional study conducted over a 6-month period in Hue, a city in central Vietnam. The participants were 993 randomly selected adults aged between 18 and 60 years. Information was collected through face-to-face interviews on the types of information sources that were consulted, including traditional media (television), Internet, and health education courses, as well as the impact of such information on health care use (emergency department visits, hospitalizations, doctor visits). Multivariable logistic regression analyses were performed at a 95\% confidence level. Results: The prevalence of watching television, using the Internet, and attending health education courses to obtain health information were 50.9\% (505/993), 32.9\% (327/993), and 8.7\% (86/993), respectively. After further adjustments for self-reported health status, the presence of health insurance, and monthly income, respondents who watched television and used the Internet to obtain health information were 1.7 times more likely to visit a doctor (television: adjusted odds ratio [AOR] 1.69, 95\% CI 1.30-2.19; Internet: AOR 1.64, 95\% CI 1.23-2.19), and also significantly associated with inpatient hospitalization (P=.003). Conclusions: The use of widely available mass media sources (eg, television and the Internet) to obtain health information was associated with higher health care utilization. How this interest in health-related information can be used so that it will have a beneficial effect on care-seeking behavior should be a topic of concern to further health promotion in developing countries. ",
doi="10.2196/jmir.8328",
url="http://www.jmir.org/2017/12/e405/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29254911"
}


@Article{info:doi/10.2196/medinform.8026,
author="Arcury, A. Thomas
and Quandt, A. Sara
and Sandberg, C. Joanne
and Miller Jr, P. David
and Latulipe, Celine
and Leng, Xiaoyan
and Talton, W. Jenifer
and Melius, P. Kathryn
and Smith, Alden
and Bertoni, G. Alain",
title="Patient Portal Utilization Among Ethnically Diverse Low Income Older Adults: Observational Study",
journal="JMIR Med Inform",
year="2017",
month="Nov",
day="14",
volume="5",
number="4",
pages="e47",
keywords="electronic health records",
keywords="electronic personal health information management",
keywords="health disparities",
keywords="aging",
keywords="rural health",
abstract="Background: Patient portals can improve patient communication with providers, provide patients with greater health information access, and help improve patient decision making, if they are used. Because research on factors facilitating and limiting patient portal utilization has not been conceptually based, no leverage points have been indicated for improving utilization. Objective: The primary objective for this analysis was to use a conceptual framework to determine potentially modifiable factors affecting patient portal utilization by older adults (aged 55 years and older) who receive care at clinics that serve low income and ethnically diverse communities. The secondary objective was to delineate how patient portal utilization is associated with perceived usefulness and usability. Methods: Patients from one urban and two rural clinics serving low income patients were recruited and completed interviewer-administered questionnaires on patient portal utilization. Results: A total of 200 ethnically diverse patients completed questionnaires, of which 41 (20.5\%) patients reported utilizing portals. Education, social support, and frequent Internet utilization improve the odds of patient portal utilization; receiving health care at a rural clinic decreases the odds of portal utilization. Conclusions: Leverage points to address disparities in patient portal utilization include providing training for older adults in patient portal utilization, involving spouses or other care partners in this training, and making information technology access available at public places in rural and urban communities. ",
doi="10.2196/medinform.8026",
url="http://medinform.jmir.org/2017/4/e47/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29138129"
}


@Article{info:doi/10.2196/jmir.7401,
author="Chiu, Ching-Ju
and Liu, Chia-Wen",
title="Understanding Older Adult's Technology Adoption and Withdrawal for Elderly Care and Education: Mixed Method Analysis from National Survey",
journal="J Med Internet Res",
year="2017",
month="Nov",
day="03",
volume="19",
number="11",
pages="e374",
keywords="Internet adoption",
keywords="Internet withdrawal",
keywords="digital opportunity",
keywords="information literacy",
keywords="middle-aged and older adults",
keywords="Taiwan",
abstract="Background: Elderly adults have comprised the fastest growing population adopting the Internet and computer technology over the past decade. However, how their experiences can shed light on elderly learning theory has not been examined much in the literature. Objective: This study investigated the factors and reasons associated with Internet adoption and withdrawal among older adults in Taiwan, and if any gender differences exist in this context. Methods: Data on participants aged 50 years and older from the nationally representative ``Digital Opportunity Survey on Individuals and Households in Taiwan,'' who did not use the Internet in 2005 but adopted it in 2007 (n=1548), and those who reported using Internet in 2011 but then withdrew (n=1575), were analyzed. Factors and reasons associated with Internet adoption and withdrawal were examined using both quantitative and qualitative data. Results: Education level independently predicted Internet adoption behavior. With regard to the reasons for adoption, 66\% (62/94) of participants indicated they started using the Internet to meet certain ``needs''; for example, ``keeping up with the world'' (40.4\%, 38/94) was listed as the most critical reason, followed by ``job needs'' (25.5\%, 24/94). Older adults with a positive attitude toward the Internet with regard to increasing employment opportunities (OR 2.0, 95\% CI 1.0-3.9, P=.04) and the amount of information obtained (OR 0.5, 95\% CI 0.3-0.9, P=.01), as well as enriching recreation and entertainment (OR 0.6, 95\% CI 0.4-0.9, P=.02), were less likely to withdraw from the Internet. The most common reason for Internet withdrawal was ``psychological barriers'' (eg, no available time, no meaningful use, or nothing worth reading/watching; 66.3\%, 193/291), followed by ``health barriers'' (eg, eyes or body deteriorate with Internet use; 21.0\%, 61/291). Although psychological barriers were the most important factor for Internet withdrawal for both men (72.5\%, 100/138) and women (62\%, 93/150), women were more likely than men to be affected by health barriers (26.0\%, 39/150 vs 15.9\%, 22/138; P=.004) and anthropic factors or accidental barriers (7.3\%, 11/150 vs 2.9\%, 4/138; P=.02). Conclusions: Our findings that the need to keep up with the world associated with Internet adoption, and gender differences in reasons behind Internet withdrawal, such that women reported more health and anthropic factors or accidental barriers than man, may provide a new perspective that help health educators understand strategies that encourage older adults to keep learning, an important component of active aging. ",
doi="10.2196/jmir.7401",
url="http://www.jmir.org/2017/11/e374/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29101093"
}


@Article{info:doi/10.2196/mental.8311,
author="Berry, Natalie
and Bucci, Sandra
and Lobban, Fiona",
title="Use of the Internet and Mobile Phones for Self-Management of Severe Mental Health Problems: Qualitative Study of Staff Views",
journal="JMIR Ment Health",
year="2017",
month="Nov",
day="01",
volume="4",
number="4",
pages="e52",
keywords="psychosis",
keywords="bipolar disorder",
keywords="mHealth",
keywords="eHealth",
keywords="clinicians",
keywords="mobile phone",
keywords="Internet",
keywords="intervention",
abstract="Background: Researchers are currently investigating the feasibility, acceptability, and efficacy of digital health interventions for people who experience severe mental health problems such as psychosis and bipolar disorder. Although the acceptability of digital health interventions for severe mental health problems appears to be relatively high and some people report successfully using the Internet and mobile phones to manage their mental health, the attitudes of mental health care staff toward such approaches have yet to be considered. Objective: The aim of this study was to explore mental health care staff experiences of clients with severe mental health problems engaging with the Internet and mobile phones to self-manage their mental health and their views toward these behaviors. The study also sought to examine the opinions expressed by mental health care staff toward digital health interventions for severe mental health problems to identify potential facilitators and barriers to implementation. Methods: Four focus groups were conducted with 20 staff working in mental health care services in the North West of the England using a topic guide. Focus groups involved 12 staff working in secondary care psychological services (7 participants in focus group 1 and 5 participants in focus group 4), 4 staff working in a rehabilitation unit (focus group 2), and 4 staff working in a community mental health team (focus group 3). Focus groups were transcribed verbatim, and transcripts were analyzed thematically to identify key themes that emerged from the data. Results: Four overarching themes, two with associated subthemes, were identified: (1) staff have conflicting views about the pros and cons of using Web-based resources and digital health interventions to manage mental health; (2) digital health interventions could increase access to mental health support options for severe mental health problems but may perpetuate the digital divide; (3) digital health interventions' impact on staff roles and responsibilities; and (4) digital health interventions should be used to enhance, not replace, face-to-face support. Conclusions: This study is the first, to our knowledge, to qualitatively explore the experiences and attitudes of mental health care staff toward individuals with severe mental health problems using the Internet, mobile phones, and digital health interventions to self-manage their mental health. Understanding the positive and negative experiences and views shared by staff toward both current and potential digital health intervention use has enabled the identification of several considerations for implementation. Additionally, the findings suggest mental health care staff need clear guidance and training in relation to their responsibilities in recommending reputable and secure websites, forums, and digital health interventions and in how to manage professional boundaries on the Internet. Overall, the study highlights that digital health interventions could be well received by staff working in mental health services but importantly, such management options must be presented to frontline staff as an avenue to enhance care and extend choice, rather than as a method to reduce costs. ",
doi="10.2196/mental.8311",
url="http://mental.jmir.org/2017/4/e52/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29092809"
}


@Article{info:doi/10.2196/jmir.8481,
author="Stellefson, Michael
and Paige, R. Samantha
and Tennant, Bethany
and Alber, M. Julia
and Chaney, H. Beth
and Chaney, Don
and Grossman, Suzanne",
title="Reliability and Validity of the Telephone-Based eHealth Literacy Scale Among Older Adults: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2017",
month="Oct",
day="26",
volume="19",
number="10",
pages="e362",
keywords="social media",
keywords="aging",
keywords="health literacy",
keywords="Web 2.0",
keywords="Internet",
abstract="Background: Only a handful of studies have examined reliability and validity evidence of scores produced by the 8-item eHealth literacy Scale (eHEALS) among older adults. Older adults are generally more comfortable responding to survey items when asked by a real person rather than by completing self-administered paper-and-pencil or online questionnaires. However, no studies have explored the psychometrics of this scale when administered to older adults over the telephone. Objective: The objective of our study was to examine the reliability and internal structure of eHEALS data collected from older adults aged 50 years or older responding to items over the telephone. Methods: Respondents (N=283) completed eHEALS as part of a cross-sectional landline telephone survey. Exploratory structural equation modeling (E-SEM) analyses examined model fit of eHEALS scores with 1-, 2-, and 3-factor structures. Subsequent analyses based on the partial credit model explored the internal structure of eHEALS data. Results: Compared with 1- and 2-factor models, the 3-factor eHEALS structure showed the best global E-SEM model fit indices (root mean square error of approximation=.07; comparative fit index=1.0; Tucker-Lewis index=1.0). Nonetheless, the 3 factors were highly correlated (r range .36 to .65). Item analyses revealed that eHEALS items 2 through 5 were overfit to a minor degree (mean square infit/outfit values <1.0; t statistics less than --2.0), but the internal structure of Likert scale response options functioned as expected. Overfitting eHEALS items (2-5) displayed a similar degree of information for respondents at similar points on the latent continuum. Test information curves suggested that eHEALS may capture more information about older adults at the higher end of the latent continuum (ie, those with high eHealth literacy) than at the lower end of the continuum (ie, those with low eHealth literacy). Item reliability (value=.92) and item separation (value=11.31) estimates indicated that eHEALS responses were reliable and stable. Conclusions: Results support administering eHEALS over the telephone when surveying older adults regarding their use of the Internet for health information. eHEALS scores best captured 3 factors (or subscales) to measure eHealth literacy in older adults; however, statistically significant correlations between these 3 factors suggest an overarching unidimensional structure with 3 underlying dimensions. As older adults continue to use the Internet more frequently to find and evaluate health information, it will be important to consider modifying the original eHEALS to adequately measure societal shifts in online health information seeking among aging populations. ",
doi="10.2196/jmir.8481",
url="http://www.jmir.org/2017/10/e362/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29074471"
}


@Article{info:doi/10.2196/jmir.7981,
author="LaMonica, M. Haley
and English, Amelia
and Hickie, B. Ian
and Ip, Jerome
and Ireland, Catriona
and West, Stacey
and Shaw, Tim
and Mowszowski, Loren
and Glozier, Nick
and Duffy, Shantel
and Gibson, A. Alice
and Naismith, L. Sharon",
title="Examining Internet and eHealth Practices and Preferences: Survey Study of Australian Older Adults With Subjective Memory Complaints, Mild Cognitive Impairment, or Dementia",
journal="J Med Internet Res",
year="2017",
month="Oct",
day="25",
volume="19",
number="10",
pages="e358",
keywords="eHealth",
keywords="dementia",
keywords="mild cognitive impairment",
keywords="Internet",
keywords="Alzheimer disease",
abstract="Background: Interest in electronic health (eHealth) technologies to screen for and treat a variety of medical and mental health problems is growing exponentially. However, no studies to date have investigated the feasibility of using such e-tools for older adults with mild cognitive impairment (MCI) or dementia. Objective: The objective of this study was to describe patterns of Internet use, as well as interest in and preferences for eHealth technologies among older adults with varying degrees of cognitive impairment. Methods: A total of 221 participants (mean age=67.6 years) attending the Healthy Brain Ageing Clinic at the University of Sydney, a specialist mood and memory clinic for adults ?50 years of age, underwent comprehensive clinical and neuropsychological assessment and completed a 20-item self-report survey investigating current technology use and interest in eHealth technologies. Descriptive statistics and Fisher exact tests were used to characterize the findings, including variability in the results based on demographic and diagnostic factors, with diagnoses including subjective cognitive impairment (SCI), MCI, and dementia. Results: The sample comprised 27.6\% (61/221) SCI, 62.0\% (137/221) MCI, and 10.4\% (23/221) dementia (mean Mini-Mental State Examination=28.2). The majority of participants reported using mobile phones (201/220, 91.4\%) and computers (167/194, 86.1\%) routinely, with most respondents having access to the Internet at home (204/220, 92.6\%). Variability was evident in the use of computers, mobile phones, and health-related websites in relation to sociodemographic factors, with younger, employed respondents with higher levels of education being more likely to utilize these technologies. Whereas most respondents used email (196/217, 90.3\%), the use of social media websites was relatively uncommon. The eHealth intervention of most interest to the broader sample was memory strategy training, with 82.7\% (172/208) of participants reporting they would utilize this form of intervention. Preferences for other eHealth interventions varied in relation to educational level, with university-educated participants expressing greater interest in interventions related to mood (P=.01), socialization (P=.02), memory (P=.01), and computer-based exercises (P=.046). eHealth preferences also varied in association, with diagnosis for interventions targeting sleep (P=.01), nutrition (P=.004), vascular risk factors (P=.03), and memory (P=.02). Conclusions: Technology use is pervasive among older adults with cognitive impairment, though variability was noted in relation to age, education, vocational status, and diagnosis. There is also significant interest in Web-based interventions targeting cognition and memory, as well as other risk factors for cognitive decline, highlighting the urgent need for the development, implementation, and study of eHealth technologies tailored specifically to older adults, including those with MCI and early dementia. Strategies to promote eHealth use among older adults who are retired or have lower levels of education will also need to be considered. ",
doi="10.2196/jmir.7981",
url="http://www.jmir.org/2017/10/e358/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29070481"
}


@Article{info:doi/10.2196/jmir.7895,
author="Woods, S. Susan
and Forsberg, W. Christopher
and Schwartz, C. Erin
and Nazi, M. Kim
and Hibbard, H. Judith
and Houston, K. Thomas
and Gerrity, Martha",
title="The Association of Patient Factors, Digital Access, and Online Behavior on Sustained Patient Portal Use: A Prospective Cohort of Enrolled Users",
journal="J Med Internet Res",
year="2017",
month="Oct",
day="17",
volume="19",
number="10",
pages="e345",
keywords="patient portal",
keywords="personal health record",
keywords="Internet",
keywords="broadband",
keywords="digital inclusion",
keywords="social determinants",
abstract="Background: As electronic health records and computerized workflows expand, there are unprecedented opportunities to digitally connect with patients using secure portals. To realize the value of patient portals, initial reach across populations will need to be demonstrated, as well as sustained usage over time. Objective: The study aim was to identify patient factors associated with short-term and long-term portal usage after patients registered to access all portal functions. Methods: We prospectively followed a cohort of patients at a large Department of Veterans Affairs (VA) health care facility who recently completed identity proofing to use the VA patient portal. Information collected at baseline encompassed patient factors potentially associated with portal usage, including: demographics, Internet access and use, health literacy, patient activation, and self-reported health conditions. The primary outcome was the frequency of portal log-ins during 6-month and 18-month time intervals after study enrollment. Results: A total of 270 study participants were followed prospectively. Almost all participants (260/268, 97.0\%) reported going online, typically at home (248/268, 92.5\%). At 6 months, 84.1\% (227/270) of participants had visited the portal, with some variation in usage across demographic and health-related subgroups. There were no significant differences in portal log-ins by age, gender, education, marital status, race/ethnicity, distance to a VA facility, or patient activation measure. Significantly higher portal usage was seen among participants using high-speed broadband at home, greater self-reported ability using the Internet, and routinely going online. By 18 months, 91\% participants had logged in to the portal, and no significant associations were found between usage and demographics, health status, or patient activation. When examining portal activity between 6 and 18 months, patients who were infrequent or high portal users remained in those categories, respectively. Conclusions: Short-term and long-term portal usage was associated with having broadband at home, high self-rated ability when using the Internet, and overall online behavior. Digital inclusion, or ready access to the Internet and digital skills, appears to be a social determinant in patient exposure to portal services. ",
doi="10.2196/jmir.7895",
url="http://www.jmir.org/2017/10/e345/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29042345"
}


@Article{info:doi/10.2196/medinform.8092,
author="Sakaguchi-Tang, K. Dawn
and Bosold, L. Alyssa
and Choi, K. Yong
and Turner, M. Anne",
title="Patient Portal Use and Experience Among Older Adults: Systematic Review",
journal="JMIR Med Inform",
year="2017",
month="Oct",
day="16",
volume="5",
number="4",
pages="e38",
keywords="aged",
keywords="patient portals",
keywords="personal health records",
keywords="utilization",
keywords="usability",
keywords="user experience",
abstract="Background: The older adult population (65 years or older) in the United States is growing, and it is important for communities to consider ways to support the aging population. Patient portals and electronic personal health records (ePHRs) are technologies that could better serve populations with the highest health care needs, such as older adults. Objective: The aim of this study was to assess the existing research landscape related to patient portal and ePHR use and experience among older adults and to understand the benefits and barriers to older adults' use and adoption of patient portals and ePHRs. Methods: We searched six pertinent bibliographic databases for papers, published from 2006 to 2016 and written in English, that focused on adults 60 years or older and their use of or experience with patient portals or ePHRs. We adapted preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to review papers based on exclusion and inclusion criteria. We then applied thematic analysis to identify key themes around use, experience, and adoption. Results: We retrieved 199 papers after an initial screening and removal of duplicate papers. Then we applied an inclusion and exclusion criteria, resulting in a final set of 17 papers that focused on 15 separate projects. The majority of papers described studies involving qualitative research, including interviews and focus groups. They looked at the experience and use of ePHRs and patient portals. Overall, we found 2 main barriers to use: (1) privacy and security and (2) access to and ability to use technology and the Internet. We found 2 facilitators: (1) technical assistance and (2) family and provider advice. We also reported on older adults' experience, including satisfaction with the system and improvement of the quality of their health care. Several studies captured features that older adults wanted from these systems such as further assistance managing health-related tasks and contextual health advice and tips. Conclusions: More research is needed to better understand the patient portal experience among older adults from initial use to adoption. There are also opportunities to explore the role of design in addressing barriers and supporting facilitators to patient portal and ePHR use. Finally, the future use of these systems by older adults should be anticipated and considered in the design process. ",
doi="10.2196/medinform.8092",
url="http://medinform.jmir.org/2017/4/e38/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29038093"
}


@Article{info:doi/10.2196/publichealth.7009,
author="Tatara, Naoe
and Hammer, Lewi Hugo
and Andreassen, Kristin Hege
and Mirkovic, Jelena
and Kj{\o}llesdal, R{\aa}berg Marte Karoline",
title="The Association Between Commonly Investigated User Factors and Various Types of eHealth Use for Self-Care of Type 2 Diabetes: Case of First-Generation Immigrants From Pakistan in the Oslo Area, Norway",
journal="JMIR Public Health Surveill",
year="2017",
month="Oct",
day="05",
volume="3",
number="4",
pages="e68",
keywords="immigrants",
keywords="type 2 diabetes",
keywords="self-care",
keywords="information seeking behavior",
abstract="Background: Sociodemographic and health-related factors are often investigated for their association with the active use of electronic health (eHealth). The importance of such factors has been found to vary, depending on the purpose or means of eHealth and the target user groups. Pakistanis are one of the biggest immigrant groups in the Oslo area, Norway. Due to an especially high risk of developing type 2 diabetes (T2D) among this population, knowledge about their use of eHealth for T2D self-management and prevention (self-care) will be valuable for both understanding this vulnerable group and for developing effective eHealth services. Objective: The aim of this study was to examine how commonly were the nine types of eHealth for T2D self-care being used among our target group, the first-generation Pakistani immigrants living in the Oslo area. The nine types of eHealth use are divided into three broad categories based on their purpose: information seeking, communication, and active self-care. We also aimed to investigate how sociodemographic factors, as well as self-assessment of health status and digital skills are associated with the use of eHealth in this group. Methods: A survey was carried out in the form of individual structured interviews from September 2015 to January 2016 (N=176). For this study, dichotomous data about whether or not an informant had used each of the nine types of eHealth in the last 12 months and the total number of positive answers were used as dependent variables in a regression analysis. The independent variables were age, gender, total years of education, digital skills (represented by frequency of asking for help when using information and communication technology [ICT]), and self-assessment of health status. Principal component analyses were applied to make categories of independent variables to avoid multicollinearity. Results: Principal component analysis yielded three components: knowledge, comprising total years of education and digital skills; health, comprising age and self-assessment of health status; and gender, as being a female. With the exception of closed conversation with a few specific acquaintances about self-care of T2D (negatively associated, P=.02) and the use of ICT for relevant information-seeking by using search engines (not associated, P=.18), the knowledge component was positively associated with all the other dependent variables. The health component was negatively associated with the use of ICT for closed conversation with a few specific acquaintances about self-care of T2D (P=.01) but not associated with the other dependent variables. Gender component showed no association with any of the dependent variables. Conclusions: In our sample, knowledge, as a composite measure of education and digital skills, was found to be the main factor associated with eHealth use regarding T2D self-care. Enhancing digital skills would encourage and support more active use of eHealth for T2D self-care. ",
doi="10.2196/publichealth.7009",
url="http://publichealth.jmir.org/2017/4/e68/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28982646"
}


@Article{info:doi/10.2196/jmir.6989,
author="Zhang, Yan
and Lauche, Romy
and Sibbritt, David
and Olaniran, Bolanle
and Cook, Ronald
and Adams, Jon",
title="Comparison of Health Information Technology Use Between American Adults With and Without Chronic Health Conditions: Findings From The National Health Interview Survey 2012",
journal="J Med Internet Res",
year="2017",
month="Oct",
day="05",
volume="19",
number="10",
pages="e335",
keywords="health information technology",
keywords="chronic illness",
abstract="Background: Health information technology (HIT) is utilized by people with different chronic conditions such as diabetes and hypertension. However, there has been no comparison of HIT use between persons without a chronic condition, with one chronic condition, and multiple (?2) chronic conditions (MCCs). Objective: The aim of the study was to assess the difference in HIT use between persons without a chronic condition, with one chronic condition, and with MCCs, to describe the characteristics of HIT use among those with chronic conditions and to identify the predictors of HIT use of the persons with one chronic condition and MCCs. Methods: A secondary data analysis was conducted in spring 2017 using the National Health Interview Survey (NHIS) 2012 Family Core and Sample Adult Core datasets that yielded 34,525 respondents aged 18 years and older. Measures included overall HIT use (ie, any use of the following five HIT on the Internet: seeking health information, ordering prescription, making appointment, emailing health provider, and using health chat groups), as well as sociodemographic and health-related characteristics. Sociodemographic and health characteristics were compared between HIT users and nonusers among those who reported having at least one chronic condition using chi-square tests. Independent predictors of HIT use were identified using multiple logistic regression analyses for those with one chronic condition, with MCCs, and without a chronic condition. Analyses were weighted and performed at significance level of .005. Results: In 2012, adults with one health chronic condition (raw count 4147/8551, weighted percentage 48.54\%) was significantly higher than among those with MCCs (3816/9637, 39.55\%) and those with none of chronic condition (7254/16,337, 44.40\%, P<.001). Seeking health information was the most prevalent HIT use. Chi-square tests revealed that among adults with chronic conditions, those who used HIT were significantly different from their counterpart peers who did not use HIT in terms of sociodemographic and health characteristics (P<.001). Overall, the significant factors related to HIT use were similar among the adults with one chronic condition, with MCCs, or without a chronic condition: younger age, female sex, non-Hispanic white, higher education level, and higher income level were shown to be positively related to the HIT use. Conclusions: This study provides a snapshot of HIT use among those with chronic conditions and potential factors related to such use. Clinical care and public health communication efforts attempting to leverage more HIT use should acknowledge differential HIT usage as identified in this study to better address communication inequalities and persistent disparities in socioeconomic status. ",
doi="10.2196/jmir.6989",
url="http://www.jmir.org/2017/10/e335/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28982644"
}


@Article{info:doi/10.2196/jmir.7786,
author="Hong, Alicia Y.
and Zhou, Zi
and Fang, Ya
and Shi, Leiyu",
title="The Digital Divide and Health Disparities in China: Evidence From a National Survey and Policy Implications",
journal="J Med Internet Res",
year="2017",
month="Sep",
day="11",
volume="19",
number="9",
pages="e317",
keywords="digital divide",
keywords="health disparities",
keywords="Internet",
keywords="mobile phone",
keywords="China",
abstract="Background: The digital divide persists despite broad accessibility of mobile tools. The relationship between the digital divide and health disparities reflects social status in terms of access to resources and health outcomes; however, data on this relationship are limited from developing countries such as China. Objective: The aim of this study was to examine the current rates of access to mobile tools (Internet use and mobile phone ownership) among older Chinese individuals (aged ?45 years), the predictors of access at individual and community levels, and the relationship between access to mobile tools and health outcomes. Methods: We drew cross-sectional data from a national representative survey, the China Health and Retirement Longitudinal Study (CHARLS), which focused on the older population (aged ?45 years). We used two-level mixed logistic regression models, controlling for unobserved heterogeneity at the community and individual levels for data analysis. In addition to individual-level socioeconomic status (SES), we included community-level resources such as neighborhood amenities, health care facilities, and community organizations. Health outcomes were measured by self-reported health and absence of disability based on validated scales. Results: Among the 18,215 participants, 6.51\% had used the Internet in the past month, and 83\% owned a mobile phone. In the multivariate models, Internet use was strongly associated with SES, rural or urban residence, neighborhood amenities, community resources, and geographic region. Mobile phone ownership was strongly associated with SES and rural/urban residence but not so much with neighborhood amenities and community resources. Internet use was a significant predictor of self-reported health status, and mobile phone ownership was significantly associated with having disability even after controlling for potential confounders at the individual and community levels. Conclusions: This study is one of the first to examine digital divide and its relationship with health disparities in China. The data showed a significant digital divide in China, especially in the older population. Internet access is still limited to people with higher SES; however, the mobile phone has been adopted by the general population. The digital divide is associated with not only individual SES but also community resources. Future electronic health (eHealth) programs need to consider the accessibility of mobile tools and develop culturally appropriate programs for various social groups. ",
doi="10.2196/jmir.7786",
url="http://www.jmir.org/2017/9/e317/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28893724"
}


@Article{info:doi/10.2196/ijmr.8072,
author="Zhang, WB Melvyn
and Tran, Xuan Bach
and Le, Thi Huong
and Nguyen, Duc Hinh
and Nguyen, Tat Cuong
and Tran, Dinh Tho
and Latkin, A. Carl
and Ho, CM Roger",
title="Perceptions of Health-Related Information on Facebook: Cross-Sectional Study Among Vietnamese Youths",
journal="Interact J Med Res",
year="2017",
month="Sep",
day="07",
volume="6",
number="2",
pages="e16",
keywords="health information",
keywords="social media",
keywords="Facebook",
keywords="beliefs",
abstract="Background: While health information websites may have previously been the core source of information about health-related conditions on the Internet, social networking sites are increasingly replacing those websites as a source of health-related information. The increasingly popularity of social networking sites among the general population has consequential impact on health policies as well as health-related interventions. To date, there remains a paucity of research conducted in developing countries like Vietnam looking at the influence of social networking sites. Objective: Our goal is to establish the baseline use of Facebook among Vietnamese youths and establish their perception of the reliability and usefulness of health-related information that they previously encountered while using the social networking site. Methods: An online cross-sectional study was conducted from August 2015 to October 2015. Respondent-driven sampling (RDS) technique was used in the recruitment of participants. Sociodemographic, health status, behaviors, Facebook use and belief of information on Facebook, and interpersonal influence of social network sites were collected via an online structured questionnaire. Results: Among 1080 participants, 72.87\% (787/1080) reported being interested in health information on Facebook, and 50.74\% (548/1080) and 17.50\% (189/1080) perceived the information to be reliable and useful, respectively. A total of 10.93\% (118/1080) of the participants also reported that they would follow the health advice they obtained from Facebook. Of significance, 7.13\% (77/1080) of the participants also reported peer influences on their behavior. Factors that mediate Vietnamese perceptions of the information online include gender, level of perceived stress, age, educational level, and interpersonal influences from Facebook. Conclusions: Our study is perhaps one of the first conducted in Vietnam that looks at the relationship between health information on Facebook and factors that might influence young Vietnamese perceptions of the information and the consequential use of that information. ",
doi="10.2196/ijmr.8072",
url="http://www.i-jmr.org/2017/2/e16/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28882813"
}


@Article{info:doi/10.2196/jmir.7512,
author="Ariens, FM Lieneke
and Schussler-Raymakers, ML Florine
and Frima, Cynthia
and Flinterman, Annebeth
and Hamminga, Eefje
and Arents, WM Bernd
and Bruijnzeel-Koomen, AFM Carla
and de Bruin-Weller, S. Marjolein
and van Os-Medendorp, Harmieke",
title="Barriers and Facilitators to eHealth Use in Daily Practice: Perspectives of Patients and Professionals in Dermatology",
journal="J Med Internet Res",
year="2017",
month="Sep",
day="05",
volume="19",
number="9",
pages="e300",
keywords="dermatology",
keywords="eHealth",
keywords="implementation",
keywords="barriers",
keywords="facilitators",
abstract="Background: The number of eHealth interventions in the management of chronic diseases such as atopic dermatitis (AD) is growing. Despite promising results, the implementation and use of these interventions is limited. Objectives: This study aimed to assess opinions of the most important stakeholders influencing the implementation and use of eHealth services in daily dermatology practice. Methods: The perspectives of health care professionals and patients towards the implementation and use of eHealth services in daily practice were assessed by using a mixed method design. A cross-sectional survey based on the eHealth implementation toolkit (eHit) was conducted to explore factors influencing the adoption of eHealth interventions offering the possibility of e-consultations, Web-based monitoring, and Web-based self-management training among dermatologists and dermatology nurses. The perspectives of patients with atopic dermatitis (AD) regarding the use of eHealth services were discussed in an online focus group. Results: Health care professionals (n=99) and patients (n=9) acknowledged the value of eHealth services and were willing to use these digital tools in daily dermatology practice. Key identified barriers (statements with <50\% of the participants scoring totally agree or agree) in the implementation and adoption of eHealth interventions included concerns about the availability (12/99, 12\%) and allocation (14/99, 14\%) of resources, financial aspects (26/99, 26\%), reliability, security, and confidentially of the intervention itself (29/99, 29\%), and the lack of education and training (6/99, 6\%). Conclusions: Health care professionals and patients acknowledge the benefits arising from the implementation and use of eHealth services in daily dermatology practice. However, some important barriers were identified that might be useful in addressing the implementation strategy in order to enhance the implementation success of eHealth interventions in dermatology. ",
doi="10.2196/jmir.7512",
url="http://www.jmir.org/2017/9/e300/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28874336"
}


@Article{info:doi/10.2196/jmir.7953,
author="Heffner, L. Jaimee
and Mull, E. Kristin",
title="Smartphone Ownership Among US Adult Cigarette Smokers: 2014 Health Information National Trends Survey (HINTS) Data",
journal="J Med Internet Res",
year="2017",
month="Aug",
day="31",
volume="19",
number="8",
pages="e305",
keywords="mHealth",
keywords="mobile health",
keywords="tobacco",
keywords="smoking",
keywords="nicotine use disorder",
abstract="Background: Despite increasing interest in smartphone apps as a platform for delivery of tobacco cessation interventions, no previous studies have evaluated the prevalence and characteristics of smokers who can access smartphone-delivered interventions. Objective: To guide treatment development in this new platform and to evaluate disparities in access to smartphone-delivered interventions, we examined associations of smartphone ownership with demographics, tobacco use and thoughts about quitting, other health behaviors, physical and mental health, health care access, and Internet and technology utilization using a nationally representative sample of US adult smokers. Methods: Data were from the National Cancer Institute's 2014 Health Information National Trends Survey 4 (HINTS 4), Cycle 4. This mailed survey targeted noninstitutionalized individuals aged 18 years or older using two-stage stratified random sampling. For this analysis, we restricted the sample to current smokers with complete data on smartphone ownership (n=479). Results: Nearly two-thirds (weighted percent=63.8\%, 248/479) of smokers reported owning a smartphone. Those who were younger (P<.001), employed (P=.002), never married (P=.002), and had higher education (P=.002) and income (P<.001) had the highest rates of ownership. Smartphone owners did not differ from nonowners on frequency of smoking, recent quit attempts, or future plans to quit smoking, although they reported greater belief in the benefits of quitting (P=.04). Despite being equally likely to be overweight or obese, smartphone owners reported greater fruit and vegetable consumption (P=.03) and were more likely to report past-year efforts to increase exercise (P=.001) and to lose weight (P=.02). No differences in health care access and utilization were found. Smartphone owners reported better physical and mental health in several domains and higher access to and utilization of technology and the Internet, including for health reasons. Conclusions: Smartphone ownership among smokers mirrors many trends in the general population, including the overall rate of ownership and the association with younger age and higher socioeconomic status. Apps for smoking cessation could potentially capitalize on smartphone owners' efforts at multiple health behavior changes and interest in communicating with health care providers via technology. These data also highlight the importance of accessible treatment options for smokers without smartphones in order to reach smokers with the highest physical and mental health burden and prevent worsening of tobacco-related health disparities as interventions move to digital platforms. ",
doi="10.2196/jmir.7953",
url="https://www.jmir.org/2017/8/e305/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28860108"
}


@Article{info:doi/10.2196/ijmr.6231,
author="Vismara, Michele Marco Flavio
and Toaff, Joseph
and Pulvirenti, Giuliana
and Settanni, Chiara
and Colao, Emma
and Lavano, Marianna Serena
and Cemicetti, Riccardo
and Cotugno, David
and Perrotti, Giuseppe
and Meschesi, Viviana
and Montera, Roberto
and Zepponi, Barbara
and Rapetto, Umberto
and Marotta, Rosa",
title="Internet Use and Access, Behavior, Cyberbullying, and Grooming: Results of an Investigative Whole City Survey of Adolescents",
journal="Interact J Med Res",
year="2017",
month="Aug",
day="29",
volume="6",
number="2",
pages="e9",
keywords="adolescent",
keywords="Internet",
keywords="social media",
keywords="questionnaires",
keywords="data collection",
abstract="Background: According to the Digital Agenda for Europe, the way children use the Internet and mobile technologies has changed dramatically in the past years. Objective: The aims of this study were to: (1) breakdown the modalities of access and use of the Internet by teenagers to assess risks and risky behaviors; and (2) provide scientific data to evaluate and counsel safe use of the Internet and new technologies by teenagers. Methods: The study was conducted under the program ``Strategies for a Better Internet for Children'' started in May 2012 by the European Commission. It represents the main result of the project launched by Telecom Italia, ``Anche io ho qualcosa da dire'' (I too have something to say), thanks to which many contributions were collected and used to develop a survey. The questionnaire was structured in 45 questions, covering three macro areas of interest. It was approved by the Department Board at University of Magna Graecia's School of Medicine. After authorization from the regional high school authority, it was administered to all 1534 students (aged 13-19 years) in the city of Catanzaro, Italy. Results: The data was broken down into three main groups: (1) describing education and access to the Internet; (2) methods of use and social networking; and (3) perception and evaluation of risk and risky behaviors. Among noteworthy results in the first group, we can mention that the average age of first contact with information technologies was around 9 years. Moreover, 78.87\% (1210/1534) of the interviewed students reported having access to a smartphone or a tablet. Among the results of the second group, we found that the most used social networks were Facebook (85.78\%, 1316/1534), YouTube (61.14\%, 938/1534), and Google+ (51.56\%, 791/1534). About 71.31\% (1094/1534) of the interviewed teenagers use their name and surname on social networks, and 40.09\% (615/1534) of them knew all their Facebook contacts personally. Among the results of the third group, we found that 7.69\% (118/1534) of the interviewed teenagers have uploaded pictures or movies of which they felt ashamed; 27.05\% (415/1534) have received invitations from people they met on the Internet to meet in real life; and 8.67\% (133/1534) have accepted such invitations. Conclusions: The results offer a breakdown of the teenagers' use of the Internet, focusing on how teenagers learn to use and access it while taking into account factors such as parental coaching, schooling, or self-education. It describes how they approach and interact with social networks and how they perceive risks and risky behaviors on the Internet. Information technology must be seen as an instrument and not as a hindrance. For this to happen, parental guidance, schooling, and medical counseling are needed for a sound development of the child in this critical stage. ",
doi="10.2196/ijmr.6231",
url="http://www.i-jmr.org/2017/2/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28851675"
}


@Article{info:doi/10.2196/jmir.7520,
author="Jones, Louise
and Jacklin, Kristen
and O'Connell, E. Megan",
title="Development and Use of Health-Related Technologies in Indigenous Communities: Critical Review",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="20",
volume="19",
number="7",
pages="e256",
keywords="Indians, North American",
keywords="Canada",
keywords="telemedicine",
keywords="self-help devices",
keywords="needs assessment",
keywords="aging",
abstract="Background: Older Indigenous adults encounter multiple challenges as their age intersects with health inequities. Research suggests that a majority of older Indigenous adults prefer to age in place, and they will need culturally safe assistive technologies to do so. Objective: The aim of this critical review was to examine literature concerning use, adaptation, and development of assistive technologies for health purposes by Indigenous peoples. Methods: Working within Indigenous research methodologies and from a decolonizing approach, searches of peer-reviewed academic and gray literature dated to February 2016 were conducted using keywords related to assistive technology and Indigenous peoples. Sources were reviewed and coded thematically. Results: Of the 34 sources captured, only 2 concerned technology specifically for older Indigenous adults. Studies detailing technology with Indigenous populations of all ages originated primarily from Canada (n=12), Australia (n=10), and the United States (n=9) and were coded to four themes: meaningful user involvement and community-based processes in development, the digital divide, Indigenous innovation in technology, and health technology needs as holistic and interdependent. Conclusions: A key finding is the necessity of meaningful user involvement in technology development, especially in communities struggling with the digital divide. In spite of, or perhaps because of this divide, Indigenous communities are enthusiastically adapting mobile technologies to suit their needs in creative, culturally specific ways. This enthusiasm and creativity, coupled with the extensive experience many Indigenous communities have with telehealth technologies, presents opportunity for meaningful, culturally safe development processes. ",
doi="10.2196/jmir.7520",
url="http://www.jmir.org/2017/7/e256/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28729237"
}


@Article{info:doi/10.2196/diabetes.6751,
author="Sheon, R. Amy
and Bolen, D. Shari
and Callahan, Bill
and Shick, Sarah
and Perzynski, T. Adam",
title="Addressing Disparities in Diabetes Management Through Novel Approaches to Encourage Technology Adoption and Use",
journal="JMIR Diabetes",
year="2017",
month="Jul",
day="13",
volume="2",
number="2",
pages="e16",
keywords="diabetes",
keywords="chronic illness",
keywords="vulnerable populations",
keywords="digital divide",
keywords="community health workers",
keywords="healthcare disparities",
keywords="patient portals",
keywords="patient engagement",
keywords="meaningful use",
keywords="health literacy",
doi="10.2196/diabetes.6751",
url="http://diabetes.jmir.org/2017/2/e16/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291090"
}


@Article{info:doi/10.2196/jmir.7736,
author="Guendelman, Sylvia
and Broderick, Andrew
and Mlo, Hmellisa
and Gemmill, Alison
and Lindeman, David",
title="Listening to Communities: Mixed-Method Study of the Engagement of Disadvantaged Mothers and Pregnant Women With Digital Health Technologies",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="05",
volume="19",
number="7",
pages="e240",
keywords="digital divide",
keywords="health information management",
keywords="consumer health information",
keywords="pregnant women",
keywords="mothers",
abstract="Background: US health care providers are increasingly demanding patient engagement with digital health technologies to enroll in care, access personal health information, communicate with providers, and monitor their own health. Such engagement may be difficult for disadvantaged populations who may have limited health literacy, time constraints, or competing priorities. Objective: We aimed to understand the extent of adoption and use of digital health tools and to identify key perceived psychological motivators of technology use among disadvantaged first-time pregnant women and mothers of young children. Methods: We recruited women from health organizations serving low-income communities in the Midwest and on the East and West coasts. A total of 92 women participated in 14 focus groups. During each session, we administered worksheets that measured 3 utilization outcomes: the number of recent Web-based health-seeking activities, current use of digital health-management practices (eg, accessing personal health information, communicating with providers, and scheduling appointments), and potential adoption of digital health-management tools among low users or nonusers. Responses to the worksheets and to a pre-focus group survey on demographics, technology access, and motivators of use were examined to create user profiles. Separate regression models identified the motivators (eHealth literacy, internal health orientation, and trust in digital information) associated with these outcomes. Qualitative data were incorporated to illustrate the worksheet responses.  Results: Whereas 97\% of the participants reported that they had searched for health information on the Internet in the past year, 42\% did not engage in digital health-management practices. Among the low users and nonusers, 49\% expressed interest in future adoption of digital health tools. Web-based health information-seeking activities were associated with digital health-management practices (P<.001). When controlling for covariates, eHealth literacy was positively correlated with the number of Web-based health-seeking activities (beta=.03, 95\% CI 0.00-0.07). However, an internal health orientation was a much stronger correlate of digital health-management practices (beta=.13, 95\% CI 0.02-0.24), whereas trust in digital information increased the odds of potential adoption (vs no adoption) in adjusted models (OR 5.21, 95\% CI 0.84-32.53). Demographic characteristics were not important drivers of digital health use and few differences distinguished use among mothers and pregnant women. Conclusions: Seeking health information on the Internet may be an important gateway toward engaging in digital health-management practices. Notably, different consumer motivators influence digital health tool use. The relative contributions of each must be explored to design tools and interventions that enhance competencies for the management of self and child health among disadvantaged mothers and pregnant women. Unless we address disparities in digital health tool use, benefits from their use will accrue predominantly to individuals with the resources and skills to use technology effectively. ",
doi="10.2196/jmir.7736",
url="http://www.jmir.org/2017/7/e240/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28679489"
}


@Article{info:doi/10.2196/mhealth.6494,
author="Nebeker, Camille
and Murray, Kate
and Holub, Christina
and Haughton, Jessica
and Arredondo, M. Elva",
title="Acceptance of Mobile Health in Communities Underrepresented in Biomedical Research: Barriers and Ethical Considerations for Scientists",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jun",
day="28",
volume="5",
number="6",
pages="e87",
keywords="telemedicine",
keywords="cultural diversity",
keywords="ethics, research",
keywords="ethics committees",
keywords="research",
keywords="privacy",
keywords="informed consent",
abstract="Background:  The rapid expansion of direct-to-consumer wearable fitness products (eg, Flex 2, Fitbit) and research-grade sensors (eg, SenseCam, Microsoft Research; activPAL, PAL Technologies) coincides with new opportunities for biomedical and behavioral researchers. Underserved communities report among the highest rates of chronic disease and could benefit from mobile technologies designed to facilitate awareness of health behaviors. However, new and nuanced ethical issues are introduced with new technologies, which are challenging both institutional review boards (IRBs) and researchers alike. Given the potential benefits of such technologies, ethical and regulatory concerns must be carefully considered.  Objective: Our aim was to understand potential barriers to using wearable sensors among members of Latino, Somali and Native Hawaiian Pacific Islander (NHPI) communities. These ethnic groups report high rates of disparate health conditions and could benefit from wearable technologies that translate the connection between physical activity and desired health outcomes. Moreover, these groups are traditionally under-represented in biomedical research.  Methods: We independently conducted formative research with individuals from southern California, who identified as Latino, Somali, or Native Hawaiian Pacific Islander (NHPI). Data collection methods included survey (NHPI), interview (Latino), and focus group (Somali) with analysis focusing on cross-cutting themes.  Results: The results pointed to gaps in informed consent, challenges to data management (ie, participant privacy, data confidentiality, and data sharing conventions), social implications (ie, unwanted attention), and legal risks (ie, potential deportation). Conclusions:  Results shed light on concerns that may escalate the digital divide. Recommendations include suggestions for researchers and IRBs to collaborate with a goal of developing meaningful and ethical practices that are responsive to diverse research participants who can benefit from technology-enabled research methods. Trial Registration: ClinicalTrials.gov NCT02505165; https://clinicaltrials.gov/ct2/show/NCT02505165 (Archived by WebCite at http://www.Webcitation.org/6r9ZSUgoT) ",
doi="10.2196/mhealth.6494",
url="http://mhealth.jmir.org/2017/6/e87/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28659258"
}


@Article{info:doi/10.2196/jmir.7017,
author="Zhang, Ni
and Campo, Shelly
and Yang, Jingzhen
and Eckler, Petya
and Snetselaar, Linda
and Janz, Kathleen
and Leary, Emily",
title="What Motivates Young Adults to Talk About Physical Activity on Social Network Sites?",
journal="J Med Internet Res",
year="2017",
month="Jun",
day="22",
volume="19",
number="6",
pages="e226",
keywords="physical activity",
keywords="social marketing",
keywords="social media",
abstract="Background: Electronic word-of-mouth on social network sites has been used successfully in marketing. In social marketing, electronic word-of-mouth about products as health behaviors has the potential to be more effective and reach more young adults than health education through traditional mass media. However, little is known about what motivates people to actively initiate electronic word-of-mouth about health behaviors on their personal pages or profiles on social network sites, thus potentially reaching all their contacts on those sites. Objective: This study filled the gap by applying a marketing theoretical model to explore the factors associated with electronic word-of-mouth on social network sites about leisure-time physical activity. Methods: A Web survey link was sent to undergraduate students at one of the Midwestern universities and 439 of them completed the survey. Results: The average age of the 439 participants was 19 years (SD=1 year, range: 18-24). Results suggested that emotional engagement with leisure-time physical activity (ie, affective involvement in leisure-time physical activity) predicted providing relevant opinions or information on social network sites. Social network site users who perceived stronger ties with all their contacts were more likely to provide and seek leisure-time physical activity opinions and information. People who provided leisure-time physical activity opinions and information were more likely to seek opinions and information, and people who forwarded information about leisure-time physical activity were more likely to chat about it. Conclusions: This study shed light on the application of the electronic word-of-mouth theoretical framework in promoting health behaviors. The findings can also guide the development of future social marketing interventions using social network sites to promote leisure-time physical activity. ",
doi="10.2196/jmir.7017",
url="http://www.jmir.org/2017/6/e226/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28642215"
}


@Article{info:doi/10.2196/jmir.6855,
author="Ghweeba, Mayada
and Lindenmeyer, Antje
and Shishi, Sobhi
and Abbas, Mostafa
and Waheed, Amani
and Amer, Shaymaa",
title="What Predicts Online Health Information-Seeking Behavior Among Egyptian Adults? A Cross-Sectional Study",
journal="J Med Internet Res",
year="2017",
month="Jun",
day="22",
volume="19",
number="6",
pages="e216",
keywords="Internet",
keywords="information-seeking behavior",
keywords="computer literacy",
keywords="surveys and questionnaires",
keywords="Egypt",
abstract="Background: Over the last decade, the Internet has become an important source of health-related information for a wide range of users worldwide. Yet, little is known about the personal characteristics of Egyptian Internet users who search for online health information (OHI). Objective: The aim of the study was to identify the personal characteristics of Egyptian OHI seekers and to determine any associations between their personal characteristics and their health information-seeking behavior. Methods: ?This cross-sectional questionnaire study was conducted from?June to October 2015.?A Web-based questionnaire was sent to Egyptian users aged 18 years and older (N=1400) of a popular Arabic-language health information website. The questionnaire included (1) demographic characteristics; (2) self-reported general health status; and (3) OHI-seeking?behavior?that included frequency of use, different topics sought, and self-reported impact of obtained OHI on health?behaviors. Data were?analyzed?using descriptive statistics and multiple regression analysis. Results: A total of 490 participants completed the electronic questionnaire with a response rate equivalent to 35.0\% (490/1400). Regarding personal characteristics, 57.1\% (280/490) of participants were females, 63.4\% (311/490) had a university level qualification, and 37.1\% (182/490) had a chronic health problem. The most commonly sought OHI by the participants was nutrition-related. Results of the multiple regression analysis showed that 31.0\% of the variance in frequency of seeking OHI among Egyptian adults can be predicted by personal characteristics. Participants who sought OHI more frequently were likely to be female, of younger age, had higher education levels, and good self-reported general health. Conclusions: Our results provide insights into personal characteristics and OHI-seeking behaviors of Egyptian OHI users. This will contribute to better recognize their needs, highlight ways to increase the availability of appropriate OHI, and may lead to the provision of tools allowing Egyptian OHI users to navigate to the highest-quality health information. ",
doi="10.2196/jmir.6855",
url="http://www.jmir.org/2017/6/e216/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28642216"
}


@Article{info:doi/10.2196/publichealth.7526,
author="Jabson, M. Jennifer
and Patterson, G. Joanne
and Kamen, Charles",
title="Understanding Health Information Seeking on the Internet Among Sexual Minority People: Cross-Sectional Analysis From the Health Information National Trends Survey",
journal="JMIR Public Health Surveill",
year="2017",
month="Jun",
day="19",
volume="3",
number="2",
pages="e39",
keywords="sexual orientation",
keywords="Internet-based health information seeking",
keywords="internet access",
keywords="sexual minority",
keywords="homosexuality",
keywords="bisexuality",
abstract="Background: Individuals who face barriers to health care are more likely to access the Internet to seek health information. Pervasive stigma and heterosexism in the health care setting are barriers to health care for sexual minority people (SMP, ie, lesbian, gay, and bisexual people); therefore, SMP may be more likely to use the Internet as a source of health information compared to heterosexual people. Objective: Currently, there is a dearth of published empirical evidence concerning health information seeking on the Internet among SMP; the current project addresses this gap. Methods: Data from the 2015 Health Information National Trends Survey Food and Drug Administration Cycle were used to describe and summarize health information seeking among SMP (n=105) and heterosexual people (n=3405). Results: Almost all of the SMP in this sample reported having access to the Internet (92.4\%, 97/105). SMP were equally as likely as heterosexual people to seek health information on the Internet (adjusted odds ratio [aOR] 0.94, 95\% CI 0.56-1.66) and to report incidental exposure to health information online (aOR 1.02, 95\% CI 0.66-1.60). SMP were 58\% more likely to watch a health-related video on YouTube than heterosexual people (aOR 1.58, 95\% CI 1.00-2.47). Incidental exposure to health information was associated with seeking health information for oneself (aOR 3.87, 95\% CI 1.16-14.13) and for someone else (aOR 6.30, 95\% CI 2.40-17.82) among SMP. Conclusions: SMP access the Internet at high rates and seek out health information online. Their incidental exposure could be associated with seeking information for self or others. This suggests that online interventions could be valuable for delivering or promoting health information for SMP. ",
doi="10.2196/publichealth.7526",
url="http://publichealth.jmir.org/2017/2/e39/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28630036"
}


@Article{info:doi/10.2196/jmir.7303,
author="Villanti, C. Andrea
and Johnson, L. Amanda
and Ilakkuvan, Vinu
and Jacobs, A. Megan
and Graham, L. Amanda
and Rath, M. Jessica",
title="Social Media Use and Access to Digital Technology in US Young Adults in 2016",
journal="J Med Internet Res",
year="2017",
month="Jun",
day="07",
volume="19",
number="6",
pages="e196",
keywords="social media",
keywords="technology",
keywords="young adults",
abstract="Background: In 2015, 90\% of US young adults with Internet access used social media. Digital and social media are highly prevalent modalities through which young adults explore identity formation, and by extension, learn and transmit norms about health and risk behaviors during this developmental life stage. Objective: The purpose of this study was to provide updated estimates of social media use from 2014 to 2016 and correlates of social media use and access to digital technology in data collected from a national sample of US young adults in 2016. Methods: Young adult participants aged 18-24 years in Wave 7 (October 2014, N=1259) and Wave 9 (February 2016, N=989) of the Truth Initiative Young Adult Cohort Study were asked about use frequency for 11 social media sites and access to digital devices, in addition to sociodemographic characteristics. Regular use was defined as using a given social media site at least weekly. Weighted analyses estimated the prevalence of use of each social media site, overlap between regular use of specific sites, and correlates of using a greater number of social media sites regularly. Bivariate analyses identified sociodemographic correlates of access to specific digital devices. Results: In 2014, 89.42\% (weighted n, 1126/1298) of young adults reported regular use of at least one social media site. This increased to 97.5\% (weighted n, 965/989) of young adults in 2016. Among regular users of social media sites in 2016, the top five sites were Tumblr (85.5\%), Vine (84.7\%), Snapchat (81.7\%), Instagram (80.7\%), and LinkedIn (78.9\%). Respondents reported regularly using an average of 7.6 social media sites, with 85\% using 6 or more sites regularly. Overall, 87\% of young adults reported access or use of a smartphone with Internet access, 74\% a desktop or laptop computer with Internet access, 41\% a tablet with Internet access, 29\% a smart TV or video game console with Internet access, 11\% a cell phone without Internet access, and 3\% none of these. Access to all digital devices with Internet was lower in those reporting a lower subjective financial situation; there were also significant differences in access to specific digital devices with Internet by race, ethnicity, and education. Conclusions: The high mean number of social media sites used regularly and the substantial overlap in use of multiple social media sites reflect the rapidly changing social media environment. Mobile devices are a primary channel for social media, and our study highlights disparities in access to digital technologies with Internet access among US young adults by race/ethnicity, education, and subjective financial status. Findings from this study may guide the development and implementation of future health interventions for young adults delivered via the Internet or social media sites. ",
doi="10.2196/jmir.7303",
url="http://www.jmir.org/2017/6/e196/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28592394"
}


@Article{info:doi/10.2196/mhealth.7628,
author="Shen, Chen
and Wang, Ping Man
and Chu, TW Joanna
and Wan, Alice
and Viswanath, Kasisomayajula
and Chan, Chee Sophia Siu
and Lam, Hing Tai",
title="Health App Possession Among Smartphone or Tablet Owners in Hong Kong: Population-Based Survey",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jun",
day="05",
volume="5",
number="6",
pages="e77",
keywords="apps",
keywords="smartphone",
keywords="Chinese",
abstract="Background: Health apps are increasingly used with important implications for health. Hong Kong is one of the most technologically advanced and connected cities---smartphone ownership and Internet access rates are among the highest in the world. Objective: We investigated the prevalence of health app possession and related sociodemographic factors and health behaviors among smartphone or tablet owners in Hong Kong. Methods: A territory-wide population-based dual (landline and mobile) telephone survey was conducted in 2016. Respondents were asked whether they had health-related apps on their smartphones or tablets and what functions were available on the apps (eg, tracking physical activity and logging health records). Logistic regression was used to calculate the adjusted odds ratio (aOR) and 95\% CI of health app possession for different demographic characteristics, socioeconomic position (education, employment, and income), health behaviors (smoking, alcohol, and physical activity) and health (body mass index and chronic diseases). Results: Of the 4129 smartphone or tablet owners (81.28\%, 4129/5080 respondents), 995 (24.10\%) had a health app. Tracking physical activity (67.0\% of 995) and logging health records (43.0\% of 995) were the most common functions of the health apps. Overall, younger age, higher education, and household income were associated with having health apps (all P<.001). Compared with physical inactivity, engaging in moderate physical activity ?1 day/week was associated with having health apps (aOR 1.45 [95\% CI 1.20-1.75] for 1-3 days/week, and aOR 1.32 [95\% CI 1.07-1.62] for ?4 days/week). Having a history of chronic diseases was associated with having health apps (aOR 1.36 [95\% CI 1.11-1.68]). Conclusions: We have shown a lower prevalence of use of information and communication technologies (ICTs) in respondents with lower education and income in the most developed Chinese city. This could be seen as a confirmation of the ``Inverse information law,'' which suggests that those most in need have less use of services and hence receive less benefits from advancements in medicine and health related ICTs. ",
doi="10.2196/mhealth.7628",
url="http://mhealth.jmir.org/2017/6/e77/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28583905"
}


@Article{info:doi/10.2196/jmir.7417,
author="Greenberg, J. Alexandra
and Falisi, L. Angela
and Finney Rutten, J. Lila
and Chou, Sylvia Wen-Ying
and Patel, Vaishali
and Moser, P. Richard
and Hesse, W. Bradford",
title="Access to Electronic Personal Health Records Among Patients With Multiple Chronic Conditions: A Secondary Data Analysis",
journal="J Med Internet Res",
year="2017",
month="Jun",
day="02",
volume="19",
number="6",
pages="e188",
keywords="electronic personal health information",
keywords="electronic health records",
keywords="patient engagement",
keywords="multiple chronic conditions",
abstract="Background: In the United States, national incentives for offering access to electronic personal health records (ePHRs) through electronic means are geared toward creating a culture of patient engagement. One group of patients who stand to benefit from online access to ePHRs is the growing population with multiple chronic conditions (MCC). However, little is known about the current availability and use of ePHRs and patient portals among those managing MCC. Objective: The aim was to determine the associations between number of chronic conditions and sociodemographic characteristics and usage of ePHRs, and to assess how the public's use of ePHRs varies across subpopulations, including those with MCC. Methods: This study used data collected from the 2014 Health Information National Trends Survey (HINTS), and assessed differences in use of ePHRs between those with and without MCC (N=3497) using multiple logistic regression techniques. Variables associated with health care systems (insurance status, having a regular provider) and patient-reported self-efficacy were included in the statistical models. Results: Those with MCC (n=1555) had significantly higher odds of accessing their records three or more times in the past year compared to those reporting no chronic conditions (n=1050; OR 2.46, 95\% CI 1.37-4.45), but the overall percentage of those with MCC using ePHRs remained low (371 of 1529 item respondents, 25.63\% weighted). No difference in odds of accessing their records was found between those reporting one chronic condition (n=892) and those reporting none (n=1050; OR 1.02, 95\% CI 0.66-1.58). Significant differences in odds of accessing ePHRs were seen between income and age groups (P<.001 and P=.05, respectively), and by whether respondents had a regular provider (P=.03). Conclusions: We conclude that ePHRs provide a unique opportunity to enhance MCC patient self-management, but additional effort is needed to ensure that these patients are able to access their ePHRs. An increase in availability of patient access to their ePHRs may provide an opportunity to increase patient engagement and support self-management for all patients and especially those with MCC. ",
doi="10.2196/jmir.7417",
url="http://www.jmir.org/2017/6/e188/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28576755"
}


@Article{info:doi/10.2196/mental.7435,
author="McCrabb, Sam
and Baker, L. Amanda
and Attia, John
and Balogh, J. Zsolt
and Lott, Natalie
and Palazzi, Kerrin
and Naylor, Justine
and Harris, A. Ian
and Doran, Christopher
and George, Johnson
and Wolfenden, Luke
and Skelton, Eliza
and Bonevski, Billie",
title="Who is More Likely to Use the Internet for Health Behavior Change? A Cross-Sectional Survey of Internet Use Among Smokers and Nonsmokers Who Are Orthopedic Trauma Patients",
journal="JMIR Ment Health",
year="2017",
month="May",
day="30",
volume="4",
number="2",
pages="e18",
keywords="Internet",
keywords="health",
keywords="eHealth",
keywords="health care",
keywords="smoking",
keywords="orthopedic trauma",
abstract="Background: eHealth presents opportunities to provide population groups with accessible health interventions, although knowledge about Internet access, peoples' interest in using the Internet for health, and users' characteristics are required prior to eHealth program development. Objective: This study surveyed hospital patients to examine rates of Internet use, interest in using the Internet for health, and respondent characteristics related to Internet use and interest in using the Internet for health. For patients who smoke, preferences for types of smoking cessation programs for use at home and while in hospital were also examined. Methods: An online cross-sectional survey was used to survey 819 orthopedic trauma patients (response rate: 72.61\%, 819/1128) from two public hospitals in New South Wales, Australia. Logistic regressions were used to examine associations between variables. Results: A total of 72.7\% (574/790) of respondents had at least weekly Internet access and more than half (56.6\%, 357/631) reported interest in using the Internet for health. Odds of at least weekly Internet usage were higher if the individual was born overseas (OR 2.21, 95\% CI 1.27-3.82, P=.005), had a tertiary education (OR 3.75, 95\% CI 2.41-5.84, P<.001), or was a nonsmoker (OR 3.75, 95\% CI 2.41-5.84, P<.001). Interest in using the Internet for health increased with high school (OR 1.85, 95\% CI 1.09-3.15, P=.02) or tertiary education (OR 2.48, 95\% CI 1.66-3.70, P<.001), and if household incomes were more than AUS \$100,000 (OR 2.5, 95\% CI 1.25-4.97, P=.009). Older individuals were less interested in using the Internet for health (OR 0.98, 95\% CI 0.97-0.99, P<.001). Conclusions: Online interventions may be a potential tool for health care in this hospitalized population. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614001147673; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366829\&isReview=true (Archived by WebCite at http://www.webcitation.org/6qg26u3En) ",
doi="10.2196/mental.7435",
url="http://mental.jmir.org/2017/2/e18/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28559228"
}


@Article{info:doi/10.2196/mhealth.7323,
author="Mitchell, Marc
and White, Lauren
and Oh, Paul
and Alter, David
and Leahey, Tricia
and Kwan, Matthew
and Faulkner, Guy",
title="Uptake of an Incentive-Based mHealth App: Process Evaluation of the Carrot Rewards App",
journal="JMIR Mhealth Uhealth",
year="2017",
month="May",
day="30",
volume="5",
number="5",
pages="e70",
keywords="financial incentives",
keywords="mHealth",
keywords="behavioral economics",
keywords="public health",
abstract="Background: Behavioral economics has stimulated renewed interest in financial health incentives worldwide. The Carrot Rewards app was developed as part of a public-private partnership to reward Canadians with loyalty points (eg, movies and groceries) for downloading the app, referring friends, and completing an average of 1 to 2 educational health quizzes per week (``micro-learning''), with long-term objectives of increasing health knowledge and encouraging healthy behaviors. Objective: The main objective of this study was to evaluate uptake of a loyalty points-based mHealth app during the exclusive 3-month launch period in British Columbia (BC), Canada. The secondary aims were to describe the health and sociodemographic characteristics of users, as well as participation levels (eg, proportion of quizzes completed and friends referred). Methods: The app was promoted via loyalty program email campaigns (1.64 million emails). Number of downloads and registrations (users enter age, gender, and valid BC postal code to register) were collected. Additional sociodemographics were inferred by linking postal codes with census data at the local health area (LHA) level. Health risk assessments were also deployed. Participation levels were collected over 3 months and descriptive data were presented. Results: In 3 months, 67,464 individuals downloaded the app; in its first week, Carrot Rewards was the most downloaded health app in Canada. Among valid users (n=57,885; at least one quiz completed), the majority were female (62.96\%; 36,446/57,885) and aged 18 to 34 years (54.34\%; 31,459/57,885). More than half of the users (52.40\%; 30,332/57,885) resided in LHAs where the median personal income was below the provincial average (Can \$28,765). Furthermore, 64.42\% (37,291/57,885) of users lived in metropolitan (ie, urban) LHAs, compared with 56.17\% of the general BC population. The most prevalent risk factors were ``not'' meeting physical activity guidelines (72.70\%; 31,765/43,692) and ``not'' getting the flu shot last year (67.69\%; 30,286/44,739). Regarding participation, 60.05\% (34,761/57,885) of users were classified as ``very high'' engagers (>75\% quiz completion rate). Conclusions: Early results suggest that loyalty points may promote mHealth app uptake. The app was downloaded by younger females especially, and BC residents from higher and lower income regions were equally represented. Loyalty points appear to have driven participation throughout the inaugural 3-month period (ie, quiz completion). ",
doi="10.2196/mhealth.7323",
url="http://mhealth.jmir.org/2017/5/e70/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28559224"
}


@Article{info:doi/10.2196/jmir.6853,
author="van Boekel, C. Leonieke
and Peek, TM Sebastiaan
and Luijkx, G. Katrien",
title="Diversity in Older Adults' Use of the Internet: Identifying Subgroups Through Latent Class Analysis",
journal="J Med Internet Res",
year="2017",
month="May",
day="24",
volume="19",
number="5",
pages="e180",
keywords="Internet",
keywords="aged",
keywords="cluster analysis",
keywords="health",
abstract="Background: As for all individuals, the Internet is important in the everyday life of older adults. Research on older adults' use of the Internet has merely focused on users versus nonusers and consequences of Internet use and nonuse. Older adults are a heterogeneous group, which may implicate that their use of the Internet is diverse as well. Older adults can use the Internet for different activities, and this usage can be of influence on benefits the Internet can have for them. Objective: The aim of this paper was to describe the diversity or heterogeneity in the activities for which older adults use the Internet and determine whether diversity is related to social or health-related variables. Methods: We used data of a national representative Internet panel in the Netherlands. Panel members aged 65 years and older and who have access to and use the Internet were selected (N=1418). We conducted a latent class analysis based on the Internet activities that panel members reported to spend time on. Second, we described the identified clusters with descriptive statistics and compared the clusters using analysis of variance (ANOVA) and chi-square tests. Results: Four clusters were distinguished. Cluster 1 was labeled as the ``practical users'' (36.88\%, n=523). These respondents mainly used the Internet for practical and financial purposes such as searching for information, comparing products, and banking. Respondents in Cluster 2, the ``minimizers'' (32.23\%, n=457), reported lowest frequency on most Internet activities, are older (mean age 73 years), and spent the smallest time on the Internet. Cluster 3 was labeled as the ``maximizers'' (17.77\%, n=252); these respondents used the Internet for various activities, spent most time on the Internet, and were relatively younger (mean age below 70 years). Respondents in Cluster 4, the ``social users,'' mainly used the Internet for social and leisure-related activities such as gaming and social network sites. The identified clusters significantly differed in age (P<.001, $\omega$2=0.07), time spent on the Internet (P<.001, $\omega$2=0.12), and frequency of downloading apps (P<.001, $\omega$2=0.14), with medium to large effect sizes. Social and health-related variables were significantly different between the clusters, except social and emotional loneliness. However, effect sizes were small. The minimizers scored significantly lower on psychological well-being, instrumental activities of daily living (iADL), and experienced health compared with the practical users and maximizers. Conclusions: Older adults are a diverse group in terms of their activities on the Internet. This underlines the importance to look beyond use versus nonuse when studying older adults' Internet use. The clusters we have identified in this study can help tailor the development and deployment of eHealth intervention to specific segments of the older population. ",
doi="10.2196/jmir.6853",
url="http://www.jmir.org/2017/5/e180/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28539302"
}


@Article{info:doi/10.2196/jmir.6830,
author="Mattsson, Susanne
and Olsson, Gustaf Erik Martin
and Johansson, Birgitta
and Carlsson, Maria",
title="Health-Related Internet Use in People With Cancer: Results From a Cross-Sectional Study in Two Outpatient Clinics in Sweden",
journal="J Med Internet Res",
year="2017",
month="May",
day="15",
volume="19",
number="5",
pages="e163",
keywords="Oncology",
keywords="eHealth",
keywords="support",
abstract="Background: The access to various forms of support during the disease trajectory is crucial for people with cancer. The provision and use of Internet health services is increasing, and it is important to further investigate the preferences and demographical characteristics of its users. Investigating the uptake and perceived value of Internet health services is a prerequisite to be able to meet the needs in the targeted group. Objective: The objective of this study was to investigate health-related Internet use among people with cancer. Methods: The health online support questionnaire (HOSQ), examining the incentives for health-related Internet support use, was administered in two Swedish outpatient hospital clinics. Of the 350 copies of the questionnaire handed out, 285 (81.4\%) were returned, answered by persons with cancer who had completed treatment or were under active surveillance or another medical treatment. Results: A total of 215 (76.2\%, 215/282) participants reported Internet use since being diagnosed with cancer. Internet-users were younger (P<.001), more likely to have a partner (P=.03), and had a higher level of education than nonusers (P<.001). The most common health-related activity on the Internet was searching for information (77.2\%, 166/215), and users searched significantly more immediately after diagnosis compared with later on (P<.001). Use of My Healthcare Contacts was considered the most valuable Internet activity. Having a university degree (P ?.001) and being younger in age (P=.01) were associated with a significantly higher frequency of health- related Internet use. Conclusions: People with cancer turn to the Internet for informational support that enables them to influence their care and to stay in touch with friends and relatives. Demographical differences regarding the uptake of Web-based support remains. This indicates a need for research on how to bridge this digital gap. By learning more about the use of health-related support on the Web among people with cancer, adequate support can be offered and potential strain reduced. ",
doi="10.2196/jmir.6830",
url="http://www.jmir.org/2017/5/e163/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28506959"
}


@Article{info:doi/10.2196/mhealth.6940,
author="Ng, Kwok
and Tynj{\"a}l{\"a}, Jorma
and Kokko, Sami",
title="Ownership and Use of Commercial Physical Activity Trackers Among Finnish Adolescents: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="May",
day="04",
volume="5",
number="5",
pages="e61",
keywords="social determinants of health",
keywords="mobile phone",
keywords="health promotion",
keywords="disabled children",
keywords="physical activity",
keywords="adolescent",
abstract="Background: Mobile phone apps for monitoring and promoting physical activity (PA) are extremely popular among adults. Devices, such as heart rate monitors or sports watches (HRMs/SWs) that work with these apps are at sufficiently low costs to be available through the commercial markets. Studies have reported an increase in PA levels among adults with devices; however, it is unknown whether the phenomena are similar during early adolescence. At a time when adolescents start to develop their own sense of independence and build friendship, the ease of smartphone availability in developed countries needs to be investigated in important health promoting behaviors such as PA. Objective: The objective of this study was to investigate the ownership and usage of PA trackers (apps and HRM/SW) among adolescents in a national representative sample and to examine the association between use of devices and PA levels. Methods: The Finnish school-aged physical activity (SPA) study consisted of 4575 adolescents, aged 11-, 13-, and 15-years, who took part in a web-based questionnaire during school time about PA behaviors between April and May 2016. Binary logistic regression analyses were used to test the associations between moderate to vigorous physical activity (MVPA) and devices, after controlling for gender, age, disability, and family affluence. Results: PA tracking devices have been categorized into two types, which are accessible to adolescents: (1) apps and (2) HRM/SW. Half the adolescents (2351/4467; 52.63\%) own apps for monitoring PA, yet 16.12\% (720/4467) report using apps. Fewer adolescents (782/4413; 17.72\%) own HRM/SW and 9.25\% (408/4413) use HRM/SW. In this study, users of HRM/SW were 2.09 times (95\% CI 1.64-2.67), whereas users of apps were 1.4 times (95\% CI 1.15-1.74) more likely to meet PA recommendations of daily MVPA for at least 60 min compared with adolescents without HRM/SW or without apps. Conclusions: To our knowledge, this is the first study that describes the situation in Finland with adolescents using PA trackers and its association with PA levels. Implications of the use of apps and HRM/SW by adolescents are discussed. ",
doi="10.2196/mhealth.6940",
url="http://mhealth.jmir.org/2017/5/e61/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28473304"
}


@Article{info:doi/10.2196/jmir.6731,
author="Latulippe, Karine
and Hamel, Christine
and Giroux, Dominique",
title="Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies",
journal="J Med Internet Res",
year="2017",
month="Apr",
day="27",
volume="19",
number="4",
pages="e136",
keywords="Internet",
keywords="social media",
keywords="telemedecine",
keywords="healthcare disparities",
abstract="Background: eHealth is developing rapidly and brings with it a promise to reduce social health inequalities (SHIs). Yet, it appears that it also has the potential to increase them. Objectives: The general objective of this review was to set out how to ensure that eHealth contributes to reducing SHIs rather than exacerbating them. This review has three objectives: (1) identifying characteristics of people at risk of experiencing social inequality in health; (2) determining the possibilities of developing eHealth tools that avoid increasing SHI; and (3) modeling the process of using an eHealth tool by people vulnerable to SHI. Methods: Following the EPPI approach (Evidence for Policy and Practice of Information of the Institute of Education at the University of London), two databases were searched for the terms SHIs and eHealth and their derivatives in titles and abstracts. Qualitative, quantitative, and mixed articles were included and evaluated. The software NVivo (QSR International) was employed to extract the data and allow for a metasynthesis of the data. Results: Of the 73 articles retained, 10 were theoretical, 7 were from reviews, and 56 were based on empirical studies. Of the latter, 40 used a quantitative approach, 8 used a qualitative approach, 4 used mixed methods approach, and only 4 were based on participatory research-action approach. The digital divide in eHealth is a serious barrier and contributes greatly to SHI. Ethnicity and low income are the most commonly used characteristics to identify people at risk of SHI. The most promising actions for reducing SHI via eHealth are to aim for universal access to the tool of eHealth, become aware of users' literacy level, create eHealth tools that respect the cultural attributes of future users, and encourage the participation of people at risk of SHI. Conclusions: eHealth has the potential to widen the gulf between those at risk of SHI and the rest of the population. The widespread expansion of eHealth technologies calls for rigorous consideration of interventions, which are not likely to exacerbate SHI. ",
doi="10.2196/jmir.6731",
url="http://www.jmir.org/2017/4/e136/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28450271"
}


@Article{info:doi/10.2196/jmir.6838,
author="Ernsting, Clemens
and Dombrowski, U. Stephan
and Oedekoven, Monika
and O{\textasciiacute}Sullivan, L. Julie
and Kanzler, Melanie
and Kuhlmey, Adelheid
and Gellert, Paul",
title="Using Smartphones and Health Apps to Change and Manage Health Behaviors: A Population-Based Survey",
journal="J Med Internet Res",
year="2017",
month="Apr",
day="05",
volume="19",
number="4",
pages="e101",
keywords="telemedicine",
keywords="eHealth",
keywords="mHealth",
keywords="smartphone",
keywords="mobile apps",
keywords="health promotion",
keywords="chronic disease",
keywords="health literacy",
keywords="quality of life",
abstract="Background: Chronic conditions are an increasing challenge for individuals and the health care system. Smartphones and health apps are potentially promising tools to change health-related behaviors and manage chronic conditions. Objective: The aim of this study was to explore (1) the extent of smartphone and health app use, (2) sociodemographic, medical, and behavioral correlates of smartphone and health app use, and (3) associations of the use of apps and app characteristics with actual health behaviors. Methods: A population-based survey (N=4144) among Germans, aged 35 years and older, was conducted. Sociodemographics, presence of chronic conditions, health behaviors, quality of life, and health literacy, as well as the use of the Internet, smartphone, and health apps were assessed by questionnaire at home visit. Binary logistic regression models were applied. Results: It was found that 61.25\% (2538/4144) of participants used a smartphone. Compared with nonusers, smartphone users were younger, did more research on the Internet, were more likely to work full-time and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy. Among smartphone users, 20.53\% (521/2538) used health apps. App users were younger, less likely to be native German speakers, did more research on the Internet, were more likely to report chronic conditions, engaged more in physical activity, and low fat diet, and were more health literate compared with nonusers who had a smartphone. Health apps focused on smoking cessation (232/521, 44.5\%), healthy diet (201/521, 38.6\%), and weight loss (121/521, 23.2\%). The most common app characteristics were planning (264/521, 50.7\%), reminding (188/521, 36.1\%), prompting motivation (179/521 34.4\%), and the provision of information (175/521, 33.6\%). Significant associations were found between planning and the health behavior physical activity, between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctor's advice. Conclusions: Although there were many smartphone and health app users, a substantial proportion of the population was not engaged. Findings suggest age-related, socioeconomic-related, literacy-related, and health-related disparities in the use of mobile technologies. Health app use may reflect a user's motivation to change or maintain health behaviors. App developers and researchers should take account of the needs of older people, people with low health literacy, and chronic conditions. ",
doi="10.2196/jmir.6838",
url="http://www.jmir.org/2017/4/e101/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28381394"
}


@Article{info:doi/10.2196/jmir.6668,
author="Baumann, Eva
and Czerwinski, Fabian
and Reifegerste, Doreen",
title="Gender-Specific Determinants and Patterns of Online Health Information Seeking: Results From a Representative German Health Survey",
journal="J Med Internet Res",
year="2017",
month="Apr",
day="04",
volume="19",
number="4",
pages="e92",
keywords="health information seeking",
keywords="social media",
keywords="gender differences",
keywords="frequency of seeking",
keywords="Internet",
abstract="Background: Online health information-seeking behavior (OHISB) is currently a widespread and common behavior that has been described as an important prerequisite of empowerment and health literacy. Although demographic factors such as socioeconomic status (SES), age, and gender have been identified as important determinants of OHISB, research is limited regarding the gender-specific motivational determinants of OHISB and differences between women and men in the use of online resources for health information purposes. Objective: The aim of this study was to identify gender-specific determinants and patterns of OHISB by analyzing data from a representative German sample of adults (N=1728) with special attention to access and frequency of use as well as topics and sources of OHISB. Methods: We employed a 2-step analysis, that is, after exploring differences between users and nonusers of online health information using logistic regression models, we highlighted gender-specific determinants of the frequency of OHISB by applying zero-truncated negative binomial models. Results: Age (odds ratio, OR for females=0.97, 95\% CI 0.96-0.99) and degree of satisfaction with one's general practitioner (GP) (OR for males=0.73, 95\% CI 0.57-0.92) were gender-specific determinants of access to OHISB. Regarding the frequency of OHISB, daily Internet use (incidence rate ratio, IRR=1.67, 95\% CI 1.19-2.33) and a strong interest in health topics (IRR=1.45, 95\% CI 1.19-1.77) were revealed to be more important predictors than SES (IRR for high SES=1.25, 95\% CI 0.91-1.73). Conclusions: Users indicate that the Internet seems to be capable of providing a valuable source of informational support and patient empowerment. Increasing the potential value of the Internet as a source for health literacy and patient empowerment requires need-oriented and gender-specific health communication efforts, media, and information strategies. ",
doi="10.2196/jmir.6668",
url="http://www.jmir.org/2017/4/e92/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28377367"
}


@Article{info:doi/10.2196/ijmr.4447,
author="Ware, Patrick
and Bartlett, J. Susan
and Par{\'e}, Guy
and Symeonidis, Iphigenia
and Tannenbaum, Cara
and Bartlett, Gillian
and Poissant, Lise
and Ahmed, Sara",
title="Using eHealth Technologies: Interests, Preferences, and Concerns of Older Adults",
journal="Interact J Med Res",
year="2017",
month="Mar",
day="23",
volume="6",
number="1",
pages="e3",
keywords="Internet",
keywords="telemedicine",
keywords="self care",
keywords="chronic disease",
abstract="Background: The Internet and eHealth technologies represent new opportunities for managing health. Age, sex, socioeconomic status, and current technology use are some of the known factors that influence individuals' uptake of eHealth; however, relatively little is known about facilitators and barriers to eHealth uptake specific to older adults, particularly as they relate to their experiences in accessing health care. Objective: The aim of our study was to explore the interests, preferences, and concerns of older adults in using the Internet and eHealth technologies for managing their health in relation to their experiences with the current health care system. Methods: Two focus groups (n=15) were conducted with adults aged 50+ years. Pragmatic thematic analysis using an inductive approach was conducted to identify the interests, preferences, and concerns of using the Internet and eHealth technologies. Results: Five themes emerged that include (1) Difficulty in identifying credible and relevant sources of information on the Web; (2) Ownership, access, and responsibility for medical information; (3) Peer communication and support; (4) Opportunities to enhance health care interactions; and (5) Privacy concerns. These findings support the potential value older adults perceive in eHealth technologies, particularly in their ability to provide access to personal health information and facilitate communication between providers and peers living with similar conditions. However, in order to foster acceptance, these technologies will need to provide personal and general health information that is secure, readily accessible, and easily understood. Conclusions: Older adults have diverse needs and preferences that, in part, are driven by their experiences and frustrations with the health care system. Results can help inform the design and implementation of technologies to address gaps in care and access to health information for older adults with chronic conditions who may benefit the most from this approach. ",
doi="10.2196/ijmr.4447",
url="http://www.i-jmr.org/2017/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28336506"
}


@Article{info:doi/10.2196/jmir.5834,
author="Nicholl, Honor
and Tracey, Catherine
and Begley, Thelma
and King, Carole
and Lynch, M. Aileen",
title="Internet Use by Parents of Children With Rare Conditions: Findings From a Study on Parents' Web Information Needs",
journal="J Med Internet Res",
year="2017",
month="Feb",
day="28",
volume="19",
number="2",
pages="e51",
keywords="rare diseases",
keywords="parents",
keywords="Internet",
keywords="consumer health information",
keywords="social media",
keywords="professional-patient relations",
abstract="Background: Parents of children with rare conditions increasingly use the Internet to source information on their child's condition. This study reports on part of a larger study whose overall aim was to identify the Internet use by parents when seeking information on their child's rare condition, with the specific purpose of using the findings to aid in the development of a website specifically designed to meet the parents' needs. It presents findings on why these parents use the Internet, the information and support content they source, and the impact these resources have on their capacity to care for and manage their child's condition. Objective: To (1) ascertain parents' general Internet usage patterns, (2) identify the nature of the information parents most frequently searched for, and (3) determine the effect the Internet-sourced information had on parents of children with rare conditions. Methods: Data collection was conducted in 2 parts: Part 1 was a focus group interview (n=8) to inform the development of the questionnaire, and Part 2 was a questionnaire (Web- and paper-based). All respondents (N=128) completed the questionnaire using the Internet. Results: Parents frequently and habitually used the Internet and social media to gather information on their child's condition. These Web-based resources provide parents with a parent-to-parent support platform that allows them to share their experiences and information with other parents, which, the respondents considered, improved their knowledge and understanding of their child's condition. The respondents also reported that these resources positively impacted on their decision making, care, and management of their child's condition. However, they reported receiving mixed responses when wishing to engage and share with health care professionals their Internet and social media interactions and information outcomes. Conclusions: This study adds to the emerging body of research on the Internet use by parents of children with rare conditions to source information on their child's condition. The evolving and ever increasing parent-to-parent support systems via social media are impacting on parents' capacity to manage their children. Implications for practice include health care professionals' response to this knowledge and capacity shift, and the significance of these changes when interacting with parents. The key message of this study was that parents of children with rare conditions are habitual users of the Internet to source information about their children's conditions. Social media, especially Facebook, has an increasing role in the lives of these parents for information and support. Parents' interest in information gathering and sharing includes a desire for shared dialogue with health care professionals. ",
doi="10.2196/jmir.5834",
url="http://www.jmir.org/2017/2/e51/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28246072"
}


@Article{info:doi/10.2196/jmir.5507,
author="Ker{\"a}nen, Susanna Niina
and Kangas, Maarit
and Immonen, Milla
and Simil{\"a}, Heidi
and Enwald, Heidi
and Korpelainen, Raija
and J{\"a}ms{\"a}, Timo",
title="Use of Information and Communication Technologies Among Older People With and Without Frailty: A Population-Based Survey",
journal="J Med Internet Res",
year="2017",
month="Feb",
day="14",
volume="19",
number="2",
pages="e29",
keywords="frail elderly",
keywords="Internet",
keywords="smartphone",
keywords="population characteristics",
keywords="logistic regression",
keywords="aged",
abstract="Background: Use of information and communication technologies (ICT) among seniors is increasing; however, studies on the use of ICT by seniors at the highest risk of health impairment are lacking. Frail and prefrail seniors are a group that would likely benefit from preventive nutrition and exercise interventions, both of which can take advantage of ICT. Objective: The objective of the study was to quantify the differences in ICT use, attitudes, and reasons for nonuse among physically frail, prefrail, and nonfrail home-dwelling seniors. Methods: This was a population-based questionnaire study on people aged 65-98 years living in Northern Finland. A total of 794 eligible individuals responded out of a contacted random sample of 1500. Results: In this study, 29.8\% (237/794) of the respondents were classified as frail or prefrail. The ICT use of frail persons was lower than that of the nonfrail ones. In multivariable logistic regression analysis, age and education level were associated with both the use of Internet and advanced mobile ICT such as smartphones or tablets. Controlling for age and education, frailty or prefrailty was independently related to the nonuse of advanced mobile ICT (odds ratio, OR=0.61, P=.01), and frailty with use of the Internet (OR=0.45, P=.03). The frail or prefrail ICT nonusers also held the most negative opinions on the usefulness or usability of mobile ICT. When opinion variables were included in the model, frailty status remained a significant predictor of ICT use. Conclusions: Physical frailty status is associated with older peoples' ICT use independent of age, education, and opinions on ICT use. This should be taken into consideration when designing preventive and assistive technologies and interventions for older people at risk of health impairment. ",
doi="10.2196/jmir.5507",
url="http://www.jmir.org/2017/2/e29/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28196791"
}


@Article{info:doi/10.2196/jmir.5636,
author="Carter, Allison
and Forrest, I. Jamie
and Kaida, Angela",
title="Association Between Internet Use and Body Dissatisfaction Among Young Females: Cross-Sectional Analysis of the Canadian Community Health Survey",
journal="J Med Internet Res",
year="2017",
month="Feb",
day="09",
volume="19",
number="2",
pages="e39",
keywords="body satisfaction",
keywords="Internet use",
keywords="girls",
keywords="young women",
keywords="Canada",
abstract="Background: Recent research suggests Internet exposure, including Facebook use, is positively correlated with body dissatisfaction, especially among girls and young women. Canada has one of the highest Internet access rates in the world, yet no previous study has examined this relationship using nationally representative data. Objective: Our objective was to evaluate the relationship between Internet use and body dissatisfaction among a national, population-based sample of Canadian females 12-29 years of age. Methods: We used cross-sectional data from the Canadian Community Health Survey 2011-2012. Body dissatisfaction was measured using a 5-point Likert scale and defined as ``very dissatisfied/dissatisfied'' with one's body. The explanatory variable was time spent using the Internet per week in the past 3 months, ranging from none/<1 hour to >20 hours. We used multinomial logistic regression to investigate whether greater Internet use was associated with increasing odds of being very dissatisfied/dissatisfied, neutral, or satisfied with one's body, using very satisfied as the referent. Probability survey sampling weights were applied to all analyses. Results: Of 2983 included participants, sampled to represent 940,786 young Canadian females, most were 20-29 years old (61.98\%) and living in households with an annual income Can \$80,000 or more (44.61\%). The prevalence of body dissatisfaction was 14.70\%, and 25- to 29-year-olds were more likely than 12- to 14-year-olds to be very dissatisfied or dissatisfied with their body (20.76\% vs 6.34\%). Few (5.01\%) reported none/<1 hour of Internet use, over half (56.93\%) reported 1-10 hours, and one-fifth (19.52\%) reported spending >20 hours online per week. Adjusting for age and income, the odds of being very dissatisfied/dissatisfied, relative to very satisfied, were greater in the highest versus lowest Internet use group (adjusted odds ratio [AOR] 3.03, 95\% CI 1.19-7.70). The AORs for this level of body dissatisfaction increased across increasing levels of Internet use, ranging from 0.88 (95\% CI 0.35-2.21) to 3.03 (95\% CI 1.19-7.70). Additionally, those who spent 11-14 hours online were more likely to be neutral (AOR 3.66, 95\% CI 1.17-11.45) and those who spent 15-20 hours online were more likely to be neutral (AOR 4.36, 95\% CI 1.18-16.13) or satisfied (AOR 2.82, 95\% CI 1.14-7.01) with their bodies, relative to very satisfied, compared with those spending no time or <1 hour online. Conclusions: A substantial proportion of Canadian females 12-29 years of age spent large amounts of time (>20 hours) on the Internet each week, and body dissatisfaction was significantly more likely among this group. Those who spent 11-20 hours online were also more likely to be less satisfied with their bodies. Efforts are needed to support girls and young women to achieve and maintain a positive body image in today's digital age. ",
doi="10.2196/jmir.5636",
url="http://www.jmir.org/2017/2/e39/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28183688"
}


@Article{info:doi/10.2196/jmir.6176,
author="Kazley, Swanson Abby
and Hamidi, Bashir
and Balliet, Wendy
and Baliga, Prabhakar",
title="Social Media Use Among Living Kidney Donors and Recipients: Survey on Current Practice and Potential",
journal="J Med Internet Res",
year="2016",
month="Dec",
day="20",
volume="18",
number="12",
pages="e328",
keywords="living kidney donation",
keywords="kidney transplant",
keywords="social media",
abstract="Background: In the United States, there is a national shortage of organs donated for transplant. Among the solid organs, most often kidneys are donated by living donors, but the lack of information and complicated processes limit the number of individuals who serve as living kidney donors. Social media can be a tool for advocacy, educating the public about the need, process, and outcomes of live kidney donors, yet little is known about social media use by kidney transplant patients. Objective: The purpose of this study was to examine the social media use of potential kidney transplant patients and their willingness to use social media and their networks to advocate and educate about living kidney donation. Methods: Using a validated survey, we modified the instrument to apply to the patient population of interest attending the Medical University of South Carolina, Charleston, SC, USA. The questions on the survey inquired about current social media use, sites visited, frequency and duration of social media use, and willingness to use social media to share the need for living kidney donors. We asked patients who had received a transplant and those awaiting a transplant to complete the survey during an office visit. Participation was voluntary. Results: A total of 199 patients completed the survey. Approximately half of all kidney transplant patients surveyed used social media (104/199, 52.3\%), and approximately one-third (66/199, 33.2\%) had more than 100 friends in their social media network. Facebook was the most popular site, and 51\% (102/199) reported that they would be willing to post information about living kidney donation on their social networks. More than a quarter of the sample (75/199, 37.7\%) had posted about their health status in the past. Conclusions: Social media holds great promise for health-related education and awareness. Our study shows the current social media use of kidney transplant patients. In turn, such information can be used to design interventions to ensure appropriate decision making about live kidney donation. Transplant programs can help increase the number of living donors by providing guidance to kidney transplant patients in how to use social media, to be advocates, and to provide information about living kidney donation to their social network. ",
doi="10.2196/jmir.6176",
url="http://www.jmir.org/2016/12/e328/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27998880"
}


@Article{info:doi/10.2196/jmir.6400,
author="Celi, Anthony Leo
and Davidzon, Guido
and Johnson, EW Alistair
and Komorowski, Matthieu
and Marshall, C. Dominic
and Nair, S. Sunil
and Phillips, T. Colin
and Pollard, J. Tom
and Raffa, D. Jesse
and Salciccioli, D. Justin
and Salgueiro, Muge Francisco
and Stone, J. David",
title="Bridging the Health Data Divide",
journal="J Med Internet Res",
year="2016",
month="Dec",
day="20",
volume="18",
number="12",
pages="e325",
keywords="electronic health records",
keywords="machine learning",
keywords="health care policy",
keywords="medical education",
keywords="collaboration",
doi="10.2196/jmir.6400",
url="http://www.jmir.org/2016/12/e325/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27998877"
}


@Article{info:doi/10.2196/jmir.6385,
author="Luger, M. Tana
and Hogan, P. Timothy
and Richardson, M. Lorilei
and Cioffari-Bailiff, Lisa
and Harvey, Kimberly
and Houston, K. Thomas",
title="Older Veteran Digital Disparities: Examining the Potential for Solutions Within Social Networks",
journal="J Med Internet Res",
year="2016",
month="Nov",
day="23",
volume="18",
number="11",
pages="e296",
keywords="Internet",
keywords="digital divide",
keywords="social network",
keywords="Veterans",
abstract="Background: Older adults typically have less access to the Internet than other age groups, and older Veterans may use the Internet even less due to economic and geographic reasons. Objective: To explore solutions to this problem, our study examined older Veterans' reported ability to access technology through their close social ties. Methods: Data were collected via mail survey from a sample of Veterans aged 65 years and older (N=266). Results: Nearly half (44.0\%, 117/266) of the sample reported having no Internet access. Yet, among those without current access, older Veterans reported having a median of 5 (IQR 7) close social ties with home Internet access. These older Veterans also reported that they would feel comfortable asking a median of 2 (IQR 4) social ties for help to access the Internet, and that a median of 2 (IQR 4) social ties would directly access the Internet for the older Veteran to help with health management. Conclusions: Findings suggest that even older Veterans without current Internet access have at least two social ties with home Internet who could be called upon for technology support. Thus, older Veterans may be willing to call upon these ``surrogate seekers'' for technology assistance and support in health management. This has implications for the digital divide, technology design, and health care policy. ",
doi="10.2196/jmir.6385",
url="http://www.jmir.org/2016/11/e296/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27881361"
}


@Article{info:doi/10.2196/jmir.6511,
author="Robotham, Dan
and Satkunanathan, Safarina
and Doughty, Lisa
and Wykes, Til",
title="Do We Still Have a Digital Divide in Mental Health? A Five-Year Survey Follow-up",
journal="J Med Internet Res",
year="2016",
month="Nov",
day="22",
volume="18",
number="11",
pages="e309",
keywords="digital divide",
keywords="socioeconomic factors",
keywords="technology",
keywords="mobile phone",
keywords="psychotic disorders",
keywords="distance counseling",
abstract="Background: Nearly everyone in society uses the Internet in one form or another. The Internet is heralded as an efficient way of providing mental health treatments and services. However, some people are still excluded from using Internet-enabled technology through lack of resources, skills, and confidence. Objective: Five years ago, we showed that people with severe mental illness were at risk of digital exclusion, especially middle-aged patients with psychosis and/or people from black or minority ethnic groups with psychosis. An understanding of the breadth of potential digital exclusion is vital for the implementation of digital health services. The aim of this study is to understand the context of digital exclusion for people who experience mental illness. Methods: We conducted a survey involving people with a primary diagnosis of psychosis or depression in London, United Kingdom. A total of 241 participants were recruited: 121 with psychosis and 120 with depression. The majority of surveys were collected face-to-face (psychosis: n=109; depression: n=71). Participants answered questions regarding familiarity, access, use, motivation, and confidence with Internet-enabled technologies (ie, computers and mobile phones). Variables predicting digital exclusion were identified in regression analyses. The results were compared with the survey conducted in 2011. Results: Digital exclusion has declined since 2011. Online survey collection introduced biases into the sample, masking those who were likely to be excluded. Only 18.3\% (20/109) of people with psychosis in our sample were digitally excluded, compared with 30\% (28/93) in 2011 ($\chi$21=3.8, P=.04). People with psychosis had less confidence in using the Internet than people with depression ($\chi$21=7.4, P=.004). Only 9.9\% (24/241) of participants in the total sample were digitally excluded, but the majority of these people had psychosis (n=20). Those with psychosis who were digitally excluded were significantly older than their included peers (t30=3.3, P=.002) and had used services for longer (t97=2.5, P=.02). Younger people were more likely to use mobile phones. Digitally excluded participants cited a lack of knowledge as a barrier to digital inclusion, and most wanted to use the Internet via computers (rather than mobile phones). Conclusions: Digital exclusion is lower, but some remain excluded. Facilitating inclusion among this population means helping them develop skills and confidence in using technology, and providing them with access. Providing mobile phones without basic information technology training may be counterproductive because excluded people may be excluded from mobile technology too. An evidence-based digital inclusion strategy is needed within the National Health Service to help digitally excluded populations access Internet-enabled services. ",
doi="10.2196/jmir.6511",
url="http://www.jmir.org/2016/11/e309/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27876684"
}


@Article{info:doi/10.2196/jmir.6362,
author="Delano{\"e}, Agathe
and L{\'e}pine, Johanie
and Turcotte, St{\'e}phane
and Leiva Portocarrero, Esther Maria
and Robitaille, Hubert
and Gigu{\`e}re, MC Anik
and Wilson, J. Brenda
and Witteman, O. Holly
and L{\'e}vesque, Isabelle
and Guillaumie, Laurence
and L{\'e}gar{\'e}, France",
title="Role of Psychosocial Factors and Health Literacy in Pregnant Women's Intention to Use a Decision Aid for Down Syndrome Screening: A Theory-Based Web Survey",
journal="J Med Internet Res",
year="2016",
month="Oct",
day="28",
volume="18",
number="10",
pages="e283",
keywords="decision aids",
keywords="behavior",
keywords="intention",
keywords="prenatal diagnosis",
keywords="decision making",
keywords="health literacy",
abstract="Background: Deciding about undergoing prenatal screening is difficult, as it entails risks, potential loss and regrets, and challenges to personal values. Shared decision making and decision aids (DAs) can help pregnant women give informed and values-based consent or refusal to prenatal screening, but little is known about factors influencing the use of DAs. Objective: The objective of this study was to identify the influence of psychosocial factors on pregnant women's intention to use a DA for prenatal screening for Down syndrome (DS). We also added health literacy variables to explore their influence on pregnant women's intention. Methods: We conducted a survey of pregnant women in the province of Quebec (Canada) using a Web panel. Eligibility criteria included age >18 years, >16 weeks pregnant, low-risk pregnancy, and having decided about prenatal screening for the current pregnancy. We collected data based on an extended version of the Theory of Planned Behavior assessing 7 psychosocial constructs (intention, attitude, anticipated regret, subjective norm, descriptive norm, moral norm, and perceived control), 3 related sets of beliefs (behavioral, normative, and control beliefs), 4 health literacy variables, and sociodemographics. Eligible women watched a video depicting the behavior of interest before completing a Web-based questionnaire. We performed descriptive, bivariate, and ordinal logistic regression analyses. Results: Of the 383 eligible pregnant women who agreed to participate, 350 pregnant women completed the Web-based questionnaire and 346 were retained for analysis (completion rate 350/383, 91.4\%; mean age 30.1, SD 4.3, years). In order of importance, factors influencing intention to use a DA for prenatal screening for DS were attitude (odds ratio, OR, 9.16, 95\% CI 4.02-20.85), moral norm (OR 7.97, 95\% CI 4.49-14.14), descriptive norm (OR 2.83, 95\% CI 1.63-4.92), and anticipated regret (OR 2.43, 95\% CI 1.71-3.46). Specific attitudinal beliefs significantly related to intention were that using a DA would reassure them (OR 2.55, 95\% CI 1.73-4.01), facilitate their reflections with their spouse (OR 1.55, 95\% CI 1.05-2.29), and let them know about the advantages of doing or not doing the test (OR 1.53, 95\% CI 1.05-2.24). Health literacy did not add to the predictive power of our model (P values range .43-.92). Conclusions: Implementation interventions targeting the use of a DA for prenatal screening for DS by pregnant women should address a number of modifiable factors, especially by introducing the advantages of using the DA (attitude), informing pregnant women that they might regret not using it (anticipated regret), and presenting the use of DAs as a common practice (descriptive norm). However, interventions on moral norms related to the use of DA should be treated with caution. Further studies that include populations with low health literacy are needed before decisive claims can be made. ",
doi="10.2196/jmir.6362",
url="http://www.jmir.org/2016/10/e283/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27793792"
}


@Article{info:doi/10.2196/jmir.5188,
author="Amo, Laura",
title="Education-Based Gaps in eHealth: A Weighted Logistic Regression Approach",
journal="J Med Internet Res",
year="2016",
month="Oct",
day="12",
volume="18",
number="10",
pages="e267",
keywords="information storage and retrieval",
keywords="eHealth",
keywords="models, statistical",
abstract="Background: Persons with a college degree are more likely to engage in eHealth behaviors than persons without a college degree, compounding the health disadvantages of undereducated groups in the United States. However, the extent to which quality of recent eHealth experience reduces the education-based eHealth gap is unexplored. Objective: The goal of this study was to examine how eHealth information search experience moderates the relationship between college education and eHealth behaviors. Methods: Based on a nationally representative sample of adults who reported using the Internet to conduct the most recent health information search (n=1458), I evaluated eHealth search experience in relation to the likelihood of engaging in different eHealth behaviors. I examined whether Internet health information search experience reduces the eHealth behavior gaps among college-educated and noncollege-educated adults. Weighted logistic regression models were used to estimate the probability of different eHealth behaviors. Results: College education was significantly positively related to the likelihood of 4 eHealth behaviors. In general, eHealth search experience was negatively associated with health care behaviors, health information-seeking behaviors, and user-generated or content sharing behaviors after accounting for other covariates. Whereas Internet health information search experience has narrowed the education gap in terms of likelihood of using email or Internet to communicate with a doctor or health care provider and likelihood of using a website to manage diet, weight, or health, it has widened the education gap in the instances of searching for health information for oneself, searching for health information for someone else, and downloading health information on a mobile device. Conclusion: The relationship between college education and eHealth behaviors is moderated by Internet health information search experience in different ways depending on the type of eHealth behavior. After controlling for college education, it was found that persons who experienced more fruitful Internet health information searches are generally less likely to engage in eHealth behaviors. ",
doi="10.2196/jmir.5188",
url="http://www.jmir.org/2016/10/e267/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27733329"
}


@Article{info:doi/10.2196/jmir.5910,
author="Lyles, Rees Courtney
and Allen, Y. Jill
and Poole, Dolly
and Tieu, Lina
and Kanter, H. Michael
and Garrido, Terhilda",
title="``I Want to Keep the Personal Relationship With My Doctor'': Understanding Barriers to Portal Use among African Americans and Latinos",
journal="J Med Internet Res",
year="2016",
month="Oct",
day="03",
volume="18",
number="10",
pages="e263",
keywords="electronic health record",
keywords="African Americans",
keywords="Hispanic Americans",
keywords="qualitative research",
abstract="Background: Despite the widespread implementation of electronic health records (EHRs), there is growing evidence that racial/ethnic minority patients do not use portals as frequently as non-Hispanic whites to access their EHR information online. This differential portal use could be problematic for health care disparities since early evidence links portal use to better outcomes. Objective: We sought to understand specific barriers to portal use among African American and Latino patients at Kaiser Permanente, which has had a portal in place for over a decade, and broad uptake among the patient population at large. Methods: We conducted 10 focus groups with 87 participants in 2012 and 2013 among African American and Latino Kaiser Permanente members in the mid-Atlantic, Georgia, and Southern California regions. Members were eligible to participate if they were not registered for portal access. Focus groups were conducted within each racial/ethnic group, and each included individuals who were older, had a chronic disease, or were parents (as these are the three biggest users of the portal at Kaiser Permanente overall). We videotaped each focus group and transcribed the discussion for analysis. We used general inductive coding to develop themes for major barriers to portal use, overall and separately by racial/ethnic group. Results: We found that lack of support was a key barrier to initiating portal use in our sample---both in terms of technical assistance as well as the fear of the portal eroding existing personal relationships with health care providers. This held true across a range of focus groups representing a mix of age, income, health conditions, and geographic regions. Conclusions: Our study was among the first qualitative explorations of barriers to portal use among racial/ethnic subgroups. Our findings suggest that uniform adoption of portal use across diverse patient groups requires more usable and personalized websites, which may be particularly important for reducing health care disparities. This work is particularly important as all health care systems continue to offer and promote more health care features online via portals. ",
doi="10.2196/jmir.5910",
url="http://www.jmir.org/2016/10/e263/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27697748"
}


@Article{info:doi/10.2196/publichealth.4885,
author="Dietrich, Janine Janan
and Laher, Fatima
and Hornschuh, Stefanie
and Nkala, Busisiwe
and Chimoyi, Lucy
and Otwombe, Kennedy
and Kaida, Angela
and Gray, Elisabeth Glenda
and Miller, Cari",
title="Investigating Sociodemographic Factors and HIV Risk Behaviors Associated With Social Networking Among Adolescents in Soweto, South Africa: A Cross-Sectional Survey",
journal="JMIR Public Health Surveill",
year="2016",
month="Sep",
day="28",
volume="2",
number="2",
pages="e154",
keywords="mobile phone",
keywords="adolescent health",
keywords="HIV",
keywords="health",
keywords="social networking",
keywords="mhealth",
keywords="South Africa",
abstract="Background: Internet access via mobile phones and computers facilitates interaction and potential health communication among individuals through social networking. Many South African adolescents own mobile phones and can access social networks via apps. Objective: We investigated sociodemographic factors and HIV risk behaviors of adolescent social networking users in Soweto, South Africa. Methods: We conducted an interviewer-administered, cross-sectional survey of adolescents aged 14-19 years. Independent covariates of social networking were assessed by multivariate logistic regression analysis. Results: Of 830 adolescents, 57\% (475/830) were females and the median age was found to be 18 years (interquartile range 17-18). Social networking was used by 60\% of adolescents (494/830); more than half, that is, 87\% (396/494) accessed social networks through mobile phones and 56\% (275/494) spent more than 4 hours per day using their mobile phones. Social networking was independently associated with mobile usage 2-4 hours (adjusted odds ratio [AOR]: 3.06, CI: 1.69-5.51) and more than 4 hours per day (AOR: 6.16, CI: 3.46-10.9) and one (AOR: 3.35, CI: 1.79-6.27) or more sexual partner(s) (AOR: 2.58, CI: 1.05-6.36). Conclusions: Mobile phone--based social networking is prevalent among sexually active adolescents living in Soweto and may be used as an entry point for health promotion and initiation of low-cost adolescent health interventions. ",
doi="10.2196/publichealth.4885",
url="http://publichealth.jmir.org/2016/2/e154/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27683173"
}


@Article{info:doi/10.2196/jmir.6374,
author="Isaacs, Talia
and Hunt, Daniel
and Ward, Danielle
and Rooshenas, Leila
and Edwards, Louisa",
title="The Inclusion of Ethnic Minority Patients and the Role of Language in Telehealth Trials for Type 2 Diabetes: A Systematic Review",
journal="J Med Internet Res",
year="2016",
month="Sep",
day="26",
volume="18",
number="9",
pages="e256",
keywords="telemedicine",
keywords="telehealth",
keywords="type 2 diabetes",
keywords="diabetes mellitus",
keywords="ethnic minorities",
keywords="trial recruitment",
keywords="systematic review",
keywords="language",
keywords="English proficiency",
keywords="health communication",
abstract="Background: Type 2 diabetes is a serious, pervasive metabolic condition that disproportionately affects ethnic minority patients. Telehealth interventions can facilitate type 2 diabetes monitoring and prevent secondary complications. However, trials designed to test the effectiveness of telehealth interventions may underrecruit or exclude ethnic minority patients, with language a potential barrier to recruitment. The underrepresentation of minorities in trials limits the external validity of the findings for this key patient demographic. Objective: This systematic review examines (1) the research reporting practices and prevalence of ethnic minority patients included in telehealth randomized controlled trials (RCTs) targeting type 2 diabetes and the trial characteristics associated with recruiting a high proportion of minority patients, and (2) the proportion of included RCTs that report using English language proficiency as a patient screening criterion and how and why they do so. Methods: Telehealth RCTs published in refereed journals targeting type 2 diabetes as a primary condition for adults in Western majority English-speaking countries were included. Ethnically targeted RCTs were excluded from the main review, but were included in a post hoc subgroup analysis. Abstract and full-text screening, risk of bias assessment, and data extraction were independently conducted by two reviewers. Results: Of 3358 records identified in the search, 79 articles comprising 58 RCTs were included. Nearly two-thirds of the RCTs (38/58) reported on the ethnic composition of participants, with a median proportion of 23.5\% patients (range 0\%-97.7\%). Fourteen studies (24\%) that included at least 30\% minority patients were all US-based, predominantly recruited from urban areas, and described the target population as underserved, financially deprived, or uninsured. Eight of these 14 studies (57\%) offered intervention materials in a language other than English or employed bilingual staff. Half of all identified RCTs (29/58) included language proficiency as a participant-screening criterion. Language proficiency was operationalized using nonstandardized measures (eg, having sufficient ``verbal fluency''), with only three studies providing reasons for excluding patients on language grounds. Conclusions: There was considerable variability across studies in the inclusion of ethnic minority patients in RCTs, with higher participation rates in countries with legislation to mandate their inclusion (eg, United States) than in those without such legislation (eg, United Kingdom). Less than 25\% of the RCTs recruited a sizeable proportion of ethnic minorities, which raises concerns about external validity. The lack of objective measures or common procedures for assessing language proficiency across trials implies that language-related eligibility decisions are often based on trial recruiters' impressionistic judgments, which could be subject to bias. The variability and inconsistent reporting on ethnicity and other socioeconomic factors in descriptions of research participants could be more specifically emphasized in trial reporting guidelines to promote best practice. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews: CRD42015024899; http://www.crd.york.ac.uk/PROSPERO/display\_record.asp?ID=CRD42015024899 (Archived by WebCite at http://www.webcitation.org/6kQmI2bdF) ",
doi="10.2196/jmir.6374",
url="http://www.jmir.org/2016/9/e256/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27670360"
}


@Article{info:doi/10.2196/cancer.5711,
author="Drewes, Caroline
and Kirkovits, Thomas
and Schiltz, Daniel
and Schinkoethe, Timo
and Haidinger, Renate
and Goldmann-Posch, Ursula
and Harbeck, Nadia
and Wuerstlein, Rachel",
title="EHealth Acceptance and New Media Preferences for Therapy Assistance Among Breast Cancer Patients",
journal="JMIR Cancer",
year="2016",
month="Sep",
day="14",
volume="2",
number="2",
pages="e13",
keywords="eHealth",
keywords="mHealth",
keywords="breast cancer",
keywords="adherence",
keywords="compliance",
keywords="new media",
keywords="therapy improvement",
abstract="Background: Electronic health (eHealth) and mobile communication-based health care (mHealth) applications have been increasingly utilized in medicine over the last decade, and have facilitated improved adherence to therapy regimens in patients with chronic conditions. Due to the long duration of breast cancer therapy, and the long course of disease in metastatic breast cancer, a need for more intensified physician-patient communication has emerged. Various support mechanisms, including new media such as mHealth and eHealth, have been proposed for this purpose. Objective: The aim of this study was to analyze the correlation between sociodemographic factors, as well as health status of breast cancer patients, and their current utilization of new media, or their willingness to use Internet and mobile phone apps for improvement of therapy management. Methods: The survey for this study was conducted anonymously during the 2012 Mamazone Projekt Diplompatient meeting (Augsburg, Germany), which hosted approximately 375 participants per day. A total of 168 questionnaires were completed. The questionnaire aimed to assess sociodemographic status, disease patterns, and current use of new media (ie, Internet, mobile phone, and mobile phone apps) in breast cancer patients. Habits and frequency of use for these new technologies, as well as patients' affinity towards eHealth and mHealth tools for therapy management improvement, were investigated. Results: Almost all participants used the Internet (95.8\%, 161/168), with 91.5\% (151/165) also utilizing this technology for health-related issues. Approximately 23\% (38/168) of respondents owned a mobile phone. When asked about their preferences for therapy assistance, 67.3\% (113/168) of respondents were interested in assistance via the Internet, 25.0\% (42/168) via mobile phone, and 73.2\% (123/168) via call center. Patients diagnosed with breast cancer <5 years before the survey were significantly more interested in a call center than patients diagnosed >5 years before survey participation. Conclusions: The vast majority of breast cancer patients accept the Internet for therapy assistance, which indicates that eHealth is a promising medium to improve patient-physician communication. Such technologies may improve individual disease management and ultimately lead to an enhanced adherence to therapy regimens. ",
doi="10.2196/cancer.5711",
url="http://cancer.jmir.org/2016/2/e13/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410189"
}


@Article{info:doi/10.2196/mental.5988,
author="Rickwood, Debra
and Webb, Marianne
and Kennedy, Vanessa
and Telford, Nic",
title="Who Are the Young People Choosing Web-based Mental Health Support? Findings From the Implementation of Australia's National Web-based Youth Mental Health Service, eheadspace",
journal="JMIR Ment Health",
year="2016",
month="Aug",
day="25",
volume="3",
number="3",
pages="e40",
keywords="mental health",
keywords="adolescent",
keywords="help-seeking behavior",
keywords="telemedicine",
keywords="counseling",
keywords="Internet",
abstract="Background: The adolescent and early adult years are periods of peak prevalence and incidence for most mental disorders. Despite the rapid expansion of Web-based mental health care, and increasing evidence of its effectiveness, there is little research investigating the characteristics of young people who access Web-based mental health care. headspace, Australia's national youth mental health foundation, is ideally placed to explore differences between young people who seek Web-based mental health care and in-person mental health care as it offers both service modes for young people, and collects corresponding data from each service type. Objective: The objective of this study was to provide a comprehensive profile of young people seeking Web-based mental health care through eheadspace (the headspace Web-based counseling platform), and to compare this with the profile of those accessing help in-person through a headspace center. Methods: Demographic and clinical presentation data were collected from all eheadspace clients aged 12 to 25 years (the headspace target age range) who received their first counseling session between November 1, 2014 and April 30, 2015 via online chat or email (n=3414). These Web-based clients were compared with all headspace clients aged 12 to 25 who received their first center-based counseling service between October 1, 2014 and March 31, 2015 (n=20,015). Results: More eheadspace than headspace center clients were female (78.1\% compared with 59.1\%), and they tended to be older. A higher percentage of eheadspace clients presented with high or very high levels of psychological distress (86.6\% compared with 73.2\%), but they were at an earlier stage of illness on other indicators of clinical presentation compared with center clients. Conclusions: The findings of this study suggest that eheadspace is reaching a unique client group who may not otherwise seek help or who might wait longer before seeking help if in-person mental health support was their only option. Web-based support can lead young people to seek help at an earlier stage of illness and appears to be an important component in a stepped continuum of mental health care. ",
doi="10.2196/mental.5988",
url="http://mental.jmir.org/2016/3/e40/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27562729"
}


@Article{info:doi/10.2196/cancer.5785,
author="An, C. Lawrence
and Wallner, Lauren
and Kirch, Alexander Matthias",
title="Online Social Engagement by Cancer Patients: A Clinic-Based Patient Survey",
journal="JMIR Cancer",
year="2016",
month="Aug",
day="19",
volume="2",
number="2",
pages="e10",
keywords="cancer patients",
keywords="Internet",
keywords="information",
keywords="social support",
abstract="Background: The Internet is commonly used as a source of health information, but little is known about the Internet practices specific to cancer patients. Objective: To understand cancer patients' use of the Internet as an informational resource and for social support. Methods: The researchers conducted a survey of 1282 patients at a comprehensive cancer center to assess frequency of Internet access and online behaviors. Results: Of the cancer patients surveyed, 1096 (85.49\%) had Internet access; of those with Internet access, 953 (86.95\%) reported going online at least weekly, and 747 (68.16\%) reported daily online activity. Grouping Internet users by their level of online social engagement revealed that out of 1096 users, 331 (30.20\%) had not sought out social connections online, 227 (20.71\%) had read about experiences from other cancer patients, 410 (37.41\%) had also written about their personal experiences, and 128 (11.68\%) had participated in a formal online group for cancer patients. Increased online social engagement was associated with an increased perception that the Internet was useful for social support. Conclusions: Internet use among cancer patients was common, and most patients reported that they found useful information about their cancer diagnosis online. Cancer patients who actively posted or shared content perceived more social support from the Internet than those who used the Internet solely as an informational resource or to read about other cancer patients' experiences. Physicians have a great opportunity to direct users to quality health information on the Web. ",
doi="10.2196/cancer.5785",
url="http://cancer.jmir.org/2016/2/e10/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410186"
}


@Article{info:doi/10.2196/mental.6068,
author="Rai, Minnie
and Vigod, N. Simone
and Hensel, M. Jennifer",
title="Barriers to Office-Based Mental Health Care and Interest in E-Communication With Providers: A Survey Study",
journal="JMIR Ment Health",
year="2016",
month="Aug",
day="01",
volume="3",
number="3",
pages="e35",
keywords="e-communication",
keywords="mental health",
keywords="technology",
keywords="barriers",
keywords="social media",
abstract="Background: With rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom. Objective: To examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns. Methods: We conducted a survey in the waiting room of our outpatient mental health program located in an urban, academic ambulatory hospital. The survey assessed (1) age, mobile phone ownership, and general e-communication usage, (2) barriers to attending office-based appointments, (3) preferences for, and interest in, e-communication for mental health care, and (4) concerns about e-communication use for mental health care. We analyzed the data descriptively and examined associations between the presence of barriers, identifying as a social media user, and interest level in e-communication. Results: Respondents (N=68) were predominantly in the age range of 25-54 years. The rate of mobile phone ownership was 91\% (62/68), and 59\% (40/68) of respondents identified as social media users. There was very low existing use of e-communication between providers and patients, with high levels of interest endorsed by survey respondents. Respondents expressed an interest in using e-communication with their provider to share updates and get feedback, coordinate care, and get general information. In regression analysis, both a barrier to care and identifying as a social media user were significantly associated with e-communication interest (P=.03 and P=.003, respectively). E-communication interest was highest among people who both had a barrier to office-based care and were a social media user. Despite high interest, there were also many concerns including privacy and loss of in-person contact. Conclusions: A high burden of barriers to attending office-based care paired with a high interest in e-communication supports the integration of e-communication within our outpatient services. There may be early adopters to target: those with identified barriers to office-based care and who are active on social media. There is also a need for caution and preservation of existing services for those who choose not to, or cannot, access e-services. ",
doi="10.2196/mental.6068",
url="http://mental.jmir.org/2016/3/e35/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27480108"
}


@Article{info:doi/10.2196/jmir.5605,
author="Torrent-Sellens, Joan
and D{\'i}az-Chao, {\'A}ngel
and Soler-Ramos, Ivan
and Saig{\'i}-Rubi{\'o}, Francesc",
title="Modelling and Predicting eHealth Usage in Europe: A Multidimensional Approach From an Online Survey of 13,000 European Union Internet Users",
journal="J Med Internet Res",
year="2016",
month="Jul",
day="22",
volume="18",
number="7",
pages="e188",
keywords="Internet",
keywords="eHealth usage",
keywords="health care",
keywords="health drivers",
keywords="health barriers",
keywords="health attitude",
keywords="health information",
keywords="health empowerment",
keywords="information and communication technologies",
keywords="structural equation modelling",
keywords="Europe",
abstract="Background: More advanced methods and models are needed to evaluate the participation of patients and citizens in the shared health care model that eHealth proposes. Objective: The goal of our study was to design and evaluate a predictive multidimensional model of eHealth usage. Methods: We used 2011 survey data from a sample of 13,000 European citizens aged 16--74 years who had used the Internet in the previous 3 months. We proposed and tested an eHealth usage composite indicator through 2-stage structural equation modelling with latent variables and measurement errors. Logistic regression (odds ratios, ORs) to model the predictors of eHealth usage was calculated using health status and sociodemographic independent variables. Results: The dimensions with more explanatory power of eHealth usage were health Internet attitudes, information health Internet usage, empowerment of health Internet users, and the usefulness of health Internet usage. Some 52.39\% (6811/13,000) of European Internet users' eHealth usage was more intensive (greater than the mean). Users with long-term health problems or illnesses (OR 1.20, 95\% CI 1.12--1.29) or receiving long-term treatment (OR 1.11, 95\% CI 1.03--1.20), having family members with long-term health problems or illnesses (OR 1.44, 95\% CI 1.34--1.55), or undertaking care activities for other people (OR 1.58, 95\% CI 1.40--1.77) had a high propensity toward intensive eHealth usage. Sociodemographic predictors showed that Internet users who were female (OR 1.23, 95\% CI 1.14--1.31), aged 25--54 years (OR 1.12, 95\% CI 1.05--1.21), living in larger households (3 members: OR 1.25, 95\% CI 1.15--1.36; 5 members: OR 1.13, 95\% CI 0.97--1.28; ?6 members: OR 1.31, 95\% CI 1.10--1.57), had more children <16 years of age (1 child: OR 1.29, 95\% CI 1.18--1.14; 2 children: OR 1.05, 95\% CI 0.94--1.17; 4 children: OR 1.35, 95\% CI 0.88--2.08), and had more family members >65 years of age (1 member: OR 1.33, 95\% CI 1.18--1.50; ?4 members: OR 1.82, 95\% CI 0.54--6.03) had a greater propensity toward intensive eHealth usage. Likewise, users residing in densely populated areas, such as cities and large towns (OR 1.17, 95\% CI 1.09--1.25), also had a greater propensity toward intensive eHealth usage. Educational levels presented an inverted U shape in relation to intensive eHealth usage, with greater propensities among those with a secondary education (OR 1.08, 95\% CI 1.01--1.16). Finally, occupational categories and net monthly income data suggest a higher propensity among the employed or self-employed (OR 1.07, 95\% CI 0.99--1.15) and among the minimum wage stratum, earning ?{\texteuro}1000 per month (OR 1.66, 95\% CI 1.48--1.87). Conclusions: We provide new evidence of inequalities that explain intensive eHealth usage. The results highlight the need to develop more specific eHealth practices to address different realities. ",
doi="10.2196/jmir.5605",
url="http://www.jmir.org/2016/7/e188/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27450189"
}


@Article{info:doi/10.2196/publichealth.5579,
author="Hudnut-Beumler, Julia
and Po'e, Eli
and Barkin, Shari",
title="The Use of Social Media for Health Promotion in Hispanic Populations: A Scoping Systematic Review",
journal="JMIR Public Health Surveill",
year="2016",
month="Jul",
day="11",
volume="2",
number="2",
pages="e32",
keywords="social media",
keywords="social networking",
keywords="Hispanic Americans",
keywords="public health",
keywords="health behavior",
abstract="Background: The Internet is an increasingly popular platform for public health interventions due to its distinct ability to communicate with, engage, and educate communities. Given the widespread use of the Internet, these interventions could be a means of equalizing access to information to address health disparities in minority populations, such as Hispanics. Hispanics are disproportionately affected by poor health outcomes, including obesity, diabetes, and human immunodeficiency virus/acquired immune deficiency syndrome. Although underserved and underrepresented, Hispanics are among the leading users of social media in the United States. Previous reviews have examined the use of social media in public health efforts, but, to our knowledge, none have focused on the Hispanic population. Objective: To conduct a scoping systematic review of the published literature to capture the ways social media has been used in health interventions aimed at Hispanic populations and identify gaps in existing knowledge to provide recommendations for future research. Methods: We performed a systematic review of the literature related to social media, public health, and Hispanics using the PubMed, PsycINFO, and EMBASE databases to locate peer-reviewed studies published between January 1, 2010, and December 31, 2015. Each article was reviewed for the following inclusion criteria: social media as a main component of study methodology or content; public health topic; majority Hispanic/Latino study population; English or Spanish language; and original research study. Relevant data were extracted from articles meeting inclusion criteria including publication year, location, study design, social media platform, use of social media, target population, and public health topic. Results: Of the 267 articles retrieved, a total of 27 unique articles met inclusion criteria. All were published in 2012 or later. The most common study design was a cross-sectional survey, which was featured in 10 of the 27 (37\%) articles. All articles used social media for at least one of the following three purposes: recruiting study participants (14 of 27, 52\%), promoting health education (12 of 27, 44\%), and/or describing social media users (12 of 27, 44\%). All but one article used multiple social media platforms, though Facebook was by far the most popular appearing in 24 of the 27 (89\%). A diverse array of Hispanic populations was targeted, and health topics featured. Of these, the most highly represented were articles on sexual health directed toward Latino men who have sex with men (12 of 27, 44\%). Healthy eating and active living received the second greatest focus (4 of 27, 15\%). Conclusions: Social media offers a potential accessible venue for health interventions aimed at Hispanics, a group at disproportionate risk for poor health outcomes. To date, most publications are descriptive in nature, with few indicating specific interventions and associated outcomes to improve health. ",
doi="10.2196/publichealth.5579",
url="http://publichealth.jmir.org/2016/2/e32/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27400979"
}


@Article{info:doi/10.2196/jmir.5065,
author="Gonzalez, Mariaelena
and Sanders-Jackson, Ashley
and Emory, Jason",
title="Online Health Information-Seeking Behavior and Confidence in Filling Out Online Forms Among Latinos: A Cross-Sectional Analysis of the California Health Interview Survey, 2011-2012",
journal="J Med Internet Res",
year="2016",
month="Jul",
day="04",
volume="18",
number="7",
pages="e184",
keywords="communications media",
keywords="social media",
keywords="health information-seeking behavior",
keywords="online forms",
keywords="Hispanic Americans",
abstract="Background: Health information is increasingly being disseminated online, but there is a knowledge gap between Latinos and non-Hispanic whites, particularly those whose English language proficiency is poor, in terms both of online health information-seeking behavior and computer literacy skills. This knowledge gap may also exist between US- and foreign-born Latinos. Objective: The specific aim of this study was to examine Internet use, online health information-seeking behavior, and confidence in filling out online forms among Latinos, particularly as it relates to health-risk behaviors. We then stratified our sample by nativity. Methods: We used the adult population file of the 2011-2012 California Health Interview Survey, analyzing Internet use, online health information-seeking behavior, and confidence in filling out online forms using binary logistic regression among Latinos and whites (N=27,289), Latinos (n=9506), and Latinos who use the Internet (n=6037). Results: Foreign-born Latinos (OR 0.71, 95\% CI 0.58-0.88, P=.002) have lower odds of engaging in online health information-seeking behavior, and higher odds (OR 2.90, 95\% CI 2.07-4.06, P<.001) of reporting a lack of confidence in filling out online forms compared to US-born Latinos. Correlates of online health information-seeking behavior and form confidence varied by nativity. Conclusions: Latinos, particularly foreign-born individuals, are at an increased risk of being left behind as the move to increase online content delivery and care expands. As online health information dissemination and online health portals become more popular, the impact of these sites on Latino gaps in coverage and care should be considered. ",
doi="10.2196/jmir.5065",
url="http://www.jmir.org/2016/7/e184/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27377466"
}


@Article{info:doi/10.2196/mental.5966,
author="Fulford, Hamish
and McSwiggan, Linda
and Kroll, Thilo
and MacGillivray, Stephen",
title="Exploring the Use of Information and Communication Technology by People With Mood Disorder: A Systematic Review and Metasynthesis",
journal="JMIR Ment Health",
year="2016",
month="Jul",
day="01",
volume="3",
number="3",
pages="e30",
keywords="information and communication technology",
keywords="ICTs",
keywords="mood disorder",
keywords="metasynthesis",
keywords="self-management",
abstract="Background: There is a growing body of evidence relating to how information and communication technology (ICT) can be used to support people with physical health conditions. Less is known regarding mental health, and in particular, mood disorder. Objective: To conduct a metasynthesis of all qualitative studies exploring the use of ICTs by people with mood disorder. Methods: Searches were run in eight electronic databases using a systematic search strategy. Qualitative and mixed-method studies published in English between 2007 and 2014 were included. Thematic synthesis was used to interpret and synthesis the results of the included studies. Results: Thirty-four studies were included in the synthesis. The methodological design of the studies was qualitative or mixed-methods. A global assessment of study quality identified 22 studies as strong and 12 weak with most having a typology of findings either at topical or thematic survey levels of data transformation. A typology of ICT use by people with mood disorder was created as a result of synthesis. Conclusions: The systematic review and metasynthesis clearly identified a gap in the research literature as no studies were identified, which specifically researched how people with mood disorder use mobile ICT. Further qualitative research is recommended to understand the meaning this type of technology holds for people. Such research might provide valuable information on how people use mobile technology in their lives in general and also, more specifically, how they are being used to help with their mood disorders. ",
doi="10.2196/mental.5966",
url="http://mental.jmir.org/2016/3/e30/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27370327"
}


@Article{info:doi/10.2196/jmir.5741,
author="Gopalan, Anjali
and Makelarski, A. Jennifer
and Garibay, B. Lori
and Escamilla, Veronica
and Merchant, M. Raina
and Wolfe Sr, B. Marcus
and Holbrook, Rebecca
and Lindau, Tessler Stacy",
title="Health-Specific Information and Communication Technology Use and Its Relationship to Obesity in High-Poverty, Urban Communities: Analysis of a Population-Based Biosocial Survey",
journal="J Med Internet Res",
year="2016",
month="Jun",
day="28",
volume="18",
number="6",
pages="e182",
keywords="obesity",
keywords="technology",
keywords="Internet",
keywords="urban health",
abstract="Background: More than 35\% of American adults are obese. For African American and Hispanic adults, as well as individuals residing in poorer or more racially segregated urban neighborhoods, the likelihood of obesity is even higher. Information and communication technologies (ICTs) may substitute for or complement community-based resources for weight management. However, little is currently known about health-specific ICT use among urban-dwelling people with obesity. Objective: We describe health-specific ICT use and its relationship to measured obesity among adults in high-poverty urban communities. Methods: Using data collected between November 2012 and July 2013 from a population-based probability sample of urban-dwelling African American and Hispanic adults residing on the South Side of Chicago, we described patterns of ICT use in relation to measured obesity defined by a body mass index (BMI) of ?30 kg/m2. Among those with BMI?30 kg/m2, we also assessed the association between health-specific ICT use and diagnosed versus undiagnosed obesity as well as differences in health-specific ICT use by self-reported comorbidities, including diabetes and hypertension. Results: The survey response rate was 44.6\% (267 completed surveys/598.4 eligible or likely eligible individuals); 53.2\% were African American and 34.6\% were Hispanic. More than 35\% of the population reported an annual income of less than US \$25,000. The population prevalence of measured obesity was 50.2\%. People with measured obesity (BMI?30 kg/m2) were more likely to report both general (81.5\% vs 67.0\%, P=.04) and health-specific (61.1\% vs 41.2\%, P=.01) ICT use. In contrast, among those with measured obesity, being told of this diagnosis by a physician was not associated with increased health-specific ICT use. People with measured obesity alone had higher rates of health-specific use than those with comorbid hypertension and/or diabetes diagnoses (77.1\% vs 60.7\% vs 47.4\%, P=.04). Conclusions: In conclusion, ICT-based health resources may be particularly useful for people in high-poverty urban communities with isolated measured obesity, a population that is at high risk for poor health outcomes. ",
doi="10.2196/jmir.5741",
url="http://www.jmir.org/2016/6/e182/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27352770"
}


@Article{info:doi/10.2196/jmir.5486,
author="Watson, Bekeela
and Robinson, H.Z Dana
and Harker, Laura
and Arriola, Jacob Kimberly R.",
title="The Inclusion of African-American Study Participants in Web-Based Research Studies: Viewpoint",
journal="J Med Internet Res",
year="2016",
month="Jun",
day="22",
volume="18",
number="6",
pages="e168",
keywords="Web-based interventions",
keywords="African-Americans",
keywords="social media",
keywords="Internet",
keywords="research techniques",
doi="10.2196/jmir.5486",
url="http://www.jmir.org/2016/6/e168/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27334683"
}


@Article{info:doi/10.2196/ijmr.4749,
author="Xesfingi, Sofia
and Vozikis, Athanassios",
title="eHealth Literacy: In the Quest of the Contributing Factors",
journal="Interact J Med Res",
year="2016",
month="May",
day="25",
volume="5",
number="2",
pages="e16",
keywords="eHealth literacy",
keywords="health information",
keywords="Internet",
keywords="demographic factors",
keywords="life-style habits",
abstract="Background: Understanding the factors that influence eHealth in a country is particularly important for health policy decision makers and the health care market, as it provides critical information to develop targeted and tailored interventions for relevant patient--consumer segments, and further suggests appropriate strategies for training the health illiterate part of the population. Objective: The objective of the study is to assess the eHealth literacy level of Greek citizens, using the eHealth Literacy Scale (eHEALS), and further explore the factors that shape it and are associated with it. Methods: This empirical study relies on a unique sample of 1064 citizens in Greece in the year 2013. The participants were requested to answer various questions about their ability to solve health-related issues using the Internet, and to provide information about their demographic characteristics and life-style habits. Ordered logit models were used to describe a certain citizen's likelihood of being eHealth literate. Results: The demographic factors show that the probability of an individual being eHealth literate decreases by 23\% (P=.001) when the individual ages and increases by 53\% (P<.001) when he or she acquires higher level of education. Among the life-style variables, physical exercise appears to be strongly and positively associated with the level of eHealth literacy (P=.001). Additionally, other types of technology literacies, such as computer literacy and information literacy, further enhance the eHealth performance of citizens and have the greatest impact among all factors. Conclusions: The factors influencing eHealth literacy are complex and interdependent. However, the Internet is a disruptive factor in the relationship between health provider and health consumer. Further research is needed to examine how several factors associate with eHealth literacy, since, the latter is not only related to health care outcomes but also can be a tool for disseminating social inequalities. ",
doi="10.2196/ijmr.4749",
url="http://www.i-jmr.org/2016/2/e16/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27226146"
}


@Article{info:doi/10.2196/jmir.5592,
author="Yepes, Maryam
and Maurer, J{\"u}rgen
and Viswanathan, Barathi
and Gedeon, Jude
and Bovet, Pascal",
title="Potential Reach of mHealth Versus Traditional Mass Media for Prevention of Chronic Diseases: Evidence From a Nationally Representative Survey in a Middle-Income Country in Africa",
journal="J Med Internet Res",
year="2016",
month="May",
day="20",
volume="18",
number="5",
pages="e114",
keywords="digital divide",
keywords="mHealth",
keywords="eHealth",
keywords="mass media",
keywords="mobile phone",
keywords="noncommunicable diseases",
keywords="short message service",
keywords="email",
keywords="internet access",
keywords="developing countries",
keywords="low- and middle-income countries",
keywords="Africa",
abstract="Background: Public radio and television announcements have a long tradition in public health education. With the global rise of computer and mobile device ownership, short message service (SMS) and email-based health services (mHealth) are promising new tools for health promotion. Objective: Our objectives were to examine 1) self-reported exposure to programs related to noncommunicable diseases (NCDs) on national public television and radio during the 12 months preceding the survey (2013--2014), 2) current ownership of a mobile phone, smartphone, computer, or tablet, and use of the Internet, and 3) willingness of individuals to receive SMS or emails with information on health, with a focus on distribution of these variables across different demographic, socioeconomic status (SES), and NCD risk groups. Methods: We obtained data in a population survey of 1240 participants aged 25--64 years conducted in 2013--2014 in the Seychelles, a rapidly developing small island state in the African region. We administered a structured questionnaire and measured NCD risk factors. Univariate and multivariate analyses explored the relationships between outcomes and sociodemographic variables. Results: Of 1240 participants, 1037 (83.62\%) reported exposure to NCD-related programs on public television, while a lower proportion of 740 adults (59.67\%), reported exposure via public radio (P <.001). Exposure to NCD-related programs on public television was associated with older age (P <.001) and female sex (P <.001), but not with SES, while exposure to NCD-related programs on public radio was associated with older age (P <.001) and lower SES (P <.001). A total of 1156 (93.22\%) owned a mobile phone and ownership was positively associated with female sex (P <.001), younger age (P <.001), and higher SES (P <.001). Only 396 adults (31.93\%) owned a smartphone and 244 adults (19.67\%) used their smartphone to access the Internet. A total of 1048 adults (84.51\%) reported willingness to receive health-related SMS, which was positively associated with female sex (P <.001), younger age (P <.001), and higher SES (P <.001). Controlling for SES, exposure to NCD-related programs on public television or radio and willingness to receive health-related SMS were not independently associated with a person's NCD risk. Conclusions: Broadcasting health programs through traditional mass media (national public radio and television) reached the majority of the population under study, including older adults and those in lower socioeconomic groups. With a high penetration of mobile phones and willingness to receive health-related SMS, mHealth presents an opportunity for health programs, especially when targeted SMS messages are intended for younger adults and those in higher socioeconomic groups. By contrast, due to reduced Internet access, email-based programs had a more limited reach for health promotion programs. These findings emphasize the different reach of interventions using SMS or email versus traditional mass media, according to demographic and socioeconomic categories, for health education programs in a developing country. ",
doi="10.2196/jmir.5592",
url="http://www.jmir.org/2016/5/e114/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27207074"
}


@Article{info:doi/10.2196/mhealth.4928,
author="Ramirez, Veronica
and Johnson, Emily
and Gonzalez, Cesar
and Ramirez, Vanessa
and Rubino, Barbara
and Rossetti, Gina",
title="Assessing the Use of Mobile Health Technology by Patients: An Observational Study in Primary Care Clinics",
journal="JMIR mHealth uHealth",
year="2016",
month="Apr",
day="19",
volume="4",
number="2",
pages="e41",
keywords="Mobile health applications",
keywords="mobile health technology",
keywords="telemedicine",
abstract="Background: There is significant potential for mobile health technology to improve health outcomes for patients with chronic diseases. However, there is a need for further development of mobile health technology that would help to improve the health of lower-income communities. Objective: The study objective was to assess mobile phone and app usage among a culturally diverse patient population, and to determine whether patients would be interested in using mobile health technology to help manage their chronic diseases. Methods: An observational study was conducted with patients of the Internal Medicine resident primary care clinics of Los Angeles County and University of Southern California (LAC+USC) Medical Center. Self-reported information regarding demographics, current mobile phone usage, current mobile health app and social media usage, barriers to using mobile phones or mobile health apps, and interest in using a mobile health app was collected. Results: Ninety-one percent of patients owned a mobile phone, with 76\% (169/223) of these reporting having a mobile phone with Internet capability. Fifty-seven percent of subjects used mobile apps on their mobile phones, and 32\% (41/130) of these used mobile apps related to their health. Eighty-six percent (207/241) of respondents voiced interest in using a mobile app to improve their health, and 40\% (88/221) stated they would use such an app daily. Patients stated they would find the mobile health app most useful for nutrition, exercise, and obtaining general information on medical conditions. Conclusions: Despite the fact that the majority of our primary care patients were of lower socioeconomic status, they utilized mobile phones with Internet and mobile app capabilities to a great extent. There was substantial interest among our patients in using mobile health technology to both manage chronic disease and improve overall health. Given that cultural, educational, and socioeconomic disparities strongly correlate with higher rates of chronic diseases such as obesity, diabetes and hypertension, access to culturally relevant mobile health tools may empower patients in these populations to improve health outcomes. ",
doi="10.2196/mhealth.4928",
url="http://mhealth.jmir.org/2016/2/e41/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27095507"
}


@Article{info:doi/10.2196/publichealth.4442,
author="Manganello, A. Jennifer
and Gerstner, Gena
and Pergolino, Kristen
and Graham, Yvonne
and Strogatz, David",
title="Understanding Digital Technology Access and Use Among New York State Residents to Enhance Dissemination of Health Information",
journal="JMIR Public Health Surveill",
year="2016",
month="Apr",
day="18",
volume="2",
number="1",
pages="e9",
keywords="media",
keywords="New York",
keywords="Internet",
keywords="health information",
keywords="eHealth",
abstract="Background: Many state and local health departments, as well as community organizations, have been using new technologies to disseminate health information to targeted populations. Yet little data exist that show access and use patterns, as well as preferences for receiving health information, at the state level. Objective: This study was designed to obtain information about media and technology use, and health information seeking patterns, from a sample of New York State (NYS) residents. Methods: A cross-sectional telephone survey (with mobile phones and landlines) was developed to assess media and technology access, use patterns, and preferences for receiving health information among a sample of 1350 residents in NYS. The survey used random digit dialing methodology. A weighted analysis was conducted utilizing Stata/SE software. Results: Data suggest that NYS residents have a high level of computer and Internet use; 82\% have at least one working computer at home, and 85\% use the Internet at least sometimes. Mobile phone use is also high; 90\% indicated having a mobile phone, and of those 63\% have a smartphone. When asked about preferences for receiving health information from an organization, many people preferred websites (49\%); preferences for other sources varied by demographic characteristics. Conclusions: Findings suggest that the Internet and other technologies are viable ways to reach NYS residents, but agencies and organizations should still consider using traditional methods of communication in some cases, and determine appropriate channels based on the population of interest. ",
doi="10.2196/publichealth.4442",
url="http://publichealth.jmir.org/2016/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27227163"
}


@Article{info:doi/10.2196/jmir.5105,
author="Gordon, P. Nancy
and Hornbrook, C. Mark",
title="Differences in Access to and Preferences for Using Patient Portals and Other eHealth Technologies  Based on Race, Ethnicity, and Age: A Database and Survey Study of Seniors in a Large Health Plan",
journal="J Med Internet Res",
year="2016",
month="Mar",
day="04",
volume="18",
number="3",
pages="e50",
keywords="eHealth disparities",
keywords="patient portals",
keywords="race-ethnic disparities",
keywords="seniors",
keywords="Internet use",
keywords="health information technology disparities",
abstract="Background: Patients are being encouraged to go online to obtain health information and interact with their health care systems. However, a 2014 survey found that less than 60\% of American adults aged 65 and older use the Internet, with much lower usage among black and Latino seniors compared with non-Hispanic white seniors, and among older versus younger seniors. Objective: Our aims were to (1) identify race/ethnic and age cohort disparities among seniors in use of the health plan's patient portal, (2) determine whether race/ethnic and age cohort disparities exist in access to digital devices and preferences for using email- and Web-based modalities to interact with the health care system, (3) assess whether observed disparities in preferences and patient portal use are due simply to barriers to access and inability to use the Internet, and (4) learn whether older adults not currently using the health plan's patient portal or website have a potential interest in doing so in the future and what kind of support might be best suited to help them. Methods: We conducted two studies of seniors aged 65-79 years. First, we used administrative data about patient portal account status and utilization in 2013 for a large cohort of English-speaking non-Hispanic white (n=183,565), black (n=16,898), Latino (n=12,409), Filipino (n=11,896), and Chinese (n=6314) members of the Kaiser Permanente Northern California health plan. Second, we used data from a mailed survey conducted in 2013-2014 with a stratified random sample of this population (final sample: 849 non-Hispanic white, 567 black, 653 Latino, 219 Filipino, and 314 Chinese). These data were used to examine race/ethnic and age disparities in patient portal use and readiness and preferences for using digital communication for health-related purposes. Results: Adults aged 70-74 and 75-79 were significantly less likely than 65-69 year olds to be registered to use the patient portal, and among those registered, to have used the portal to send messages, view lab test results, or order prescription refills. Across all age groups, non-Hispanic whites and Chinese seniors were significantly more likely than black, Latino, and Filipino seniors to be registered and to have performed these actions. The survey found that black, Latino, and Filipino seniors and those 75 years old and older were significantly less likely to own digital devices (eg, computers, smartphones), use the Internet and email, and be able and willing to use digital technology to perform health care-related tasks, including obtaining health information, than non-Hispanic whites, Chinese, and younger seniors (aged 65-69), respectively. The preference for using non-digital modalities persisted even among Internet users. Conclusions: Health plans, government agencies, and other organizations that serve diverse groups of seniors should include social determinants such as race/ethnicity and age when monitoring trends in eHealth to ensure that eHealth disparities do not induce greater health status and health care disparities between more privileged and less privileged groups. ",
doi="10.2196/jmir.5105",
url="http://www.jmir.org/2016/3/e50/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26944212"
}


@Article{info:doi/10.2196/jmir.4124,
author="Park, Eunhee
and Kim, Heejung
and Steinhoff, Andreanna",
title="Health-Related Internet Use by Informal Caregivers of Children and Adolescents: An Integrative Literature Review",
journal="J Med Internet Res",
year="2016",
month="Mar",
day="03",
volume="18",
number="3",
pages="e57",
keywords="Internet",
keywords="caregivers",
keywords="children",
keywords="adolescent",
keywords="eHealth",
keywords="consumer health information",
abstract="Background: Internet-based health resources can support informal caregivers who are caring for children or adolescents with health care needs. However, few studies discriminate informal caregivers' needs from those of their care recipients or those of people caring for adults. Objective: This study reviews the literature of health-related Internet use among informal caregivers of children and adolescents. Methods: A total of 17 studies were selected from literature searches conducted in 6 electronic databases: PubMed, Cochrane, CINAHL, PsycINFO, ERIC, and EMBASE. All databases searches were limited to articles published in the years 2004 to 2014 in peer-reviewed publications. Search terms consisted of ``health-related Internet use,'' ``eHealth,'' ``Internet use for health-related purpose(s),'' ``Web-based resource(s),'' and ``online resources,'' combined with informal caregiver (or ``parents'') of  ``child,'' ``adolescent,'' ``student,'' ``youth,'' and ``teen.'' The age range of the children receiving care was limited to younger than 22 years. Their informal caregivers were defined as persons (parents) who provided unpaid care or assistance to a child or an adolescent with health problems. Results: Among 17 empirical studies, the majority of informal caregivers of children with medical issues were the parents. Quantitative studies (14/17, 77\%) reported prevalence and predictors of health-related Internet use, while mixed-methods and qualitative studies (3/17, 24\%) investigated informal caregiver perceptions of helpful health-related Internet use and barriers of use. The prevalence of health-related Internet use varied (11\%-90\%) dependent upon how health-related Internet use was operationalized and measured. Disease-specific information was used for decision making about treatment, while social support via virtual communities and email were used for informal caregiver emotional needs. A digital divide of Internet access was identified in lower educated minorities. Most studies had methodological challenges resulting from convenience sampling, cross-sectional surveys, lack of theoretical frameworks, or no clear definitions of health-related Internet use. Conclusions: This study provides an important understanding of how family members use Internet-based information and support systems during child caregiving. Healthcare providers and policy makers should integrate family needs into their current practices and policies. Further rigorous research is required to design efficient and effective nursing interventions. ",
doi="10.2196/jmir.4124",
url="http://www.jmir.org/2016/3/e57/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26940750"
}


@Article{info:doi/10.2196/jmir.4375,
author="McCloud, F. Rachel
and Okechukwu, A. Cassandra
and Sorensen, Glorian
and Viswanath, Kasisomayajula",
title="Entertainment or Health? Exploring the Internet Usage Patterns of the Urban Poor: A Secondary Analysis of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2016",
month="Mar",
day="03",
volume="18",
number="3",
pages="e46",
keywords="health communication",
keywords="socioeconomic factors",
keywords="information-seeking behavior",
keywords="Internet",
abstract="Background: Important gaps remain in our knowledge of how individuals from low socioeconomic position (SEP) use the Internet for resources and in understanding the full range of activities they perform online. Although self-report data indicate that low SEP individuals use the Internet less than high SEP people for health information and for other beneficial capital-enhancing activities, these results may not provide an accurate overall view of online use. Objective: The aim of this study was to determine the ways in which low SEP individuals use the Internet, including for entertainment, social networking, and capital-enhancing functions, and how they are associated with health information seeking. Methods: Detailed Web tracking data were collected from 118 low SEP individuals who participated in the intervention group of a randomized controlled trial that provided Internet access. Websites were grouped by topic, including categories of capital-enhancing websites that provided access to resources and information. Different types of online activities were summed into an Internet use index. Single and multiple negative binomial regression models were fitted with the Internet use index as the predictor and health information seeking as the outcome. Next, models were fitted with low, medium, and high Web usage in capital-enhancing, entertainment, and social network categories to determine their associations with health information seeking. Results: Participants used the Web for diverse purposes, with 63.6\% (75/118) accessing the Internet for all defined types of Internet use. Each additional category of Internet use was associated with 2.12 times the rate of health information seeking (95\% CI 1.84-2.44, P<.001). Higher use of each type of capital-enhancing information was associated with higher rates of health information seeking, with high uses of government (incident rate ratio [IRR] 8.90, 95\% CI 4.82-16.42, P<.001) and news (IRR 11.36, 95\% CI 6.21-20.79, P<.001) websites associated with the highest rates of health information seeking compared to their lowest use categories. High entertainment website use (IRR 3.91, 95\% CI 2.07-7.37, P<.001) and high social network use (IRR 2.06, 95\% CI 1.08-3.92, P=.03) were also associated with higher health information seeking. Conclusions: These data clearly show that familiarity and skills in using the Internet enhance the capacity to use it for diverse purposes, including health and to increase capital, and that Internet usage for specific activities is not a zero sum game. Using it for one type of topic, such as entertainment, does not detract from using it for other purposes. Findings may inform ways to engage low SEP groups with Internet resources. ",
doi="10.2196/jmir.4375",
url="http://www.jmir.org/2016/3/e46/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26940637"
}


@Article{info:doi/10.2196/jmir.5244,
author="Roettl, Johanna
and Bidmon, Sonja
and Terlutter, Ralf",
title="What Predicts Patients' Willingness to Undergo Online Treatment and Pay for Online Treatment? Results from a Web-Based Survey to Investigate the Changing Patient-Physician Relationship",
journal="J Med Internet Res",
year="2016",
month="Feb",
day="04",
volume="18",
number="2",
pages="e32",
keywords="physician-patient relationship, online treatment",
keywords="general practitioners",
keywords="willingness to pay",
abstract="Background: Substantial research has focused on patients' health information--seeking behavior on the Internet, but little is known about the variables that may predict patients' willingness to undergo online treatment and willingness to pay additionally for online treatment. Objective: This study analyzed sociodemographic variables, psychosocial variables, and variables of Internet usage to predict willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the general practitioner (GP). Methods: An online survey of 1006 randomly selected German patients was conducted. The sample was drawn from an e-panel maintained by GfK HealthCare. Missing values were imputed; 958 usable questionnaires were analyzed. Variables with multi-item measurement were factor analyzed. Willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the GP were predicted using 2 multiple regression models. Results: Exploratory factor analyses revealed that the disposition of patients' personality to engage in information-searching behavior on the Internet was unidimensional. Exploratory factor analysis with the variables measuring the motives for Internet usage led to 2 separate factors: perceived usefulness (PU) of the Internet for health-related information searching and social motives for information searching on the Internet. Sociodemographic variables did not serve as significant predictors for willingness to undergo online treatment offered by the GP, whereas PU (B=.092, P=.08), willingness to communicate with the GP more often in the future (B=.495, P<.001), health-related information--seeking personality (B=.369, P<.001), actual use of online communication with the GP (B=.198, P<.001), and social motive (B=.178, P=.002) were significant predictors. Age, gender, satisfaction with the GP, social motive, and trust in the GP had no significant impact on the willingness to pay additionally for online treatment, but it was predicted by health-related information--seeking personality (B=.127, P=.07), PU (B=--.098, P=.09), willingness to undergo online treatment (B=.391, P<.001), actual use of online communication with the GP (B=.192, P=.001), highest education level (B=.178, P<.001), monthly household net income (B=.115, P=.01), and willingness to communicate with the GP online more often in the future (B=.076, P=.03). Conclusions: Age, gender, and trust in the GP were not significant predictors for either willingness to undergo online treatment or to pay additionally for online treatment. Willingness to undergo online treatment was partly determined by the actual use of online communication with the GP, willingness to communicate online with the GP, health information--seeking personality, and social motivation for such behavior. Willingness to pay extra for online treatment was influenced by the monthly household net income category and education level. The results of this study are useful for online health care providers and physicians who are considering offering online treatments as a viable number of patients would appreciate the possibility of undergoing an online treatment offered by their GP. ",
doi="10.2196/jmir.5244",
url="http://www.jmir.org/2016/2/e32/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26846162"
}


@Article{info:doi/10.2196/jmir.4373,
author="Aicken, RH Catherine
and Estcourt, S. Claudia
and Johnson, M. Anne
and Sonnenberg, Pam
and Wellings, Kaye
and Mercer, H. Catherine",
title="Use of the Internet for Sexual Health Among Sexually Experienced Persons Aged 16 to 44 Years: Evidence from a Nationally Representative Survey of the British Population",
journal="J Med Internet Res",
year="2016",
month="Jan",
day="20",
volume="18",
number="1",
pages="e14",
keywords="sexual health",
keywords="sexually transmitted diseases",
keywords="contraception",
keywords="health care-seeking behavior",
keywords="Internet",
keywords="eHealth",
keywords="surveys",
keywords="information-seeking behavior",
abstract="Background: Those who go online regarding their sexual health are potential users of new Internet-based sexual health interventions. Understanding the size and characteristics of this population is important in informing intervention design and delivery. Objective: We aimed to estimate the prevalence in Britain of recent use of the Internet for key sexual health reasons (for chlamydia testing, human immunodeficiency virus [HIV] testing, sexually transmitted infection [STI] treatment, condoms/contraceptives, and help/advice with one's sex life) and to identify associated sociodemographic and behavioral factors. Methods: Complex survey analysis of data from 8926 sexually experienced persons aged 16-44 years in a 2010-2012 probability survey of Britain's resident population. Prevalence of recent (past year) use of Internet sources for key sexual health reasons was estimated. Factors associated with use of information/support websites were identified using logistic regression to calculate age-adjusted odds ratios (AORs). Results: Recent Internet use for chlamydia/HIV testing or STI treatment (combined) was very low (men: 0.31\%; women: 0.16\%), whereas 2.35\% of men and 0.51\% of women reported obtaining condoms/contraceptives online. Additionally, 4.49\% of men and 4.57\% of women reported recent use of information/support websites for advice/help with their sex lives. Prevalence declined with age (men 16-24 years: 7.7\%; 35-44 years: 1.84\%, P<.001; women 16-24 years: 7.8\%; 35-44 years: 1.84\%, P<.001). Use of information/support websites was strongly associated with men's higher socioeconomic status (managerial/professional vs semiroutine/routine: AOR 1.93, 95\% CI 1.27-2.93, P<.001). Despite no overall association with area-level deprivation, those in densely populated urban areas were more likely to report use of information/support websites than those living in rural areas (men: AOR 3.38, 95\% CI 1.68-6.77, P<.001; women: AOR 2.51, 95\% CI 1.34-4.70, P<.001). No statistically significant association was observed with number of sex partners reported after age adjustment, but use was more common among men reporting same-sex partners (last 5 years: AOR 2.44, 95\% CI 1.27-4.70), women reporting sex with multiple partners without condoms (last year: AOR 1.90, 95\% CI 1.11-3.26), and, among both sexes, reporting seeking sex online (last year, men: AOR 1.80, 95\% CI 1.16-2.79; women: AOR 3.00, 95\% CI 1.76-5.13). No association was observed with reporting STI diagnosis/es (last 5 years) or (after age adjustment) recent use of any STI service or non-Internet sexual health seeking. Conclusions: A minority in Britain used the Internet for the sexual health reasons examined. Use of information/support websites was reported by those at greater STI risk, including younger people, indicating that demand for online STI services, and Internet-based sexual health interventions in general, may increase over time in this and subsequent cohorts. However, the impact on health inequalities needs addressing during design and evaluation of online sexual health interventions so that they maximize public health benefit. ",
doi="10.2196/jmir.4373",
url="http://www.jmir.org/2016/1/e14/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26792090"
}


@Article{info:doi/10.2196/mhealth.4374,
author="Landry, Megan
and Vyas, Amita
and Turner, Monique
and Glick, Sara
and Wood, Susan",
title="Evaluation of Social Media Utilization by Latino Adolescents: Implications for Mobile Health Interventions",
journal="JMIR mHealth uHealth",
year="2015",
month="Sep",
day="29",
volume="3",
number="3",
pages="e89",
keywords="acculturation",
keywords="Latino/a",
keywords="sex",
keywords="short message service",
keywords="social networking",
abstract="Background: Trends in social media use, including sending/receiving short message service (SMS) and social networking, are constantly changing, yet little is known about adolescent's utilization and behaviors. This longitudinal study examines social media utilization among Latino youths, and differences by sex and acculturation. Objectives: The purpose of this study was to examine Latino adolescents' social media utilization and behavior over a 16-month period, and to assess whether changes in use differed by sex and acculturation. Methods: This study included 555 Latino youths aged 13-19 who completed baseline and 16-month follow-up surveys. Prevalence of social media utilization and frequency, by sex and acculturation categories, was examined using generalized estimating equations. Results: Women are more likely to use SMS, but men are significantly more likely to SMS a girl/boyfriend (P=.03). The use of Internet by men and women to research health information increased over time. Facebook use declined over time (P<.001), whereas use of YouTube (P=.03) and Instagram (P<.001) increased, especially among women and more US acculturated youths. Conclusion: Social media is ubiquitous in Latino adolescents' lives and may be a powerful mode for public health intervention delivery. ",
doi="10.2196/mhealth.4374",
url="http://mhealth.jmir.org/2015/3/e89/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26420553"
}


@Article{info:doi/10.2196/med20.4116,
author="Wangberg, C. Silje
and S{\o}rensen, Tove
and Andreassen, K. Hege",
title="Using the Internet to Support Exercise and Diet: A Stratified Norwegian Survey",
journal="Med 2.0",
year="2015",
month="Aug",
day="26",
volume="4",
number="2",
pages="e3",
keywords="Internet",
keywords="Health Behaviors",
keywords="Social Disparities",
keywords="Health Literacy",
abstract="Background: Internet is used for a variety of health related purposes. Use differs and has differential effects on health according to socioeconomic status. Objective: We investigated to what extent the Norwegian population use the Internet to support exercise and diet, what kind of services they use, and whether there are social disparities in use. We expected to find differences according to educational attainment. Methods: In November 2013 we surveyed a stratified sample of 2196 persons drawn from a Web panel of about 50,000 Norwegians over 15 years of age. The questionnaire included questions about using the Internet, including social network sites (SNS), or mobile apps in relation to exercise or diet, as well as background information about education, body image, and health. The survey email was opened by 1187 respondents (54\%). Of these, 89 did not click on the survey hyperlink (declined to participate), while another 70 did not complete the survey. The final sample size is thus 1028 (87\% response rate). Compared to the Norwegian census the sample had a slight under-representation of respondents under the age of 30 and with low education. The data was weighted accordingly before analyses. Results: Sixty-nine percent of women and 53\% of men had read about exercise or diet on the Internet ($\chi$2= 25.6, P<.001). More people with higher education (71\%, $\chi$2=19.1, P<.001), reported this. The same gender difference was found for using Internet-based interventions with 20\% of women compared to14\% of men reporting having used these interventions ($\chi$2=7.9, P= .005), for having posted a status about exercise or diet on Facebook or other SNS (23\% vs 12\%, $\chi$2=18.8, P<.001), and for having kept an online exercise or diet journal (21\% vs 15\%, $\chi$2=7.0, P=.008). Evaluations of own physical appearance accounted for some of the gender differences in using online exercise or diet journals. Seven percent of the total sample reported having used electronic communication to ask professionals about exercise or diet, while a few more had discussed online with peers (10\%). Asking professionals online was more common amongst those with only primary education (13\%, $\chi$2<10.5, P=.005).? Conclusions: Gender and education are related to how the Internet is used to support health behaviors. We should be aware of the potential role of the Internet in accelerating social disparities in health, and continue to monitor population use. For Internet- and mobile-based interventions to support health behaviors, this study provides information relevant to tailoring of delivery media and components to user. ",
doi="10.2196/med20.4116",
url="http://www.medicine20.com/2015/2/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26310277"
}


@Article{info:doi/10.2196/jmir.4548,
author="Pollard, Mary Christina
and Pulker, Elizabeth Claire
and Meng, Xingqiong
and Kerr, Anne Deborah
and Scott, Anne Jane",
title="Who Uses the Internet as a Source of Nutrition and Dietary Information? An Australian Population Perspective",
journal="J Med Internet Res",
year="2015",
month="Aug",
day="26",
volume="17",
number="8",
pages="e209",
keywords="information seeking behavior",
keywords="Internet",
keywords="media, social",
keywords="behavior, eating food habits",
keywords="public health practice",
keywords="nutrition",
keywords="food, diet, Western",
abstract="Background: The Internet contains a plethora of nutrition information. Health organizations are increasingly using the Internet to deliver population-wide health information and interventions. Effective interventions identify their target population and their needs; however, little is known about use of the Internet as a source of nutrition information. Objective: The aim was to assess the change in prevalence and demographic characteristics of Western Australian adults accessing the Internet as a source of nutrition information and identify specific information needs. Methods: Data were pooled from the Western Australian Department of Health's 3-yearly Nutrition Monitoring Survey Series telephone survey between 1995 and 2012 of 7044 participants aged 18 to 64 years. Outcome variables were the main sources of nutrition information used in the last year and yes/no responses to 4 suggestions to what would make it easier to eat a healthy diet. Sociodemographic variables were collected. Results: The proportion of respondents using the Internet for nutrition information increased from <1\% in 1995-2001 to 9.1\% in 2004 and 33.7\% in 2012. Compared to 2004, logistic regression showed that the odds of using the Internet for this information increased significantly in 2009 (OR 2.84, 95\% CI 2.07-3.88) and 2012 (OR 5.20, 95\% CI 3.86-7.02, P<.001). Respondents using the Internet as a source were more likely to be female (OR 1.30, 95\% CI 1.05-1.60, P=.02), live in a metropolitan area (OR 1.26, 95\% CI 1.03-1.54, P=.03), born in countries other than Australia/UK/Ireland (OR 1.41, 95\% CI 1.07-1.85, P=.02), more educated (university: OR 2.46, 95\% CI 1.77-3.42, P<.001), and were less likely to be older (55-64 years: OR 0.38, 95\% CI 0.25-0.57, P<.001). The majority of respondents agreed the following information would assist them to make healthier choices: more ways to prepare healthy foods (72.0\%, 95\% CI 70.7-73.3), quicker ways to prepare healthy foods (79.0\%, 95\% CI 77.8-80.1), how to choose healthy foods (68.8\%, 95\% CI 67.5-70.1), and knowing more about cooking (54.7\%, 95\% CI 53.3-56.1). Those using the Internet for nutrition information were more likely than nonusers to want to know quicker ways to prepare healthy foods (83.0\% vs 78.1\%, P=.005) and information on choosing healthy foods (76.3\% vs 67.3\%, P<.001). Conclusions: Use of the Internet as a main source of nutrition information has grown rapidly since 2004; one-third of Western Australian adults reported using the Internet for this purpose in 2012. Information on preparing healthy foods (ideas, quicker ways), choosing ingredients, and knowing more about cooking would make it easier to eat a healthy diet. For Internet users, emphasis should be on quicker ways and choosing ingredients. These finding have implications for policy makers and practitioners and suggest that traditional health promotion tactics should continue to be used to reach the broader population. ",
doi="10.2196/jmir.4548",
url="http://www.jmir.org/2015/8/e209/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26310192"
}


@Article{info:doi/10.2196/mhealth.3986,
author="Williams, Patrick John
and Schroeder, Dirk",
title="Popular Glucose Tracking Apps and Use of mHealth by Latinos With Diabetes: Review",
journal="JMIR mHealth uHealth",
year="2015",
month="Aug",
day="25",
volume="3",
number="3",
pages="e84",
keywords="diabetes mellitus",
keywords="mobile health",
keywords="mobile applications",
keywords="systematic review",
keywords="Hispanic",
abstract="Background: Diabetes mellitus in the United States is an increasingly common chronic disease, costing hundreds of billions of dollars and contributing to hundreds of thousands of deaths each year.  The prevalence of diabetes is over 50\% higher in Latinos than in the general population, and this group also suffers from higher rates of complications and diabetes-related mortality than NHWs.  mHealth is a promising new treatment modality for diabetes, though few smartphone apps have been designed specifically for Latinos. Objective: The objectives of our study were: (1) to identify the most common features of the most popular diabetes apps and consider how such features may be improved to meet the needs of Latinos; (2) to determine the use of diabetes apps among a sample of online Hispanics in the US. Methods: Our study consisted of two parts.  First, 20 of the most popular diabetes apps were reviewed in order to ascertain the most prevalent features and functionalities.  Second, an online survey was fielded through a popular health website for Latinos (HolaDoctor) inquiring about respondents' use of diabetes apps. Results: Approximately one-third of apps reviewed were available in Spanish.  The most common features were blood glucose recording/annotation and activity logs.  The majority of apps permitted exportation of data via e-mail but only a third enabled uploading to an online account.  Twenty percent of apps reviewed could connect directly with a glucometer, and 30\% had reminder functionalities prompting patients to take medications or check blood glucose levels.Over 1600 online surveys were completed during the second half of April 2014.  More than 90\% of respondents were from the United States, including Puerto Rico.  The majority of respondents used a device running on an Android platform while only a quarter used an iPhone.  Use of diabetes apps was approximately 3\% among diabetic respondents and 3.6\% among diabetic respondents who also had a smartphone.  Among app users, blood glucose and medication diaries were the most frequently used functionalities while hemoglobin A1c and insulin diaries were the least used.  A significant majority of app users did not share their progress on social media though many of these were willing to share it with their doctor. Conclusions: Latino diabetics have unique needs and this should be reflected in diabetes apps designed for this population.  Existing research as well as our survey results suggest that many Latinos do not possess the prerequisite diabetes knowledge or self-awareness to fully benefit from the most prevalent functionalities offered by the most popular diabetes apps.  We recommend developers incorporate more basic features such as diabetes education, reminders to check blood glucose levels or take medications, Spanish language interfaces, and glucometer connectivities, which are relatively underrepresented in the most popular diabetes apps currently available in Spanish. ",
doi="10.2196/mhealth.3986",
url="http://mhealth.jmir.org/2015/3/e84/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26307533"
}


@Article{info:doi/10.2196/jmir.4308,
author="Sadah, A. Shouq
and Shahbazi, Moloud
and Wiley, T. Matthew
and Hristidis, Vagelis",
title="A Study of the Demographics of Web-Based Health-Related Social Media Users",
journal="J Med Internet Res",
year="2015",
month="Aug",
day="06",
volume="17",
number="8",
pages="e194",
keywords="online social media",
keywords="demographics",
keywords="health forums",
keywords="health care disparity",
keywords="drug reviews",
abstract="Background: The rapid spread of Web-based social media in recent years has impacted how patients share health-related information. However, little work has studied the demographics of these users. Objective: Our aim was to study the demographics of users who participate in health-related Web-based social outlets to identify possible links to health care disparities. Methods: We analyze and compare three different types of health-related social outlets: (1) general Web-based social networks, Twitter and Google+, (2) drug review websites, and (3) health Web forums. We focus on the following demographic attributes: age, gender, ethnicity, location, and writing level. We build and evaluate domain-specific classifiers to infer missing data where possible. The estimated demographic statistics are compared against various baselines, such as Internet and social networks usage of the population. Results: We found that (1) drug review websites and health Web forums are dominated by female users, (2) the participants of health-related social outlets are generally older with the exception of the 65+ years bracket, (3) blacks are underrepresented in health-related social networks, (4) users in areas with better access to health care participate more in Web-based health-related social outlets, and (5) the writing level of users in health-related social outlets is significantly lower than the reading level of the population. Conclusions: We identified interesting and actionable disparities in the participation of various demographic groups to various types of health-related social outlets. These disparities are significantly distinct from the disparities in Internet usage or general social outlets participation. ",
doi="10.2196/jmir.4308",
url="http://www.jmir.org/2015/8/e194/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26250986"
}


@Article{info:doi/10.2196/resprot.4010,
author="Moreland, Julia
and French, L. Tara
and Cumming, P. Grant",
title="The Prevalence of Online Health Information Seeking Among Patients in Scotland: A Cross-Sectional Exploratory Study",
journal="JMIR Res Protoc",
year="2015",
month="Jul",
day="15",
volume="4",
number="3",
pages="e85",
keywords="online health information seeking",
keywords="health care-seeking behavior",
keywords="health information seeking",
keywords="health seeking",
keywords="digital divide",
abstract="Background: Online health information seeking is an activity that needs to be explored in Scotland.  While there are a growing number of studies that adopt a qualitative approach to this issue and attempt to understand the behaviors associated with online health information seeking, previous studies focusing on quantifying the prevalence and pattern of online health seeking in the United Kingdom have been based on Internet users in general. Objective: This exploratory study sought to describe the prevalence of online health information seeking in a rural area of Scotland based on primary data from a patient population. Methods: A survey design was employed utilizing self-completed questionnaires, based on the Pew Internet and American Life Project; questionnaires were distributed among adult patients in 10 primary care centers in a rural community in Scotland. Results: A convenience sample of 571 (0.10\% of the total population in Grampian, N=581,198) patients completed the questionnaire. A total of 68.4\% (379/554) of patients had previously used the Internet to acquire health information. A total of 25.4\% (136/536) of patients consulted the Internet for health information regarding their current appointment on the day surveyed; 34.6\% (47/136) of these patients were influenced to attend their appointment as a result of that online health information.  A total of 43.2\% (207/479) of patients stated the health information helped improve their health and 67.1\% (290/432) indicated that they had learned something new.  A total of 34.0\% (146/430) of patients talked to a health professional about the information they had found and 90.0\% (376/418) reported that the information was useful.In total, 70.4\% (145/206) of patients were concerned about obtaining health information online from reliable sources. A total of 67.1\% (139/207) of patients were concerned that a health site may sell their personal information, yet only 6.7\% (36/535) checked the privacy policy of the site visited.  However, 27.9\% (55/197) of patients were not concerned about their employer finding out what health sites they visited, whereas 37.5\% (78/208) were concerned that others would find out. Conclusions: The results suggest that online health information-seeking behavior influences offline health-related behavior among the population surveyed.  Patient attitudes to online health information seeking were focused on issues relating to trust, reliability, privacy, and confidentiality.  This study provides support for the growing phenomenon of an empowered, computer-literate, health information consumer, and the impact of this phenomenon must be considered in the context of the patient-health professional dynamic.  The unpredictable nature of human thought and action in relation to this field of study requires an ongoing program of ethnographic research, both physical and virtual, within a Health Web Science framework.  This study has provided a baseline of the prevalence of online health information seeking in the Grampian region of Scotland. ",
doi="10.2196/resprot.4010",
url="http://www.researchprotocols.org/2015/3/e85/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26177562"
}


@Article{info:doi/10.2196/mhealth.4438,
author="Post, Ann Lori
and Vaca, E. Federico
and Biroscak, J. Brian
and Dziura, James
and Brandt, Cynthia
and Bernstein, L. Steven
and Taylor, Richard
and Jagminas, Liudvikas
and D'Onofrio, Gail",
title="The Prevalence and Characteristics of Emergency Medicine Patient Use of New Media",
journal="JMIR mHealth uHealth",
year="2015",
month="Jul",
day="08",
volume="3",
number="3",
pages="e72",
keywords="medical informatics",
keywords="new media",
keywords="health care services",
keywords="personal health management",
keywords="mobile phones",
abstract="Background: Little is known about ``new media'' use, defined as media content created or consumed on demand on an electronic device, by patients in emergency department (ED) settings. The application of this technology has the potential to enhance health care beyond the index visit. Objective: The objectives are to determine the prevalence and characteristics of ED patients' use of new media and to then define and identify the potential of new media to transcend health care barriers and improve the public's health. Methods: Face-to-face, cross-sectional surveys in Spanish and English were given to 5,994 patients who were sequentially enrolled from July 12 to August 30, 2012. Data were collected from across a Southern Connecticut health care system's 3 high-volume EDs for 24 hours a day, 7 days a week for 6 weeks. The EDs were part of an urban academic teaching hospital, an urban community hospital, and an academic affiliate hospital. Results: A total of 5,994 (89\% response rate) ED patients reported identical ownership of cell phones (85\%, P<.001) and smartphones (51\%, P<.001) that were used for calling (99\%, P<.001). The older the patient, however, the less likely it was that the patient used the phone for texting (96\% vs 16\%, P<.001). Income was positively associated with smartphone ownership (P<.001) and the use of health apps (P>.05) and personal health records (P<.001). Ownership of iPhones compared to Android phones were similar (44\% vs 45\%, P<.05). Race and ethnicity played a significant role in texting and  smartphone ownership, with Hispanics reporting the highest rates of 79\% and 56\%, respectively, followed by black non-Hispanics at 77\% and 54\%, respectively, and white non-Hispanics at 65\% and 42\%, respectively (P<.05). Conclusions: There is a critical mass of ED patients who use new media. Older persons are less comfortable texting and using smartphone apps. Income status has a positive relationship with smartphone ownership and use of smartphone apps. Regardless of income, however, texting and ownership of smartphones was highest for Latinos and black non-Latinos. These findings have implications for expanding health care beyond the ED visit through the use of cell phones, smartphones, texting, the Internet, and health care apps to improve the health of the public. ",
doi="10.2196/mhealth.4438",
url="http://mhealth.jmir.org/2015/3/e72/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26156096"
}


@Article{info:doi/10.2196/jmir.4420,
author="Borrelli, Belinda
and Bartlett, Kiera Yvonne
and Tooley, Erin
and Armitage, J. Christopher
and Wearden, Alison",
title="Prevalence and Frequency of mHealth and eHealth Use Among US and UK Smokers and Differences by Motivation to Quit",
journal="J Med Internet Res",
year="2015",
month="Jul",
day="4",
volume="17",
number="7",
pages="e164",
keywords="smoking cessation",
keywords="eHealth",
keywords="mHealth",
keywords="health behavior",
keywords="motivation",
keywords="text messaging",
abstract="Background: Both mHealth and eHealth interventions for smoking cessation are rapidly being developed and tested. There are no data on use of mHealth and eHealth technologies by smokers in general or by smokers who are not motivated to quit smoking. Objective: The aims of our study were to (1) assess technology use (eg, texting, social media, Internet) among smokers in the United States and United Kingdom, (2) examine whether technology use differs between smokers who are motivated to quit and smokers who are not motivated to quit, (3) examine previous use of technology to assist with smoking cessation, and (4) examine future intentions to use technology to assist with smoking cessation. Methods: Participants were 1000 adult smokers (54.90\%, 549/1000 female; mean age 43.9, SD 15.5 years; US: n=500, UK: n=500) who were recruited via online representative sampling strategies. Data were collected online and included demographics, smoking history, and frequency and patterns of technology use. Results: Among smokers in general, there was a high prevalence of mobile and smartphone ownership, sending and receiving texts, downloading and using apps, using Facebook, and visiting health-related websites. Smokers who were unmotivated to quit were significantly less likely to own a smartphone or handheld device that connects to the Internet than smokers motivated to quit. There was a significantly lower prevalence of sending text messages among US smokers unmotivated to quit (78.2\%, 179/229) versus smokers motivated to quit (95.0\%, 229/241), but no significant differences between the UK groups (motivated: 96.4\%, 239/248; unmotivated: 94.9\%, 223/235). Smokers unmotivated to quit in both countries were significantly less likely to use a handheld device to read email, play games, browse the Web, or visit health-related websites versus smokers motivated to quit. US smokers had a high prevalence of app downloads regardless of motivation to quit, but UK smokers who were motivated to quit had greater prevalence of app downloads than smokers unmotivated to quit. US smokers were significantly more likely to have a Facebook account (87.0\%, 435/500) than UK smokers (76.4\%, 382/500), but smokers unmotivated to quit in both countries used Facebook less frequently than smokers motivated to quit. Smokers who were unmotivated to quit were less likely to have used eHealth or mHealth platforms to help them quit smoking in the past and less likely to say that they would use them for smoking cessation in the future. Conclusions: Although smokers unmotivated to quit make less use of technology than smokers motivated to quit, there is sufficient prevalence to make it worthwhile to develop eHealth and mHealth interventions to encourage cessation. Short and low-effort communications, such as text messaging, might be better for smokers who are less motivated to quit. Multiple channels may be required to reach unmotivated smokers. ",
doi="10.2196/jmir.4420",
url="http://www.jmir.org/2015/7/e164/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26149323"
}


@Article{info:doi/10.2196/jmir.3916,
author="Chilukuri, Nymisha
and West, Meredith
and Henderson, Lynn Janice
and Lawson, Shari
and Ehsanipoor, Robert
and Costigan, Kathleen
and Polk, Sarah
and Bennett, Wendy",
title="Information and Communication Technology Use Among Low-Income Pregnant and Postpartum Women by Race and Ethnicity: A Cross-Sectional Study",
journal="J Med Internet Res",
year="2015",
month="Jul",
day="03",
volume="17",
number="7",
pages="e163",
keywords="pregnancy",
keywords="health services accessibility",
keywords="postpartum period",
keywords="cell phones",
keywords="text messaging",
keywords="Internet",
keywords="health status disparities",
keywords="Hispanic Americans",
abstract="Background: Pregnancy and the postpartum period provide windows of opportunity to impact perinatal and lifelong preventive health behavior for women and their families, but these opportunities are often missed. Understanding racial/ethnic differences in information and communication technology (ICT) use could inform technology-based interventions in diverse populations. Objective: The objective of the study was to evaluate differences in the use of ICT between racial and ethnic groups as well as by English language proficiency. Methods: We conducted a cross-sectional study of 246 women who were aged 18 years or older and pregnant or within 1 year of delivery. They were recruited from 4 hospital-based outpatient clinics and completed a self-administered survey. We used multivariate regression analysis to evaluate the association between race/ethnicity and ICT (mobile phone/short message service [SMS] text message, Internet, and social network) usage by race/ethnicity and perceived English language proficiency after adjusting for age, income, marital status, and insurance status. Results: In all, 28\% (69/246) of participants were Latina, 40\% (98/246) were African American, 23\% (56/246) were white, and 9\% (23/246) from other racial/ethnic groups. Of the Latinas, 84\% (58/69) reported limited English language proficiency and 59\% (41/69) were uninsured. More than 90\% of all participants reported mobile phone use, but more than 25\% (65/246) had changed phone numbers 2 or more times in the past year. Compared to white women, African American women were less likely to SMS text message (OR 0.07, 95\% CI 0.01-0.63) and Latinas were less likely to use the Internet to find others with similar concerns (OR 0.23, 95\% CI 0.08-0.73). Women with limited English language proficiency were less likely to use the Internet overall (OR 0.30, 95\% CI 0.09-0.99) or use email (OR 0.22, 95\% CI 0.08-0.63) compared to women with adequate English language proficiency. Conclusions: Mobile phones are widely available for the delivery of health interventions to low-income, racially diverse pregnant and postpartum women, but disparities in Internet use and SMS text messaging exist. Interventions or programs requiring Web-based apps may have lower uptake unless alternatives are available, such as those adapted for limited English proficiency populations. ",
doi="10.2196/jmir.3916",
url="http://www.jmir.org/2015/7/e163/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26142162"
}


@Article{info:doi/10.2196/cancer.4178,
author="Rising, J. Camella
and Bol, Nadine
and Kreps, L. Gary",
title="Age-Related Use and Perceptions of eHealth in Men With Prostate Cancer: A Web-Based Survey",
journal="JMIR Cancer",
year="2015",
month="Jun",
day="25",
volume="1",
number="1",
pages="e6",
keywords="consumer health information",
keywords="prostate cancer",
keywords="age groups",
keywords="information-seeking behavior",
keywords="social support",
keywords="psychosocial aspects",
abstract="Background: Men with prostate cancer require ample information and support along the continuum of care, and eHealth is one way to meet such critical information and support needs. Currently, evidence about how age influences use and perceptions about prostate cancer eHealth information and support is lacking. Objective: The aim of this paper is to explore use and perceptions about eHealth among men living with prostate cancer. Specifically, we aimed to analyze men with prostate cancer by age-specific cohorts to identify potential age-related differences in use and perceptions about prostate cancer eHealth information. Methods: We used survey methodology to examine how men under 65 years old with prostate cancer differ from those aged 65 years old or older in use and perceptions about prostate cancer eHealth information and support (n=289). Results: We found that men in the younger cohort used the Internet more often to be informed about treatment options (P=.04) and to learn more about staging/grading (P=.01) than men in the older cohort. Results also showed comparatively greater use of online prostate cancer information for emotional support and encouragement by the younger as compared to the older cohort (P=.001). Furthermore, the older cohort reported more negative psychosocial effects of eHealth (eg, more anxious, depressed) than younger men (P=.002). We also found that as a result of more frequent Internet use, younger men experienced more positive psychosocial effects (eg, more informed, in control) from accessing information about prostate cancer through eHealth channels (b=-0.10, 95\% CI -0.28 to 0). Conclusions: Men with prostate cancer have different information and support needs; our findings suggest that these needs might vary by age. Future research is needed to unravel age-related factors underlying these differences to be better able to tailor prostate cancer eHealth information to men's information and support needs. ",
doi="10.2196/cancer.4178",
url="http://www.jmir.org/2015/1/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410165"
}


@Article{info:doi/10.2196/mhealth.3437,
author="Genz, Andrew
and Kirk, Gregory
and Piggott, Damani
and Mehta, H. Shruti
and Linas, S. Beth
and Westergaard, P. Ryan",
title="Uptake and Acceptability of Information and Communication Technology in a Community-Based Cohort of People Who Inject Drugs: Implications for Mobile Health Interventions",
journal="JMIR mHealth uHealth",
year="2015",
month="Jun",
day="25",
volume="3",
number="2",
pages="e70",
keywords="substance abuse",
keywords="intravenous",
keywords="Internet",
keywords="cellular phone",
keywords="text messaging",
keywords="telemedicine",
abstract="Background: Mobile phone and Internet-based technologies are increasingly used to disseminate health information and facilitate delivery of medical care.  While these strategies hold promise for reducing barriers to care for medically-underserved populations, their acceptability among marginalized populations such as people who inject drugs is not well-understood. Objective: To understand patterns of mobile phone ownership, Internet use and willingness to receive health information via mobile devices among people who inject drugs. Methods: We surveyed current and former drug injectors participating in a longitudinal cohort study in Baltimore, Maryland, USA. Respondents completed a 12-item, interviewer-administered questionnaire during a regular semi-annual study visit that assessed their use of mobile technology and preferred modalities of receiving health information. Using data from the parent study, we used logistic regression to evaluate associations among participants' demographic and clinical characteristics and their mobile phone and Internet use. Results: The survey was completed by 845 individuals, who had a median age of 51 years. The sample was 89\% African-American, 65\% male, and 33\% HIV-positive. Participants were generally of low education and income levels. Fewer than half of respondents (40\%) indicated they had ever used the Internet. Mobile phones were used by 86\% of respondents. Among mobile phone owners, 46\% had used their phone for text messaging and 25\% had accessed the Internet on their phone. A minority of respondents (42\%) indicated they would be interested in receiving health information via phone or Internet. Of those receptive to receiving health information, a mobile phone call was the most favored modality (66\%) followed by text messaging (58\%) and Internet (51\%). Conclusions: Utilization of information and communication technology among this cohort of people who inject drugs was reported at a lower level than what has been estimated for the general U.S. population. Our findings identify a potential barrier to successful implementation of  mobile health and Internet-based interventions for people who inject drugs, particularly those who are older and have lower levels of income and educational attainment. As mobile communication technology continues to expand, future studies should re-examine whether mHealth applications become more accessible and accepted by socioeconomically disadvantaged groups. ",
doi="10.2196/mhealth.3437",
url="http://mhealth.jmir.org/2015/2/e70/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26111915"
}


@Article{info:doi/10.2196/jmir.3801,
author="Gidwani, Risha
and Zulman, Donna",
title="Association Between Acute Medical Exacerbations and Consuming or Producing Web-Based Health Information: Analysis From Pew Survey Data",
journal="J Med Internet Res",
year="2015",
month="Jun",
day="23",
volume="17",
number="6",
pages="e145",
keywords="Internet",
keywords="health knowledge, attitudes, practice",
keywords="emergencies",
keywords="hospitalization",
abstract="Background: The Internet is an increasingly important resource for individuals who seek information from both health professionals and peers. While the demographic and health characteristics of persons who use health information technology has been well described, less is known about the relationship between these health characteristics and level of engagement with health information technology. Even less is known about whether persons who produce Web-based health information differ in health status from persons who consume such content. Objective: We explored the health characteristics of persons who engage with the Internet for the purposes of consuming or producing Web-based health information, and specifically, whether healthier versus sicker persons engage with health information technology in different ways. Methods: We analyzed data from the 2012 Pew Health survey, a landline and cell phone survey of 3104 adults in the United States. Using multiple logistic regression with sampling weights, we examined the association between sociodemographic and health characteristics and the consumption or production of Web-based health information. Sociodemographic variables included age, sex, race, and education. Health characteristics included self-reported health status, presence of chronic condition(s), and having an acute medical exacerbation. Acute medical exacerbations were defined as an emergency department visit, hospitalization, or other serious medical emergency in the last 12 months. Results: The majority of the sample reported good or excellent health (79.7\%), although 50.3\% reported having at least one chronic condition. About a fifth (20.2\%) of the sample experienced an acute medical exacerbation in the past year. Education was the sociodemographic characteristic most strongly associated with consuming Web-based health information. The strongest health-related predictors of consuming Web-based health information were an acute medical exacerbation (OR 2.39, P<.001) and having a chronic condition (OR 1.54, P=.007). Having an acute medical exacerbation was the only predictor of producing Web-based health information (OR 1.97, P=.003). All participants, regardless of health status, were most interested in Web-based health information regarding diseases or medical problems. However, persons with acute medical exacerbations were more likely to seek Web-based health information regarding medical tests, procedures, and drugs compared to persons without acute medical exacerbations. Conclusions: Producers of Web-based health information differ from consumers of this information in important health characteristics that could skew the content of peer-generated Web-based health information and overrepresent the experiences of persons with acute medical exacerbations. Providers may have a role to play in directing patients towards high-quality, easy-to-understand online information, especially information regarding treatments and procedures. ",
doi="10.2196/jmir.3801",
url="http://www.jmir.org/2015/6/e145/"
}


@Article{info:doi/10.2196/jmir.4127,
author="Bidmon, Sonja
and Terlutter, Ralf",
title="Gender Differences in Searching for Health Information on the Internet and the Virtual Patient-Physician Relationship in Germany: Exploratory Results on How Men and Women Differ and Why",
journal="J Med Internet Res",
year="2015",
month="Jun",
day="22",
volume="17",
number="6",
pages="e156",
keywords="gender differences",
keywords="physician-patient relations",
keywords="information seeking behavior",
keywords="general practitioners",
keywords="statistical factor analysis",
abstract="Background: Many studies have shown that women use the Internet more often for health-related information searches than men, but we have limited knowledge about the underlying reasons. We also do not know whether and how women and men differ in their current use of the Internet for communicating with their general practitioner (GP) and in their future intention to do so (virtual patient-physician relationship). Objective: This study investigates (1) gender differences in health-related information search behavior by exploring underlying emotional, motivational, attitudinal as well as cognitive variables, situational involvement, and normative influences, and different personal involvement regarding health-related information searching and (2) gender differences in the virtual patient-physician relationship. Methods: Gender differences were analyzed based on an empirical online survey of 1006 randomly selected German patients. The sample was drawn from an e-panel maintained by GfK HealthCare. A total of 958 usable questionnaires were analyzed. Principal component analyses were carried out for some variables. Differences between men (517/958) and women (441/958) were analyzed using t tests and Kendall's tau-b tests. The survey instrument was guided by several research questions and was based on existing literature. Results: Women were more engaged in using the Internet for health-related information searching. Gender differences were found for the frequency of usage of various Internet channels for health-related information searches. Women used the Internet for health-related information searches to a higher degree for social motives and enjoyment and they judged the usability of the Internet medium and of the information gained by health information searches higher than men did. Women had a more positive attitude toward Web 2.0 than men did, but perceived themselves as less digitally competent. Women had a higher health and nutrition awareness and a greater reluctance to make use of medical support, as well as a higher personal disposition of being well-informed as a patient. Men may be more open toward the virtual patient-physician relationship. Conclusions: Women have a stronger social motive for and experience greater enjoyment in health-related information searches, explained by social role interpretations, suggesting these needs should be met when offering health-related information on the Internet. This may be interesting for governmental bodies as well as for the insurance and the pharmaceutical industries. Furthermore, women may be more easily convinced by health awareness campaigns and are, therefore, the primary target group for them. Men are more open to engaging in a virtual relationship with the GP; therefore, they could be the primary target group for additional online services offered by GPs. There were several areas for GPs to reinforce the virtual patient-physician relationship: the fixing of personal appointments, referral to other doctors, writing prescriptions, and discussions of normal test results and doctor's notes/certificates of health. ",
doi="10.2196/jmir.4127",
url="http://www.jmir.org/2015/6/e156/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26099325"
}


@Article{info:doi/10.2196/jmir.4048,
author="Rowlands, Jean Ingrid
and Loxton, Deborah
and Dobson, Annette
and Mishra, Devi Gita",
title="Seeking Health Information Online: Association With Young Australian Women's Physical, Mental, and Reproductive Health",
journal="J Med Internet Res",
year="2015",
month="May",
day="18",
volume="17",
number="5",
pages="e120",
keywords="Internet",
keywords="women's health",
keywords="young adults",
keywords="health status",
keywords="mental health",
keywords="information seeking behavior",
abstract="Background: Relatively little is known about the extent to which young adults use the Internet as a health information resource and whether there are factors that distinguish between those who do and do not go online for health information. Objective: The aim was to identify the sociodemographic, physical, mental, and reproductive health factors associated with young women's use of the Internet for health information. Methods: We used data from 17,069 young women aged 18-23 years who participated in the Australian Longitudinal Study on Women's Health. Multivariable logistic regression was used to estimate the association between sociodemographic, physical, mental, and reproductive health factors associated with searching the Internet for health information. Results: Overall, 43.54\% (7433/17,069) of women used the Internet for health information. Women who used the Internet had higher odds of regular urinary or bowel symptoms (OR 1.44, 95\% CI 1.36-1.54), psychological distress (very high distress: OR 1.24, 95\% CI 1.13-1.37), self-reported mental health diagnoses (OR 1.16, 95\% CI 1.09-1.23), and menstrual symptoms (OR 1.25, 95\% CI 1.15-1.36) than women who did not use the Internet for health information. Internet users were less likely to have had blood pressure checks (OR 0.85, 95\% CI 0.78-0.93) and skin cancer checks (OR 0.90, 95\% CI 0.84-0.97) and to have had a live birth (OR 0.74, 95\% CI 0.64-0.86) or pregnancy loss (OR 0.88, 95\% CI 0.79-0.98) than non-Internet users. Conclusions: Women experiencing ``stigmatized'' conditions or symptoms were more likely to search the Internet for health information. The Internet may be an acceptable resource that offers ``anonymized'' information or support to young women and this has important implications for health service providers and public health policy. ",
doi="10.2196/jmir.4048",
url="http://www.jmir.org/2015/5/e120/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25986630"
}


@Article{info:doi/10.2196/jmir.3943,
author="Jones, B. Ray
and Ashurst, J. Emily
and Atkey, Jo
and Duffy, Barbara",
title="Older People Going Online: Its Value and Before-After Evaluation of Volunteer Support",
journal="J Med Internet Res",
year="2015",
month="May",
day="18",
volume="17",
number="5",
pages="e122",
keywords="digital inclusion",
keywords="health informatics",
keywords="social return on investment",
keywords="older people",
abstract="Background: Although Internet usage can benefit older people by reducing social isolation, increasing access to services, and improving health and well-being, only a minority are online. Barriers to Internet uptake include attitude and a lack of knowledge and help. We have evaluated volunteer support in helping older people go online. Knowing what value the Internet has been to older people who have just gone online should guide how it is ``sold'' to those remaining offline. Objective: Objectives of this study are (1) to assess the feasibility of recruiting volunteers aged 50 years and older and supporting them in helping people (ie, beneficiaries) aged 65 years and older go online, (2) to assess the impact of beneficiaries using the Internet on contacts with others, loneliness, and mental health, and (3) to assess the perceived value to beneficiaries of going online. Methods: Beneficiaries received help in using the Internet from 32 volunteers in one of two ways: (1) one-on-one in their own homes, receiving an average of 12 hours of help over eight visits, or (2) in small group sessions, receiving 12 hours of help over six visits. We assessed, at registration and follow-up, the number of contacts with others, using Lubben's 6-item Lubben Social Network Scale (LBNS-6), loneliness, using De Jong Gierveld's 6-item De Jong Gierveld loneliness scale (DJG-6), and mental well-being, using Tennant's Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). We also assessed how beneficiaries valued going online using a Social Return on Investment (SROI) approach by postal survey. Results: A total of 144 beneficiaries were recruited with the aim of helping them go online via one-on-one (n=58) or small group (n=86) sessions. Data through to follow-up were available on 76.4\% (110/144) of participants. From baseline to follow-up, the number of contacts with others was significantly increased---LBNS-6, mean 13.7 to mean 17.6---loneliness scores were reduced---DJG-6, mean 2.38 to mean 1.80---and mental well-being improved---SWEMWBS, mean 24.06 to mean 24.96. Out of six options, beneficiaries valued better communication with family and friends most and better health care least as a benefit of using the Internet. Out of nine options, having the Internet was valued less than having TV, but more than, for example, having a weekly visit from a cleaner. There were no associations between values placed on Internet use or volunteer help and psychological improvements. Conclusions: Volunteer help to go online seemed to result in increased social contacts, reduced loneliness, and improved mental well-being and was valued quite highly by beneficiaries. Although the use of the Internet for health care was the least valued, improved social contact can improve health. Contacting family is likely to be the best ``selling point'' of the Internet for older people. ",
doi="10.2196/jmir.3943",
url="http://www.jmir.org/2015/5/e122/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25986724"
}


@Article{info:doi/10.2196/jmir.3932,
author="Reinwand, A. Dominique
and Schulz, N. Daniela
and Crutzen, Rik
and Kremers, PJ Stef
and de Vries, Hein",
title="Who Follows eHealth Interventions as Recommended? A Study of Participants' Personal Characteristics From the Experimental Arm of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2015",
month="May",
day="11",
volume="17",
number="5",
pages="e115",
keywords="eHealth",
keywords="Web-based intervention",
keywords="intervention use",
keywords="computer tailoring",
keywords="personal characteristics",
keywords="health lifestyle",
keywords="multiple health behaviors",
keywords="intervention adherence",
keywords="socioeconomic status",
abstract="Background: Computer-tailored eHealth interventions to improve health behavior have been demonstrated to be effective and cost-effective if they are used as recommended. However, different subgroups may use the Internet differently, which might also affect intervention use and effectiveness. To date, there is little research available depicting whether adherence to intervention recommendations differs according to personal characteristics. Objective: The aim was to assess which personal characteristics are associated with using an eHealth intervention as recommended. Methods: A randomized controlled trial was conducted among a sample of the adult Dutch population (N=1638) testing an intervention aimed at improving 5 healthy lifestyle behaviors: increasing fruit and vegetable consumption, increasing physical activity, reducing alcohol intake, and promoting smoking cessation. Participants were asked to participate in those specific online modules for which they did not meet the national guideline(s) for the respective behavior(s). Participants who started with fewer than the recommended number of modules of the intervention were defined as users who did not follow the intervention recommendation. Results: The fewer modules recommended to participants, the better participants adhered to the intervention modules. Following the intervention recommendation increased when participants were older ($\chi$21=39.8, P<.001), female ($\chi$21=15.8, P<.001), unemployed ($\chi$21=7.9, P=.003), ill ($\chi$21=4.5, P=.02), or in a relationship ($\chi$21=7.8, P=.003). No significant relevant differences were found between groups with different levels of education, incomes, or quality of life. Conclusion: Our findings indicate that eHealth interventions were used differently by subgroups. The more frequent as-recommended intervention use by unemployed, older, and ill participants may be an indication that these eHealth interventions are attractive to people with a greater need for health care information. Further research is necessary to make intervention use more attractive for people with unhealthy lifestyle patterns. ",
doi="10.2196/jmir.3932",
url="http://www.jmir.org/2015/5/e115/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25963607"
}


@Article{info:doi/10.2196/mhealth.3347,
author="Peragallo Urrutia, Rachel
and Berger, A. Alexander
and Ivins, A. Amber
and Beckham, Jenna A.
and Thorp Jr, M. John
and Nicholson, K. Wanda",
title="Internet Use and Access Among Pregnant Women via Computer and Mobile Phone: Implications for Delivery of Perinatal Care",
journal="JMIR mHealth uHealth",
year="2015",
month="Mar",
day="30",
volume="3",
number="1",
pages="e25",
keywords="pregnancy",
keywords="postpartum period",
keywords="Internet",
keywords="mobile phone",
keywords="health behavior",
keywords="risk reduction behavior",
abstract="Background: The use of Internet-based behavioral programs may be an efficient, flexible method to enhance prenatal care and improve pregnancy outcomes. There are few data about access to, and use of, the Internet via computers and mobile phones among pregnant women. Objective: We describe pregnant women's access to, and use of, computers, mobile phones, and computer technologies (eg, Internet, blogs, chat rooms) in a southern United States population. We describe the willingness of pregnant women to participate in Internet-supported weight-loss interventions delivered via computers or mobile phones. Methods: We conducted a cross-sectional survey among 100 pregnant women at a tertiary referral center ultrasound clinic in the southeast United States. Data were analyzed using Stata version 10 (StataCorp) and R (R Core Team 2013). Means and frequency procedures were used to describe demographic characteristics, access to computers and mobile phones, and use of specific Internet modalities. Chi-square testing was used to determine whether there were differences in technology access and Internet modality use according to age, race/ethnicity, income, or children in the home. The Fisher's exact test was used to describe preferences to participate in Internet-based postpartum weight-loss interventions via computer versus mobile phone. Logistic regression was used to determine demographic characteristics associated with these preferences. Results: The study sample was 61.0\% white, 26.0\% black, 6.0\% Hispanic, and 7.0\% Asian with a mean age of 31.0 (SD 5.1). Most participants had access to a computer (89/100, 89.0\%) or mobile phone (88/100, 88.0\%) for at least 8 hours per week. Access remained high (>74\%) across age groups, racial/ethnic groups, income levels, and number of children in the home. Internet/Web (94/100, 94.0\%), email (90/100, 90.0\%), and Facebook (50/100, 50.0\%) were the most commonly used Internet technologies. Women aged less than 30 years were more likely to report use of Twitter and chat rooms compared to women 30 years of age or older. Of the participants, 82.0\% (82/100) were fairly willing or very willing to participate in postpartum lifestyle intervention. Of the participants, 83.0\% (83/100) were fairly willing or very willing to participate in an Internet intervention delivered via computer, while only 49.0\% (49/100) were fairly willing or very willing to do so via mobile phone technology. Older women and women with children tended to be less likely to desire a mobile phone-based program. Conclusions: There is broad access and use of computer and mobile phone technology among southern US pregnant women with varied demographic characteristics.  Pregnant women are willing to participate in Internet-supported perinatal interventions. Our findings can inform the development of computer- and mobile phone-based approaches for the delivery of clinical and educational interventions. ",
doi="10.2196/mhealth.3347",
url="http://mhealth.jmir.org/2015/1/e25/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25835744"
}


@Article{info:doi/10.2196/ijmr.3955,
author="Disler, T. Rebecca
and Inglis, C. Sally
and Newton, J. Phillip
and Currow, C. David
and Macdonald, S. Peter
and Glanville, R. Allan
and Donesky, DorAnne
and Carrieri-Kohlman, Virginia
and Davidson, M. Patricia",
title="Patterns of Technology Use in Patients Attending a Cardiopulmonary Outpatient Clinic: A Self-Report Survey",
journal="Interact J Med Res",
year="2015",
month="Mar",
day="06",
volume="4",
number="1",
pages="e5",
keywords="chronic obstructive pulmonary disease",
keywords="chronic disease",
keywords="self-management",
keywords="self-care",
keywords="telemedicine, eHealth",
keywords="mHealth",
abstract="Background: Self-management education for cardiopulmonary diseases is primarily provided through time-limited, face-to-face programs, with access limited to a small percentage of patients. Telecommunication tools will increasingly be an important component of future health care delivery. Objective: The purpose of this study was to describe the patterns of technology use in patients attending a cardiopulmonary clinic in an academic medical center. Methods: A prevalence survey was developed to collect data on participant demographics (age in years, sex, and socioeconomic status); access to computers, Internet, and mobile phones; and use of current online health support sites or programs. Surveys were offered by reception staff to all patients attending the outpatient clinic. Results: A total of 123 surveys were collected between March and April 2014. Technological devices were a pervasive part of everyday life with respondents engaged in regular computer (102/123, 82.9\%), mobile telephone (115/117, 98.3\%), and Internet (104/121, 86.0\%) use. Emailing (101/121, 83.4\%), researching and reading news articles (93/121, 76.9\%), social media (71/121, 58.7\%), and day-to-day activities (65/121, 53.7\%) were the most common telecommunication activities. The majority of respondents reported that access to health support programs and assistance through the Internet (82/111, 73.9\%) would be of use, with benefits reported as better understanding of health information (16/111, 22.5\%), avoidance of difficult travel requirements and time-consuming face-to-face appointments (13/111, 18.3\%), convenient and easily accessible help and information (12/111, 16.9\%), and access to peer support and sharing (9/111, 12.7\%). The majority of patients did not have concerns over participating in the online environment (87/111, 78.4\%); the few concerns noted related to privacy and security (10/15), information accuracy (2/15), and computer literacy and access (2/15). Conclusions: Chronic disease burden and long-term self-management tasks provide a compelling argument for accessible and convenient avenues to obtaining ongoing treatment and peer support. Online access to health support programs and assistance was reported as useful and perceived as providing convenient, timely, and easily accessible health support and information. Distance from the health care facility and a lack of information provision through traditional health sources were both barriers and enablers to telehealth. This is particularly important in the context of a cardiopulmonary clinic that attracts patients from a large geographical area, and in patients who are most likely to have high health care utilization needs in the future. Telecommunication interfaces will be an increasingly important adjunct to traditional forms of health care delivery. ",
doi="10.2196/ijmr.3955",
url="http://www.i-jmr.org/2015/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25798814"
}


@Article{info:doi/10.2196/mhealth.3663,
author="Tran, Clifton Michael
and Labrique, Bernard Alain
and Mehra, Sucheta
and Ali, Hasmot
and Shaikh, Saijuddin
and Mitra, Maithilee
and Christian, Parul
and West Jr, Keith",
title="Analyzing the Mobile ``Digital Divide'': Changing Determinants of Household Phone Ownership Over Time in Rural Bangladesh",
journal="JMIR mHealth uHealth",
year="2015",
month="Feb",
day="25",
volume="3",
number="1",
pages="e24",
keywords="digital",
keywords="mobile Health (mHealth)",
keywords="finances",
keywords="mobile",
keywords="phones",
keywords="Bangladesh",
keywords="family characteristics",
keywords="Demography, ownership",
keywords="socioeconomic factors",
abstract="Background: We had a unique opportunity to examine demographic determinants of household mobile phone ownership in rural Bangladesh using socioeconomic data collected as part of a multiyear longitudinal cohort study of married women of reproductive age. Objectives: This paper explores how the demographics of household mobile phone owners have changed over time in a representative population of rural Bangladesh. Methods: We present data collected between 2008 and 2011 on household mobile phone ownership and related characteristics including age, literacy, education, employment, electricity access, and household wealth among 35,306 individuals. Respondents were enrolled when found to be newly pregnant and contributed socioeconomic information once over the course of the time period serving as a ``sample'' of families within the population at that time. Univariate and multiple logistic regressions analyses were performed to identify the socioeconomic determinants of household phone ownership. Results: Across 3 fiscal years, we found that reported household ownership of at least 1 working mobile phone grew from 29.85\% in the first fiscal year to 56.07\% in the third fiscal year. Illiteracy, unavailability of electricity, and low quartiles of wealth were identified as overall demographic constraints to mobile phone ownership. However, over time, these barriers became less evident and equity gaps among demographic status began to dissipate as access to mobile technology became more democratized. We saw a high growth rate in ownership among households in lower economic standing (illiterate, without electricity, low and lowest wealth index), likely a result of competitive pricing and innovative service packages that improve access to mobile phones as the mobile phone market matures. In contrast, as market saturation is rapidly attained in the most privileged demographics (literate, secondary schooling, electricity, high wealth index), members of the lower wealth quartiles seem to be following suit, with more of an exponential growth. Conclusions: Upward trends in household mobile phone ownership in vulnerable populations over time underline the potential to leverage this increasingly ubiquitous infrastructure to extend health and finance services across social and economic strata. ",
doi="10.2196/mhealth.3663",
url="http://mhealth.jmir.org/2015/1/e24/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25720457"
}


@Article{info:doi/10.2196/ijmr.3127,
author="Kim, Heejung",
title="Understanding Internet Use Among Dementia Caregivers: Results of Secondary Data Analysis Using the US Caregiver Survey Data",
journal="Interact J Med Res",
year="2015",
month="Feb",
day="23",
volume="4",
number="1",
pages="e1",
keywords="Internet",
keywords="dementia",
keywords="caregiver",
keywords="stress",
keywords="consumer health information",
abstract="Background: Informal caregivers of persons with dementia experience higher levels of chronic stress in the caregiving trajectory. The Internet provides diverse types of caregiver resources that may help ameliorate their stress and relevant negative outcomes. However, there is limited information about the prevalence and factors of using Internet-based resources for health- and caregiving-related purposes in informal caregivers of persons with dementia. Objective: Specific aims of this study were (1) to determine the prevalence and factors of caregiver's health-related Internet use and (2) to compare sociodemographic and caregiving-related characteristics between health-related Internet users and non--health-related Internet users among informal caregivers of persons with dementia. Methods: This quantitative investigation was a descriptive correlational design using a secondary data analysis. Primary data were collected via a survey conducted in 2009 by the National Alliance for Caregiving and the American Association of Retired Persons. Telephone interviews utilizing standardized questionnaires were used to collect self-reported information about sociodemographics and caregiving-related history (N=450). Descriptive statistics and a hierarchical binary logistic regression analysis were completed based on the stress process model. Results: Approximately 59\% (265/450) of dementia caregivers were identified as health-related Internet users. Caregivers' sociodemographics and their subjective responses of caregiving stress were the most significant factors to identify health-related Internet users followed by workload assisting in instrumental activities of daily living of persons with dementia. There were significant differences for caregiver's age, levels of education and income, hours spent caregiving, and the relationship to persons with dementia between health-related Internet users and non--health-related Internet users (P<.05 for all). After controlling for confounding effects, younger age of persons with dementia (OR 0.278, 95\% CI 0.085-0.906), higher education levels of caregivers (OR 3.348, 95\% CI 2.019-5.552), shorter caregiving time spent per week (OR 0.452, 95\% CI 0.243-0.840), higher levels of caregiver's emotional stress (OR 1.249, 95\% CI 1.004-1.555), and financial hardship (OR 4.61, 95\% CI 1.416-14.978) were identified as newly emerging factors of health-related Internet use. Conclusions: Although the Internet provided useful resources for caregivers of persons with dementia, dementia caregivers reported lower levels of health-related Internet use compared to the general public. Our findings confirmed the impact of age, education levels, and/or income on Internet use reported in previous studies. However, the predictive value of subjective responses of caregiving stress for health-related Internet use was a new addition. These findings will assist health care providers, researchers, and policy makers in identifying who is the least likely to access Internet-based resources and how Internet-based strategies can best be designed, implemented, and distributed to meet the needs of this group of users. ",
doi="10.2196/ijmr.3127",
url="http://www.i-jmr.org/2015/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25707033"
}


@Article{info:doi/10.2196/jmir.3813,
author="Pouchieu, Camille
and M{\'e}jean, Caroline
and Andreeva, A. Valentina
and Kesse-Guyot, Emmanuelle
and Fassier, Philippine
and Galan, Pilar
and Hercberg, Serge
and Touvier, Mathilde",
title="How Computer Literacy and Socioeconomic Status Affect Attitudes Toward a Web-Based Cohort: Results From the NutriNet-Sant{\'e} Study",
journal="J Med Internet Res",
year="2015",
month="Feb",
day="02",
volume="17",
number="2",
pages="e34",
keywords="computer literacy",
keywords="Internet",
keywords="cohort study",
keywords="attitudes",
abstract="Background: In spite of the growing literature in the field of e-epidemiology, clear evidence about computer literacy or attitudes toward respondent burden among e-cohort participants is largely lacking. Objective: We assessed the computer and Internet skills of participants in the NutriNet-Sant{\'e} Web-based cohort. We then explored attitudes toward the study demands/respondent burden according to levels of computer literacy and sociodemographic status. Methods: Self-reported data from 43,028 e-cohort participants were collected in 2013 via a Web-based questionnaire. We employed unconditional logistic and linear regression analyses. Results: Approximately one-quarter of participants (23.79\%, 10,235/43,028) reported being inexperienced in terms of computer use. Regarding attitudes toward participant burden, women tended to be more favorable (eg, ``The overall website use is easy'') than were men (OR 0.65, 95\% CI 0.59-0.71, P<.001), whereas better educated participants (>12 years of schooling) were less likely to accept the demands associated with participation (eg, ``I receive questionnaires too often'') compared to their less educated counterparts (OR 1.62, 95\% CI 1.48-1.76, P<.001). Conclusions: A substantial proportion of participants had low computer/Internet skills, suggesting that this does not represent a barrier to participation in Web-based cohorts. Our study also suggests that several subgroups of participants with lower computer skills (eg, women or those with lower educational level) might more readily accept the demands associated with participation in the Web cohort. These findings can help guide future Web-based research strategies. ",
doi="10.2196/jmir.3813",
url="http://www.jmir.org/2015/2/e34/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25648178"
}


@Article{info:doi/10.2196/mhealth.3345,
author="Jospe, R. Michelle
and Fairbairn, A. Kirsty
and Green, Peter
and Perry, L. Tracy",
title="Diet App Use by Sports Dietitians: A Survey in Five Countries",
journal="JMIR mHealth uHealth",
year="2015",
month="Jan",
day="22",
volume="3",
number="1",
pages="e7",
keywords="nutritional requirements",
keywords="nutrition assessment",
keywords="dietary self-monitoring",
keywords="mobile apps",
keywords="questionnaire",
keywords="telemedicine",
keywords="sports nutritional sciences",
abstract="Background: Despite the hundreds of diet apps available for use on smartphones (mobile phones), no studies have examined their use as tools for dietary assessment and tracking in sports nutrition. Objective: The aim is to examine the prevalence and perceptions of using smartphone diet apps for dietary assessment and tracking among sports dietitians. Methods: A cross-sectional online survey to examine the use and perception of diet apps was developed and distributed to sports dietitians in Australia, Canada, New Zealand, the United Kingdom, and the United States (US). Results: The overall response rate from the 1709 sports dietitians invited to participate was 10.3\% (n=180). diet apps were used by 32.4\% (57/176) of sports dietitians to assess and track the dietary intake of athletes. Sports dietitians from the US were more likely to use smartphone diet apps than sports dietitians from other countries (OR=5.61, 95\% CI 1.84-17.08, P=.002). Sports dietitians used 28 different diet apps, with 56\% (32/57) choosing MyFitnessPal. Overall, sports dietitians held a positive perception of smartphone diet apps, with the majority of respondents viewing diet apps as ``better'' (25/53, 47\%) or ``equivalent'' (22/53, 41\%) when compared with traditional dietary assessment methods. Conclusions: Nearly one-third of sports dietitians used mobile phone diet apps in sports nutrition practice, and viewed them as useful in helping to assess and track the dietary intake of athletes. ",
doi="10.2196/mhealth.3345",
url="http://mhealth.jmir.org/2015/1/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25616274"
}


@Article{info:doi/10.2196/mhealth.4001,
author="McBride, L. Deborah
and LeVasseur, A. Sandra
and Li, Dongmei",
title="Non-Work-Related Use of Personal Mobile Phones by Hospital Registered Nurses",
journal="JMIR mHealth uHealth",
year="2015",
month="Jan",
day="13",
volume="3",
number="1",
pages="e3",
keywords="distraction",
keywords="smartphone",
keywords="cellular phone",
keywords="Internet",
keywords="nurses",
keywords="hospital",
keywords="non-work related smartphone use",
abstract="Background: Personal mobile phones and other personal communication devices (smartphones and tablet computers) provide users with an ever-increasing number and diversity of non-work-related activities while at work. In hospitals, where the vigilance of health care workers is essential for patient care, the potential distraction of these devices could be hazardous to patients. Objective: The objective of this study was to determine the frequency of non-work-related use of personal mobile phones and other personal communication devices among hospital registered nurses. Methods: In March 2014, a previously validated 30-question survey was emailed to the 10,978 members of the Academy of Medical Surgical Nurses. There were 825 respondents who met the inclusion criteria. Results: The use of a personal mobile phone or other personal communication device while working (excluding meal times and breaks) was reported by 78.1\% (644/825) of respondents. Nurses reported regularly (sometimes, often, or always) sending personal emails and text messages (38.6\%, 318/825), reading news (25.7\%, 212/825), checking/posting on social networking sites (20.8\%, 172/825), shopping (9.6\%, 79/825), and playing games (6.5\%, 54/825) while working. Conclusions: This study found that hospital nurses frequently use their personal mobile phones or other personal communication devices for non-work-related activities at work. The primary activity reported was to send personal emails and text messages to family and friends. ",
doi="10.2196/mhealth.4001",
url="http://mhealth.jmir.org/2015/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25586982"
}


@Article{info:doi/10.2196/jmir.3588,
author="Silver, Pannor Michelle",
title="Patient Perspectives on Online Health Information and Communication With Doctors: A Qualitative Study of Patients 50 Years Old and Over",
journal="J Med Internet Res",
year="2015",
month="Jan",
day="13",
volume="17",
number="1",
pages="e19",
keywords="health communication",
keywords="Internet",
keywords="online health information seeking",
keywords="barriers to patient-doctor communication",
keywords="adults 50 years old and over",
keywords="qualitative research",
abstract="Background: As health care systems around the world shift toward models that emphasize self-care management, there is increasing pressure for patients to obtain health information online. It is critical that patients are able to identify potential problems with using the Internet to diagnose and treat a health issue and that they feel comfortable communicating with their doctor about the health information they acquire from the Internet. Objective: Our aim was to examine patient-identified (1) problems with using the Internet to identify and treat a health issue, (2) barriers to communication with a doctor about online health information seeking, and (3) facilitators of communication with a doctor about patient searches for health information on the Internet. Methods: For this qualitative exploratory study, semistructured interviews were conducted with a sample of 56 adults age 50 years old and over. General concerns regarding use of the Internet to diagnose and treat a health issue were examined separately for participants based on whether they had ever discussed health information obtained through the Internet with a doctor. Discussions about barriers to and facilitators of communication about patient searches for health information on the Internet with a doctor were analyzed using thematic analysis. Results: Six higher-level general concerns emerged: (1) limitations in own ability, (2) credibility/limitations of online information, (3) anxiety, (4) time consumption, (5) conflict, and (6) non-physical harm. The most prevalent concern raised by participants who communicated with a doctor about their online health information seeking related to the credibility or limitations in online information. Participants who had never communicated with a doctor about their online health information seeking most commonly reported concerns about non-physical harm. Four barriers to communication emerged: (1) concerns about embarrassment, (2) concerns that the doctor doesn't want to hear about it, (3) belief that there is no need to bring it up, and (4) forgetting to bring it up. Facilitators of communication included: (1) having a family member present at doctor visits, (2) doctor-initiated inquiries, and (3) encountering an advertisement that suggested talking with a doctor. Conclusions: Overall, participants displayed awareness of potential problems related to online health information seeking. Findings from this study point to a set of barriers as well as facilitators of communication about online health information seeking between patients and doctors. This study highlights the need for enhanced patient communication skills, eHealth literacy assessments that are accompanied by targeted resources pointing individuals to high-quality credible online health information, and the need to remind patients of the importance of consulting a medical professional when they use online health resources to diagnose and treat a health issue. ",
doi="10.2196/jmir.3588",
url="http://www.jmir.org/2015/1/e19/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25586865"
}


@Article{info:doi/10.2196/jmir.3749,
author="Medlock, Stephanie
and Eslami, Saeid
and Askari, Marjan
and Arts, L. Derk
and Sent, Danielle
and de Rooij, E. Sophia
and Abu-Hanna, Ameen",
title="Health Information--Seeking Behavior of Seniors Who Use the Internet: A Survey",
journal="J Med Internet Res",
year="2015",
month="Jan",
day="08",
volume="17",
number="1",
pages="e10",
keywords="aged",
keywords="aged, 80 and over",
keywords="information-seeking behavior",
keywords="Internet",
keywords="patient education",
keywords="empowerment",
abstract="Background: The Internet is viewed as an important source for health information and a medium for patient empowerment. However, little is known about how seniors use the Internet in relation to other sources for health information. Objective: The aim was to determine which information resources seniors who use the Internet use and trust for health information, which sources are preferred, and which sources are used by seniors for different information needs. Methods: Questions from published surveys were selected based on their relevance to the study objectives. The Autonomy Preference Index was used to assess information needs and preferences for involvement in health decisions. Invitation to participate in this online survey was sent to the email list of a local senior organization (298 addresses) in the Netherlands. Results: There were 118 respondents with a median age of 72 years (IQR 67-78 years). Health professionals, pharmacists, and the Internet were the most commonly used and trusted sources of health information. Leaflets, television, newspapers, and health magazines were also important sources. Respondents who reported higher use of the Internet also reported higher use of other sources (P<.001). Use of health professionals, pharmacists, leaflets, telephone, television, and radio were not significantly different; use of all other resources was significantly higher in frequent Internet users. When in need of health information, preferred sources were the Internet (46/105, 43.8\%), other sources (eg, magazines 38/105, 36.2\%), health professionals (18/105, 17.1\%), and no information seeking (3/105, 2.8\%). Of the 51/107 respondents who indicated that they had sought health information in the last 12 months, 43 sought it after an appointment, 23 were preparing for an appointment, and 20 were deciding if an appointment was needed. The source used varied by the type of information sought. The Internet was used most often for symptoms (27/42, 64\%), prognosis (21/31, 68\%), and treatment options (23/41, 62\%), whereas health professionals were asked for additional information on medications (20/36, 56\%), side effects (17/36, 47\%), coping (17/31, 55\%), practical care (12/14, 86\%), and nutrition/exercise (18/30, 60\%). Conclusions: For these seniors who use the Internet, the Internet was a preferred source of health information. Seniors who report higher use of the Internet also report higher use of other information resources and were also the primary consumers of paper-based resources. Respondents most frequently searched for health information after an appointment rather than to prepare for an appointment. Resources used varied by health topic. Future research should seek to confirm these findings in a general elderly population, investigate how seniors seek and understand information on the Internet, and investigate how to reach seniors who prefer not to use the Internet for health information. ",
doi="10.2196/jmir.3749",
url="http://www.jmir.org/2015/1/e10/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25574815"
}


@Article{info:doi/10.2196/jmir.3781,
author="Hing, Nerilee
and Russell, Thomas Alex Myles
and Gainsbury, Melissa Sally
and Blaszczynski, Alex",
title="Characteristics and Help-Seeking Behaviors of Internet Gamblers Based on Most Problematic Mode of Gambling",
journal="J Med Internet Res",
year="2015",
month="Jan",
day="07",
volume="17",
number="1",
pages="e13",
keywords="gambling",
keywords="Internet",
keywords="pathological gambling",
keywords="treatment",
abstract="Background: Previous studies of problem Internet gamblers have failed to distinguish whether their problem gambling relates to Internet or land-based gambling modes. Therefore, characteristics and help-seeking behaviors of people whose gambling problems relate specifically to Internet gambling are unknown, but could inform the optimal alignment of treatment and support services with the needs and preferences of problem gamblers. Objective: This study aimed to compare (1) characteristics of problem Internet gamblers and problem land-based gamblers and (2) uptake of different types and modes of help between problem Internet gamblers and problem land-based gamblers. Hypothesis 1 was that problem Internet gamblers are less likely to seek help. Hypothesis 2 was that problem Internet gamblers are more likely to use online modes of help. Methods: A sample of 620 respondents meeting criteria for problem gambling was drawn from an online survey of 4594 Australian gamblers. Respondents were recruited through advertisements on gambling and gambling help websites, Facebook, and Google. Measures consisted of gambling participation; proportion of gambling on the Internet; most problematic mode of gambling; help seeking from 11 different sources of formal help, informal help, and self-help for gambling problems; psychological distress (Kessler 6); problem gambling severity (Problem Gambling Severity Index, PGSI); and demographics. Results: Problem Internet gamblers were significantly more likely than problem land-based gamblers to be male ($\chi$21=28.3, P<.001, $\phi$=0.21), younger (t616.33=4.62, P<.001, d=0.37), have lower psychological distress ($\chi$21=5.4, P=.02, $\phi$=0.09), and experience problems with sports and race wagering ($\chi$24=228.5, P<.001, $\phi$=0.61). Uptake of help was significantly lower among problem Internet compared to problem land-based gamblers ($\chi$21=6.9, P<.001, $\phi$=0.11), including from face-to-face services, gambling helplines, online groups, self-exclusion from land-based venues, family or friends, and self-help strategies. Both problem Internet and problem land-based gamblers had similarly low use of online help. However, problem land-based gamblers (37.6\%, 126/335) were significantly more likely to have sought land-based formal help compared to problem Internet gamblers (23.5\%, 67/285; $\chi$21=14.3, P<.001, $\phi$=0.15). Conclusions: The findings suggest that more targeted and innovative efforts may be needed to increase use of gambling help by problem Internet gamblers. Alternatively, their lower PGSI and K6 scores suggest Internet problem gamblers may have less need for gambling-related help. This is the first known study to classify problem Internet gamblers as those whose problem gambling specifically relates to Internet gambling. Further research is needed to better understand why help-seeking rates are lower among Internet problem gamblers. ",
doi="10.2196/jmir.3781",
url="http://www.jmir.org/2015/1/e13/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25567672"
}


@Article{info:doi/10.2196/mental.4004,
author="Torous, John
and Chan, Richard Steven
and Yee-Marie Tan, Shih
and Behrens, Jacob
and Mathew, Ian
and Conrad, J. Erich
and Hinton, Ladson
and Yellowlees, Peter
and Keshavan, Matcheri",
title="Patient Smartphone Ownership and Interest in Mobile Apps to Monitor Symptoms of Mental Health Conditions: A Survey in Four Geographically Distinct Psychiatric Clinics",
journal="JMIR Mental Health",
year="2014",
month="Dec",
day="23",
volume="1",
number="1",
pages="e5",
keywords="psychiatry",
keywords="mobile health",
keywords="smartphone",
abstract="Background: Despite growing interest in mobile mental health and utilization of smartphone technology to monitor psychiatric symptoms, there remains a lack of knowledge both regarding patient ownership of smartphones and their interest in using such to monitor their mental health. Objective: To provide data on psychiatric outpatients' prevalence of smartphone ownership and interest in using their smartphones to run applications to monitor their mental health. Methods: We surveyed 320 psychiatric outpatients from four clinics around the United States in order to capture a geographically and socioeconomically diverse patient population. These comprised a state clinic in Massachusetts (n=108), a county clinic in California (n=56), a hybrid public and private clinic in Louisiana (n=50), and a private/university clinic in Wisconsin (n=106). Results: Smartphone ownership and interest in utilizing such to monitor mental health varied by both clinic type and age with overall ownership of 62.5\% (200/320), which is slightly higher than the average United States' rate of ownership of 58\% in January 2014. Overall patient interest in utilizing smartphones to monitor symptoms was 70.6\% (226/320). Conclusions: These results suggest that psychiatric outpatients are interested in using their smartphones to monitor their mental health and own the smartphones capable of running mental healthcare related mobile applications. ",
doi="10.2196/mental.4004",
url="http://mental.jmir.org/2014/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26543905"
}


@Article{info:doi/10.2196/jmir.3368,
author="Shahab, Lion
and Brown, Jamie
and Gardner, Benjamin
and Smith, George Samuel",
title="Seeking Health Information and Support Online: Does It Differ as a Function of Engagement in Risky Health Behaviors? Evidence From the Health Information National Trends Survey",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="06",
volume="16",
number="11",
pages="e253",
keywords="health-risk behavior",
keywords="online support",
keywords="Internet-based intervention",
keywords="information seeking",
keywords="health information and national trends survey (HINTS)",
abstract="Background: The Internet is an important tool to deliver health behavior interventions, yet little is known about Internet access and use of health-related information, or support, by the intended intervention recipients. Objective: Our aim was to evaluate whether health-related Internet use differed as a function of common health-risk behaviors (excessive alcohol consumption, smoking, low fruit/vegetable intake, inactive/sedentary lifestyle, unprotected sun exposure, or obesity). Methods: Sociodemographic, health behavior characteristics, and information on Internet access and use were assessed in the nationally representative US Health Information National Trends Survey (HINTS) 4. Data from 3911 participants collated in 2011/12 were included. Results: Of the 78.2\% (95\% CI 76.1-80.1) of participants who had ever accessed the Internet, approximately three-quarters (78.2\%, 95\% CI 75.4-80.7) had obtained health-related information online last year. About half had used the Internet as the first source of health-related information (47.8\%, 95\% CI 44.8-50.7) or to access behavioral support (56.9\%, 95\% CI 53.7-60.0) in the last year. Adjusting for sociodemographic determinants of going online (being younger, white, female, with at least college education) revealed few differences in Internet access and use between health-risk behaviors. Participants with inadequate sun protection were less likely to access the Internet (OR 0.59, 95\% CI 0.04-0.88) and those with low fruit/vegetable intake were less likely to have gone online to obtain health-related information last year (OR 0.60, 95\% CI 0.45-0.80). Smokers in particular were likely to use the Internet to obtain behavioral support (OR 1.90, 95\% CI 1.35-2.68). Conclusions: Internet access and use to obtain health-related information and support is widespread and mostly independent of engagement in various health-risk behaviors. However, those with low fruit/vegetable intake or inadequate sun-protective behaviors may be more difficult to reach with Internet-based interventions. In addition, when developing online health promotions, relevant sociodemographic determinants of Internet use need to be targeted to maximize their impact. ",
doi="10.2196/jmir.3368",
url="http://www.jmir.org/2014/11/e253/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25380308"
}


@Article{info:doi/10.2196/mhealth.3710,
author="Bender, S. Melinda
and Choi, JiWon
and Arai, Shoshana
and Paul, M. Steven
and Gonzalez, Prisila
and Fukuoka, Yoshimi",
title="Digital Technology Ownership, Usage, and Factors Predicting Downloading Health Apps Among Caucasian, Filipino, Korean, and Latino Americans: The Digital Link to Health Survey",
journal="JMIR mHealth uHealth",
year="2014",
month="Oct",
day="22",
volume="2",
number="4",
pages="e43",
keywords="digital technology",
keywords="mobile health apps",
keywords="mHealth",
keywords="Latinos",
keywords="Filipinos",
keywords="Koreans",
keywords="cross-sectional survey",
abstract="Background: Interventions using mobile health (mHealth) apps have been effective in promoting healthy lifestyle behavior change and hold promise in improving health outcomes to thereby reduce health disparities among diverse racial/ethnic populations, particularly Latino and Asian American subgroups (Filipinos and Koreans) at high risk for diabetes and cardiovascular disease. Latinos and Asian Americans are avid digital technology owners and users. However, limited datasets exist regarding digital technology ownership and use, especially among specific racial/ethnic subgroups. Such information is needed to inform development of culturally tailored mHealth tools for use with lifestyle interventions promoting healthy behaviors for these at-risk racial/ethnic populations. Objective: The intent of the study was to examine (1) digital technology ownership and usage, and (2) factors predicting downloading health apps for Caucasian, Filipino, Korean, and Latino American subgroups. Methods: A cross-sectional survey conducted in August 2013 through December 2013 recruited 904 participants (Caucasians n=172, Filipinos n=250, Koreans n=234, and Latinos n=248), age >18 years, from California community events, clinics, churches, and online. English, Spanish, and Korean surveys were administered via paper or online. Descriptive statistics characterized the sociodemographics and digital technology ownership/usage of the 904 participants. Differences among groups in categorical variables were examined using chi-square statistics. Logistic regression was used to determine factors predicting downloading health apps. Results: Overall, mean age was 44 years (SD 16.1), with 64.3\% (581/904) female. Only 44.7\% (404/904) of all participants reported English as their primary language (Caucasian 98.3\%, 169/172; Filipino 67.6\%, 169/250; Korean 9.4\%, 22/234, and Latino 17.7\%, 44/248. Overall, mobile phone ownership was 92.8\% (839/904). Compared to all groups, Koreans were more likely to own a mobile phone (82.8\%, 194/234), computer (91.4\%, 214/234), or tablet (55.2\%, 129/234), whereas Latinos (67.5\%, 167/248; 65.3\%, 162/248; 24.4\%, 61/248, respectively) were least likely. Internet access via mobile phones (90.5\%, 818/904) was higher than computers (78.6\%, 711/904). Odds of downloading health apps increased with college (OR 2.62, 95\% CI 1.44-4.80) or graduate school (OR 2.93, 95\% CI 1.43-6.00) compared to some high school; and family history of heart attack (OR 2.02, 95\% CI 1.16-3.51). Odds of downloading health apps were reduced with: race/ethnicity, Latino (OR 0.37, 95\% CI 0.20-0.69), and Korean (OR 0.52, 95\% CI 0.31-0.88) compared to Caucasians; increasing age (OR 0.96, 95\% CI 0.95-0.97); and completing paper surveys (OR 0.50, 95\% CI 0.34-0.75). Conclusions: This survey study uniquely targeted specific racial/ethnic subgroups. Results indicated that despite a narrowing racial/ethnic ``digital divide'', some disparities still exist, particularly among racial/ethnic groups with less education and whose primary language is not English. Findings will be used to inform development and evaluation of culturally tailored mHealth apps for use with interventions promoting healthy behavior change for Filipinos, Koreans, and Latinos. ",
doi="10.2196/mhealth.3710",
url="http://mhealth.jmir.org/2014/4/e43/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25339246"
}


@Article{info:doi/10.2196/jmir.3386,
author="Wang, Ping Man
and Wang, Xin
and Viswanath, Kasisomayajula
and Wan, Alice
and Lam, Hing Tai
and Chan, S. Sophia",
title="Digital Inequalities of Family Life Information Seeking and Family Well-Being Among Chinese Adults in Hong Kong: A Population Survey",
journal="J Med Internet Res",
year="2014",
month="Oct",
day="03",
volume="16",
number="10",
pages="e227",
keywords="socioeconomic factors",
keywords="information seeking behavior",
keywords="family health",
abstract="Background: Inequalities in Internet use and health information seeking are well documented, but less is known about information for family life activities. Objective: We investigated the social determinants of online family life information seeking behaviors and its associations with family well-being among Chinese adults in Hong Kong. Methods: A probability-based telephone survey was conducted in 2012 to record family life information seeking behaviors, including frequency of seeking and paying attention to family life information, levels of trust, and perceived usefulness of family life information. Family well-being was assessed using 3 single items on perceived family harmony, happiness, and health, with higher scores indicating greater well-being. Adjusted odds ratios for family life information seeking behaviors by socioeconomic characteristics and lifestyle behaviors, and adjusted beta coefficients for family well-being by family life information seeking behaviors were calculated. Results: Of 1537 respondents, 57.57\% (855/1537) had ever and 26.45\% (407/1537) sought monthly family life information through the Internet. Lower educational attainment and household income, smoking, and physical inactivity were associated with less frequent seeking and paying attention (all P<.05). Greater perceived family health was associated with more frequent attention (adjusted $\beta$=.32, 95\% CI.11-.52), greater levels of trust (adjusted $\beta$=.28, 95\% CI .07-.48), and perceived usefulness (adjusted $\beta$=.23, 95\% CI .01-.45) of family life information. Frequent attention and higher level of trust were also associated with greater family harmony (adjusted $\beta$=.22, 95\% CI .002-.41) and happiness (adjusted $\beta$=.23, 95\% CI .003-.42), respectively. Conclusions: This is the first study investigating family life information seeking behaviors and suggested inequalities of online family life information seeking behaviors. The association between family life information seeking behavior and family well-being needs to be confirmed in prospective studies. ",
doi="10.2196/jmir.3386",
url="http://www.jmir.org/2014/10/e227/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25281831"
}


@Article{info:doi/10.2196/jmir.3146,
author="Neufingerl, Nicole
and Cobain, R. Mark
and Newson, S. Rachel",
title="Web-Based Self-Assessment Health Tools: Who Are the Users and What Is the Impact of Missing Input Information?",
journal="J Med Internet Res",
year="2014",
month="Sep",
day="26",
volume="16",
number="9",
pages="e215",
keywords="cardiovascular disease",
keywords="risk assessment",
keywords="Web applications",
keywords="consumer health information",
keywords="preventive health services",
keywords="cholesterol",
keywords="blood pressure",
abstract="Background: Web-based health applications, such as self-assessment tools, can aid in the early detection and prevention of diseases. However, there are concerns as to whether such tools actually reach users with elevated disease risk (where prevention efforts are still viable), and whether inaccurate or missing information on risk factors may lead to incorrect evaluations. Objective: This study aimed to evaluate (1) evaluate whether a Web-based cardiovascular disease (CVD) risk communication tool (Heart Age tool) was reaching users at risk of developing CVD, (2) the impact of awareness of total cholesterol (TC), HDL-cholesterol (HDL-C), and systolic blood pressure (SBP) values on the risk estimates, and (3) the key predictors of awareness and reporting of physiological risk factors. Methods: Heart Age is a tool available via a free open access website. Data from 2,744,091 first-time users aged 21-80 years with no prior heart disease were collected from 13 countries in 2009-2011. Users self-reported demographic and CVD risk factor information. Based on these data, an individual's 10-year CVD risk was calculated according to Framingham CVD risk models and translated into a Heart Age. This is the age for which the individual's reported CVD risk would be considered ``normal''. Depending on the availability of known TC, HDL-C, and SBP values, different algorithms were applied. The impact of awareness of TC, HDL-C, and SBP values on Heart Age was determined using a subsample that had complete risk factor information. Results: Heart Age users (N=2,744,091) were mostly in their 20s (22.76\%) and 40s (23.99\%), female (56.03\%), had multiple (mean 2.9, SD 1.4) risk factors, and a Heart Age exceeding their chronological age (mean 4.00, SD 6.43 years). The proportion of users unaware of their TC, HDL-C, or SBP values was high (77.47\%, 93.03\%, and 46.55\% respectively). Lacking awareness of physiological risk factor values led to overestimation of Heart Age by an average 2.1-4.5 years depending on the (combination of) unknown risk factors (P<.001). Overestimation was greater in women than in men, increased with age, and decreased with increasing CVD risk. Awareness of physiological risk factor values was higher among diabetics (OR 1.47, 95\% CI 1.46-1.50 and OR 1.74, 95\% CI 1.71-1.77), those with family history of CVD (OR 1.22, 95\% CI 1.22-1.23 and OR 1.43, 95\% CI 1.42-1.44), and increased with age (OR 1.05, 95\% CI 1.05-1.05 and OR 1.07, 95\% CI 1.07-1.07). It was lower in smokers (OR 0.52, 95\% CI 0.52-0.53 and OR 0.71, 95\% CI 0.71-0.72) and decreased with increasing Heart Age (OR 0.92, 95\% CI 0.92-0.92 and OR 0.97, 95\% CI 0.96-0.97) (all P<.001). Conclusions: The Heart Age tool reached users with low-moderate CVD risk, but with multiple elevated CVD risk factors, and a heart age higher than their real age. This highlights that Web-based self-assessment health tools can be a useful means to interact with people who are at risk of developing disease, but where interventions are still viable. Missing information in the self-assessment health tools was shown to result in inaccurate self-health assessments. Subgroups at risk of not knowing their risk factors are identifiable and should be specifically targeted in health awareness programs. ",
doi="10.2196/jmir.3146",
url="http://www.jmir.org/2014/9/e215/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25261155"
}


@Article{info:doi/10.2196/jmir.3049,
author="LeRouge, Cynthia
and Van Slyke, Craig
and Seale, Deborah
and Wright, Kevin",
title="Baby Boomers' Adoption of Consumer Health Technologies: Survey on Readiness and Barriers",
journal="J Med Internet Res",
year="2014",
month="Sep",
day="08",
volume="16",
number="9",
pages="e200",
keywords="baby boomer",
keywords="readiness",
keywords="adoption",
keywords="consumer health technology",
keywords="man-machine systems",
keywords="aging",
keywords="health",
keywords="human factors",
keywords="design",
keywords="user interfaces",
keywords="personal computing",
abstract="Background: As they age, baby boomers (born 1946-1964) will have increasing medical needs and are likely to place large demand on health care resources. Consumer health technologies may help stem rising health care needs and costs by improving provider-to-patient communication, health monitoring, and information access and enabling self-care. Research has not explored the degree to which baby boomers are ready for, or are currently embracing, specific consumer health technologies This study explores how baby boomers' readiness to use various technologies for health purposes compares to other segments of the adult population. Objective: The goals of the study are to (1) examine what technologies baby boomers are ready to use for health purposes, (2) investigate barriers to baby boomers' use of technology for health purposes, and (3) understand whether readiness for and barriers to baby boomers' use of consumer health technologies differ from those of other younger and older consumers. Methods: Data were collected via a survey offered to a random sample of 3000 subscribers to a large pharmacy benefit management company. Respondents had the option to complete the survey online or by completing a paper-based version of the survey. Results: Data from 469 respondents (response rate 15.63\%) were analyzed, including 258 baby boomers (aged 46-64 years), 72 younger (aged 18-45 years), and 139 older (age >64 years) participants. Baby boomers were found to be similar to the younger age group, but significantly more likely than the older age group to be ready to use 5 technologies for health purposes (health information websites, email, automated call centers, medical video conferencing, and texting). Baby boomers were less ready than the younger age group to adopt podcasts, kiosks, smartphones, blogs, and wikis for health care purposes. However, baby boomers were more likely than older adults to use smartphones and podcasts for health care purposes. Specific adoption barriers vary according to the technology. Conclusions: Baby boomers have commonalities with and distinctions from both younger and older adults in their readiness to adopt specific consumer health technologies and the barriers they experience to adoption. Baby boomers' nuances regarding readiness to adopt and the barriers associated with the various forms of consumer health technology should be taken into account by those interested in promoting consumer health technologies use among baby boomers when developing applications, choosing technologies, preparing users for use, and in promotional tactics. ",
doi="10.2196/jmir.3049",
url="http://www.jmir.org/2014/9/e200/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25199475"
}


@Article{info:doi/10.2196/jmir.3289,
author="Kowalski, Christoph
and Kahana, Eva
and Kuhr, Kathrin
and Ansmann, Lena
and Pfaff, Holger",
title="Changes Over Time in the Utilization of Disease-Related Internet Information in Newly Diagnosed Breast Cancer Patients 2007 to 2013",
journal="J Med Internet Res",
year="2014",
month="Aug",
day="26",
volume="16",
number="8",
pages="e195",
keywords="disease-related Internet information",
keywords="digital divide",
keywords="multilevel analysis",
keywords="breast neoplasms",
keywords="hospital differences",
abstract="Background: As the number of people with Internet access rises, so does the use of the Internet as a potentially valuable source for health information. Insight into patient use of this information and its correlates over time may reveal changes in the digital divide based on patient age and education. Existing research has focused on patient characteristics that predict Internet information use and research on treatment context is rare. Objective: This study aims to (1) present data on the proportion of newly diagnosed breast cancer patients treated in German breast centers from 2007 to 2013 who used the Internet for information on their disease, (2) look into correlations between Internet utilization and sociodemographic characteristics and if these change over time, and (3) determine if use of Internet information varies with the hospitals in which the patients were initially treated. Methods: Data about utilization of the Internet for breast cancer--specific health information was obtained in a postal survey of breast cancer patients that is conducted annually in Germany with a steady response rate of 87\% of consenting patients. Data from the survey were combined with data obtained by hospital personnel (eg, cancer stage and type of surgery). Data from 27,491 patients from 7 consecutive annual surveys were analyzed for this paper using multilevel regression modeling to account for clustering of patients in specific hospitals. Results: Breast cancer patients seeking disease-specific information on the Internet increased significantly from 26.96\% (853/3164) in 2007 to 37.21\% (1485/3991) in 2013. Similar patterns of demographic correlates were found for all 7 cohorts. Older patients (?70 years) and patients with <10 years of formal education were less likely to use the Internet for information on topics related to their disease. Internet use was significantly higher among privately insured patients and patients living with a partner. Higher cancer stage and a foreign native language were associated with decreased use in the overall model. Type of surgery was not found to be associated with Internet use in the multivariable models. Intraclass correlation coefficients were small (0.00-0.03) suggesting only a small contribution of the hospital to the patients' decision to use Internet information. There was no clear indication of a decreased digital divide based on age and education. Conclusions: Use of the Internet for health information is on the rise among breast cancer patients. The strong age- and education-related differences raise the question of how relevant information can be adequately provided to all patients, especially to those with limited education, older age, and living without a partner. ",
doi="10.2196/jmir.3289",
url="http://www.jmir.org/2014/8/e195/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25158744"
}


@Article{info:doi/10.2196/jmir.3161,
author="M{\'e}jean, Caroline
and Szabo de Edelenyi, Fabien
and Touvier, Mathilde
and Kesse-Guyot, Emmanuelle
and Julia, Chantal
and Andreeva, A. Valentina
and Hercberg, Serge",
title="Motives for Participating in a Web-Based Nutrition Cohort According to Sociodemographic, Lifestyle, and Health Characteristics: The NutriNet-Sant{\'e} Cohort Study",
journal="J Med Internet Res",
year="2014",
month="Aug",
day="07",
volume="16",
number="8",
pages="e189",
keywords="Internet",
keywords="cohort study",
keywords="population characteristics",
keywords="motivation",
keywords="participation",
abstract="Background: In traditional epidemiological studies, participants are likely motivated by perceived benefits, feelings of accomplishment, and belonging. No study has explored motives for participation in a Web-based cohort and the associated participant characteristics, although such information is useful for enhancing recruitment and improving cohort retention. Objective: We aimed to evaluate the relationships between motives for participation and sociodemographic, health, and lifestyle characteristics of participants in the NutriNet-Sant{\'e} Web-based cohort, designed to identify nutritional risk or protective factors for chronic diseases. Methods: The motives for participation were assessed using a specifically developed questionnaire administered approximately 2 years after baseline. A total of 6352 completed the motives questionnaire (43.34\%, 6352/15,000 randomly invited cohort participants). We studied the associations between motives (dependent variables) and individual characteristics with multivariate multinomial logistic regression models providing odds ratios and 95\% confidence intervals. Results: In total, 46.45\% (2951/6352) of participants reported that they would not have enrolled if the study had not been conducted on the Internet, whereas 28.75\% (1826/6352) were not sure. Men (OR 1.21, 95\% CI 1.04-1.42), individuals aged 26-35 years (OR 1.51, 95\% CI 1.20-1.91), and obese participants (OR 1.30, 95\% CI 1.02-1.65) were more inclined to be motivated by the Internet aspect. Compared with younger adults and managerial staff, individuals >55 years (OR 0.60, 95\% CI 0.48-0.45) and employees/manual workers were less likely motivated by the Internet aspect (OR 0.77, 95\% CI 0.63-0.92). Regarding reasons for participation, 61.37\% (3898/6352) reported participating to help advance public health research on chronic disease prevention; 22.24\% (1413/6352) to help advance nutrition-focused research; 6.89\% (438/6352) in response to the call from the media, after being encouraged by a close friend/associate, or a medical provider. Individuals >45 years (vs younger participants) were more likely (OR 1.62, 95\% CI 1.07-2.47), whereas overweight and obese participants (vs nonobese participants) were less likely to participate in the study for reasons related to helping public health research on chronic disease prevention (OR 0.72, 95\% CI 0.58-0.89; OR 0.62, 95\% CI 0.46-0.84; respectively). Exclusive public funding of the study was important for 67.02\% (4257/6352) of the participants. Men (OR 1.37, 95\% CI 1.17-1.61) and persons >55 years (OR 1.97, 95\% CI 1.57-2.47) were more likely to consider the exclusive public funding as very important. Conclusions: The use of the Internet, the willingness to help advance public health research, and the study being publicly funded were key motives for participating in the Web-based NutriNet-Sant{\'e} cohort. These motives differed by sociodemographic profile and obesity, yet were not associated with lifestyle or health status. These findings can help improve the retention strategies in Web-based cohorts, particularly during decisive study periods when principal exposure information is collected. ",
doi="10.2196/jmir.3161",
url="http://www.jmir.org/2014/8/e189/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25135800"
}


@Article{info:doi/10.2196/jmir.3499,
author="Lee, Ji Young
and Boden-Albala, Bernadette
and Larson, Elaine
and Wilcox, Adam
and Bakken, Suzanne",
title="Online Health Information Seeking Behaviors of Hispanics in New York City: A Community-Based Cross-Sectional Study",
journal="J Med Internet Res",
year="2014",
month="Jul",
day="22",
volume="16",
number="7",
pages="e176",
keywords="Internet",
keywords="information seeking behavior",
keywords="health behavior",
keywords="consumer health information",
keywords="hispanic Americans",
abstract="Background: The emergence of the Internet has increased access to health information and can facilitate active individual engagement in health care decision making. Hispanics are the fastest-growing minority group in the United States and are also the most underserved in terms of access to online health information. A growing body of literature has examined correlates of online health information seeking behaviors (HISBs), but few studies have included Hispanics. Objective: The specific aim of this descriptive, correlational study was to examine factors associated with HISBs of Hispanics. Methods: The study sample (N=4070) was recruited from five postal zip codes in northern Manhattan for the Washington Heights Inwood Informatics Infrastructure for Comparative Effectiveness Research project. Survey data were collected via interview by bilingual community health workers in a community center, households, and other community settings. Data were analyzed using bivariate analyses and logistic regression. Results: Among individual respondents, online HISBs were significantly associated with higher education (OR 3.03, 95\% CI 2.15-4.29, P<.001), worse health status (OR 0.42, 95\% CI 0.31-0.57, P<.001), and having no hypertension (OR 0.60, 95\% CI 0.43-0.84, P=.003). Online HISBs of other household members were significantly associated with respondent factors: female gender (OR 1.60, 95\% CI 1.22-2.10, P=.001), being younger (OR 0.75, 95\% CI 0.62-0.90, P=.002), being married (OR 1.36, 95\% CI 1.09-1.71, P=.007), having higher education (OR 1.80, 95\% CI 1.404-2.316, P<.001), being in worse health (OR 0.59, 95\% CI 0.46-0.77, P<.001), and having serious health problems increased the odds of their household members' online HISBs (OR 1.83, 95\% CI 1.29-2.60, P=.001). Conclusions: This large-scale community survey identified factors associated with online HISBs among Hispanics that merit closer examination. To enhance online HISBs among Hispanics, health care providers and policy makers need to understand the cultural context of the Hispanic population. Results of this study can provide a foundation for the development of informatics-based interventions to improve the health of Hispanics in the United States. ",
doi="10.2196/jmir.3499",
url="http://www.jmir.org/2014/7/e176/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25092120"
}


@Article{info:doi/10.2196/jmir.3117,
author="Kontos, Emily
and Blake, D. Kelly
and Chou, Sylvia Wen-Ying
and Prestin, Abby",
title="Predictors of eHealth Usage: Insights on The Digital Divide From the Health Information National Trends Survey 2012",
journal="J Med Internet Res",
year="2014",
month="Jul",
day="16",
volume="16",
number="7",
pages="e172",
keywords="health communication",
keywords="communication barriers",
keywords="Internet",
keywords="consumer health information",
abstract="Background: Recent eHealth developments have elevated the importance of assessing the extent to which technology has empowered patients and improved health, particularly among the most vulnerable populations. With noted disparities across racial and social groups in chronic health outcomes, such as cancer, obesity, and diabetes, it is essential that researchers examine any differences in the implementation, uptake, and impact of eHealth strategies across groups that bear a disproportionate burden of disease. Objective: The goal was to examine eHealth use by sociodemographic factors, such as race/ethnicity, socioeconomic status (SES), age, and sex. Methods: We drew data from National Cancer Institute's 2012 Health Information National Trends Survey (HINTS) (N=3959) which is publicly available online. We estimated multivariable logistic regression models to assess sociodemographic predictors of eHealth use among adult Internet users (N=2358) across 3 health communication domains (health care, health information--seeking, and user-generated content/sharing). Results: Among online adults, we saw no evidence of a digital use divide by race/ethnicity. However, there were significant differences in use by SES, particularly for health care and health information--seeking items. Patients with lower levels of education had significantly lower odds of going online to look for a health care provider (high school or less: OR 0.50, 95\% CI 0.33-0.76) using email or the Internet to communicate with a doctor (high school or less: OR 0.46, 95\% CI 0.29-0.72), tracking their personal health information online (high school or less: OR 0.53, 95\% CI 0.32-0.84), using a website to help track diet, weight, and physical activity (high school or less: OR 0.64, 95\% CI 0.42-0.98; some college: OR 0.67, 95\% CI 0.49-0.93), or downloading health information to a mobile device (some college: OR 0.54, 95\% CI 0.33-0.89). Being female was a consistent predictor of eHealth use across health care and user-generated content/sharing domains, whereas age was primarily influential for health information--seeking. Conclusions: This study illustrates that lower SES, older, and male online US adults were less likely to engage in a number of eHealth activities compared to their counterparts. Future studies should assess issues of health literacy and eHealth literacy and their influence on eHealth engagement across social groups. Clinical care and public health communication efforts attempting to leverage Web 2.0 and 3.0 platforms should acknowledge differential eHealth usage to better address communication inequalities and persistent disparities in health. ",
doi="10.2196/jmir.3117",
url="http://www.jmir.org/2014/7/e172/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25048379"
}


@Article{info:doi/10.2196/med20.3213,
author="Se{\c{c}}kin, G{\"u}l",
title="Health Information on the Web and Consumers' Perspectives on Health Professionals' Responses to Information Exchange",
journal="Med 2.0",
year="2014",
month="Jul",
day="08",
volume="3",
number="2",
pages="e4",
keywords="health communication",
keywords="Internet",
keywords="information",
keywords="patient-physician relationship",
abstract="Background: Health information technology, which is sometimes referred to as informaticization of medicine, is changing the extent to which patients become competent producers of their own health by enabling them access to health information anytime and anywhere. Objective: This research provides preliminary information on users' perceptions of the extent to which use of the Internet for health information impacts medical encounters. We specifically explored the following questions: (1) To what extent perceptions of positive or negative changes in medical encounters are associated with sociodemographic background of online health information seekers, and how often the Internet information is discussed with providers? (2) To what extent is there an association between perceived changes in medical encounters and frequency of referring to the Internet during medical encounters? (3) To what extent is there an association between sociodemographic background of online health information users and frequency of discussing of the Internet information with providers? Methods: The data for this study was derived from a national sampling of online health and medical information users who participated in the Study of Health and Medical Information in Cyberspace---Survey of User Perceptions (N=710). This study used a nationally representative online research panel of the US adults maintained by the Knowledge Networks. Analysis of variance (ANOVA), chi-square, and t tests were performed to examine the data. Results: Although Internet sources allow people the opportunity to gather health or medical information, discussion of this information was not a very common activity. It is noteworthy that half of the sample never or rarely discussed health/medical information obtained from Internet sources with health professionals. Chi-square analyses revealed that discussion of online health information with providers were associated with education, income, and marital status. We also found that discussion of the Internet information mostly promotes better physician-patient interactions. Analyses with post-hoc tests identified that perceived changes in medical encounters were associated with age, education, and income. However, 9.1\% (64/703) of our respondents strongly agreed that the interactions with their providers have been strained. T test analyses showed that marital status, race, and gender were not significant. Conclusions: Embracing new technologies, and adapting to changing roles and relationships in delivery of medical care are critical to effective delivery of patient-centered care. Health professionals could also guide patients on how to evaluate information and where to access to reliable and accurate information. ",
doi="10.2196/med20.3213",
url="http://www.medicine20.com/2014/2/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25075248"
}


@Article{info:doi/10.2196/jmir.2934,
author="Beck, Fran{\c{c}}ois
and Richard, Jean-Baptiste
and Nguyen-Thanh, Viet
and Montagni, Ilaria
and Parizot, Isabelle
and Renahy, Emilie",
title="Use of the Internet as a Health Information Resource Among French Young Adults: Results From a Nationally Representative Survey",
journal="J Med Internet Res",
year="2014",
month="May",
day="13",
volume="16",
number="5",
pages="e128",
keywords="health communication",
keywords="information dissemination",
keywords="access to information",
keywords="Internet",
keywords="trust",
keywords="young adults",
abstract="Background: The Internet is one of the main resources of health information especially for young adults, but website content is not always trustworthy or validated. Little is known about this specific population and the importance of online health searches for use and impact. It is fundamental to assess behaviors and attitudes of young people looking for online health-related information and their level of trust in such information. Objective: The objective is to describe the characteristics of Internet users aged 15-30 years who use the Web as a health information resource and their trust in it, and to define the context and the effect of such use on French young adults' behavior in relation to their medical consultations. Methods: We used the French Health Barometer 2010, a nationally representative survey of 27,653 individuals that investigates population health behaviors and concerns. Multivariate logistic regressions were performed using a subsample of 1052 young adults aged 15-30 years to estimate associations between demographics, socioeconomic, and health status and (1) the use of the Internet to search for health information, and (2) its impact on health behaviors and the physician-patient relationship. Results: In 2010, 48.5\% (474/977) of Web users aged 15-30 years used the Internet for health purposes. Those who did not use the Internet for health purposes reported being informed enough by other sources (75.0\%, 377/503), stated they preferred seeing a doctor (74.1\%, 373/503) or did not trust the information on the Internet (67.2\%, 338/503). However, approximately 80\% (371/474) of young online health seekers considered the information found online reliable. Women (P<.001) and people with higher sociocultural positions (OR 0.5, 95\% CI 0.3-0.9 and OR 0.4, 95\% CI 0.2-0.7 for employees and manual workers, respectively, vs individuals with executive or manager positions) were more likely to use the Internet for health purposes. For a subsample of women only, online health seeking was more likely among those having a child (OR 1.8, 95\% CI 1.1-2.7) and experiencing psychological distress (OR 2.0, 95\% CI 1.0-4.0). Finally, for online health seekers aged 15-30 years, one-third (33.3\%, 157/474) reported they changed their health behaviors (eg, frequency of medical consultations, way of taking care of one's own health) because of their online searches. Different factors were associated with different outcomes of change, but psychological distress, poor quality of life, and low income were the most common. Conclusions: The Internet is a useful tool to spread health information and prevention campaigns, especially to target young adults. Young adults trust online information and consider the Internet as a valid source of health advice. Health agencies should ensure the improvement of online health information quality and the creation of health-related websites and programs dedicated to young adults. ",
doi="10.2196/jmir.2934",
url="http://www.jmir.org/2014/5/e128/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24824164"
}


@Article{info:doi/10.2196/jmir.3187,
author="O'Neill, Braden
and Ziebland, Sue
and Valderas, Jose
and Lupi{\'a}{\~n}ez-Villanueva, Francisco",
title="User-Generated Online Health Content: A Survey of Internet Users in the United Kingdom",
journal="J Med Internet Res",
year="2014",
month="Apr",
day="30",
volume="16",
number="4",
pages="e118",
keywords="eHealth",
keywords="consumer health information",
keywords="patient education",
keywords="health education",
keywords="health promotion",
keywords="social media",
keywords="superusers",
abstract="Background: The production of health information has begun to shift from commercial organizations to health care users themselves. People increasingly go online to share their own health and illness experiences and to access information others have posted, but this behavior has not been investigated at a population level in the United Kingdom. Objective: This study aims to explore access and production of user-generated health content among UK Internet users and to investigate relationships between frequency of use and other variables. Methods: We undertook an online survey of 1000 UK Internet users. Descriptive and multivariate statistical analyses were used to interpret the data. Results: Nearly one-quarter of respondents (23.7\%, 237/1000) reported accessing and sharing user-generated health content online, whereas more than 20\% (22.2\%, 222/1000) were unaware that it was possible to do this. Respondents could be divided into 3 groups based on frequency of use: rare users (78.7\%, 612/778) who accessed and shared content less than weekly, users (13.9\%, 108/778) who did so weekly, and superusers (7.5\%, 58/778) who did so on a daily basis. Superusers were more likely to be male (P<.001) and to be employed (P<.001), but there were no differences between the groups with respect to educational level (P=.99) or health status (P=.63). They were more likely to use the Internet for varied purposes such as banking and shopping (P<.001). Conclusions: Although this study found reasonably widespread access of user-generated online health content, only a minority of respondents reported doing so frequently. As this type of content proliferates, superusers are likely to shape the health information that others access. Further research should assess the effect of user-generated online content on health outcomes and use of health services by Internet users. ",
doi="10.2196/jmir.3187",
url="http://www.jmir.org/2014/4/e118/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24784798"
}


@Article{info:doi/10.2196/mhealth.2841,
author="BinDhim, F. Nasser
and McGeechan, Kevin
and Trevena, Lyndal",
title="Who Uses Smoking Cessation Apps? A Feasibility Study Across Three Countries via Smartphones",
journal="JMIR Mhealth Uhealth",
year="2014",
month="Feb",
day="06",
volume="2",
number="1",
pages="e4",
keywords="smartphone",
keywords="handheld computers",
keywords="health promotion",
keywords="tobacco and smoking",
keywords="global health",
keywords="prevention",
keywords="apps",
keywords="health Informatics",
keywords="public health",
abstract="Background: Smartphone use is growing worldwide. While hundreds of smoking cessation apps are currently available in the app stores, there is no information about who uses them. Smartphones also offer potential as a research tool, but this has not previously been explored. Objective: This study aims to measure and compare the uptake of a smoking cessation app over one year in Australia, the United Kingdom, and the United States. It also assesses the feasibility of conducting research via an app, describing respondents' characteristics (demographics, smoking status, and other health related app use), and examining differences across countries. Methods: This is a cross-sectional exploratory study of adults 18 years and older, passively recruited over one year in 2012, who downloaded this study app (Quit Advisor) via the two largest app stores (Apple and Android). Results: The total number of app downloads after one year was 1751, 72.98\% (1278/1751) of them were Apple operation system users. Of these 1751 participants, 47.68\% (835/1751) were from the United States, 29.18\% (511/1751) were from the United Kingdom, and 16.68\% (292/1751) were from Australia. There were 602 participants, 36.75\% (602/1638) that completed a questionnaire within the app. Of these 602 participants, 58.8\% (354/602) were female and the mean age was 32 years. There were no significant differences between countries in terms of age, operation system used, number of quitting attempts, and language spoken at home. However, there were significant differences between countries in terms of gender and stage of change. There were 77.2\% (465/602) of the respondents that were ready to quit in the next 30 days and the majority of these had never sought professional help (eg, ``Quitline''). More than half had downloaded smoking cessation apps in the past and of these, three-quarters had made quitting attempts (lasted at least 24 hours) using an app before. Respondents who had attempted to quit three times or more in the previous year were more likely to have tried smoking cessation apps (OR 3.3, 95\% CI 2.1-5.2). There were 50.2\% (302/602) of the respondents that had used other health related apps before. Of these, 89.4\% (270/302) were using health related apps at least once a week, but 77.5\% (234/302) never checked the credibility of the health app publishers before downloading. Conclusions: A smartphone app was able to reach smokers across three countries that were not seeking professional help, but were ready to quit within the next 30 days. Respondents were relatively young and almost demographically similar across all three countries. They also frequently used other health related apps, mostly without checking the credibility of their publishers. ",
doi="10.2196/mhealth.2841",
url="http://mhealth.jmir.org/2014/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25098439"
}


@Article{info:doi/10.2196/jmir.2528,
author="Salgado, Victoria M.
and Mejia, Raul
and Kaplan, P. Celia
and Perez-Stable, J. Eliseo",
title="Smoking Behavior and Use of Tobacco Industry Sponsored Websites Among Medical Students and Young Physicians in Argentina",
journal="J Med Internet Res",
year="2014",
month="Feb",
day="06",
volume="16",
number="2",
pages="e35",
keywords="smoking",
keywords="medical students",
keywords="tobacco websites",
keywords="Latin America",
abstract="Background: Internet-based marketing has become an attractive option for promoting tobacco products due to its potential to avoid advertising restrictions. In Argentina, several cigarette brands have designed websites for the local market, which promote user participation. Objective: The intent of the study was to report on the use of tobacco company-sponsored websites by medical students and recently graduated physicians. Methods: An online self-administered survey was conducted among eligible medical students and recent graduates from the University of Buenos Aires (UBA). Sampling was from lists of email addresses of students enrolled in two required courses. Eligibility criteria were ages 18-30 years and reporting on smoking status. Questions on Internet use included accessing a tobacco brand website at least once during their lifetime and any use of tobacco promotional materials. Results: The response rate was 35.08\% (1743/4969). The final sample included 1659 participants: 73.06\% (1212/1659) were women and mean age was 26.6 years (SD 1.9). The majority were current medical students (55.70\%, 924/1659) and 27.31\% (453/1659) were current smokers. Men were more likely to report having seen a tobacco advertisement on the Internet (P=.001), to have received a tobacco promotion personally addressed to them (P=.03), to have used that promotion (P=.02), and to have accessed a tobacco-sponsored website (P=.01). Among respondents, 19.35\% (321/1659) reported having accessed a tobacco-sponsored website at least once in their lifetime and almost all of them (93.8\%, 301/321) accessed these sites only when it was necessary for participating in a marketing promotion. Most people logging on for promotions reported entering once a month or less (58.9\%, 189/321), while 25.5\% (82/321) reported accessing the tobacco industry Internet sites once a week or more. In adjusted logistic regression models, participants were more likely to have accessed a tobacco brand website if they were former smokers (OR 2.45, 95\% CI 1.42-4.22) or current (OR 8.12, 95\% CI 4.66-14.16), if they reported having seen a tobacco advertisement on the Internet (OR 2.44, 95\% CI 1.77-3.37), received a tobacco promotion personally addressed to them (OR 5.62; 95\% CI 4.19-7.55), or used one of these promotions (OR 14.05, 95\% CI 9.21-21.43). Respondents were more likely to be current smokers if they received a tobacco promotion (OR 2.64, 95\% CI 2.02-3.45) or if they used one of these promotions (OR 1.93, 95\% CI 1.31-2.85). Conclusions: Our study suggests that tobacco industry websites reach medical students and young physicians in a middle-income country with their marketing promotions. Current or proposed legislation to ban tobacco advertising needs to include Internet sites and related social media. ",
doi="10.2196/jmir.2528",
url="http://www.jmir.org/2014/2/e35/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24509433"
}


@Article{info:doi/10.2196/jmir.2673,
author="Mitchell, J. Stephanie
and Godoy, Leandra
and Shabazz, Kanya
and Horn, B. Ivor",
title="Internet and Mobile Technology Use Among Urban African American Parents: Survey Study of a Clinical Population",
journal="J Med Internet Res",
year="2014",
month="Jan",
day="13",
volume="16",
number="1",
pages="e9",
keywords="health communication",
keywords="mobile phone",
keywords="social networking, African Americans",
keywords="pediatrics",
abstract="Background: There is considerable potential for mobile technologies to empower pediatric patients and families by improving their communication with health professionals. National surveys suggest minority parents frequently communicate via mobile technology, but it is uncertain how amenable they are to receiving health care information in this format. Although the low cost and far reach characteristics of mobile health (mHealth) technology makes it advantageous for communication with minority parents, data on acceptance are needed. Objective: The objective of the study was to determine utilization of mobile and Internet technology by African American parents in an urban, underserved population, and to assess their interest in receiving health information via text messaging or other technologies (eg, social media and the Internet). Methods: A survey was administered to parents of children aged 1-12 years covered by public insurance receiving care at 3 pediatric primary care centers in Washington, DC. Results: The African American sample (N=302) was composed of primarily single (75.8\%, 229/302) mothers. Almost half had more than a high school education (47.7\%, 144/302) and incomes above US \$25,000 per year (43.0\%, 130/302). Most (97.0\%, 293/302) reported owning a cell phone, of which 91.1\% (275/302) used it to text and 78.5\% (237/302) used it to access the Internet. Most had service plans with unlimited text and data, but 26.5\% (80/302) experienced service interruptions in the previous year. Home Internet access was more prevalent among those with higher income (86.2\%, 112/130), but it was still relatively pervasive among lower income families (66.9\%, 83/124). In adjusted logistic regression models, African American mothers with income greater than US \$25,000 annually were 4 times as likely to own a tablet computer than their lower income counterparts. Of the participants, 80.8\% (244/302) used social networking, primarily Facebook, and 74.2\% (224/302) were interested in joining a social networking group about a health topic concerning their child. Although relatively few African American mothers (17.9\%, 54/302) shared health information via texting, there was strong interest in receiving health information via mobile phones (87.4\%, 264/302). There was no significant difference in Internet/mobile device use or interest in using these outlets to send/receive information about their children's health between parents of healthy children and parents of children with chronic health conditions. Conclusions: Urban African American parents are active users of the Internet and mobile technology for social interactions, but they are less likely to use it for accessing or communicating health information. However, most parents expressed an interest in receiving health information or utilizing social networking to learn more about health topics. Mobile technology and social networks may be an underutilized method of providing health information to underserved minority populations. ",
doi="10.2196/jmir.2673",
url="http://www.jmir.org/2014/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24418967"
}


@Article{info:doi/10.2196/jmir.2888,
author="Gilbert, Mark
and Hottes, Salway Travis
and Kerr, Thomas
and Taylor, Darlene
and Fairley, K. Christopher
and Lester, Richard
and Wong, Tom
and Trussler, Terry
and Marchand, Rick
and Shoveller, Jean
and Ogilvie, Gina",
title="Factors Associated With Intention to Use Internet-Based Testing for Sexually Transmitted Infections Among Men Who Have Sex With Men",
journal="J Med Internet Res",
year="2013",
month="Nov",
day="14",
volume="15",
number="11",
pages="e254",
keywords="homosexuality",
keywords="male",
keywords="Internet",
keywords="testing",
keywords="human immunodeficiency virus",
keywords="sexually transmitted infection",
keywords="health equity",
keywords="patient acceptance of health care",
abstract="Background: Internet-based testing programs are being increasingly used to reduce testing barriers for individuals at higher risk of infection, yet the population impact and potential for exacerbation of existing health inequities of these programs are not well understood. Objective: We used a large online sample of men who have sex with men (MSM) in Canada to measure acceptability of Internet-based testing and perceived advantages and disadvantages of this testing approach. Methods: We asked participants of the 2011/2012 Sex Now Survey (a serial online survey of gay and bisexual men in Canada) whether they intended to use Internet-based testing and their perceived benefits and disadvantages of use. We examined whether intention to use was associated with explanatory variables spanning (A) sociodemographics, (B) Internet and technology usage, (C) sexually transmitted infections (STI)/ human immunodeficiency virus (HIV) and risk, and (D) health care access and testing, using multivariable logistic regression (variable selection using Bayesian information criterion). Results: Overall, intention to use was high (5678/7938, 71.53\%) among participants with little variation by participant characteristics. In our final model, we retained the variables related to (B) Internet and technology usage: use of Internet to cruise for sex partners (adjusted odds ratio [AOR] 1.46, 95\% CI 1.25-1.70), use of Internet to search for sexual health information (AOR 1.36, 95\% CI 1.23-1.51), and mobile phone usage (AOR 1.19, 95\% 1.13-1.24). We also retained the variables for (D) health care access and testing: not ``out'' to primary care provider (AOR 1.24, 95\% CI 1.10-1.41), delayed/avoided testing due to privacy concerns (AOR 1.77, 95\% CI 1.49-2.11), and delayed/avoided testing due to access issues (AOR 1.65, 95\% CI 1.40-1.95). Finally, we retained the variable being HIV positive (AOR 0.56, 95\% CI 0.46-0.68) or HIV status unknown (AOR 0.89, 95\% CI 0.77-1.01), age <30 years (AOR 1.41, 95\% CI 1.22-1.62), and identifying as bisexual (AOR 1.18, 95\% CI 1.04-1.34) or straight/other (AOR 0.67, 95\% CI 0.50-0.90). The greatest perceived benefits of Internet-based testing were privacy (2249/8388, 26.81\%), general convenience (1701/8388, 20.28\%), and being able to test at any time (1048/8388, 12.49\%). The greatest perceived drawbacks were the inability to see a doctor or nurse (1507/8388, 17.97\%), wanting to talk to someone about results (1430/8388, 17.97\%), not wanting online results (1084/8388, 12.92\%), and low trust (973/8388, 11.60\%). Conclusions: The high and wide-ranging intention to use that we observed suggests Internet-based testing has the potential to reach into all subgroups of MSM and may be particularly appealing to those facing current barriers to accessing STI/HIV testing and who are more comfortable with technology. These findings will be used to inform the promotion and further evaluation of an Internet-based testing program currently under development in British Columbia, Canada. ",
doi="10.2196/jmir.2888",
url="http://www.jmir.org/2013/11/e254/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24240644"
}


@Article{info:doi/10.2196/jmir.2738,
author="Dudas, Arthur Robert
and Crocetti, Michael",
title="Pediatric Caregiver Attitudes Toward Email Communication: Survey in an Urban Primary Care Setting",
journal="J Med Internet Res",
year="2013",
month="Oct",
day="23",
volume="15",
number="10",
pages="e228",
keywords="electronic mail",
keywords="email",
keywords="primary health care",
keywords="communication",
keywords="health care disparities",
keywords="pediatrics",
abstract="Background: Overall usage of email communication between patients and physicians continues to increase, due in part to expanding the adoption of electronic health records and patient portals. Unequal access and acceptance of these technologies has the potential to exacerbate disparities in care. Little is known about the attitudes of pediatric caregivers with regard to their acceptance of email as a means to communicate with their health care providers. Objective: We conducted a survey to assess pediatric caregiver access to and attitudes toward the use of electronic communication modalities to communicate with health care providers in an urban pediatric primary care clinic. Methods: Participants were pediatric caregivers recruited from an urban pediatric primary care clinic in Baltimore, Maryland, who completed a 35-item questionnaire in this cross-sectional study. Results: Of the 229 caregivers who completed the survey (91.2\% response rate), 171 (74.6\%) reported that they use email to communicate with others. Of the email users, 145 respondents (86.3\%) stated that they would like to email doctors, although only 18 (10.7\%) actually do so. Among email users, African-American caregivers were much less likely to support the expanded use of email communication with health care providers (adjusted OR 0.34, 95\% CI 0.14-0.82) as were those with annual incomes less than US \$30,000 (adjusted OR 0.26, 95\% CI 0.09-0.74). Conclusions: Caregivers of children have access to email and many would be interested in communicating with health care providers. However, African-Americans and those in lower socioeconomic groups were much less likely to have positive attitudes toward email. ",
doi="10.2196/jmir.2738",
url="http://www.jmir.org/2013/10/e228/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24152542"
}


@Article{info:doi/10.2196/jmir.2607,
author="Van de Belt, H. Tom
and Engelen, JLPG Lucien
and Berben, AA Sivera
and Teerenstra, Steven
and Samsom, Melvin
and Schoonhoven, Lisette",
title="Internet and Social Media For Health-Related Information and Communication in Health Care: Preferences of the Dutch General Population",
journal="J Med Internet Res",
year="2013",
month="Oct",
day="02",
volume="15",
number="10",
pages="e220",
keywords="social media",
keywords="patient participation",
keywords="consumer health information",
keywords="empowerment",
keywords="Health 2.0",
abstract="Background: Health care is increasingly featured by the use of Web 2.0 communication and collaborative technologies that are reshaping the way patients and professionals interact. These technologies or tools can be used for a variety of purposes: to instantly debate issues, discover news, analyze research, network with peers, crowd-source information, seek support, and provide advice. Not all tools are implemented successfully; in many cases, the nonusage attrition rates are high. Little is known about the preferences of the Dutch general population regarding the use of the Internet and social media in health care. Objective: To determine the preferences of the general population in the Netherlands regarding the use of the Internet and social media in health care. Methods: A cross-sectional survey was disseminated via a popular Dutch online social network. Respondents were asked where they searched for health-related information, how they qualified the value of different sources, and their preferences regarding online communication with health care providers. Results were weighed for the Dutch population based on gender, age, and level of education using official statistics. Numbers and percentages or means and standard deviations were presented for different subgroups. One-way ANOVA was used to test for statistical differences. Results: The survey was completed by 635 respondents. The Internet was found to be the number one source for health-related information (82.7\%), closely followed by information provided by health care professionals (71.1\%). Approximately one-third (32.3\%) of the Dutch population search for ratings of health care providers. The most popular information topics were side effects of medication (62.5\%) and symptoms (59.7\%). Approximately one-quarter of the Dutch population prefer to communicate with a health care provider via social media (25.4\%), and 21.2\% would like to communicate via a webcam. Conclusions: The Internet is the main source of health-related information for the Dutch population. One in 4 persons wants to communicate with their physician via social media channels and it is expected that this number will further increase. Health care providers should explore new ways of communicating online and should facilitate ways for patients to connect with them. Future research should aim at comparing different patient groups and diseases, describing best practices, and determining cost-effectiveness. ",
doi="10.2196/jmir.2607",
url="http://www.jmir.org/2013/10/e220/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24088272"
}


@Article{info:doi/10.2196/jmir.2752,
author="Bianco, Aida
and Zucco, Rossella
and Nobile, A. Carmelo Giuseppe
and Pileggi, Claudia
and Pavia, Maria",
title="Parents Seeking Health-Related Information on the Internet: Cross-Sectional Study",
journal="J Med Internet Res",
year="2013",
month="Sep",
day="18",
volume="15",
number="9",
pages="e204",
keywords="adult",
keywords="consumer health information",
keywords="cross-sectional studies",
keywords="health survey",
keywords="Internet",
keywords="Italy",
keywords="questionnaires",
abstract="Background: The Internet represents an increasingly common source of health-related information, and it has facilitated a wide range of interactions between people and the health care delivery system. Objective: To establish the extent of Internet access and use to gather information about health topics and the potential implications to health care among the adult population in Calabria region, Italy. Methods: This cross-sectional study was conducted from April to June 2012. The sample consisted of 1544 adults aged ?18 years selected among parents of public school students in the geographic area of Catanzaro in southern Italy. A 2-stage sample design was planned. A letter summarizing the purpose of the study, an informed consent form, and a questionnaire were given to selected student to deliver to their parents. The final survey was formulated in 5 sections: (1) sociodemographic characteristics, (2) information about chronic diseases and main sources of health care information, (3) information about Internet use, (4) data about the effects of using the Internet to search for health information, and (5) knowledge and use of social networks. Results: A total of 1039 parents completed the questionnaire, with a response rate equivalent to 67.29\%. Regarding health-related information types, 84.7\% of respondents used the Internet to search for their own medical conditions or those of family members or relatives, 40.7\% of parents reported looking for diet, body weight, or physical activity information, 29.6\% searched for vaccines, 28.5\% for screening programs, and 16.5\% for smoking cessation tools and products. The results of the multiple logistic regression analysis showed that parents who looked for health-related information on the Internet were more likely to be female (OR 1.53, 95\% CI 1.05-2.25), with a high school diploma (OR 1.69, 95\% CI 1.02-2.81) or college degree (OR 2.14, 95\% CI 1.21-3.78), younger aged (OR 0.96, 95\% CI 0.94-0.99), with chronic conditions (OR 1.94, 95\% CI 1.17-3.19), not satisfied with their general practitioner's health-related information (OR 0.6, 95\% CI 0.38-0.97), but satisfied with information from scientific journals (OR 1.99, 95\% CI 1.33-2.98). Conclusions: Our analyses provide important insights into Internet use and health information--seeking behaviors of the Italian population and contribute to the evidence base for health communication planning. Health and public health professionals should educate the public about acquiring health information online and how to critically appraise it, and provide tools to navigate to the highest-quality information. The challenge to public health practice is to facilitate the health-promoting use of the Web among consumers in conjunction with their health care providers. ",
doi="10.2196/jmir.2752",
url="http://www.jmir.org/2013/9/e204/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24047937"
}


@Article{info:doi/10.2196/jmir.2724,
author="Post, Ann Lori
and Vaca, E. Federico
and Doran, M. Kelly
and Luco, Cali
and Naftilan, Matthew
and Dziura, James
and Brandt, Cynthia
and Bernstein, Steven
and Jagminas, Liudvikas
and D'Onofrio, Gail",
title="New Media Use by Patients Who Are Homeless: The Potential of mHealth to Build Connectivity",
journal="J Med Internet Res",
year="2013",
month="Sep",
day="03",
volume="15",
number="9",
pages="e195",
keywords="homelessness",
keywords="mHealth",
keywords="connectivity",
keywords="emergency department",
abstract="Background: Patients experiencing homelessness represent a disproportionate share of emergency department (ED) visits due to poor access to primary care and high levels of unmet health care needs. This is in part due to the difficulty of communicating and following up with patients who are experiencing homelessness. Objective: To determine the prevalence and types of ``new media'' use among ED patients who experience homelessness. Methods: This was a cross-sectional observational study with sequential enrolling of patients from three emergency departments 24/7 for 6 weeks. In total, 5788 ED patients were enrolled, of whom 249 experienced homelessness. Analyses included descriptive statistics, and unadjusted and adjusted odds ratios. Results: 70.7\% (176/249) of patients experiencing homelessness own cell phones compared to 85.90\% (4758/5539) of patients in stable housing (P=.001) with the former more likely to own Androids, 70\% (53/76) versus 43.89\% (1064/2424), and the latter more likely to have iPhones, 44.55\% (1080/2424) versus 17\% (13/76) (P=.001). There is no significant difference in new media use, modality, or frequency for both groups; however, there is a difference in contract plan with 50.02\% (2380/4758) of stably housed patients having unlimited minutes versus 37.5\% (66/176) of homeless patients. 19.78\% (941/4758) of patients in stable housing have pay-as-you-go plans versus 33.0\% (58/176) of homeless patients (P=.001). Patients experiencing homelessness are more likely to want health information on alcohol/substance abuse, mental health, domestic violence, pregnancy and smoking cessation. Conclusions: This study is unique in its characterization of new media ownership and use among ED patients experiencing homelessness. New media is a powerful tool to connect patients experiencing homelessness to health care. ",
doi="10.2196/jmir.2724",
url="http://www.jmir.org/2013/9/e195/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24001876"
}


@Article{info:doi/10.2196/med20.2559,
author="Jones, Ray",
title="Development of a Questionnaire and Cross-Sectional Survey of Patient eHealth Readiness and eHealth Inequalities",
journal="Med 2.0",
year="2013",
month="Sep",
day="02",
volume="2",
number="2",
pages="e9",
keywords="eHealth readiness",
keywords="eHealth inequalities",
keywords="digital divide",
keywords="questionnaire development",
abstract="Background: Many speak of the digital divide, but variation in the opportunity of patients to use the Internet for health (patient eHealth readiness) is not a binary difference, rather a distribution influenced by personal capability, provision of services, support, and cost. Digital divisions in health have been addressed by various initiatives, but there was no comprehensive validated measure to know if they are effective that could be used in randomized controlled trials (RCTs) covering both non-Internet-users and the range of Internet-users. Objective: The aim of this study was to develop and validate a self-completed questionnaire and scoring system to assess patient eHealth readiness by examining the spread of scores and eHealth inequalities. The intended use of this questionnaire and scores is in RCTs of interventions aiming to improve patient eHealth readiness and reduce eHealth inequalities. Methods: Based on four factors identified from the literature, a self-completed questionnaire, using a pragmatic combination of factual and attitude questions, was drafted and piloted in three stages. This was followed by a final population-based, cross-sectional household survey of 344 people used to refine the scoring system. Results: The Patient eHealth Readiness Questionnaire (PERQ) includes questions used to calculate four subscores: patients' perception of (1) provision, (2) their personal ability and confidence, (3) their interpersonal support, and (4) relative costs in using the Internet for health. These were combined into an overall PERQ score (0-9) which could be used in intervention studies. Reduction in standard deviation of the scores represents reduction in eHealth inequalities. Conclusions: PERQ appears acceptable for participants in British studies. The scores produced appear valid and will enable assessment of the effectiveness of interventions to improve patient eHealth readiness and reduce eHealth inequalities. Such methods need continued evolution and redevelopment for other environments. Full documentation and data have been published to allow others to develop the tool further. ",
doi="10.2196/med20.2559",
url="http://www.medicine20.com/2013/2/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25075244"
}


@Article{info:doi/10.2196/jmir.2635,
author="Rai, Arun
and Chen, Liwei
and Pye, Jessica
and Baird, Aaron",
title="Understanding Determinants of Consumer Mobile Health Usage Intentions, Assimilation, and Channel Preferences",
journal="J Med Internet Res",
year="2013",
month="Aug",
day="02",
volume="15",
number="8",
pages="e149",
keywords="mobile health",
keywords="consumer preferences",
keywords="adoption",
keywords="health information technology",
keywords="multivariate analyses",
abstract="Background: Consumer use of mobile devices as health service delivery aids (mHealth) is growing, especially as smartphones become ubiquitous. However, questions remain as to how consumer traits, health perceptions, situational characteristics, and demographics may affect consumer mHealth usage intentions, assimilation, and channel preferences. Objective: We examine how consumers' personal innovativeness toward mobile services (PIMS), perceived health conditions, health care availability, health care utilization, demographics, and socioeconomic status affect their (1) mHealth usage intentions and extent of mHealth assimilation, and (2) preference for mHealth as a complement or substitute for in-person doctor visits. Methods: Leveraging constructs from research in technology acceptance, technology assimilation, consumer behavior, and health informatics, we developed a cross-sectional online survey to study determinants of consumers' mHealth usage intentions, assimilation, and channel preferences. Data were collected from 1132 nationally representative US consumers and analyzed by using moderated multivariate regressions and ANOVA. Results: The results indicate that (1) 430 of 1132 consumers in our sample (37.99\%) have started using mHealth, (2) a larger quantity of consumers are favorable to using mHealth as a complement to in-person doctor visits (758/1132, 66.96\%) than as a substitute (532/1132, 47.00\%), and (3) consumers' PIMS and perceived health conditions have significant positive direct influences on mHealth usage intentions, assimilation, and channel preferences, and significant positive interactive influences on assimilation and channel preferences. The independent variables within the moderated regressions collectively explained 59.70\% variance in mHealth usage intentions, 60.41\% in mHealth assimilation, 34.29\% in preference for complementary use of mHealth, and 45.30\% in preference for substitutive use of mHealth. In a follow-up ANOVA examination, we found that those who were more favorable toward using mHealth as a substitute for in-person doctor visits than as a complement indicated stronger intentions to use mHealth (F1,702=20.14, P<.001) and stronger assimilation of mHealth (F1,702=41.866, P<.001). Conclusions: Multiple predictors are shown to have significant associations with mHealth usage intentions, assimilation, and channel preferences. We suggest that future initiatives to promote mHealth should shift targeting of consumers from coarse demographics to nuanced considerations of individual dispositions toward mobile service innovations, complementary or substitutive channel use preferences, perceived health conditions, health services availability and utilization, demographics, and socioeconomic characteristics. ",
doi="10.2196/jmir.2635",
url="http://www.jmir.org/2013/8/e149/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23912839"
}


@Article{info:doi/10.2196/jmir.2612,
author="McCully, N. Scout
and Don, P. Brian
and Updegraff, A. John",
title="Using the Internet to Help With Diet, Weight, and Physical Activity: Results From the Health Information National Trends Survey (HINTS)",
journal="J Med Internet Res",
year="2013",
month="Aug",
day="01",
volume="15",
number="8",
pages="e148",
keywords="physical activity",
keywords="weight loss",
keywords="dietary habits",
keywords="Web-based",
keywords="Internet",
keywords="utilization",
abstract="Background: The Internet offers a viable platform for cost-effective and wide-reaching health interventions. However, little is known about use of the Internet to help with diet, weight, and physical activity (DWPA) using a nationally representative sample from the United States. Objective: To (1) assess the demographic characteristics of people who use the Internet to help with DWPA, (2) assess whether usage trends changed over time, and (3) investigate the associations between using the Internet for DWPA and health behaviors. Methods: Data on Internet users from the 2007 and 2011 iterations of the Health Information National Trends Survey (HINTS), N=4827 were analyzed using multiple logistic regression to determine the demographic correlates of using the Internet for help with DWPA. Multiple linear regression was used to test the associations between Internet use for DWPA and three health behaviors: fruit intake, vegetable intake, and physical activity. Results: A larger percentage of Internet users used the Internet for DWPA in 2011 (42.83\%) than in 2007 (40.43\%). In general, Internet users who were younger (OR 0.98, P<.001), more educated (OR 1.40, P<.001), married (OR 1.06, P=.03), of a minority race (non-Hispanic blacks: OR 1.14, P=.02; Hispanics: OR 1.42, P=.01), and who had a higher Body Mass Index (BMI) (OR 1.04, P<.001) were more likely to use the Internet for DWPA. Across survey years, gender was not associated with using the Internet for DWPA (OR 1.03, P=.12), but there was a significant interaction between survey year and gender (OR 1.95, P=.002); in 2007, men were more likely to use the Internet for DWPA, but women were more likely to do so in 2011. Using the Internet for DWPA was associated with more vegetable intake (B=.22, P=.002), more fruit intake (B=.19, P=.001), and more moderate exercise (B=.25, P=.001), although the strength of the associations between using the Internet for DWPA and fruit intake and exercise was weaker in 2011 than in 2007. Conclusions: Contrary to prior research, our population-level study did not show a pronounced gender difference in the use of the Internet for DWPA. Our results support the increasing viability of the Internet as a platform for behavior change intervention, as a growing percentage of Internet users are turning to the Internet for help with DWPA. Additionally, using the Internet for DWPA is associated with better DWPA-related health behaviors. ",
doi="10.2196/jmir.2612",
url="http://www.jmir.org/2013/8/e148/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23906945"
}


@Article{info:doi/10.2196/jmir.2472,
author="Zulman, M. Donna
and Piette, D. John
and Jenchura, C. Emily
and Asch, M. Steven
and Rosland, Ann-Marie",
title="Facilitating Out-of-Home Caregiving Through Health Information Technology: Survey of Informal Caregivers' Current Practices, Interests, and Perceived Barriers",
journal="J Med Internet Res",
year="2013",
month="Jul",
day="10",
volume="15",
number="7",
pages="e123",
keywords="caregivers",
keywords="chronic disease",
keywords="medical informatics",
abstract="Background: Many patients with chronic conditions are supported by out-of-home informal caregivers---family members, friends, and other individuals who provide care and support without pay---who, if armed with effective consumer health information technology, could inexpensively facilitate their care. Objective: We sought to understand caregivers' use of, interest in, and perceived barriers to health information technology for out-of-home caregiving. Methods: We conducted 2 sequential Web-based surveys with a national sample of individuals who provide out-of-home caregiving to an adult family member or friend with a chronic illness. We queried respondents about their use of health information technology for out-of-home caregiving and used multivariable regression to investigate caregiver and care-recipient characteristics associated with caregivers' technology use for caregiving. Results: Among 316 out-of-home caregiver respondents, 34.5\% (109/316) reported using health information technology for caregiving activities. The likelihood of a caregiver using technology increased significantly with intensity of caregiving (as measured by number of out-of-home caregiving activities). Compared with very low intensity caregivers, the adjusted odds ratio (OR) of technology use was 1.88 (95\% CI 1.01-3.50) for low intensity caregivers, 2.39 (95\% CI 1.11-5.15) for moderate intensity caregivers, and 3.70 (95\% CI 1.62-8.45) for high intensity caregivers. Over 70\% (149/207) of technology nonusers reported interest in using technology in the future to support caregiving. The most commonly cited barriers to technology use for caregiving were health system privacy rules that restrict access to care-recipients' health information and lack of familiarity with programs or websites that facilitate out-of-home caregiving. Conclusions: Health information technology use for out-of-home caregiving is common, especially among individuals who provide more intense caregiving. Health care systems can address the mismatch between caregivers' interest in and use of technology by modifying privacy policies that impede information exchange. ",
doi="10.2196/jmir.2472",
url="http://www.jmir.org/2013/7/e123/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23841987"
}


@Article{info:doi/10.2196/jmir.2333,
author="Choi, G. Namkee
and DiNitto, M. Diana",
title="Internet Use Among Older Adults: Association With Health Needs, Psychological Capital, and Social Capital",
journal="J Med Internet Res",
year="2013",
month="May",
day="16",
volume="15",
number="5",
pages="e97",
keywords="older adults",
keywords="Internet use",
keywords="health needs",
keywords="psychological capital",
keywords="social capital",
abstract="Background: Previous studies have identified socioeconomic status and health status as predictors of older adults' computer and Internet use, but researchers have not examined the relationships between older adults' health needs and psychological capital (emotional well-being and self-efficacy) and social capital (social integration/ties and support networks) to different types of Internet use. Objective: This study examined (1) whether older adults' health conditions and psychological and social capital differentiate Internet users from nonusers, and (2) whether the Internet users differed in their types of Internet use on the basis of their health conditions and psychological and social capital. Methods: Data for this study came from the National Health and Aging Trends Study, which is based on a nationally representative sample of US Medicare beneficiaries aged 65 years and older. The sample for this study were those who resided in the community in their own or others' homes (N=6680). Binary logistic regression analysis was used to compare health needs, psychological capital, and social capital among (1) any type of Internet users and nonusers, (2) Internet users who engaged in health-related tasks and Internet users who did not, (3) Internet users who engaged in shopping/banking tasks and Internet users who did not, and (4) Internet users only used the Internet for email/texting and all other Internet users. Results: Depressive and anxiety symptoms, measures of psychological capital, were negatively associated with Internet use among older adults (odds ratio [OR] 0.83, 95\% CI 0.70-0.98, P=.03 and OR 0.79, 95\% CI 0.65-0.97, P=.03, respectively), whereas most measures of social capital were positively associated with Internet use. Having more chronic medical conditions and engaging in formal volunteering increased the odds of Internet use for health-related tasks by 1.15 (95\% CI 1.08-1.23, P<.001) and 1.28 (95\% CI 1.05-1.57, P=.02), respectively, but anxiety symptoms decreased the odds (OR 0.74, 95\% CI 0.55-0.99, P=.05). Religious service attendance was negatively associated with Internet use for shopping/banking activities (OR 0.75, 95\% CI 0.62-0.91, P=.01). Anxiety symptoms increased the odds of using the Internet only for emails/texting (OR 1.75, 95\% CI 1.12-2.75, P=.02), but formal volunteering decreased the odds (OR 0.63, 95\% CI 0.43-0.92, P=.02). Other correlates of Internet use solely for emails/texting were older age (80-84 years and ?85 years), a black or ``other'' racial/ethnic background, a high school education or less than high school, and lower income. Conclusions: The findings point to the importance of social capital in facilitating older adults' learning and adoption of Internet technology. Older adults who used the Internet for email/texting purposes only were the most socially and economically disadvantaged group of Internet users. Computer/Internet training for older adults and computer/Internet use for various purposes need to consider the significant role their social capital can play. ",
doi="10.2196/jmir.2333",
url="http://www.jmir.org/2013/5/e97/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23681083"
}


@Article{info:doi/10.2196/jmir.2221,
author="Thor{\'e}n, Sundewall Elisabet
and {\"O}berg, Marie
and W{\"a}nstr{\"o}m, Gunilla
and Andersson, Gerhard
and Lunner, Thomas",
title="Internet Access and Use in Adults With Hearing Loss",
journal="J Med Internet Res",
year="2013",
month="May",
day="09",
volume="15",
number="5",
pages="e91",
keywords="hearing loss",
keywords="hearing rehabilitation",
keywords="Internet",
keywords="trends",
abstract="Background: The future rehabilitation of adults with hearing loss is likely to involve online tools used by individuals at home. Online tools could also be useful for people who are not seeking professional help for their hearing problems. Hearing impairment is a disability that increases with age, and increased age is still associated with reduced use of the Internet. Therefore, to continue the research on online audiological rehabilitative tools for people with hearing loss, it is important to determine if and to what extent adults with hearing loss use the Internet. Objective: To evaluate the use of the Internet and email in a group of adults with hearing loss and to investigate if their use of Internet and email differed between genders, among different age groups, and how it compared with the general population in Sweden. Methods: Questionnaires containing multiple-choice questions about Internet access, email use, and educational level were mailed to individuals with hearing loss, who were registered as patients at a hearing aid clinic. Out of the 269 invited participants, 158 returned a completed questionnaire, which was a response rate of 58.7\%. Results: The results showed that 60\% (94/158) of the participants with hearing loss used computers and the Internet. The degree of hearing loss in the group of participants did not explain the level of Internet usage, while factors of age, gender, and education did (P<.001). More men than women used the Internet (OR 2.54, 95\% CI 1.32-4.91, P<.001). Use of the Internet was higher in the youngest age group (25-64 years) compared to the oldest age group (75-96 years, P=.001). A higher usage of the Internet was observed in the participants with hearing loss, especially the elderly, when compared with the general population of Sweden (OR 1.74, 95\% CI 1.23-3.17, P=.04). Conclusions: We conclude that the use of computers and the Internet overall is at least at the same level for people with hearing loss as for the general age-matched population in Sweden, but that this use is even higher in specific age groups. These results are important for the future work in developing and evaluating rehabilitative educational online tools for adults with hearing loss. ",
doi="10.2196/jmir.2221",
url="http://www.jmir.org/2013/5/e91/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23659867"
}


@Article{info:doi/10.2196/jmir.2645,
author="Choi, G. Namkee
and DiNitto, M. Diana",
title="The Digital Divide Among Low-Income Homebound Older Adults: Internet Use Patterns, eHealth Literacy, and Attitudes Toward Computer/Internet Use",
journal="J Med Internet Res",
year="2013",
month="May",
day="02",
volume="15",
number="5",
pages="e93",
keywords="homebound older adults",
keywords="housebound older adults",
keywords="Internet",
keywords="eHealth literacy",
keywords="attitudes toward Internet",
abstract="Background: Internet technology can provide a diverse array of online resources for low-income disabled and homebound older adults to manage their health and mental health problems and maintain social connections. Despite many previous studies of older adults' Internet use, none focused on these most vulnerable older adults. Objective: This study examined Internet use patterns, reasons for discontinued use, eHealth literacy, and attitudes toward computer/Internet use among low-income homebound individuals aged 60 and older in comparison to their younger counterparts---homebound adults under age 60. Methods: Face-to-face or telephone surveys were conducted with 980 recipients of home-delivered meals in central Texas (78\% were age 60 years and older and 22\% under age 60). The eHealth Literacy Scale (eHEALS) and the efficacy and interest subscales of the Attitudes Toward Computer/Internet Questionnaire (ATC/IQ) were used to measure the respective constructs. Age groups were compared with chi-square tests and t tests. Correlates of Internet use were analyzed with multinomial logistic regression, and correlates of eHEALS and ATC/IQ scores were analyzed with OLS regression models. Results: Only 34\% of the under-60 group and 17\% of the 60 years and older group currently used the Internet, and 35\% and 16\% of the respective group members reported discontinuing Internet use due to cost and disability. In addition to being older, never users were more likely to be black (OR 4.41; 95\% CI 2.82-6.91, P<.001) or Hispanic (OR 4.69; 95\% CI 2.61-8.44, P<.001), and to have lower incomes (OR 0.36; 95\% CI 0.27-0.49, P<.001). Discontinued users were also more likely to be black or Hispanic and to have lower incomes. Among both age groups, approximately three-fourths of the current users used the Internet every day or every few days, and their eHEALS scores were negatively associated with age and positively associated with frequency of use. Among the 60 and older group, a depression diagnosis was also negatively associated with eHEALS scores. ATC/IQ efficacy among never users of all ages and among older adults was positively associated with living alone, income, and the number of medical conditions and inversely associated with age, Hispanic ethnicity, and Spanish as the primary language. Although ATC/IQ interest among older adults was also inversely associated with age, it was not associated with Hispanic ethnicity and Spanish as the primary language. Conclusions: This study is the first to describe in detail low-income disabled and homebound adults' and older adults' Internet use. It shows very low rates of Internet use compared to the US population, either due to lack of exposure to computer/Internet technology; lack of financial resources to obtain computers and technology; or medical conditions, disabilities, and associated pain that restrict use. Recommendations to reduce the digital divide among these individuals are provided. ",
doi="10.2196/jmir.2645",
url="http://www.jmir.org/2013/5/e93/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23639979"
}


@Article{info:doi/10.2196/jmir.2317,
author="Nundy, Shantanu
and Razi, R. Rabia
and Dick, J. Jonathan
and Smith, Bryan
and Mayo, Ainoa
and O'Connor, Anne
and Meltzer, O. David",
title="A Text Messaging Intervention to Improve Heart Failure Self-Management After Hospital Discharge in a Largely African-American Population: Before-After Study",
journal="J Med Internet Res",
year="2013",
month="Mar",
day="11",
volume="15",
number="3",
pages="e53",
keywords="heart failure",
keywords="self-care",
keywords="patient education",
keywords="cellular phone",
keywords="text messaging",
keywords="African Americans",
abstract="Background: There is increasing interest in finding novel approaches to reduce health disparities in readmissions for acute decompensated heart failure (ADHF). Text messaging is a promising platform for improving chronic disease self-management in low-income populations, yet is largely unexplored in ADHF. Objective: The purpose of this pre-post study was to assess the feasibility and acceptability of a text message--based (SMS: short message service) intervention in a largely African American population with ADHF and explore its effects on self-management. Methods: Hospitalized patients with ADHF were enrolled in an automated text message--based heart failure program for 30 days following discharge. Messages provided self-care reminders and patient education on diet, symptom recognition, and health care navigation. Demographic and cell phone usage data were collected on enrollment, and an exit survey was administered on completion. The Self-Care of Heart Failure Index (SCHFI) was administered preintervention and postintervention and compared using sample t tests (composite) and Wilcoxon rank sum tests (individual). Clinical data were collected through chart abstraction. Results: Of 51 patients approached for recruitment, 27 agreed to participate and 15 were enrolled (14 African-American, 1 White). Barriers to enrollment included not owning a personal cell phone (n=12), failing the Mini-Mental exam (n=3), needing a proxy (n=2), hard of hearing (n=1), and refusal (n=3). Another 3 participants left the study for health reasons and 3 others had technology issues. A total of 6 patients (5 African-American, 1 White) completed the postintervention surveys. The mean age was 50 years (range 23-69) and over half had Medicaid or were uninsured (60\%, 9/15). The mean ejection fraction for those with systolic dysfunction was 22\%, and at least two-thirds had a prior hospitalization in the past year. Participants strongly agreed that the program was easy to use (83\%), reduced pills missed (66\%), and decreased salt intake (66\%). Maintenance (mean composite score 49 to 78, P=.003) and management (57 to 86, P=.002) improved at 4 weeks, whereas confidence did not change (57 to 75, P=.11). Of the 6 SCHFI items that showed a statistically significant improvement, 5 were specifically targeted by the texting intervention. Conclusions: Over half of ADHF patients in an urban, largely African American community were eligible and interested in participating in a text messaging program following discharge. Access to mobile phones was a significant barrier that should be addressed in future interventions. Among the participants who completed the study, we observed a high rate of satisfaction and preliminary evidence of improvements in heart failure self-management. ",
doi="10.2196/jmir.2317",
url="http://www.jmir.org/2013/3/e53/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23478028"
}


@Article{info:doi/10.2196/jmir.2297,
author="Thackeray, Rosemary
and Crookston, T. Benjamin
and West, H. Joshua",
title="Correlates of Health-Related Social Media Use Among Adults",
journal="J Med Internet Res",
year="2013",
month="Jan",
day="30",
volume="15",
number="1",
pages="e21",
keywords="social media",
keywords="Internet",
keywords="health information",
keywords="consumer",
abstract="Background: Sixty percent of Internet users report using the Internet to look for health information. Social media sites are emerging as a potential source for online health information. However, little is known about how people use social media for such purposes. Objectives: The purpose of this study was two-fold: (1) to establish the frequency of various types of online health-seeking behaviors, and (2) to identify correlates of 2 health-related online activities, social networking sites (SNS) for health-related activities and consulting online user-generated content for answers about health care providers, health facilities, or medical treatment. Methods: The study consisted of a telephone survey of 1745 adults who reported going online to look for health-related information. Four subscales were created to measure use of online resources for (1) using SNS for health-related activities; (2) consulting online rankings and reviews of doctors, hospitals or medical facilities, and drugs or medical treatments; (3) posting a review online of doctors, hospitals or medical facilities, and drugs or medical treatments, and (4) posting a comment or question about health or medical issues on various social media. Univariate and multivariate logistic regression analyses were performed. Results: Respondents consulted online rankings or reviews (41.15\%), used SNS for health (31.58\%), posted reviews (9.91\%), and posted a comment, question, or information (15.19\%). Respondents with a chronic disease were nearly twice as likely to consult online rankings (odds ratio [OR] 2.09, 95\% CI 1.66-2.63, P<.001). Lower odds of consulting online reviews were associated with less formal education (OR 0.49, 95\% CI 0.37-0.65, P<.001) and being male (OR 0.71, 95\% CI 0.57-0.87, P<.001). Respondents with higher incomes were 1.5 times as likely to consult online rankings or reviews (OR 1.49, 95\% CI 0.10-2.24, P=.05), than respondents with a regular provider (OR 2.05, 95\% CI 1.52-2.78, P<.001), or living in an urban/suburban location (OR 1.61, 95\% CI 1.17-2.22, P<.001). Older respondents were less likely to use SNS for health-related activities (OR 0.96, 95\% CI 0.95-0.97, P<.001), as were males (OR 0.70, 95\% CI 0.56-0.87, P<.001), whereas respondents with a regular provider had nearly twice the likelihood of using SNS for health-related activities (OR 1.89, 95\% CI 1.43-2.52, P<.001). Conclusions: People are using social media for seeking health information. However, individuals are more likely to consume information than they are to contribute to the dialog. The inherent value of ``social'' in social media is not being captured with online health information seeking. People with a regular health care provider, chronic disease, and those in younger age groups are more likely to consult online rankings and reviews and use SNS for health-related activities. ",
doi="10.2196/jmir.2297",
url="http://www.jmir.org/2013/1/e21/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23367505"
}


@Article{info:doi/10.2196/ijmr.2314,
author="Zarghom, Saman
and Di Fonzo, David
and Leung, Fok-Han",
title="Does Socioeconomic Status Affect Patients' Ease of Use of a Touch-Screen (iPad) Patient Survey?",
journal="Interact J Med Res",
year="2013",
month="Jan",
day="11",
volume="2",
number="1",
pages="e1",
keywords="socioeconomic factors",
keywords="age factors",
keywords="medical informatics",
keywords="computer-user interface",
doi="10.2196/ijmr.2314",
url="http://www.i-jmr.org/2013/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23612116"
}


@Article{info:doi/10.2196/jmir.2358,
author="Duplaga, Mariusz",
title="Acceptance of Internet-Based Health Care Services Among Households in Poland: Secondary Analysis of a Population-Based Survey",
journal="J Med Internet Res",
year="2012",
month="Nov",
day="27",
volume="14",
number="6",
pages="e164",
keywords="eHealth",
keywords="health care service",
keywords="Internet use",
keywords="computer use",
abstract="Background: Polish society is benefiting from growing access to the Internet, but the use of advanced e-services is still limited. The provision of Internet-based health services depends not only on the penetration of the Internet into society, but also on the acceptance of this technology by potential users. Objective: The main objective of this study was focused on the assessment of predictors of acceptance of Internet use for provision of health services (eg, sociodemographic status, the use of information technologies, and consumption of health care services) among households in Poland. Methods: The study was based on a secondary analysis of the dataset from the 2011 Social Diagnosis survey (a biannual survey conducted since 2001 about economic and non-economic aspects of household and individual living conditions in Poland). Analysis of the questionnaire results focused on the situations of the households included in the study. The predictors for 2 outcome variables describing the acceptance of households for Internet use for provision of a full health care service, or at least access to information and download of required forms, were assessed using multivariate logistic regression.  Results: After excluding those households that would not consider the use of health care services or for which predictor variables assumed missing values, the final analyses were conducted on data from 8915 households. Acceptance of the use of the Internet for provision of full health care services in Polish households was significantly higher among households in urban locations with ? 200,000 inhabitants than among households in rural areas; it was also higher with salaried employment as the source of income than with self-employment in agriculture (odds ratio [OR] = 0.53, 95\% CI 0.40 - 0.70), retirement pension (OR = 0.46, 95\% CI 0.39 - 0.54), disability pension (OR = 0.48, 95\% CI 0.34 - 0.68), or with several simultaneous income sources (OR = 0.66; 95\% CI 0.57 - 0.79). Furthermore, acceptance of Internet-based health care was higher in households with a higher monthly net income per capita (OR = 2.11, 95\% CI 1.75 - 2.53 for households from the lowest and the highest income interval), among households with > 1 child aged < 15 years (OR = 1.38, 95\% CI 1.20 - 1.59), among households with at least some books (with OR = 3.33, 95\% CI 2.39 - 4.64 for household with no books and those with over 500 books). Acceptance was also higher in households with a computer (OR = 1.86, 95\% CI 1.35 - 2.56), Internet access (OR = 1.95, 95\% CI 1.37 - 2.76), and Internet access for a longer duration (OR = 1.36, 95\% CI 1.06 - 1.75 and OR = 1.81, 95\% CI 1.40 - 2.33 for households with access < 1 year versus those with access for 1-5 years and > 5 years, respectively). Greater self-declared confidence in using technology was also associated with higher acceptance of the Internet for health care services (OR = 2.94, 95\% CI 2.21 - 3.91 for the least confident households versus those with the highest confidence). Furthermore, recent use of health care services increased acceptance of using the Internet for at least some health-related services (OR = 1.49, 95\% CI 1.16 - 1.91), but not for full provision of online health care services (OR = 1.20, 95\% CI 0.92 - 1.55). Neither the hospitalization of a member of a household nor the opinion about satisfying health care needs of a household affected the degree of acceptance. Conclusions: The acceptance of health care services through the Internet is higher in households from larger cities, with stable income from an employee salary, as well as with higher income levels per capita. Furthermore, general computer and Internet use in the household influenced the perception of eHealth. Paradoxically, the use of health care services or the level of satisfaction with the coverage of the household's health needs has a limited influence on acceptance of Internet-based health care services. ",
doi="10.2196/jmir.2358",
url="http://www.jmir.org/2012/6/e164/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23187116"
}


@Article{info:doi/10.2196/jmir.2036,
author="Henshaw, Helen
and Clark, A. Daniel P.
and Kang, Sujin
and Ferguson, A. Melanie",
title="Computer Skills and Internet Use in Adults Aged 50-74 Years: Influence of Hearing Difficulties",
journal="J Med Internet Res",
year="2012",
month="Aug",
day="24",
volume="14",
number="4",
pages="e113",
keywords="hearing loss",
keywords="hearing difficulties",
keywords="screening",
keywords="intervention",
keywords="hearing health care",
keywords="eHealth",
keywords="personal computer",
keywords="Internet use.",
abstract="Background: The use of personal computers (PCs) and the Internet to provide health care information and interventions has increased substantially over the past decade. Yet the effectiveness of such an approach is highly dependent upon whether the target population has both access and the skill set required to use this technology. This is particularly relevant in the delivery of hearing health care because most people with hearing loss are over 50 years (average age for initial hearing aid fitting is 74 years). Although PC skill and Internet use by demographic factors have been examined previously, data do not currently exist that examine the effects of hearing difficulties on PC skill or Internet use in older adults. Objective: To explore the effect that hearing difficulty has on PC skill and Internet use in an opportunistic sample of adults aged 50-74 years. Methods: Postal questionnaires about hearing difficulty, PC skill, and Internet use (n=3629) were distributed to adults aged 50-74 years through three family physician practices in Nottingham, United Kingdom. A subsample of 84 respondents completed a second detailed questionnaire on confidence in using a keyboard, mouse, and track pad. Summed scores were termed the ``PC confidence index.'' The PC confidence index was used to verify the PC skill categories in the postal questionnaire (ie, never used a computer, beginner, and competent). Results: The postal questionnaire response rate was 36.78\% (1298/3529) and 95.15\% (1235/1298) of these contained complete information. There was a significant between-category difference for PC skill by PC confidence index (P<.001), thus verifying the three-category PC skill scale. PC and Internet use was greater in the younger respondents (50-62 years) than in the older respondents (63-74 years). The younger group's PC and Internet use was 81.0\% and 60.9\%, respectively; the older group's PC and Internet use was 54.0\% and 29.8\%, respectively. Those with slight hearing difficulties in the older group had significantly greater odds of PC use compared to those with no hearing difficulties (odds ratio [OR]=1.57, 95\% confidence interval [CI] 1.06-2.30, P=.02). Those with moderate+ hearing difficulties had lower odds of PC use compared with those with no hearing difficulties, both overall (OR=0.58, 95\% CI 0.39-0.87, P=.008) and in the younger group (OR=0.49, 95\% CI 0.26-0.86, P=.008). Similar results were demonstrated for Internet use by age group (older: OR=1.57, 95\% CI 0.99-2.47, P=.05; younger: OR=0.32, 95\% CI 0.16-0.62, P=.001). Conclusions: Hearing health care is of particular relevance to older adults because of the prevalence of age-related hearing loss. Our data show that older adults experiencing slight hearing difficulty have increased odds of greater PC skill and Internet use than those reporting no difficulty. These findings suggest that PC and Internet delivery of hearing screening, information, and intervention is feasible for people between 50-74 years who have hearing loss, but who would not typically present to an audiologist. ",
doi="10.2196/jmir.2036",
url="http://www.jmir.org/2012/4/e113/",
url="http://www.ncbi.nlm.nih.gov/pubmed/22954484"
}


@Article{info:doi/10.2196/jmir.2007,
author="Finney Rutten, J. Lila
and Hesse, W. Bradford
and Moser, P. Richard
and Ortiz Martinez, Patricia Ana
and Kornfeld, Julie
and Vanderpool, C. Robin
and Byrne, Margaret
and Tortolero Luna, Guillermo",
title="Socioeconomic and Geographic Disparities in Health Information Seeking and Internet Use in Puerto Rico",
journal="J Med Internet Res",
year="2012",
month="Jul",
day="19",
volume="14",
number="4",
pages="e104",
keywords="Health information seeking",
keywords="cancer information seeking",
keywords="Internet use",
keywords="disparities",
keywords="special populations",
keywords="geographic trends",
abstract="Background: Geographically isolated Hispanic populations, such as those living in Puerto Rico, may face unique barriers to health information access. However, little is known about health information access and health information-seeking behaviors of this population. Objective: To examine differences in health and cancer information seeking among survey respondents who ever used the Internet and those who did not, and to explore sociodemographic and geographic trends. Methods: Data for our analyses were from a special implementation of the Health Information National Trends Survey conducted in Puerto Rico in 2009. We collected data through random digit dialing, computer-assisted telephone interviews (N = 639). The sample was drawn from the eight geographic regions of the Puerto Rico Department of Health. To account for complex survey design and perform weighted analyses to obtain population estimates, we analyzed the data using SUDAAN. Frequencies, cross-tabulation with chi-square, and logistic regression analyses were conducted. Geographic information system maps were developed to examine geographic distributions of Internet use and information seeking. Results: Of 639 participants, 142 (weighted percentage 32.7\%) indicated that they had ever gone online to access the Internet or World Wide Web; this proportion was substantially lower than that of US mainland Hispanics who reported using the Internet (49\%). While 101 of 142 (weighted percentage 59.6\%) respondents who used the Web had ever sought health information, only 118 of 497 (weighted percentage 20.0\%) of those who did not use the Web had sought health information. The pattern was similar for cancer information: 76 of 142 respondents (weighted percentage 47.2\%) who used the Web had ever sought cancer information compared with 105 of 497 (weighted percentage 18.8\%) of those who had not used the Web. These results were slightly lower but generally consistent with US mainland Hispanics' health (50.9\%) and cancer (26.4\%) information seeking. Results of separate logistic regression models controlling for sociodemographic characteristics demonstrated that, compared with individuals who did not seek health or cancer information, those who did were over 5 times as likely to have used the Internet (odds ratio 5.11, P < .001). Those who sought cancer information were over twice as likely to have used the Internet (odds ratio 2.5, P < .05). The frequency of Internet use and health and cancer information seeking was higher in the San Juan metro region than in more rural areas. Conclusions: Our results contribute to the evidence base for health and cancer communication planning for Puerto Rico, and suggest that health education and outreach efforts should explore the use of available and trusted methods of dissemination such as radio and television, as well as community-based health care providers and organizations, to supplement and encourage use of the Internet as a source of health information. ",
doi="10.2196/jmir.2007",
url="http://www.jmir.org/2012/4/e104/",
url="http://www.ncbi.nlm.nih.gov/pubmed/22849971"
}


@Article{info:doi/10.2196/jmir.2095,
author="Montague, Enid
and Perchonok, Jennifer",
title="Health and Wellness Technology Use by Historically Underserved Health Consumers: Systematic Review",
journal="J Med Internet Res",
year="2012",
month="May",
day="31",
volume="14",
number="3",
pages="e78",
keywords="health care disparities",
keywords="biomedical technology",
keywords="health education",
keywords="health knowledge, attitudes, and practice",
keywords="health care quality, access, and evaluation",
keywords="educational technology",
keywords="cultural diversity",
abstract="Background: The implementation of health technology is a national priority in the United States and widely discussed in the literature. However, literature about the use of this technology by historically underserved populations is limited. Information on culturally informed health and wellness technology and the use of these technologies to reduce health disparities facing historically underserved populations in the United States is sparse in the literature. Objective: To examine ways in which technology is being used by historically underserved populations to decrease health disparities through facilitating or improving health care access and health and wellness outcomes. Methods: We conducted a systematic review in four library databases (PubMed, PsycINFO, Web of Science, and Engineering Village) to investigate the use of technology by historically underserved populations. Search strings consisted of three topics (eg, technology, historically underserved populations, and health). Results: A total of 424 search phrases applied in the four databases returned 16,108 papers. After review, 125 papers met the selection criteria. Within the selected papers, 30 types of technology, 19 historically underserved groups, and 23 health issues were discussed. Further, almost half of the papers (62 papers) examined the use of technology to create effective and culturally informed interventions or educational tools. Finally, 12 evaluation techniques were used to assess the technology. Conclusions: While the reviewed studies show how technology can be used to positively affect the health of historically underserved populations, the technology must be tailored toward the intended population, as personally relevant and contextually situated health technology is more likely than broader technology to create behavior changes. Social media, cell phones, and videotapes are types of technology that should be used more often in the future. Further, culturally informed health information technology should be used more for chronic diseases and disease management, as it is an innovative way to provide holistic care and reminders to otherwise underserved populations. Additionally, design processes should be stated regularly so that best practices can be created. Finally, the evaluation process should be standardized to create a benchmark for culturally informed health information technology. ",
doi="10.2196/jmir.2095",
url="http://www.jmir.org/2012/3/e78/",
url="http://www.ncbi.nlm.nih.gov/pubmed/22652979"
}


@Article{info:doi/10.2196/jmir.1947,
author="Thompson, A. Lindsay
and Ferdig, Rick
and Black, Erik",
title="Online Schools and Children With Special Health and Educational Needs: Comparison With Performance in Traditional Schools",
journal="J Med Internet Res",
year="2012",
month="Apr",
day="30",
volume="14",
number="3",
pages="e62",
keywords="Virtual schooling",
keywords="schools",
keywords="K-12",
keywords="children with special health care needs",
keywords="online learning",
keywords="education, adolescent health services, special education",
abstract="Background: In the United States, primary and secondary online schools are institutions that deliver online curricula for children enrolled in kindergarten through 12th grade (K-12). These institutions commonly provide opportunities for online instruction in conjunction with local schools for students who may need remediation, have advanced needs, encounter unqualified local instructors, or experience scheduling conflicts. Internet-based online schooling may potentially help children from populations known to have educational and health disadvantages, such as those from certain racial or ethnic backgrounds, those of low socioeconomic status, and children with special health care needs (CSHCN). Objective: To describe the basic and applied demographics of US online-school users and to compare student achievement in traditional versus online schooling environments. Methods: We performed a brief parental survey in three states examining basic demographics and educational history of the child and parents, the child's health status as measured by the CSHCN Screener, and their experiences and educational achievement with online schools and class(es). Results were compared with state public-school demographics and statistical analyses controlled for state-specific independence. Results: We analyzed responses from 1971 parents with a response rate of 14.7\% (1971/13,384). Parents of online-school participants were more likely to report having a bachelor's degree or higher than were parents of students statewide in traditional schools, and more of their children were white and female. Most notably, the prevalence of CSHCN was high (476/1971, 24.6\%) in online schooling. Children who were male, black, or had special health care needs reported significantly lower grades in both traditional and online schools. However, when we controlled for age, gender, race, and parental education, parents of CSHCN or black children reported significantly lower grades in online than in traditional schooling (adjusted odds ratio [aOR] 1.45, 95\% confidence interval [CI] 1.29--1.62 for CSHCN, P < .001; aOR 2.73, 95\% CI 2.11--3.53 for black children, P < .001.) In contrast, parents with a bachelor's degree or higher reported significantly higher online-school grades than traditional-school grades for their children (aOR 1.45, 95\% CI 1.15--1.82, P < .001). Conclusions: The demographics of children attending online schools do not mirror those of the state-specific school populations. CSHCN seem to opt into online schools at a higher rate. While parents report equivalent educational achievement in online and traditional classrooms, controlling for known achievement risks suggests that CSHCN and black children have lower performance in online than in traditional schools. Given the millions of students now in online schools, future studies must test whether direct assistance in online schools, such as taking individualized education plans into consideration, will narrow known disparities in educational success. Only then can online schools emerge as a true educational alternative for at-risk populations. ",
doi="10.2196/jmir.1947",
url="http://www.jmir.org/2012/3/e62/",
url="http://www.ncbi.nlm.nih.gov/pubmed/22547538"
}


@Article{info:doi/10.2196/jmir.1670,
author="Liang, Te-Hsin",
title="Matrix Analysis of the Digital Divide in eHealth Services Using Awareness, Want, and Adoption Gap",
journal="J Med Internet Res",
year="2012",
month="Feb",
day="13",
volume="14",
number="1",
pages="e11",
keywords="Consumer behavior process",
keywords="digital divide",
keywords="eHealth",
keywords="innovation adoption process",
abstract="Background: The digital divide usually refers to access or usage, but some studies have identified two other divides: awareness and demand (want). Given that the hierarchical stages of the innovation adoption process of a customer are interrelated, it is necessary and meaningful to analyze the digital divide in eHealth services through three main stages, namely, awareness, want, and adoption. Objective: By following the three main integrated stages of the innovation diffusion theory, from the customer segment viewpoint, this study aimed to propose a new matrix analysis of the digital divide using the awareness, want, and adoption gap ratio (AWAG). I compared the digital divide among different groups. Furthermore, I conducted an empirical study on eHealth services to present the practicability of the proposed methodology. Methods: Through a review and discussion of the literature, I proposed hypotheses and a new matrix analysis. To test the proposed method, 3074 Taiwanese respondents, aged 15 years and older, were surveyed by telephone. I used the stratified simple random sampling method, with sample size allocation proportioned by the population distribution of 23 cities and counties (strata). Results: This study proposed the AWAG segment matrix to analyze the digital divide in eHealth services. First, awareness and want rates were divided into two levels at the middle point of 50\%, and then the 2-dimensional cross of the awareness and want segment matrix was divided into four categories: opened group, desire-deficiency group, perception-deficiency group, and closed group. Second, according to the degrees of awareness and want, each category was further divided into four subcategories. I also defined four possible strategies, namely, hold, improve, evaluate, and leave, for different regions in the proposed matrix. An empirical test on two recently promoted eHealth services, the digital medical service (DMS) and the digital home care service (DHCS), was conducted. Results showed that for both eHealth services, the digital divides of awareness, want, and adoption existed across demographic variables, as well as between computer owners and nonowners, and between Internet users and nonusers. With respect to the analysis of the AWAG segment matrix for DMS, most of the segments, except for people with marriage status of Other or without computers, were positioned in the opened group. With respect to DHCS, segments were separately positioned in the opened, perception-deficiency, and closed groups. Conclusions: Adoption does not closely follow people's awareness or want, and a huge digital divide in adoption exists in DHS and DHCS. Thus, a strategy to promote adoption should be used for most demographic segments. ",
doi="10.2196/jmir.1670",
url="http://www.jmir.org/2012/1/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/22329958"
}


@Article{info:doi/10.2196/jmir.1894,
author="Paul, Louise Christine
and Carey, Leanne Mariko
and Hall, Edna Alix
and Lynagh, Clare Marita
and Sanson-Fisher, W. Robert
and Henskens, Alexander Frans",
title="Improving Access to Information and Support for Patients With Less Common Cancers: Hematologic Cancer Patients' Views About Web-Based Approaches",
journal="J Med Internet Res",
year="2011",
month="Dec",
day="21",
volume="13",
number="4",
pages="e112",
keywords="Cancer",
keywords="hematologic diseases",
keywords="information-seeking behavior",
keywords="social support",
abstract="Background: Meeting the psychosocial needs of vulnerable groups such as cancer survivors remains an ongoing challenge. This is particularly so for those who have less access to the usual forms of medical specialist and in-person support networks. Internet-based approaches offer an opportunity to better meet patients' information and support needs by overcoming the barrier of geographic isolation. Objective: The aim of the study was to assess the reported level of access to the Internet, preferred sources of information, and preferred sources of support among survivors of hematologic cancers. Method: A population-based, Australian state cancer registry invited eligible survivors to complete a survey about psychosocial needs, including items measuring Internet access and patterns of use. Of the 732 eligible survivors invited to participate, 268 (36.6\%) completed and returned the pen-and-paper-based survey. Results: The majority of participants (186/254, 73.2\%) reported a high level of access to the Internet, with higher Internet access associated with a higher level of education, larger household, younger age, and being married or employed. A total of 62.2\% (156/251) of survivors indicated they were likely to use the Internet for accessing information, with the percentage much lower (69/251, 28\%) for accessing support via the Internet. Likelihood of using the Internet for support was associated with feeling anxious and being employed. Conclusions: While the Internet appears to offer promise in increasing equitable access to information and support for cancer survivors for both metropolitan and regional areas, it is viewed less favorably for support and by particular subgroups (eg, older people and those without a university degree) within the survivor population. Promoting greater understanding of this mode of support may be required to achieve its potential. Information and support options other than Web-based approaches may continue to be needed by vulnerable groups of cancer survivors. ",
doi="10.2196/jmir.1894",
url="http://www.jmir.org/2011/4/e112/",
url="http://www.ncbi.nlm.nih.gov/pubmed/22189354"
}


@Article{info:doi/10.2196/jmir.1796,
author="Takahashi, Yoshimitsu
and Ohura, Tomoko
and Ishizaki, Tatsuro
and Okamoto, Shigeru
and Miki, Kenji
and Naito, Mariko
and Akamatsu, Rie
and Sugimori, Hiroki
and Yoshiike, Nobuo
and Miyaki, Koichi
and Shimbo, Takuro
and Nakayama, Takeo",
title="Internet Use for Health-Related Information via Personal Computers and Cell Phones in Japan: A Cross-Sectional Population-Based Survey",
journal="J Med Internet Res",
year="2011",
month="Dec",
day="14",
volume="13",
number="4",
pages="e110",
keywords="eHealth",
keywords="email",
keywords="cell phones",
keywords="health literacy",
keywords="information-seeking behavior",
keywords="patient-provider communication",
abstract="Background: The Internet is known to be used for health purposes by the general public all over the world. However, little is known about the use of, attitudes toward, and activities regarding eHealth among the Japanese population. Objectives: This study aimed to measure the prevalence of Internet use for health-related information compared with other sources, and to examine the effects on user knowledge, attitudes, and activities with regard to Internet use for health-related information in Japan. We examined the extent of use via personal computers and cell phones. Methods: We conducted a cross-sectional survey of a quasi-representative sample (N = 1200) of the Japanese general population aged 15--79 years in September 2007. The main outcome measures were (1) self-reported rates of Internet use in the past year to acquire health-related information and to contact health professionals, family, friends, and peers specifically for health-related purposes, and (2) perceived effects of Internet use on health care. Results: The prevalence of Internet use via personal computer for acquiring health-related information was 23.8\% (286/1200) among those surveyed, whereas the prevalence via cell phone was 6\% (77). Internet use via both personal computer and cell phone for communicating with health professionals, family, friends, or peers was not common. The Internet was used via personal computer for acquiring health-related information primarily by younger people, people with higher education levels, and people with higher household incomes. The majority of those who used the Internet for health care purposes responded that the Internet improved their knowledge or affected their lifestyle attitude, and that they felt confident in the health-related information they obtained from the Internet. However, less than one-quarter thought it improved their ability to manage their health or affected their health-related activities. Conclusions: Japanese moderately used the Internet via personal computers for health purposes, and rarely used the Internet via cell phones. Older people, people with lower education levels, and people with lower household incomes were less likely to access the Internet via cell phone. The Internet moderately improved users' health-related knowledge and attitudes but seldom changed their health-related abilities and activities. To encourage communication between health providers and consumers, it is important to improve eHealth literacy, especially in middle-aged people. It is also important to make adequate amendments to the reimbursement payment system and nationwide eHealth privacy and security framework, and to develop a collaborative relationship among industry, government, and academia. ",
doi="10.2196/jmir.1796",
url="http://www.jmir.org/2011/4/e110/",
url="http://www.ncbi.nlm.nih.gov/pubmed/22169526"
}


@Article{info:doi/10.2196/jmir.1581,
author="van Deursen, M. Alexander J. A.
and van Dijk, M. Jan A. G.",
title="Internet Skills Performance Tests: Are People Ready for eHealth?",
journal="J Med Internet Res",
year="2011",
month="Apr",
day="29",
volume="13",
number="2",
pages="e35",
keywords="Internet",
keywords="eHealth",
keywords="online",
keywords="skills",
keywords="literacy",
keywords="information",
keywords="digital divide",
abstract="Background: Despite the amount of online health information, there are several barriers that limit the Internet's adoption as a source of health information. One of these barriers is highlighted in conceptualizations of the digital divide which include the differential possession of Internet skills, or ``eHealth literacy''. Most measures of Internet skills among populations at large use self-assessments. The research discussed here applies a multifaceted definition of Internet skills and uses actual performance tests. Objective: The purpose of this study was to assess how ready a sample of the general population is for eHealth. More specifically, four types of Internet skills were measured in a performance test in which subjects had to complete health-related assignments on the Internet. Methods: From November 1, 2009, through February 28, 2010, 88 subjects participated in the study. Subjects were randomly selected from a telephone directory. A selective quota sample was used divided over equal subsamples of gender, age, and education. Each subject had to accomplish assignments on the Internet. The Internet skills accounted for were categorized as operational (basic skills to use the Internet), formal (navigation and orientation), information (finding information), and strategic (using the information for personal benefits). The tests took approximately 1.5 hours and were conducted in a University office, making the setting equally new for all. Successful completion and time spent on the assignments---the two main outcomes---were directly measured by the test leader. Results: The subjects successfully completed an average of 73\% (5.8/8) of the operational Internet skill tasks and an average of 73\% (2.9/4) of the formal Internet skill tasks. Of the information Internet skills tasks, an average of 50\% (1.5/3) was completed successfully and, of the strategic Internet skills tasks, 35\% (0.7/2). Only 28\% (25/88) of the subjects were able to successfully complete all operational skills tasks, 39\% (34/88) all formal skills tasks, 13\% (11/88) all information skills tasks, and 20\% (18/88) both the strategic skill tasks. The time spent on the assignments varied substantially. Age and education were the most important contributors to the operational and formal Internet skills. Regarding the formal Internet skills, years of Internet experience also had some influence. Educational level of attainment was the most important contributor to the information and strategic Internet skills. Conclusions: Although the amount of online health-related information and services is consistently growing, it appears that the general population lacks the skills to keep up. Most problematic appear to be the lack of information and strategic Internet skills, which, in the context of health, are very important. The lack of these skills is also problematic for members of younger generations, who are often considered skilled Internet users. This primarily seems to account for the operational and formal Internet skills. The results of the study strongly call for policies to increase the level of Internet skills. ",
doi="10.2196/jmir.1581",
url="http://www.jmir.org/2011/2/e35/",
url="http://www.ncbi.nlm.nih.gov/pubmed/21531690"
}


@Article{info:doi/10.2196/jmir.1753,
author="Choi, Namkee",
title="Relationship Between Health Service Use and Health Information Technology Use Among Older Adults: Analysis of the US National Health Interview Survey",
journal="J Med Internet Res",
year="2011",
month="Apr",
day="20",
volume="13",
number="2",
pages="e33",
keywords="Health information technology",
keywords="older adults",
keywords="health service use",
keywords="Internet use",
abstract="Background: Older adults are the most frequent and heaviest users of health services in the United States; however, previous research on older adults' use of health information technology (HIT) has not examined the possible association of HIT use among older adults with their use of health services. Objective: This study examined the relationship between US older adults' use of health services and their use of the Internet for health-related activities, controlling for socioeconomic characteristics and aging-related limitations in sensory and cognitive function. It also examined gender differences in the pattern of association between the types of health services used and HIT use. Methods: The data for this study were drawn from the 2009 US National Health Interview Survey (NHIS), which was the first nationally representative household survey to collect data on HIT (Internet) use. First, the rates of lifetime and 12-month HIT use among sample adults (n = 27,731) by age group (18-29 to 85 and over) were analyzed. Second, bivariate analysis of sociodemographic characteristics, health status, and health service use by HIT use status among those aged 65 or older (n = 5294) was conducted. Finally, multivariate binary logistic regression analysis was used to test the study hypotheses with 12-month HIT use as the dependent variable and 12-month health service uses among the age group 65 or older as possible correlates. Results: The rates of HIT use were significantly lower among the age groups 65 or older compared with the younger age groups, although the age group 55 to 64 was not different from those younger. The rates of HIT use decreased from 32.2\% in the age group 65 to 74 to 14.5\% in the age group 75 to 84 and 4.9\% in the 85 and older age group. For both genders, having seen or talked to a general practitioner increased the odds of HIT use. However, having seen or talked to a medical specialist, eye doctor, or physical therapist/occupational therapist (PT/OT) were significantly associated with HIT use only for older women, while having seen or talked to a mental health professional only marginally increased the odds of HIT use only for older men. Having visited or talked to a chiropractor and having had overnight hospitalization, surgery, and/or homecare services were not associated with the odds of HIT use for either gender. Conclusions: Older-adult users of general health services were more likely to use HIT than nonusers of general health services, while older-adult users of specialized health services were not different from nonusers of specialized health services in their odds of HIT use. The findings have implications for narrowing the age-related and socioeconomic status-related gaps in HIT use. The access gaps among racial/ethnic minority older adults and poorly educated and/or low-income older adults are especially striking and call for concerted efforts to facilitate Internet access and HIT use among these disadvantaged older adults. ",
doi="10.2196/jmir.1753",
url="http://www.jmir.org/2011/2/e33/",
url="http://www.ncbi.nlm.nih.gov/pubmed/21752784"
}


@Article{info:doi/10.2196/jmir.1534,
author="Wang, Jong-Yi
and Bennett, Kevin
and Probst, Janice",
title="Subdividing the Digital Divide:  Differences in Internet Access and Use among Rural Residents with Medical Limitations",
journal="J Med Internet Res",
year="2011",
month="Mar",
day="03",
volume="13",
number="1",
pages="e25",
keywords="Disabled Persons",
keywords="Medical Condition Limiting Travel",
keywords="Internet, Rural Communities",
keywords="Minority Health",
abstract="Background:  Access to health care is often contingent upon an individual's ability to travel for services. Certain groups, such as those with physical limitations and rural residents, have more travel barriers than other groups, reducing their access to services. The use of the Internet may be a way for these groups to seek care or information to support their health care needs. Objective:  The purpose of this study was to examine Internet use among those whose are, for medical reasons, limited in their ability to travel. We also examined disparities in Internet use by race/ethnicity and rural residence, particularly among persons with medical conditions. Methods:  We used data from the 2001 National Household Travel Survey (NHTS), a nationally representative sample of US households, to examine Internet use among individuals with medical conditions, rural residents, and minority populations. Internet use was defined as any use within the past 6 months; among users, frequency of use and location of use were explored. Control variables included sociodemographics, family life cycle, employment status, region, and job density in the community. All analyses were weighted to reflect the complex NHTS sampling frame. Results:  Individuals with medical conditions were far less likely to report Internet use than those without medical conditions (32.6\% vs 70.3\%, P < .001). Similarly, rural residents were less likely to report Internet access and use than urban residents (59.7\% vs 69.4\%, P < .001). Nationally, 72.8\% of white respondents, versus 65.7\% of persons of ``other'' race, 51.5\% of African Americans, and 38.0\% of Hispanics reported accessing the Internet (P < .001). In adjusted analyses, persons with medical conditions and minority populations were less likely to report Internet use. Rural-urban differences were no longer significant with demographic and ecological characteristics held constant. Conclusions:  This analysis confirmed previous findings of a digital divide between urban and rural residents. Internet use and frequency was also lower among those reporting a medical condition than among those without a condition. After we controlled for many factors, however, African Americans and Hispanics were still less likely to use the Internet, and to use it less often, than whites. Policy makers should look for ways to improve the access to, and use of, the Internet among these populations. ",
doi="10.2196/jmir.1534",
url="http://www.jmir.org/2011/1/e25/",
url="http://www.ncbi.nlm.nih.gov/pubmed/21371989"
}


@Article{info:doi/10.2196/jmir.1552,
author="Zulman, M. Donna
and Kirch, Matthias
and Zheng, Kai
and An, C. Lawrence",
title="Trust in the Internet as a Health Resource Among Older Adults: Analysis of Data from a Nationally Representative Survey",
journal="J Med Internet Res",
year="2011",
month="Feb",
day="16",
volume="13",
number="1",
pages="e19",
keywords="Older adults",
keywords="Trust",
keywords="Online health information",
abstract="Background: Distrust in the Internet as a source of health information remains common among older adults. The influence of this distrust on Internet use for health-related purposes, however, is unclear. Objective: The objective of our study was to explore how older adults' trust in the Internet influences their online health-related activities, and to identify potential targets for improving health-related Internet resources for older adults. Methods: Data were obtained from a nationally representative, random digit-dial telephone survey of 1450 adults 50 years of age and older in the United States. A model was developed to conceptualize the hypothesized relationships among individual characteristics, distrust, and avoidance of the Internet as a health resource. Multivariate logistic regression analyses were conducted to examine the association between trust in online health information and use of the Internet for health-related purposes. Additional multivariate logistic regression analyses were conducted to identify the key characteristics associated with trust in online health information, adding sequentially the variables hypothesized to account for distrust among older adults: sociodemographic and health characteristics, inexperience and technical difficulties with the Internet, negative feelings toward the Internet, and lack of awareness about the sources providing the health information found online. Results: The mean (SD) age of the study population was 63.7 (10.6) years. Of the 823 (56.8\%) Internet users, 628 (76.3\%) reported using the Internet as a health resource. Trust in the Internet as a source of health information was associated with using the Internet for a number of health activities, including searching for information about a specific health condition (adjusted OR 4.43, P < .001), purchasing prescription drugs (adjusted OR 2.61, P = .03), and talking with a health care provider about information found online (adjusted OR 2.54, P = .002). Older adults (age ?65 years) were less likely to trust the Internet as a source of health information (OR 0.63, P = .04), even after adjusting for other sociodemographic characteristics and health and function. This age effect was only slightly attenuated (adjusted OR 0.69, P = .13) after adjusting for inexperience and technical difficulties with the Internet, but it disappeared entirely (adjusted OR 0.96, P = .91) after adjusting for other hypothesized contributors to distrust (including finding the Internet confusing because it provides ``too much information,'' and lacking awareness about the source providing health information found online). Conclusions: Website design features that clearly identify the source and credibility of information and minimize confusion may build trust among older adults and offer an opportunity to increase the utility of the Internet as a health resource for this population. ",
doi="10.2196/jmir.1552",
url="http://www.jmir.org/2011/1/e19/",
url="http://www.ncbi.nlm.nih.gov/pubmed/21324832"
}