@Article{info:doi/10.2196/jmir.931,
author="Stevens, J. Victor
and Funk, L. Kristine
and Brantley, J. Phillip
and Erlinger, P. Thomas
and Myers, H. Valerie
and Champagne, M. Catherine
and Bauck, Alan
and Samuel-Hodge, D. Carmen
and Hollis, F. Jack",
title="Design and Implementation of an Interactive Website to Support Long-Term Maintenance of Weight Loss",
journal="J Med Internet Res",
year="2008",
month="Jan",
day="25",
volume="10",
number="1",
pages="e1",
keywords="Internet",
keywords="website design",
keywords="behavioral interventions",
keywords="weight loss",
keywords="weight maintenance",
abstract="Background:  For most individuals, long-term maintenance of weight loss requires long-term, supportive intervention. Internet-based weight loss maintenance programs offer considerable potential for meeting this need. Careful design processes are required to maximize adherence and minimize attrition. Objective: This paper describes the development, implementation and use of a Web-based intervention program designed to help those who have recently lost weight sustain their weight loss over 1 year. Methods: The weight loss maintenance website was developed over a 1-year period by an interdisciplinary team of public health researchers, behavior change intervention experts, applications developers, and interface designers. Key interactive features of the final site include social support, self-monitoring, written guidelines for diet and physical activity, links to appropriate websites, supportive tools for behavior change, check-in accountability, tailored reinforcement messages, and problem solving and relapse prevention training. The weight loss maintenance program included a reminder system (automated email and telephone messages) that prompted participants to return to the website if they missed their check-in date. If there was no log-in response to the email and telephone automated prompts, a staff member called the participant. We tracked the proportion of participants with at least one log-in per month, and analyzed log-ins as a result of automated prompts. Results: The mean age of the 348 participants enrolled in an ongoing randomized trial and assigned to use the website was 56 years; 63\% were female, and 38\% were African American. While weight loss data will not be available until mid-2008, website use remained high during the first year with over 80\% of the participants still using the website during month 12. During the first 52 weeks, participants averaged 35 weeks with at least one log-in. Email and telephone prompts appear to be very effective at helping participants sustain ongoing website use. Conclusions: Developing interactive websites is expensive, complex, and time consuming. We found that extensive paper prototyping well in advance of programming and a versatile product manager who could work with project staff at all levels of detail were essential to keeping the development process efficient.  Trial Registration: clinicaltrials.gov NCT00054925 ",
doi="10.2196/jmir.931",
url="http://www.jmir.org/2008/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/18244892"
}


@Article{info:doi/10.2196/jmir.954,
author="van Straten, Annemieke
and Cuijpers, Pim
and Smits, Niels",
title="Effectiveness of a Web-Based Self-Help Intervention for Symptoms of Depression, Anxiety, and Stress: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2008",
month="Mar",
day="25",
volume="10",
number="1",
pages="e7",
keywords="Bibliotherapy",
keywords="psychotherapy",
keywords="problem-solving therapy",
keywords="depression",
keywords="anxiety",
keywords="stress",
abstract="Background:  Self-help therapies are often effective in reducing mental health problems. We developed a new Web-based self-help intervention based on problem-solving therapy, which may be used for people with different types of comorbid problems: depression, anxiety, and work-related stress. Objective:  The aim was to study whether a Web-based self-help intervention is effective in reducing depression, anxiety, and work-related stress (burnout). Methods:  A total of 213 participants were recruited through mass media and randomized to the intervention (n = 107) or a waiting list control group (n = 106). The Web-based course took 4 weeks. Every week an automated email was sent to the participants to explain the contents and exercises for the coming week. In addition, participants were supported by trained psychology students who offered feedback by email on the completed exercises. The core element of the intervention is a procedure in which the participants learn to approach solvable problems in a structured way. At pre-test and post-test, we measured the following primary outcomes: depression (CES-D and MDI), anxiety (SCL-A and HADS), and work-related stress (MBI). Quality of life (EQ-5D) was measured as a secondary outcome. Intention-to-treat analyses were performed. Results:  Of the 213 participants, 177 (83.1\%) completed the baseline and follow-up questionnaires; missing data were statistically imputed. Of all 107 participants in the intervention group, 9\% (n = 10) dropped out before the course started and 55\% (n = 59) completed the whole course. Among all participants, the intervention was effective in reducing symptoms of depression (CES-D: Cohen's d = 0.50, 95\% confidence interval (CI) 0.22-0.79; MDI: d = 0.33, 95\% CI 0.03-0.63) and anxiety (SCL-A: d = 0.42, 95\% CI 0.14-0.70; HADS: d = 0.33, 95\% CI 0.04-0.61) as well as in enhancing quality of life (d = 0.31, 95\% CI 0.03-0.60). Moreover, a higher percentage of patients in the intervention group experienced a significant improvement in symptoms (CES-D: odds ratio [OR] = 3.5, 95\% CI 1.9-6.7; MDI: OR = 3.7, 95\% CI 1.4-10.0; SCL-A: OR = 2.1, 95\% CI 1.0-4.6; HADS: OR = 3.1, 95\% CI 1.6-6.0). Patients in the intervention group also recovered more often (MDI: OR = 2.2; SCL-A: OR = 2.0; HADS < 8), although these results were not statistically significant. The course was less effective for work-related stress, but participants in the intervention group recovered more often from burnout than those in the control group (OR = 4.0, 95\% CI 1.2-13.5). Conclusions: We demonstrated statistically and clinically significant effects on symptoms of depression and anxiety. These effects were even more pronounced among participants with more severe baseline problems and for participants who fully completed the course. The effects on work-related stress and quality of life were less clear. To our knowledge, this is the first trial of a Web-based, problem-solving intervention for people with different types of (comorbid) emotional problems. The results are promising, especially for symptoms of depression and anxiety. Further research is needed to enhance the effectiveness for work-related stress. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 14881571 ",
doi="10.2196/jmir.954",
url="http://www.jmir.org/2008/1/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/18364344"
}


@Article{info:doi/10.2196/jmir.944,
author="Wood, B. Fred
and Siegel, R. Elliot
and Feldman, Sue
and Love, B. Cynthia
and Rodrigues, Dennis
and Malamud, Mark
and Lagana, Marie
and Crafts, Jennifer",
title="Web Evaluation at the US National Institutes of Health: Use of the American Customer Satisfaction Index Online Customer Survey",
journal="J Med Internet Res",
year="2008",
month="Feb",
day="15",
volume="10",
number="1",
pages="e4",
keywords="Surveys",
keywords="evaluation studies",
keywords="satisfaction",
keywords="Internet",
keywords="World Wide Web",
keywords="consumer health information",
abstract="Background:  The National Institutes of Health (NIH), US Department of Health and Human Services (HHS), realized the need to better understand its Web users in order to help assure that websites are user friendly and well designed for effective information dissemination. A trans-NIH group proposed a trans-NIH project to implement an online customer survey, known as the American Customer Satisfaction Index (ACSI) survey, on a large number of NIH websites---the first ``enterprise-wide'' ACSI application, and probably the largest enterprise Web evaluation of any kind, in the US government. The proposal was funded by the NIH Evaluation Set-Aside Program for two years at a cost of US \$1.5 million (US \$1.275 million for survey licenses for 60 websites at US \$18,000 per website; US \$225,000 for a project evaluation contractor). Objective:  The overall project objectives were to assess the value added to the participating NIH websites of using the ACSI online survey, identify any NIH-wide benefits (and limitations) of the ACSI, ascertain any new understanding about the NIH Web presence based on ACSI survey results, and evaluate the effectiveness of a trans-NIH approach to Web evaluation. This was not an experimental study and was not intended to evaluate the ACSI survey methodology, per se, or the impacts of its use on customer satisfaction with NIH websites. Methods:  The evaluation methodology included baseline pre-project websites profiles; before and after email surveys of participating website teams; interviews with a representative cross-section of website staff; observations of debriefing meetings with website teams; observations at quarterly trans-NIH Web staff meetings and biweekly trans-NIH leadership team meetings; and review and analysis of secondary data. Results:  Of the original 60 NIH websites signed up, 55 implemented the ACSI survey, 42 generated sufficient data for formal reporting of survey results for their sites, and 51 completed the final project survey. A broad cross-section of websites participated, and a majority reported significant benefits and new knowledge gained from the ACSI survey results. NIH websites as a group scored consistently higher on overall customer satisfaction relative to US government-wide and private sector benchmarks. Conclusions:  Overall, the enterprise-wide experiment was successful. On the level of individual websites, the project confirmed the value of online customer surveys as a Web evaluation method. The evaluation results indicated that successful use of the ACSI, whether site-by-site or enterprise-wide, depends in large part on strong staff and management support and adequate funding and time for the use of such evaluative methods. In the age of Web-based e-government, a broad commitment to Web evaluation may well be needed. This commitment would help assure that the potential of the Web and other information technologies to improve customer and citizen satisfaction is fully realized. ",
doi="10.2196/jmir.944",
url="http://www.jmir.org/2008/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/18276580"
}


@Article{info:doi/10.2196/jmir.987,
author="Graham, L. Amanda
and Papandonatos, D. George",
title="Reliability of Internet- Versus Telephone-Administered Questionnaires in a Diverse Sample of Smokers",
journal="J Med Internet Res",
year="2008",
month="Mar",
day="26",
volume="10",
number="1",
pages="e8",
keywords="Reliability",
keywords="smoking",
keywords="Internet",
keywords="diversity",
keywords="measurement",
keywords="psychometrics",
keywords="minority groups",
keywords="questionnaires",
keywords="socioeconomic factors",
keywords="social class",
keywords="poverty",
keywords="African Americans",
keywords="Hispanic Americans",
abstract="Background:  Smoking is more prevalent among lower-income individuals and certain racial/ethnic minorities. Addressing tobacco cessation among diverse populations is an urgent public health priority. As Internet use continues to rise among all segments of the US population, Web-based interventions have enormous potential to reach priority populations. Conducting Web-based smoking cessation research in priority populations requires psychometrically sound measurement instruments. To date, only one published study has examined the psychometric properties of Internet-administered measures commonly used in Web-based cessation trials. However, the sample was homogeneous with regard to race/ethnicity and income. We sought to replicate and extend these findings in a more diverse sample of smokers. Objective:  The aim was to examine the internal consistency and test-retest reliability of measures commonly used in smoking cessation clinical trials among racial/ethnic minorities and smokers with lower income. Methods:  Participants were enrolled in a randomized trial of the efficacy of an Internet smoking cessation program between June 2005 and September 2006. Following a baseline telephone assessment and randomization into the parent trial, participants were recruited to the reliability substudy. In phase I of recruitment, all participants in the parent trial were recruited to the substudy; in phase II, all consecutive racial/ethnic minority participants in the parent trial were recruited. Race and ethnicity were assessed via self-report using two standard items from the US Office of Management and Budget. An email was sent 2 days after the telephone assessment with a link to the Internet survey. Measures examined were quit methods, perceived stress, depression, social support, smoking temptations, alcohol use, perceived health status, and income. Internal consistency and test-retest reliability of Internet- versus telephone-administered measures were examined within four strata defined by race/ethnicity (non-Hispanic White, racial/ethnic minority) and annual household income (US \$40,000 or less, more than \$40,000). Results:  Of the 442 individuals invited, 319 participated (72\% response rate): 52.4\% were non-Hispanic White, 22.9\% Black, 11.6\% Hispanic, 7.8\% Asian, 4.4\% American Indian / Alaska Native, and 1\% Native Hawaiian / Other Pacific Islander. About half (49.4\%) reported an annual household income of US \$40,000 or less, and 25.7\% had a high school degree or less. Test-retest reliability was satisfactory to excellent across all strata for the majority of measures examined: 9 of 12 continuous variables had intraclass correlation coefficients ? 0.70, and 10 of 18 binary variables and both ordinal variables had kappa coefficients ? 0.70. Test-retest reliability of several quit methods varied across strata. Conclusions:  Race/ethnicity and income do not affect the psychometric properties of most Internet-administered measures examined. This knowledge adds to the confidence of conducting Web-based smoking cessation research and strengthens the scientific rigor of collecting information via the Internet on racial/ethnic minority and low-income subgroups. Trial registration: clinicaltrials.gov NCT00282009 (parent trial)                     ",
doi="10.2196/jmir.987",
url="http://www.jmir.org/2008/1/e8/",
url="http://www.ncbi.nlm.nih.gov/pubmed/18364345"
}


@Article{info:doi/10.2196/jmir.963,
author="Lau, YS Annie
and Coiera, W. Enrico",
title="Impact of Web Searching and Social Feedback on Consumer Decision Making: A Prospective Online Experiment",
journal="J Med Internet Res",
year="2008",
month="Jan",
day="22",
volume="10",
number="1",
pages="e2",
keywords="Health care consumer",
keywords="information searching",
keywords="decision making",
keywords="social feedback",
keywords="Internet",
keywords="accuracy",
keywords="confidence",
abstract="Background: The World Wide Web has increasingly become an important source of information in health care consumer decision making. However, little is known about whether searching online resources actually improves consumers' understanding of health issues. Objectives: The aim was to study whether searching on the World Wide Web improves consumers' accuracy in answering health questions and whether consumers' understanding of health issues is subject to further change under social feedback. Methods: This was a pre/post prospective online study. A convenience sample of 227 undergraduate students was recruited from the population of the University of New South Wales. Subjects used a search engine that retrieved online documents from PubMed, MedlinePlus, and HealthInsite and answered a set of six questions (before and after use of the search engine) designed for health care consumers. They were then presented with feedback consisting of a summary of the post-search answers provided by previous subjects for the same questions and were asked to answer the questions again. Results: There was an improvement in the percentage of correct answers after searching (pre-search 61.2\% vs post-search 82.0\%, P <.001) and after feedback with other subjects' answers (pre-feedback 82.0\% vs post-feedback 85.3\%, P =.051).The proportion of subjects with highly confident correct answers (ie, confident or very confident) and the proportion with highly confident incorrect answers significantly increased after searching (correct pre-search 61.6\% vs correct post-search 95.5\%, P <.001; incorrect pre-search 55.3\% vs incorrect post-search 82.0\%, P <.001). Subjects who were not as confident in their post-search answers were 28.5\% more likely than those who were confident or very confident to change their answer after feedback with other subjects' post-search answers ($\chi$21= 66.65, P <.001). Conclusions: Searching across quality health information sources on the Web can improve consumers' accuracy in answering health questions. However, a consumer's confidence in an answer is not a good indicator of the answer being correct. Consumers who are not confident in their answers after searching are more likely to be influenced to change their views when provided with feedback from other consumers. ",
doi="10.2196/jmir.963",
url="http://www.jmir.org/2008/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/18244893"
}


@Article{info:doi/10.2196/jmir.961,
author="Breckons, Matthew
and Jones, Ray
and Morris, Jenny
and Richardson, Janet",
title="What Do Evaluation Instruments Tell Us About the Quality of Complementary Medicine Information on the Internet?",
journal="J Med Internet Res",
year="2008",
month="Jan",
day="22",
volume="10",
number="1",
pages="e3",
keywords="Consumer Health Informatics",
keywords="Internet",
keywords="quality of information",
keywords="complementary medicine",
abstract="Background:  Developers of health information websites aimed at consumers need methods to assess whether their website is of ``high quality.'' Due to the nature of complementary medicine, website information is diverse and may be of poor quality. Various methods have been used to assess the quality of websites, the two main approaches being (1) to compare the content against some gold standard, and (2) to rate various aspects of the site using an assessment tool. Objective:  We aimed to review available evaluation instruments to assess their performance when?used by a researcher to evaluate websites containing information on complementary medicine and breast cancer. In particular, we wanted to see if instruments used the same criteria, agreed on the ranking of websites, were easy to use by a researcher, and if use of a single tool was sufficient to assess website quality. Methods:  Bibliographic databases, search engines, and citation searches were used to identify evaluation instruments. Instruments were included that enabled users with no subject knowledge to make an objective assessment of a website containing health information. The elements of each instrument were compared to nine main criteria defined by a previous study. Google was used to search for complementary medicine and breast cancer sites. The first six results and a purposive six from different origins (charities, sponsored, commercial) were chosen. Each website was assessed using each tool, and the percentage of criteria successfully met was recorded. The ranking of the websites by each tool was compared. The use of the instruments by others was estimated by citation analysis and Google searching. Results:  A total of 39 instruments were identified, 12 of which met the inclusion criteria; the instruments contained between 4 and 43 questions. When applied to 12 websites, there was agreement of the rank order of the sites with 10 of the instruments. Instruments varied in the range of criteria they assessed and in their ease of use. Conclusions:  Comparing the content of websites against a gold standard is time consuming and only feasible for very specific advice. Evaluation instruments offer gateway providers a method to assess websites. The checklist approach has face validity when results are compared to the actual content of ``good'' and ``bad'' websites. Although instruments differed in the range of items assessed, there was fair agreement between most available instruments. Some were easier to use than others, but these were not necessarily the instruments most widely used to date. Combining some of the better features of instruments to provide fewer, easy-to-use methods would be beneficial to gateway providers. ",
doi="10.2196/jmir.961",
url="http://www.jmir.org/2008/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/18244894"
}


@Article{info:doi/10.2196/jmir.984,
author="Bourgeois, T. Florence
and Simons, W. William
and Olson, Karen
and Brownstein, S. John
and Mandl, D. Kenneth",
title="Evaluation of Influenza Prevention in the Workplace Using a Personally Controlled Health Record: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2008",
month="Mar",
day="14",
volume="10",
number="1",
pages="e5",
keywords="Randomized controlled trial",
keywords="personally controlled health record",
keywords="Web-based",
keywords="employee health program",
keywords="influenza",
abstract="Background:  Personally controlled health records (PCHRs) are accessible over the Internet and allow individuals to maintain and manage a secure copy of their medical data. These records provide a new opportunity to provide customized health recommendations to individuals based on their record content. Health promotion programs using PCHRs can potentially be used in a variety of settings and target a large range of health issues. Objectives:  The aim was to assess the value of a PCHR in an employee health promotion program for improving knowledge, beliefs, and behavior around influenza prevention. Methods:  We evaluated a PCHR-based employee health promotion program using a randomized controlled trial design. Employees at Hewlett Packard work sites who reported reliable Internet access and email use at least once every 2 days were recruited for participation. PCHRs were provided to all participants for survey administration, and tailored, targeted health messages on influenza illness and prevention were delivered to participants in the intervention group. Participants in the control group received messages addressing cardiovascular health and sun protection. The main outcome measure was improvement in knowledge, beliefs, and behavior around influenza prevention. Secondary outcomes were influenza vaccine rates among household members, the impact of cardiovascular health and sun protection messages on the control group, and the usability and utility of the PCHR-based program for employees. Results:  The intervention did not have a statistically significant effect on the influenza knowledge elements we assessed but did impact certain beliefs surrounding influenza. Participants in the intervention group were more likely to believe that the influenza vaccine was effective (OR = 5.6; 95\% CI = 1.7-18.5), that there were actions they could take to prevent the flu (OR = 3.2; 95\% CI = 1.1-9.2), and that the influenza vaccine was unlikely to cause a severe reaction (OR = 4.4; 95\% CI = 1.3-15.3). Immunization rates did not differ between the intervention and control groups. However, participants in the intervention group were more likely to stay home during an infectious respiratory illness compared with participants in the control group (39\% [16/41] vs 14\% [5/35], respectively; P = .02). The program also succeeded in improving recognition of the signs of heart attack and stroke among participants in the control group. Overall, 78\% of participants rated the PCHR as ``extremely/very'' easy to use, and 73\% responded that they would be ``extremely/very'' likely to participate again in a PCHR-based health promotion system such as this one. Conclusions:  With a small sample size, this study identified a modest impact of a PCHR-based employee health program on influenza prevention and control. Employees found the PCHR acceptable and easy to use, suggesting that it should be explored as a common medium for health promotion in the workplace. Trial Registration: ClinicalTrials.gov NCT00142077                     ",
doi="10.2196/jmir.984",
url="http://www.jmir.org/2008/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/18343794"
}


@Article{info:doi/10.2196/jmir.974,
author="Magrabi, Farah
and Westbrook, I. Johanna
and Kidd, R. Michael
and Day, O. Richard
and Coiera, Enrico",
title="Long-Term Patterns of Online Evidence Retrieval Use in General Practice: A 12-Month Study",
journal="J Med Internet Res",
year="2008",
month="Mar",
day="19",
volume="10",
number="1",
pages="e6",
keywords="Clinical informatics",
keywords="information retrieval",
keywords="evidence-based medicine",
keywords="family practice",
keywords="evaluation studies",
keywords="Internet",
abstract="Background:  Provision of online evidence at the point of care is one strategy that could provide clinicians with easy access to up-to-date evidence in clinical settings in order to support evidence-based decision making. Objective: The aim was to determine long-term use of an online evidence system in routine clinical practice. Methods: This was a prospective cohort study. 59 clinicians who had a computer with Internet access in their consulting room participated in a 12-month trial of Quick Clinical, an online evidence system specifically designed around the needs of general practitioners (GPs). Patterns of use were determined by examination of computer logs and survey analysis. Results: On average, 9.9 searches were conducted by each GP in the first 2 months of the study. After this, usage dropped to 4.4 searches per GP in the third month and then levelled off to between 0.4 and 2.6 searches per GP per month. The majority of searches (79.2\%, 2013/2543) were conducted during practice hours (between 9 am and 5 pm) and on weekdays (90.7\%, 2315/2543). The most frequent searches related to diagnosis (33.6\%, 821/2291) and treatment (34.5\%, 844/2291). Conclusion:  GPs will use an online evidence retrieval system in routine practice; however, usage rates drop significantly after initial introduction of the system. Long-term studies are required to determine the extent to which GPs will integrate the use of such technologies into their everyday clinical practice and how this will affect the satisfaction and health outcomes of their patients. ",
doi="10.2196/jmir.974",
url="http://www.jmir.org/2008/1/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/18353750"
}