@Article{info:doi/10.2196/jmir.3871,
author="Moseley, T. Edward
and Hsu, J. Douglas
and Stone, J. David
and Celi, Anthony Leo",
title="Beyond Open Big Data: Addressing Unreliable Research",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="11",
volume="16",
number="11",
pages="e259",
keywords="open data",
keywords="unreliable research",
keywords="collaborative learning",
keywords="knowledge discovery",
keywords="peer review",
keywords="research culture",
doi="10.2196/jmir.3871",
url="http://www.jmir.org/2014/11/e259/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25405277"
}


@Article{info:doi/10.2196/jmir.3131,
author="Svensson, Madeleine
and Hult, Mari
and van der Mark, Marianne
and Grotta, Alessandra
and Jonasson, Josefine
and von Hausswolff-Juhlin, Yvonne
and R{\"o}ssner, Stephan
and Trolle Lagerros, Ylva",
title="The Change in Eating Behaviors in a Web-Based Weight Loss Program: A Longitudinal Analysis of Study Completers",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="03",
volume="16",
number="11",
pages="e234",
keywords="behavior",
keywords="counseling",
keywords="diet",
keywords="eating",
keywords="method",
keywords="questionnaires",
keywords="Internet",
keywords="weight loss",
keywords="TFEQ",
abstract="Background: Eating behaviors are essential components in weight loss programs, but limited research has explored eating behaviors in Web-based weight loss programs. Objectives: The aim was to evaluate an interactive Web-based weight loss program on eating behaviors using the 18-item Three-Factor Eating Questionnaire Revised (TFEQ-R18) which measures uncontrolled eating, emotional eating, and cognitive restrained eating. Our Web-based weight loss program is comprised of information about healthy lifestyle choices, weekly chats with experts, social networking features, databases for recipe searches, and features allowing members to self-report and track their weight, physical activity, and dietary intake on the website. Methods: On registering for the weight loss program, 23,333 members agreed to take part in the research study. The participants were then asked to complete the TFEQ-R18 questionnaire at baseline and after 3 and 6 months of participation. All data collection was conducted online, with no face-to-face contact. To study changes in TFEQ-R18 eating behaviors we restricted our study to those members who completed all 3 TFEQ-R18 questionnaires. These participants were defined as ``completers'' and the remaining as ``noncompleters.'' The relationships between sex, change in eating behaviors, and total weight loss were studied using repeated measures ANOVA and Pearson correlation coefficient. Results: In total, 22,800 individuals participated (females: 19,065/22,800, 83.62\%; mean age 39.6, SD 11.4 years; BMI 29.0 kg/m2; males: 3735/22,800, 16.38\%; mean age 43.2, SD 11.7 years; BMI 30.8 kg/m2). Noncompleters (n=22,180) were younger and reported a lower score of uncontrolled eating and a higher score of cognitive restrained eating. Over time, completers (n=620) decreased their uncontrolled eating score (from 56.3 to 32.0; P<.001) and increased their cognitive restrained eating (from 50.6 to 62.9; P<.001). Males decreased their emotional eating (from 57.2 to 35.9; P<.001), but no significant change was found among females. The baseline cognitive restrained eating score was significantly and positively associated with weight loss for completers in both men (P=.02) and women (P=.002). Conclusions: To our knowledge, this is the largest TFEQ sample that has been documented. This Web-based weight loss intervention suggests that eating behaviors (cognitive restrained eating, uncontrolled eating, and emotional eating) measured by TFEQ-R18 were significantly changed during 6 months of participation. Our findings indicate differences in eating behaviors with respect to sex, but should be interpreted with caution because attrition was high. ",
doi="10.2196/jmir.3131",
url="http://www.jmir.org/2014/11/e234/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25367316"
}


@Article{info:doi/10.2196/jmir.3575,
author="Morrison, Cecily
and Doherty, Gavin",
title="Analyzing Engagement in a Web-Based Intervention Platform Through Visualizing Log-Data",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="13",
volume="16",
number="11",
pages="e252",
keywords="engagement",
keywords="log-data analysis",
keywords="data visualisation",
keywords="Web-based interventions",
abstract="Background: Engagement has emerged as a significant cross-cutting concern within the development of Web-based interventions. There have been calls to institute a more rigorous approach to the design of Web-based interventions, to increase both the quantity and quality of engagement. One approach would be to use log-data to better understand the process of engagement and patterns of use. However, an important challenge lies in organizing log-data for productive analysis. Objective: Our aim was to conduct an initial exploration of the use of visualizations of log-data to enhance understanding of engagement with Web-based interventions. Methods: We applied exploratory sequential data analysis to highlight sequential aspects of the log data, such as time or module number, to provide insights into engagement. After applying a number of processing steps, a range of visualizations were generated from the log-data. We then examined the usefulness of these visualizations for understanding the engagement of individual users and the engagement of cohorts of users. The visualizations created are illustrated with two datasets drawn from studies using the SilverCloud Platform: (1) a small, detailed dataset with interviews (n=19) and (2) a large dataset (n=326) with 44,838 logged events. Results: We present four exploratory visualizations of user engagement with a Web-based intervention, including Navigation Graph, Stripe Graph, Start--Finish Graph, and Next Action Heat Map. The first represents individual usage and the last three, specific aspects of cohort usage. We provide examples of each with a discussion of salient features. Conclusions: Log-data analysis through data visualization is an alternative way of exploring user engagement with Web-based interventions, which can yield different insights than more commonly used summative measures. We describe how understanding the process of engagement through visualizations can support the development and evaluation of Web-based interventions. Specifically, we show how visualizations can (1) allow inspection of content or feature usage in a temporal relationship to the overall program at different levels of granularity, (2) detect different patterns of use to consider personalization in the design process, (3) detect usability issues, (4) enable exploratory analysis to support the design of statistical queries to summarize the data, (5) provide new opportunities for real-time evaluation, and (6) examine assumptions about interactivity that underlie many summative measures in this field. ",
doi="10.2196/jmir.3575",
url="http://www.jmir.org/2014/11/e252/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25406097"
}


@Article{info:doi/10.2196/jmir.3375,
author="Choi, Hee Seung
and Waltje, H. Andrea
and Ronis, L. David
and Noonan, Devon
and Hong, OiSaeng
and Richardson, R. Caroline
and Meeker, D. John
and Duffy, A. Sonia",
title="Web-Enhanced Tobacco Tactics With Telephone Support Versus 1-800-QUIT-NOW Telephone Line Intervention for Operating Engineers: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="20",
volume="16",
number="11",
pages="e255",
keywords="smoking cessation",
keywords="intervention study",
keywords="workplace",
keywords="blue collar workers",
abstract="Background: Novel interventions tailored to blue collar workers are needed to reduce the disparities in smoking rates among occupational groups. Objective: The main objective of this study was to evaluate the efficacy and usage of the Web-enhanced ``Tobacco Tactics'' intervention targeting operating engineers (heavy equipment operators) compared to the ``1-800-QUIT-NOW'' telephone line. Methods: Operating engineers (N=145) attending one of 25 safety training sessions from 2010 through 2012 were randomized to either the Tobacco Tactics website with nurse counseling by phone and access to nicotine replacement therapy (NRT) or to the 1-800-QUIT-NOW telephone line, which provided an equal number of phone calls and NRT. The primary outcome was self-reported 7-day abstinence at 30-day and 6-month follow-up. The outcomes were compared using chi-square tests, t tests, generalized mixed models, and logistic regression models. Results: The average age was 42 years and most were male (115/145, 79.3\%) and white (125/145, 86.2\%). Using an intent-to-treat analysis, the Tobacco Tactics website group showed significantly higher quit rates (18/67, 27\%) than the 1-800-QUIT NOW group (6/78, 8\%) at 30-day follow-up (P=.003), but this difference was no longer significant at 6-month follow-up. There were significantly more positive changes in harm reduction measures (quit attempts, number of cigarettes smoked per day, and nicotine dependence) at both 30-day and 6-month follow-up in the Tobacco Tactics group compared to the 1-800-QUIT-NOW group. Compared to participants in the 1-800-QUIT NOW group, significantly more of those in the Tobacco Tactics website group participated in the interventions, received phone calls and NRT, and found the intervention helpful. Conclusions: The Web-enhanced Tobacco Tactics website with telephone support showed higher efficacy and reach than the 1-800-QUIT-NOW intervention. Longer counseling sessions may be needed to improve 6-month cessation rates. Trial Registration: Clinicaltrials.gov NCT01124110; http://clinicaltrials.gov/ct2/show/NCT01124110 (Archived by WebCite at http://www.webcitation.org/6TfKN5iNL). ",
doi="10.2196/jmir.3375",
url="http://www.jmir.org/2014/11/e255/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25447467"
}


@Article{info:doi/10.2196/jmir.3444,
author="Borromeo, D. Charles
and Schleyer, K. Titus
and Becich, J. Michael
and Hochheiser, Harry",
title="Finding Collaborators: Toward Interactive Discovery Tools for Research Network Systems",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="04",
volume="16",
number="11",
pages="e244",
keywords="translational medical research",
keywords="cooperative behavior",
keywords="interprofessional relations",
keywords="interdisciplinary studies",
keywords="information systems",
keywords="information services",
abstract="Background: Research networking systems hold great promise for helping biomedical scientists identify collaborators with the expertise needed to build interdisciplinary teams. Although efforts to date have focused primarily on collecting and aggregating information, less attention has been paid to the design of end-user tools for using these collections to identify collaborators. To be effective, collaborator search tools must provide researchers with easy access to information relevant to their collaboration needs. Objective: The aim was to study user requirements and preferences for research networking system collaborator search tools and to design and evaluate a functional prototype. Methods: Paper prototypes exploring possible interface designs were presented to 18 participants in semistructured interviews aimed at eliciting collaborator search needs. Interview data were coded and analyzed to identify recurrent themes and related software requirements. Analysis results and elements from paper prototypes were used to design a Web-based prototype using the D3 JavaScript library and VIVO data. Preliminary usability studies asked 20 participants to use the tool and to provide feedback through semistructured interviews and completion of the System Usability Scale (SUS). Results: Initial interviews identified consensus regarding several novel requirements for collaborator search tools, including chronological display of publication and research funding information, the need for conjunctive keyword searches, and tools for tracking candidate collaborators. Participant responses were positive (SUS score: mean 76.4\%, SD 13.9). Opportunities for improving the interface design were identified. Conclusions: Interactive, timeline-based displays that support comparison of researcher productivity in funding and publication have the potential to effectively support searching for collaborators. Further refinement and longitudinal studies may be needed to better understand the implications of collaborator search tools for researcher workflows. ",
doi="10.2196/jmir.3444",
url="http://www.jmir.org/2014/11/e244/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25370463"
}


@Article{info:doi/10.2196/jmir.3338,
author="Meylakhs, Peter
and Rykov, Yuri
and Koltsova, Olessia
and Koltsov, Sergey",
title="An AIDS-Denialist Online Community on a Russian Social Networking Service: Patterns of Interactions With Newcomers and Rhetorical Strategies of Persuasion",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="17",
volume="16",
number="11",
pages="e261",
keywords="consumer health information",
keywords="Internet",
keywords="online communities",
keywords="AIDS denialists",
keywords="quality of health information on the Internet",
keywords="netnography",
keywords="qualitative research",
abstract="Background: The rise of social media proved to be a fertile ground for the expansion of the acquired immune deficiency syndrome (AIDS)-denialist movement (in the form of online communities). While there is substantial literature devoted to disproving AIDS-denialist views, there is a lack of studies exploring AIDS-denialists online communities that interact with an external environment. Objective: We explored three research areas: (1) reasons for newcomers to come to an AIDS-denialist community, (2) the patterns of interactions of the community with the newcomers, and (3) rhetorical strategies that denialists use for persuasion in the veracity of their views. Methods: We studied the largest AIDS-denialist community on one of the most popular social networking services in Russia. We used netnography as a method for collecting data for qualitative analysis and observed the community for 9 months (at least 2-3 times a week). While doing netnography, we periodically downloaded community discussions. In total, we downloaded 4821 posts and comments for analysis. Grounded theory approach was used for data analysis. Results: Most users came to the community for the following reasons: their stories did not fit the unitary picture of AIDS disease progression translated by popular medical discourse, health problems, concern about HIV-positive tests, and desire to dissuade community members from false AIDS beliefs. On the basis of strength in AIDS-denialist beliefs, we constructed a typology of the newcomers consisting of three ideal-typical groups: (1) convinced: those who already had become denialists before coming to the group, (2) doubters: those who were undecided about the truth of either human immunodeficiency virus (HIV) science theory or AIDS-denialist theory, and (3) orthodox: those who openly held HIV science views. Reception of a newcomer mainly depended on the newcomer's belief status. Reception was very warm for the convinced, cold or slightly hostile for the doubters, and extremely hostile or derisive for the orthodox. We identified seven main rhetorical strategies of persuasion used by the denialists on the ``undecided''. Conclusions: Contrary to the widespread public health depiction of AIDS denialists as totally irrational, our study suggests that some of those who become AIDS denialists have sufficiently reasonable grounds to suspect that ``something is wrong'' with scientific theory, because their personal experience contradicts the unitary picture of AIDS disease progression. Odd and inexplicable practices of some AIDS centers only fuel these people's suspicions. We can conclude that public health practitioners' practices may play a role in generating AIDS-denialist sentiments. In interactions with the newcomers, the experienced community members highlighted the importance of personal autonomy and freedom of choice in decision making consistent with the consumerist ideology of health care. The study findings suggest that health care workers should change a one-size-fits-all mode of counseling for a more complex and patient-tailored approach, allowing for diversity of disease progression scenarios and scientific uncertainty. ",
doi="10.2196/jmir.3338",
url="http://www.jmir.org/2014/11/e261/"
}


@Article{info:doi/10.2196/jmir.3373,
author="Hanson, L. Carl
and West, Josh
and Thackeray, Rosemary
and Barnes, D. Michael
and Downey, Jordan",
title="Understanding and Predicting Social Media Use Among Community Health Center Patients: A Cross-Sectional Survey",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="26",
volume="16",
number="11",
pages="e270",
keywords="social media",
keywords="community health centers",
keywords="medically underserved area",
abstract="Background: The use of social media by health care organizations is growing and provides Web-based tools to connect patients, caregivers, and providers. Objective: The aim was to determine the use and factors predicting the use of social media for health care--related purposes among medically underserved primary care patients. Methods: A cross-sectional survey was administered to 444 patients of a federally qualified community health center. Results: Community health center patients preferred that their providers use email, cell phones for texting, and Facebook and cell phone apps for sharing health information. Significantly more Hispanic than white patients believed their providers should use Facebook (P=.001), YouTube (P=.01), and Twitter (P=.04) for sharing health information. Use and intentions to use social media for health-related purposes were significantly higher for those patients with higher subjective norm scores. Conclusions: Understanding use and factors predicting use can increase adoption and utilization of social media for health care--related purposes among underserved patients in community health centers. ",
doi="10.2196/jmir.3373",
url="http://www.jmir.org/2014/11/e270/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25427823"
}


@Article{info:doi/10.2196/jmir.3758,
author="Griffis, M. Heather
and Kilaru, S. Austin
and Werner, M. Rachel
and Asch, A. David
and Hershey, C. John
and Hill, Shawndra
and Ha, P. Yoonhee
and Sellers, Allison
and Mahoney, Kevin
and Merchant, M. Raina",
title="Use of Social Media Across US Hospitals: Descriptive Analysis of Adoption and Utilization",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="27",
volume="16",
number="11",
pages="e264",
keywords="social media",
keywords="Internet",
keywords="health information",
abstract="Background: Use of social media has become widespread across the United States. Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health. Objective: The aim was to investigate the relationship between hospital social media extent of adoption and utilization relative to hospital characteristics. Methods: We conducted a cross-sectional review of hospital-related activity on 4 social media platforms: Facebook, Twitter, Yelp, and Foursquare. All US hospitals were included that reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey. We reviewed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status. Social media utilization was estimated from user activity specific to each social media platform, including number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews. Results: Adoption of social media varied across hospitals with 94.41\% (3351/3371) having a Facebook page and 50.82\% (1713/3371) having a Twitter account. A majority of hospitals had a Yelp page (99.14\%, 3342/3371) and almost all hospitals had check-ins on Foursquare (99.41\%, 3351/3371). Large, urban, private nonprofit, and teaching hospitals were more likely to have higher utilization of these accounts. Conclusions: Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics. This preliminary investigation of social media adoption and utilization among US hospitals provides the framework for future studies investigating the effect of social media on patient outcomes, including links between social media use and the quality of hospital care and services. ",
doi="10.2196/jmir.3758",
url="http://www.jmir.org/2014/11/e264/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25431831"
}


@Article{info:doi/10.2196/jmir.3532,
author="Aslam, A. Anosh{\'e}
and Tsou, Ming-Hsiang
and Spitzberg, H. Brian
and An, Li
and Gawron, Mark J.
and Gupta, K. Dipak
and Peddecord, Michael K.
and Nagel, C. Anna
and Allen, Christopher
and Yang, Jiue-An
and Lindsay, Suzanne",
title="The Reliability of Tweets as a Supplementary Method of Seasonal Influenza Surveillance",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="14",
volume="16",
number="11",
pages="e250",
keywords="Twitter",
keywords="tweets",
keywords="infoveillance",
keywords="infodemiology",
keywords="syndromic surveillance",
keywords="influenza",
keywords="Internet",
abstract="Background: Existing influenza surveillance in the United States is focused on the collection of data from sentinel physicians and hospitals; however, the compilation and distribution of reports are usually delayed by up to 2 weeks. With the popularity of social media growing, the Internet is a source for syndromic surveillance due to the availability of large amounts of data. In this study, tweets, or posts of 140 characters or less, from the website Twitter were collected and analyzed for their potential as surveillance for seasonal influenza. Objective: There were three aims: (1) to improve the correlation of tweets to sentinel-provided influenza-like illness (ILI) rates by city through filtering and a machine-learning classifier, (2) to observe correlations of tweets for emergency department ILI rates by city, and (3) to explore correlations for tweets to laboratory-confirmed influenza cases in San Diego. Methods: Tweets containing the keyword ``flu'' were collected within a 17-mile radius from 11 US cities selected for population and availability of ILI data. At the end of the collection period, 159,802 tweets were used for correlation analyses with sentinel-provided ILI and emergency department ILI rates as reported by the corresponding city or county health department. Two separate methods were used to observe correlations between tweets and ILI rates: filtering the tweets by type (non-retweets, retweets, tweets with a URL, tweets without a URL), and the use of a machine-learning classifier that determined whether a tweet was ``valid'', or from a user who was likely ill with the flu. Results: Correlations varied by city but general trends were observed. Non-retweets and tweets without a URL had higher and more significant (P<.05) correlations than retweets and tweets with a URL. Correlations of tweets to emergency department ILI rates were higher than the correlations observed for sentinel-provided ILI for most of the cities. The machine-learning classifier yielded the highest correlations for many of the cities when using the sentinel-provided or emergency department ILI as well as the number of laboratory-confirmed influenza cases in San Diego. High correlation values (r=.93) with significance at P<.001 were observed for laboratory-confirmed influenza cases for most categories and tweets determined to be valid by the classifier. Conclusions: Compared to tweet analyses in the previous influenza season, this study demonstrated increased accuracy in using Twitter as a supplementary surveillance tool for influenza as better filtering and classification methods yielded higher correlations for the 2013-2014 influenza season than those found for tweets in the previous influenza season, where emergency department ILI rates were better correlated to tweets than sentinel-provided ILI rates. Further investigations in the field would require expansion with regard to the location that the tweets are collected from, as well as the availability of more ILI data. ",
doi="10.2196/jmir.3532",
url="http://www.jmir.org/2014/11/e250/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25406040"
}


@Article{info:doi/10.2196/jmir.3523,
author="Delaney, P. Kevin
and Kramer, R. Michael
and Waller, A. Lance
and Flanders, Dana W.
and Sullivan, S. Patrick",
title="Using a Geolocation Social Networking Application to Calculate the Population Density of Sex-Seeking Gay Men for Research and Prevention Services",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="18",
volume="16",
number="11",
pages="e249",
keywords="Internet",
keywords="HIV",
keywords="MSM",
keywords="sampling, location services",
abstract="Background: In the United States, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) continues to have a heavy impact on men who have sex with men (MSM). Among MSM, black men under the age of 30 are at the most risk for being diagnosed with HIV. The US National HIV/AIDS strategy recommends intensifying efforts in communities that are most heavily impacted; to do so requires new methods for identifying and targeting prevention resources to young MSM, especially young MSM of color. Objective: We piloted a methodology for using the geolocation features of social and sexual networking applications as a novel approach to calculating the local population density of sex-seeking MSM and to use self-reported age and race from profile postings to highlight areas with a high density of minority and young minority MSM in Atlanta, Georgia. Methods: We collected data from a geographically systematic sample of points in Atlanta. We used a sexual network mobile phone app and collected application profile data, including age, race, and distance from each point, for either the 50 closest users or for all users within a 2-mile radius of sampled points. From these data, we developed estimates of the spatial density of application users in the entire city, stratified by race. We then compared the ratios and differences between the spatial densities of black and white users and developed an indicator of areas with the highest density of users of each race. Results: We collected data from 2666 profiles at 79 sampled points covering 883 square miles; overlapping circles of data included the entire 132.4 square miles in Atlanta. Of the 2666 men whose profiles were observed, 1563 (58.63\%) were white, 810 (30.38\%) were black, 146 (5.48\%) were another race, and 147 (5.51\%) did not report a race in their profile. The mean age was 31.5 years, with 591 (22.17\%) between the ages of 18-25, and 496 (18.60\%) between the ages of 26-30. The mean spatial density of observed profiles was 33 per square mile, but the distribution of profiles observed across the 79 sampled points was highly skewed (median 17, range 1-208). Ratio, difference, and distribution outlier measures all provided similar information, highlighting areas with higher densities of minority and young minority MSM. Conclusions: Using a limited number of sampled points, we developed a geospatial density map of MSM using a social-networking sex-seeking app. This approach provides a simple method to describe the density of specific MSM subpopulations (users of a particular app) for future HIV behavioral surveillance and allow targeting of prevention resources such as HIV testing to populations and areas of highest need. ",
doi="10.2196/jmir.3523",
url="http://www.jmir.org/2014/11/e249/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25406722"
}


@Article{info:doi/10.2196/jmir.3211,
author="Rosenberg, S. Eli
and Rothenberg, B. Richard
and Kleinbaum, G. David
and Stephenson, B. Rob
and Sullivan, S. Patrick",
title="Assessment of a New Web-Based Sexual Concurrency Measurement Tool for Men Who Have Sex With Men",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="10",
volume="16",
number="11",
pages="e246",
keywords="HIV",
keywords="sexual networks",
keywords="questionnaires",
keywords="concurrency",
keywords="MSM",
keywords="sexual network measurement",
keywords="online questionnaire",
abstract="Background: Men who have sex with men (MSM) are the most affected risk group in the United States' human immunodeficiency virus (HIV) epidemic. Sexual concurrency, the overlapping of partnerships in time, accelerates HIV transmission in populations and has been documented at high levels among MSM. However, concurrency is challenging to measure empirically and variations in assessment techniques used (primarily the date overlap and direct question approaches) and the outcomes derived from them have led to heterogeneity and questionable validity of estimates among MSM and other populations. Objective: The aim was to evaluate a novel Web-based and interactive partnership-timing module designed for measuring concurrency among MSM, and to compare outcomes measured by the partnership-timing module to those of typical approaches in an online study of MSM. Methods: In an online study of MSM aged ?18 years, we assessed concurrency by using the direct question method and by gathering the dates of first and last sex, with enhanced programming logic, for each reported partner in the previous 6 months. From these methods, we computed multiple concurrency cumulative prevalence outcomes: direct question, day resolution / date overlap, and month resolution / date overlap including both 1-month ties and excluding ties. We additionally computed variants of the UNAIDS point prevalence outcome. The partnership-timing module was also administered. It uses an interactive month resolution calendar to improve recall and follow-up questions to resolve temporal ambiguities, combines elements of the direct question and date overlap approaches. The agreement between the partnership-timing module and other concurrency outcomes was assessed with percent agreement, kappa statistic ($\kappa$), and matched odds ratios at the individual, dyad, and triad levels of analysis. Results: Among 2737 MSM who completed the partnership section of the partnership-timing module, 41.07\% (1124/2737) of individuals had concurrent partners in the previous 6 months. The partnership-timing module had the highest degree of agreement with the direct question. Agreement was lower with date overlap outcomes (agreement range 79\%-81\%, $\kappa$ range .55-.59) and lowest with the UNAIDS outcome at 5 months before interview (65\% agreement, $\kappa$=.14, 95\% CI .12-.16). All agreements declined after excluding individuals with 1 sex partner (always classified as not engaging in concurrency), although the highest agreement was still observed with the direct question technique (81\% agreement, $\kappa$=.59, 95\% CI .55-.63). Similar patterns in agreement were observed with dyad- and triad-level outcomes. Conclusions: The partnership-timing module showed strong concurrency detection ability and agreement with previous measures. These levels of agreement were greater than others have reported among previous measures. The partnership-timing module may be well suited to quantifying concurrency among MSM at multiple levels of analysis. ",
doi="10.2196/jmir.3211",
url="http://www.jmir.org/2014/11/e246/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25386801"
}


@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/jmir.3363,
author="Jackson, L. Sara
and Mejilla, Roanne
and Darer, D. Jonathan
and Oster, V. Natalia
and Ralston, D. James
and Leveille, G. Suzanne
and Walker, Jan
and Delbanco, Tom
and Elmore, G. Joann",
title="Patients Who Share Transparent Visit Notes With Others: Characteristics, Risks, and Benefits",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="12",
volume="16",
number="11",
pages="e247",
keywords="open access to information",
keywords="caregivers",
keywords="health behavior",
keywords="information sharing",
abstract="Background: Inviting patients to read their primary care visit notes may improve communication and help them engage more actively in their health care. Little is known about how patients will use the opportunity to share their visit notes with family members or caregivers, or what the benefits might be. Objective: Our goal was to evaluate the characteristics of patients who reported sharing their visit notes during the course of the study, including their views on associated benefits and risks. Methods: The OpenNotes study invited patients to access their primary care providers' visit notes in Massachusetts, Pennsylvania, and Washington. Pre- and post-intervention surveys assessed patient demographics, standardized measures of patient-doctor communication, sharing of visit notes with others during the study, and specific health behaviors reflecting the potential benefits and risks of offering patients easy access to their visit notes. Results: More than half (55.43\%, 2503/4516) of the participants who reported viewing at least one visit note would like the option of letting family members or friends have their own Web access to their visit notes, and 21.70\% (980/4516) reported sharing their visit notes with someone during the study year. Men, and those retired or unable to work, were significantly more likely to share visit notes, and those sharing were neither more nor less concerned about their privacy than were non-sharers. Compared to participants who did not share clinic notes, those who shared were more likely to report taking better care of themselves and taking their medications as prescribed, after adjustment for age, gender, employment status, and study site. Conclusions: One in five OpenNotes patients shared a visit note with someone, and those sharing Web access to their visit notes reported better adherence to self-care and medications. As health information technology systems increase patients' ability to access their medical records, facilitating access to caregivers may improve perceived health behaviors and outcomes. ",
doi="10.2196/jmir.3363",
url="http://www.jmir.org/2014/11/e247/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25405911"
}


@Article{info:doi/10.2196/jmir.3462,
author="Riippa, Iiris
and Linna, Miika
and R{\"o}nkk{\"o}, Ilona",
title="The Effect of a Patient Portal With Electronic Messaging on Patient Activation Among Chronically Ill Patients: Controlled Before-and-After Study",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="19",
volume="16",
number="11",
pages="e257",
keywords="chronic illness",
keywords="patient activation",
keywords="self-management",
keywords="diagnosis",
abstract="Background: It has been suggested that providing patients with access to their medical records and secure messaging with health care professionals improves health outcomes in chronic care by encouraging and activating patients to manage their own condition. Objectives: The aim was to evaluate the effect of access to a patient portal on patient activation among chronically ill patients. Further, the relationship between temporal proximity of a severe diagnosis and patient activation were assessed. Methods: A total of 876 chronically ill patients from public primary care were allocated to either an intervention group receiving immediate access to a patient portal that included their medical records, care plan, and secure messaging with a care team, or to a control group receiving usual care. Patient Activation Measure (PAM) at baseline and at 6-month follow-up was obtained from 80 patients in the intervention group and 57 patients in the control group; thus, a total of 137 patients were included in the final analysis. Results: No significant effect of access to patient portal on patient activation was detected in this study (F1,133=1.87, P=.17, $\eta$2=0.01). Patients starting at a lower level of activation demonstrated greater positive change in activation compared to patients starting at higher levels of activation in both the intervention and control groups. Further, patients diagnosed with a severe diagnosis during the intervention showed greater positive change in patient activation compared to patients whose last severe diagnosis was made more than 2 years ago. The results also suggest that the intervention had greatest effect on patients starting at the highest level of patient activation (difference in change of patient activation=4.82, P=.13), and among patients diagnosed within a year of the intervention (difference in change of patient activation=7.65, P=.12). Conclusions: Time since last severe diagnosis and patient activation at baseline may affect changes in patient activation, suggesting that these should be considered in evaluation of activating chronic care interventions and in the specification of possible target groups for these interventions. This may be relevant in designing services for a heterogeneous group of patients with a distinct medical history and level of activation. ",
doi="10.2196/jmir.3462",
url="http://www.jmir.org/2014/11/e257/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25413368"
}


@Article{info:doi/10.2196/jmir.3698,
author="Otte-Trojel, Terese
and de Bont, Antoinette
and van de Klundert, Joris
and Rundall, G. Thomas",
title="Characteristics of Patient Portals Developed in the Context of Health Information Exchanges: Early Policy Effects of Incentives in the Meaningful Use Program in the United States",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="21",
volume="16",
number="11",
pages="e258",
keywords="medical informatics",
keywords="meaningful use",
keywords="electronic health records",
keywords="patient-centered care",
abstract="Background: In 2014, the Centers for Medicare \& Medicaid Services in the United States launched the second stage of its Electronic Health Record (EHR) Incentive Program, providing financial incentives to providers to meaningfully use their electronic health records to engage patients online. Patient portals are electronic means to engage patients by enabling secure access to personal medical records, communication with providers, various self-management tools, and administrative functionalities. Outcomes of patient portals have mainly been reported in large integrated health systems. This may now change as the EHR Incentive Program enables and supports the use of patient portals in other types of health systems. In this paper, we focus on Health Information Exchanges (HIE): entities that facilitate data exchange within networks of independent providers. Objective: In response to the EHR Incentive Program, some Health Information Exchanges in the United States are developing patient portals and offering them to their network of providers. Such patient portals hold high value for patients, especially in fragmented health system contexts, due to the portals' ability to integrate health information from an array of providers and give patients one access point to this information. Our aim was to report on the early effects of the EHR incentives on patient portal development by HIEs. Specifically, we describe the characteristics of these portals, identify factors affecting adoption by providers during the 2013-2014 time frame, and consider what may be the primary drivers of providers' adoption of patient portals in the future. Methods: We identified four HIEs that were developing patient portals as of spring 2014. We collected relevant documents and conducted interviews with six HIE leaders as well as two providers that were implementing the portals in their practices. We performed content analysis on these data to extract information pertinent to our study objectives. Results: Our findings suggest that there are two primary types of patient portals available to providers in HIEs: (1) portals linked to EHRs of individual providers or health systems and (2) HIE-sponsored portals that link information from multiple providers' EHRs. The decision of providers in the HIEs to adopt either one of these portals appears to be a trade-off between functionality, connectivity, and cost. Our findings also suggest that while the EHR Incentive Program is influencing these decisions, it may not be enough to drive adoption. Rather, patient demand for access to patient portals will be necessary to achieve widespread portal adoption and realization of potential benefits. Conclusions: Optimizing patient value should be the main principle underlying policies intending to increase online patient engagement in the third stage of the EHR Incentive Program. We propose a number of features for the EHR Incentive Program that will enhance patient value and thereby support the growth and sustainability of patient portals provided by Health Information Exchanges. ",
doi="10.2196/jmir.3698",
url="http://www.jmir.org/2014/11/e258/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25447837"
}


@Article{info:doi/10.2196/jmir.3457,
author="Ronda, CM Maaike
and Dijkhorst-Oei, Lioe-Ting
and Rutten, EHM Guy",
title="Reasons and Barriers for Using a Patient Portal: Survey Among Patients With Diabetes Mellitus",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="25",
volume="16",
number="11",
pages="e263",
keywords="diabetes mellitus",
keywords="telemedicine",
keywords="Internet",
keywords="electronic health record",
keywords="cross-sectional studies",
keywords="patient preference",
keywords="patient access to records",
abstract="Background: The use of a Web portal for patients with diabetes mellitus to access their own personal health record may result in improved diabetes outcomes. However, the adoption by patients is slow. This may be caused by patient characteristics, but also by the content, layout, and promotion of the portal. Detailed knowledge about this could help increase patients' participation in Web portals. Objective: The aim was to study the opinions of patients with diabetes and identify perceived barriers to using a Web portal to optimize its use. Methods: We conducted a survey among patients with type 1 and type 2 diabetes mellitus from 62 primary care practices and 1 outpatient hospital clinic in the central area of the Netherlands who all used the same electronic health record with a Web portal. Questionnaires about patient characteristics, opinions about reasons for use or nonuse, and about portal content were sent to 1500 patients with a login and 3000 patients without a login to the Web portal. Patient groups were stratified according to login frequency. Demographic and diabetes-related variables were analyzed with multivariable regression analysis. Results: The total response rate was 66.63\% (2391/4399); 1390 of 4399 patients (31.60\%) were eligible for analysis. There were 413 regular users (login frequency more than once) and 758 nonusers (no login). Most nonusers (72.4\%) stated that the main reason for not requesting a login was that they were unaware of the existence of the portal. Other barriers reported by patients were disinterest in managing their own disease (28.5\%, 216/758) and feelings of inadequacy with the use of computers and Internet (11.6\%, 88/758). Patients treated by a general practitioner were more frequently nonusers compared to patients treated by an internist (78.8\%, 666/846 vs 28.3\%, 92/325; P<.001) and more users than nonusers became aware of the Web portal through their physician (94.9\%, 392/413 vs 48.8\%, 102/209; P<.001). Nonusers perceived specific portal content as not as useful as regular users did, especially access to laboratory values (71.7\%, 383/534 vs 92.3\%, 372/403), rereading clinic visits (61.3\%, 320/522 vs 89.6\%, 360/402), e-messaging (52.0\%, 262/504 vs 74.6\%, 299/401), and uploading results to the glucose diary (45.3\%, 229/506 vs 74.0\%, 288/400; all P<.001). Conclusions: Our study shows that unawareness of the patient portal is the main barrier of enrollment. Users and nonusers perceive the usefulness of the portal differently and do not have the same recommendations for additional functionalities. To increase patients' participation in a Web portal, the unawareness of its existence and its possibilities need to be addressed by their health care professionals. ",
doi="10.2196/jmir.3457",
url="http://www.jmir.org/2014/11/e263/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25424228"
}


@Article{info:doi/10.2196/jmir.3517,
author="Batenburg, Anika
and Das, Enny",
title="Emotional Approach Coping and the Effects of Online Peer-Led Support Group Participation Among Patients With Breast Cancer: A Longitudinal Study",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="28",
volume="16",
number="11",
pages="e256",
keywords="Internet",
keywords="breast neoplasms",
keywords="self-help groups",
keywords="social support",
keywords="online systems",
keywords="emotions",
abstract="Background: Previous research on the effects of online peer support on psychological well-being of patients with cancer showed mixed findings. There is a need for longitudinal studies explaining if and when online peer-led support groups are beneficial. How patients cope with emotions that come along with the cancer diagnosis might influence effectiveness of online participation. Emotional approach coping is a construct encompassing the intentional use of emotional processing and emotional expression in efforts to manage adverse circumstances. Objective: In this longitudinal study, we hypothesize that mixed findings in previous research are partly caused by individual differences in coping with emotions, which may moderate the effects of online support group participation on patients' well-being. Methods: A total of 133 Dutch patients with breast cancer filled out a baseline (T0) and a follow-up (T1, 6 months later) questionnaire assessing intensity of online participation within the online support community, emotional approach coping (ie, actively processing and expressing emotions), and psychological well-being (depression, emotional well-being, and breast cancer--related concerns). There were 109 patients who visited an online support community at both points in time. Repeated measures ANOVAs assessed change in well-being over time. Results: Results showed 3-way interactions of time, online intensity of participation, and emotional approach coping on emotional well-being (F1,89=4.232, P=.04, $\eta$2$\rho$=.045) and depression (F1,88=8.167, P=.005, $\eta$2$\rho$=.085). Online support group participation increased emotional well-being over time for patients who scored low on emotional approach coping at T0, provided that they were highly active online. Patients who were highly active online with a high score on emotional approach coping reported no change in sense of well-being, but showed the highest score on well-being overall. Participating less frequently online was only beneficial for patients who scored high on emotional approach coping, showing an increase in well-being over time. Patients participating less frequently and with a low score on emotional approach coping reported no significant change in well-being over time. Conclusions: This study extends previous findings on the effects of online peer support in two ways: by testing changes in well-being as a function of intensity of online support group participation and by examining the role of individual differences in emotional coping styles. Findings showed no negative effects of intense support group participation. Participating frequently online was especially helpful for patients who approach their emotions less actively; their emotional well-being increased over time. In contrast, frequent online users who actively approach their emotions experienced no change in well-being, reporting highest levels of well-being overall. For patients who participate less intensively within the support community, coping style seems to outweigh effects of online participation; over time, patients who actively approached emotions experienced an increase in psychological well-being, whereas patients with a low score on emotional approach coping reported no change in depression and emotional well-being. ",
doi="10.2196/jmir.3517",
url="http://www.jmir.org/2014/11/e256/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25474819"
}


@Article{info:doi/10.2196/jmir.3318,
author="Watkins, Ivan
and Xie, Bo",
title="eHealth Literacy Interventions for Older Adults: A Systematic Review of the Literature",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="10",
volume="16",
number="11",
pages="e225",
keywords="health literacy",
keywords="aging",
keywords="computers",
abstract="Background: eHealth resources offer new opportunities for older adults to access health information online, connect with others with shared health interests, and manage their health. However, older adults often lack sufficient eHealth literacy to maximize their benefit from these resources. Objective: This review evaluates the research design, methods, and findings of eHealth literacy interventions for older adults. Methods: A systematic review of peer-reviewed research articles from 28 databases in 9 fields was carried out in January 2013. Four rounds of screening of articles in these databases resulted in a final sample of 23 articles. Results: Findings indicated a significant gap in the literature for eHealth literacy interventions evaluating health outcomes as the outcome of interest, a lack of theory-based interventions, and few studies applied high-quality research design. Conclusions: Our findings emphasize the need for researchers to develop and assess theory-based interventions applying high-quality research design in eHealth literacy interventions targeting the older population. ",
doi="10.2196/jmir.3318",
url="http://www.jmir.org/2014/11/e225/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25386719"
}


@Article{info:doi/10.2196/jmir.3748,
author="Poulton, Terry
and Ellaway, H. Rachel
and Round, Jonathan
and Jivram, Trupti
and Kavia, Sheetal
and Hilton, Sean",
title="Exploring the Efficacy of Replacing Linear Paper-Based Patient Cases in Problem-Based Learning With Dynamic Web-Based Virtual Patients: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2014",
month="Nov",
day="05",
volume="16",
number="11",
pages="e240",
keywords="problem-based learning",
keywords="decision making",
keywords="education, medical",
keywords="virtual patients",
keywords="curriculum",
abstract="Background: Problem-based learning (PBL) is well established in medical education and beyond, and continues to be developed and explored. Challenges include how to connect the somewhat abstract nature of classroom-based PBL with clinical practice and how to maintain learner engagement in the process of PBL over time. Objective: A study was conducted to investigate the efficacy of decision-PBL (D-PBL), a variant form of PBL that replaces linear PBL cases with virtual patients. These Web-based interactive cases provided learners with a series of patient management pathways. Learners were encouraged to consider and discuss courses of action, take their chosen management pathway, and experience the consequences of their decisions. A Web-based application was essential to allow scenarios to respond dynamically to learners' decisions, to deliver the scenarios to multiple PBL classrooms in the same timeframe, and to record centrally the paths taken by the PBL groups. Methods: A randomized controlled trial in crossover design was run involving all learners (N=81) in the second year of the graduate entry stream for the undergraduate medicine program at St George's University of London. Learners were randomized to study groups; half engaged in a D-PBL activity whereas the other half had a traditional linear PBL activity on the same subject material. Groups alternated D-PBL and linear PBL over the semester. The measure was mean cohort performance on specific face-to-face exam questions at the end of the semester. Results: D-PBL groups performed better than linear PBL groups on questions related to D-PBL with the difference being statistically significant for all questions. Differences between the exam performances of the 2 groups were not statistically significant for the questions not related to D-PBL. The effect sizes for D-PBL--related questions were large and positive (>0.6) except for 1 question that showed a medium positive effect size. The effect sizes for questions not related to D-PBL were all small (?0.3) with a mix of positive and negative values. Conclusions: The efficacy of D-PBL was indicated by improved exam performance for learners who had D-PBL compared to those who had linear PBL. This suggests that the use of D-PBL leads to better midterm learning outcomes than linear PBL, at least for learners with prior experience with linear PBL. On the basis of tutor and student feedback, St George's University of London and the University of Nicosia, Cyprus have replaced paper PBL cases for midstage undergraduate teaching with D-PBL virtual patients, and 6 more institutions in the ePBLnet partnership will be implementing D-PBL in Autumn 2015. ",
doi="10.2196/jmir.3748",
url="http://www.jmir.org/2014/11/e240/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25373314"
}