@Article{info:doi/10.2196/jmir.3185,
author="Geraedts, S. Anna
and Kleiboer, M. Annet
and Wiezer, M. Noortje
and van Mechelen, Willem
and Cuijpers, Pim",
title="Short-Term Effects of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2014",
month="May",
day="06",
volume="16",
number="5",
pages="e121",
keywords="depression, employees, occupational therapy, Internet, prevention",
abstract="Background: Depressive disorders are highly prevalent in the working population and are associated with excessive costs. The evidence for effective worker-directed interventions for employees with depressive symptoms is limited. Treating employees with depressive symptoms before sick leave via the Internet could be beneficial and cost saving. Objective: In this study, we developed and tested the effectiveness of a Web-based guided self-help course for employees with depressive symptoms. We report on the posttreatment effectiveness of the intervention. Methods: This study is a two-arm randomized controlled trial comparing a Web-based guided self-help course to care as usual (CAU). We recruited employees from 6 different companies via the companies' intranet and posters. The main inclusion criterion was elevated depressive symptoms as measured by a score of ?16 on the Center for Epidemiological Studies Depression scale (CES-D). The intervention (Happy@Work) was based on problem-solving treatment and cognitive therapy and consisted of 6 weekly lessons. Participants were asked to submit their weekly assignment via the website after completion. They subsequently received feedback from a coach via the website. Self-report questionnaires on depressive symptoms (CES-D; primary outcome), anxiety measured by the Hospital Anxiety and Depression Scale (HADS), burnout measured by the Maslach Burnout Inventory (MBI), and work performance measured by the Health and Work Performance Questionnaire (HPQ; secondary outcomes) were completed at baseline and at posttreatment. Results: A total of 231 employees were randomized to either the intervention group (n=116) or CAU (n=115).The posttreatment assessment was completed by 171 (74.0\%) participants. Both the intervention and the CAU group showed significant improvements in the primary outcome of depressive symptoms, but no differences between the conditions was found (d=0.16, 95\% CI --0.10 to 0.41, P=.29). Significant but small effects in favor of the intervention group were found for anxiety symptoms (d=0.16, 95\% CI --0.09 to 0.42, P=.04) and exhaustion (d=0.17, 95\% CI --0.09 to 0.43, P=.02). Conclusions: This study showed that a Web-based guided self-help course for employees with depressive symptoms was not more effective in reducing depressive symptoms among employees than CAU. Large improvements in depressive symptoms in the CAU group were unforeseen and potential explanations are discussed. ",
doi="10.2196/jmir.3185",
url="http://www.jmir.org/2014/5/e121/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24800966"
}


@Article{info:doi/10.2196/jmir.3142,
author="Davies, Bethan E.
and Morriss, Richard
and Glazebrook, Cris",
title="Computer-Delivered and Web-Based Interventions to Improve Depression, Anxiety, and Psychological Well-Being of University Students: A Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2014",
month="May",
day="16",
volume="16",
number="5",
pages="e130",
keywords="systematic review",
keywords="meta-analysis",
keywords="intervention",
keywords="universities",
keywords="students",
keywords="mental health",
keywords="depression",
keywords="anxiety",
keywords="health promotion",
abstract="Background: Depression and anxiety are common mental health difficulties experienced by university students and can impair academic and social functioning. Students are limited in seeking help from professionals. As university students are highly connected to digital technologies, Web-based and computer-delivered interventions could be used to improve students' mental health. The effectiveness of these intervention types requires investigation to identify whether these are viable prevention strategies for university students. Objective: The intent of the study was to systematically review and analyze trials of Web-based and computer-delivered interventions to improve depression, anxiety, psychological distress, and stress in university students. Methods: Several databases were searched using keywords relating to higher education students, mental health, and eHealth interventions. The eligibility criteria for studies included in the review were: (1) the study aimed to improve symptoms relating to depression, anxiety, psychological distress, and stress, (2) the study involved computer-delivered or Web-based interventions accessed via computer, laptop, or tablet, (3) the study was a randomized controlled trial, and (4) the study was trialed on higher education students. Trials were reviewed and outcome data analyzed through random effects meta-analyses for each outcome and each type of trial arm comparison. Cochrane Collaboration risk of bias tool was used to assess study quality. Results: A total of 17 trials were identified, in which seven were the same three interventions on separate samples; 14 reported sufficient information for meta-analysis. The majority (n=13) were website-delivered and nine interventions were based on cognitive behavioral therapy (CBT). A total of 1795 participants were randomized and 1480 analyzed. Risk of bias was considered moderate, as many publications did not sufficiently report their methods and seven explicitly conducted completers' analyses. In comparison to the inactive control, sensitivity meta-analyses supported intervention in improving anxiety (pooled standardized mean difference [SMD] ?0.56; 95\% CI ?0.77 to ?0.35, P<.001), depression (pooled SMD ?0.43; 95\% CI ?0.63 to ?0.22, P<.001), and stress (pooled SMD ?0.73; 95\% CI ?1.27 to ?0.19, P=.008). In comparison to active controls, sensitivity analyses did not support either condition for anxiety (pooled SMD ?0.18; 95\% CI ?0.98 to 0.62, P=.66) or depression (pooled SMD ?0.28; 95\% CI ?0.75 to ?0.20, P=.25). In contrast to a comparison intervention, neither condition was supported in sensitivity analyses for anxiety (pooled SMD ?0.10; 95\% CI ?0.39 to 0.18, P=.48) or depression (pooled SMD ?0.33; 95\% CI ?0.43 to 1.09, P=.40). Conclusions: The findings suggest Web-based and computer-delivered interventions can be effective in improving students' depression, anxiety, and stress outcomes when compared to inactive controls, but some caution is needed when compared to other trial arms and methodological issues were noticeable. Interventions need to be trialed on more heterogeneous student samples and would benefit from user evaluation. Future trials should address methodological considerations to improve reporting of trial quality and address post-intervention skewed data. ",
doi="10.2196/jmir.3142",
url="http://www.jmir.org/2014/5/e130/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24836465"
}


@Article{info:doi/10.2196/jmir.3261,
author="Kramer, Jeannet
and Conijn, Barbara
and Oijevaar, Pien
and Riper, Heleen",
title="Effectiveness of a Web-Based Solution-Focused Brief Chat Treatment for Depressed Adolescents and Young Adults: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2014",
month="May",
day="29",
volume="16",
number="5",
pages="e141",
keywords="depression",
keywords="randomized controlled trial",
keywords="Internet",
keywords="Solution Focused Brief Therapy",
keywords="young adults",
abstract="Background: Up to 9\% of young people suffer from depression. Unfortunately, many in need of help remain untreated. The Internet offers anonymous ways to help depressed youth, especially those who are reluctant to search for help because of fear of stigma. Objective: Our goal was to evaluate the effectiveness of an individual chat treatment based on Solution-Focused Brief Therapy (SFBT) to young individuals aged 12-22 years with depressive symptoms by comparing it to a waiting list control group. Methods: For this study, 263 young people with depressive symptoms were randomized to the Web-based SFBT intervention, PratenOnline, or to a waiting list control condition. The chat treatment was delivered by trained professionals. Groups were compared on depressive complaints as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) after 9 weeks and 4.5 months. For the chat group only, changes in depressive symptoms at 7.5 months after baseline were explored. Results: The experimental SFBT condition (n=131) showed significantly greater improvement than the waiting list condition (n=132) in depressive symptoms at 9 weeks and 4.5 months on the CES-D, with a small between group effect size at 9 weeks (d=0.18, 95\% CI -0.10 to 0.47) and a large effect size at 4.5 months (d=0.79, 95\% CI 0.45-1.08). The percentage of participants showing a reliable and clinically significant change in depression was significantly larger for the SFBT intervention at 4.5 months only (28.2\% vs 11.4\% for the waiting list, P<.001, number needed to treat=6). At 7.5 months, the SFBT group showed further improvements. However, results have to be considered carefully because of high attrition rates. Conclusions: The Web-based SFBT chat intervention of PratenOnline was more effective than a waiting list control group in reducing depressive symptoms, and effects were larger at follow-up then at post-treatment. More studies are needed to find out if outcomes will be replicated, especially for those younger than 18 year old. Trial Registration: Netherlands Trial Register: NTR 1696; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1696 (Archived by WebCite at http://www.webcitation.org/6DspeYWrJ). ",
doi="10.2196/jmir.3261",
url="http://www.jmir.org/2014/5/e141/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24874006"
}


@Article{info:doi/10.2196/jmir.3163,
author="Bannink, Rienke
and Broeren, Suzanne
and Joosten-van Zwanenburg, Evelien
and van As, Els
and van de Looij-Jansen, Petra
and Raat, Hein",
title="Effectiveness of a Web-Based Tailored Intervention (E-health4Uth) and Consultation to Promote Adolescents' Health: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2014",
month="May",
day="30",
volume="16",
number="5",
pages="e143",
keywords="adolescents",
keywords="youth health care",
keywords="eHealth",
keywords="Internet",
keywords="Web-based tailoring",
keywords="consultation",
keywords="randomized controlled trial",
keywords="health promotion",
keywords="prevention",
abstract="Background: To promote well-being and health behaviors among adolescents, 2 interventions were implemented at 12 secondary schools. Adolescents in the E-health4Uth group received Web-based tailored messages focused on their health behaviors and well-being. Adolescents in the E-health4Uth and consultation group received the same tailored messages, but were subsequently referred to a school nurse for a consultation if they were at risk of mental health problems. Objective: This study evaluated the effect of E-health4Uth and E-health4Uth and consultation on well-being (ie, mental health status and health-related quality of life) and health behaviors (ie, alcohol and drug use, smoking, safe sex). Methods: A cluster randomized controlled trial was conducted among third- and fourth-year secondary school students (mean age 15.9, SD 0.69). School classes (clusters) were randomly assigned to (1) E-health4Uth group, (2) E-health4Uth and consultation group, or (3) control group (ie, care as usual). Adolescents completed a questionnaire at baseline and at 4-month follow-up assessing alcohol consumption, smoking, drug use, condom use, mental health via the Strengths and Difficulties Questionnaire (SDQ) and the Youth Self Report (YSR; only measured at follow-up), and health-related quality of life. Multilevel logistic, ordinal, and linear regression analyses were used to reveal differences in health behavior and well-being between the intervention groups and the control group at follow-up. Subsequently, it was explored whether demographics moderated the effects. Results: Data from 1256 adolescents were analyzed. Compared to the control intervention, the E-health4Uth intervention, as a standalone intervention, showed minor positive results in health-related quality of life (B=2.79, 95\% CI 0.72-4.87) and condom use during intercourse among adolescents of Dutch ethnicity (OR 3.59, 95\% CI 1.71-7.55) not replicated in the E-health4Uth and consultation group. The E-health4Uth and consultation intervention showed minor positive results in the mental health status of adolescents (SDQ: B=?0.60, 95\% CI ?1.17 to  ?0.04), but a negative effect on drug use among boys (OR 0.36, 95\% CI 0.13-0.96). In the subgroup of adolescents who were at risk of mental health problems at baseline (and referred for a consultation with the nurse), the E-health4Uth and consultation group showed minor to moderate positive results in mental health status (SDQ: B=?1.79, 95\% CI ?3.35 to  ?0.22; YSR: B=?9.11, 95\% CI ?17.52 to  ?0.71) and health-related quality of life (B=7.81, 95\% CI 2.41-13.21) at follow-up compared to adolescents in the control group who were at risk of mental health problems at baseline. Conclusions: Findings from this study support the use of the E-health4Uth and consultation intervention in promoting the well-being of adolescents at risk of mental health problems. Future research is needed to further evaluate the effects of the consultation as a standalone intervention, and the dual approach of further tailored eHealth messages and a consultation. Trial Registration: Nederlands Trial Register: NTR 3596; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3596 (Archived by WebCite at http://www.webcitation.org/6PmgrPOuv). ",
doi="10.2196/jmir.3163",
url="http://www.jmir.org/2014/5/e143/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24878521"
}


@Article{info:doi/10.2196/jmir.3297,
author="Evans, Douglas W.
and Wallace Bihm, Jasmine
and Szekely, Daniel
and Nielsen, Peter
and Murray, Elizabeth
and Abroms, Lorien
and Snider, Jeremy",
title="Initial Outcomes From a 4-Week Follow-Up Study of the Text4baby Program in the Military Women's Population: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2014",
month="May",
day="20",
volume="16",
number="5",
pages="e131",
keywords="Text4baby",
keywords="prenatal health care",
keywords="mobile health",
keywords="military health",
keywords="health behavior",
abstract="Background: The use of mobile phone technologies for health promotion and disease prevention has advanced rapidly in recent years. Text4baby is a theory-based mobile health (mHealth) program in which text messages are delivered to pregnant women and new mothers to improve their health care beliefs and behaviors and improve health status and clinical outcomes. Recent evaluations of Text4baby have found that it improves targeted health attitudes and beliefs, but effects on behavior have not yet been determined. Objective: In this study, investigators aimed to evaluate Text4baby in the military women's population. Methods: Investigators conducted a randomized controlled trial at Madigan Army Medical Center in Tacoma, Washington, from December 2011 through September 2013. All participants were pregnant women first presenting for care at Madigan. Investigators conducted a baseline assessment using a 24-item, self-administered online survey of attitudes and behaviors related to Text4baby message content. Participants were randomized to Text4baby plus usual care (intervention) or usual care alone (control). Investigators analyzed treatment effects of Text4baby on short-term targeted outcomes 4 weeks post enrollment. Results: For this study, 943 patients were randomized and completed a baseline assessment. The average patient age was 28 years and nearly 70\% self-identified as Caucasian. 48.7\% of enrollees (459/943) completed the first follow-up assessment. Higher rates of single and working/in-school patients dropped out of the intervention arm of the study, and we adjusted for this finding in subsequent models. However, while investigators were unable to re-survey these participants, only 1.9\% of Text4baby enrollees (18/943) dropped the service during the study period. Adjusted and unadjusted logistic generalized estimating equation models were developed to assess intervention effects on measured outcomes. In the model adjusting for age, marital status, having had a previous baby, and race/ethnicity, there was a significant effect of Text4baby intervention exposure on increased agreement with belief in the importance of taking prenatal vitamins (OR 1.91, 95\% CI 1.08-3.34, P=.024). All of these attitudes had been targeted by at least one text message during the 4-week evaluation period examined in this study. In unadjusted models, there was a significant effect of intervention exposure on belief in the importance of visiting a health care provider to be a healthy new mother (OR 1.52, 95\% CI 1.01-2.31, P=.046) and in the health risks of alcohol during pregnancy (OR 2.06, 95\% CI 1.00-4.31, P=.05). No behavioral effects of the intervention were observed in this analysis. Conclusions: Text4baby is a promising program that offers lessons for future mHealth activities. This large-scale study demonstrated initial effects of the program on attitudes and beliefs targeted by the messages received by women during the study period. Results confirm previous findings from Text4baby studies and other mHealth research. Future analyses will examine dosage effects of the intervention on behaviors and clinical outcomes. ",
doi="10.2196/jmir.3297",
url="http://www.jmir.org/2014/5/e131/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24846909"
}


@Article{info:doi/10.2196/jmir.3138,
author="Tran, Kim
and Morra, Dante
and Lo, Vivian
and Quan, D. Sherman
and Abrams, Howard
and Wu, C. Robert",
title="Medical Students and Personal Smartphones in the Clinical Environment: The Impact on Confidentiality of Personal Health Information and Professionalism",
journal="J Med Internet Res",
year="2014",
month="May",
day="22",
volume="16",
number="5",
pages="e132",
keywords="medical informatics",
keywords="communication",
keywords="hospitals",
keywords="mobile phone",
keywords="smartphones",
abstract="Background: Smartphones are becoming ubiquitous in health care settings. The increased adoption of mobile technology such as smartphones may be attributed to their use as a point-of-care information source and to perceived improvements in clinical communication and efficiency. However, little is known about medical students' use of personal smartphones for clinical work. Objective: The intent of the study was to examine final-year medical students' experience with and attitudes toward using personal mobile technology in the clinical environment, with respect to the perceived impact on patient confidentiality and provider professionalism. Methods: Cross-sectional surveys were completed by final-year medical students at the University of Toronto. Respondents were asked about the type of personal mobile phone they use, security features on their personal phone, experiences using their personal phone during clinical rotations, and attitudes about using their personal phone for clinical work purposes. Results: The overall response rate was 45.4\% (99/218). Smartphone ownership was prevalent (98\%, 97/99) with the majority (86\%, 85/99) of participants using their personal phones for patient-related communication during clinical rotations. A total of 26\% (26/99) of participants reported not having any type of security feature on their personal phone, 94\% (90/96) of participants agreed that using their personal phone for clinical work makes them more efficient, and 86\% (82/95) agreed that their personal phone allows them to provide better patient care. Although 68\% (65/95) of participants believe that the use of personal phones for patient-related communication with colleagues poses a risk to the privacy and confidentiality of patient health information, 22\% (21/96) of participants still use their personal phone to text or email identifiable patient data to colleagues. Conclusions: Our findings suggest that the use of personal smartphones for clinical work by medical students is prevalent. There is a need to more fully address the threat to patient confidentiality posed by the use of unsecured communication devices such as smartphones. ",
doi="10.2196/jmir.3138",
url="http://www.jmir.org/2014/5/e132/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24855046"
}


@Article{info:doi/10.2196/jmir.3421,
author="Min, Ha Yul
and Lee, Won Jong
and Shin, Yong-Wook
and Jo, Min-Woo
and Sohn, Guiyun
and Lee, Jae-Ho
and Lee, Guna
and Jung, Hae Kyung
and Sung, Joohon
and Ko, Seok Beom
and Yu, Jong-Han
and Kim, Jeong Hee
and Son, Ho Byung
and Ahn, Hyun Sei",
title="Daily Collection of Self-Reporting Sleep Disturbance Data via a Smartphone App in Breast Cancer Patients Receiving Chemotherapy: A Feasibility Study",
journal="J Med Internet Res",
year="2014",
month="May",
day="23",
volume="16",
number="5",
pages="e135",
keywords="mobile applications",
keywords="self report",
keywords="compliance",
keywords="breast cancer",
abstract="Background: Improvements in mobile telecommunication technologies have enabled clinicians to collect patient-reported outcome (PRO) data more frequently, but there is as yet limited evidence regarding the frequency with which PRO data can be collected via smartphone applications (apps) in breast cancer patients receiving chemotherapy. Objective: The primary objective of this study was to determine the feasibility of an app for sleep disturbance-related data collection from breast cancer patients receiving chemotherapy. A secondary objective was to identify the variables associated with better compliance in order to identify the optimal subgroups to include in future studies of smartphone-based interventions. Methods: Between March 2013 and July 2013, patients who planned to receive neoadjuvant chemotherapy for breast cancer at Asan Medical Center who had access to a smartphone app were enrolled just before the start of their chemotherapy and asked to self-report their sleep patterns, anxiety severity, and mood status via a smartphone app on a daily basis during the 90-day study period. Push notifications were sent to participants daily at 9 am and 7 pm. Data regarding the patients' demographics, interval from enrollment to first self-report, baseline Beck's Depression Inventory (BDI) score, and health-related quality of life score (as assessed using the EuroQol Five Dimensional [EQ5D-3L] questionnaire) were collected to ascertain the factors associated with compliance with the self-reporting process. Results: A total of 30 participants (mean age 45 years, SD 6; range 35-65 years) were analyzed in this study. In total, 2700 daily push notifications were sent to these 30 participants over the 90-day study period via their smartphones, resulting in the collection of 1215 self-reporting sleep-disturbance data items (overall compliance rate=45.0\%, 1215/2700). The median value of individual patient-level reporting rates was 41.1\% (range 6.7-95.6\%). The longitudinal day-level compliance curve fell to 50.0\% at day 34 and reached a nadir of 13.3\% at day 90. The cumulative longitudinal compliance curve exhibited a steady decrease by about 50\% at day 70 and continued to fall to 45\% on day 90. Women without any form of employment exhibited the higher compliance rate. There was no association between any of the other patient characteristics (ie, demographics, and BDI and EQ5D-3L scores) and compliance. The mean individual patient-level reporting rate was higher for the subgroup with a 1-day lag time, defined as starting to self-report on the day immediately after enrollment, than for those with a lag of 2 or more days (51.6\%, SD 24.0 and 29.6\%, SD 25.3, respectively; P=.03). Conclusions: The 90-day longitudinal collection of daily self-reporting sleep-disturbance data via a smartphone app was found to be feasible. Further research should focus on how to sustain compliance with this self-reporting for a longer time and select subpopulations with higher rates of compliance for mobile health care. ",
doi="10.2196/jmir.3421",
url="http://www.jmir.org/2014/5/e135/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24860070"
}


@Article{info:doi/10.2196/jmir.3298,
author="Tsuya, Atsushi
and Sugawara, Yuya
and Tanaka, Atsushi
and Narimatsu, Hiroto",
title="Do Cancer Patients Tweet? Examining the Twitter Use of Cancer Patients in Japan",
journal="J Med Internet Res",
year="2014",
month="May",
day="27",
volume="16",
number="5",
pages="e137",
keywords="communication",
keywords="co-occurrence",
keywords="Internet",
keywords="leukemia",
keywords="Web 2.0",
abstract="Background: Twitter is an interactive, real-time media that could prove useful in health care. Tweets from cancer patients could offer insight into the needs of cancer patients. Objective: The objective of this study was to understand cancer patients' social media usage and gain insight into patient needs. Methods: A search was conducted of every publicly available user profile on Twitter in Japan for references to the following: breast cancer, leukemia, colon cancer, rectal cancer, colorectal cancer, uterine cancer, cervical cancer, stomach cancer, lung cancer, and ovarian cancer. We then used an application programming interface and a data mining method to conduct a detailed analysis of the tweets from cancer patients. Results: Twitter user profiles included references to breast cancer (n=313), leukemia (n=158), uterine or cervical cancer (n=134), lung cancer (n=87), colon cancer (n=64), and stomach cancer (n=44). A co-occurrence network is seen for all of these cancers, and each cancer has a unique network conformation. Keywords included words about diagnosis, symptoms, and treatments for almost all cancers. Words related to social activities were extracted for breast cancer. Words related to vaccination and support from public insurance were extracted for uterine or cervical cancer. Conclusions: This study demonstrates that cancer patients share information about their underlying disease, including diagnosis, symptoms, and treatments, via Twitter. This information could prove useful to health care providers. ",
doi="10.2196/jmir.3298",
url="http://www.jmir.org/2014/5/e137/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24867458"
}


@Article{info:doi/10.2196/jmir.3377,
author="Tedim Cruz, V{\'i}tor
and Pais, Joana
and Alves, Iv{\^a}nia
and Ruano, Lu{\'i}s
and Mateus, C{\'a}tia
and Barreto, Rui
and Bento, Virg{\'i}lio
and Colunas, M{\'a}rcio
and Rocha, Nelson
and Coutinho, Paula",
title="Web-Based Cognitive Training: Patient Adherence and Intensity of Treatment in an Outpatient Memory Clinic",
journal="J Med Internet Res",
year="2014",
month="May",
day="07",
volume="16",
number="5",
pages="e122",
keywords="cognitive training",
keywords="neurorehabilitation",
keywords="Web-based training",
keywords="eHealth systems",
keywords="training intensity",
keywords="adherence",
keywords="memory clinic",
abstract="Background: Cognitive training has been playing an increasing role in the treatment of patients with cognitive deficits. This type of intervention, namely its intensity, can be optimized by incorporating information technology-based systems. Objective: The intent of the study was to determine the treatment intensity and patient adherence to home-based cognitive training strategies (Web-based cognitive training). Methods: A cohort of 45 patients with neurologic and psychiatric diseases attending an outpatient memory clinic (average age 50.7 years, SD 17.0; average education 7.8 years, SD 4.9) was followed over 18 months. Participants were challenged to use a Web-based cognitive training system, ``COGWEB'', on a daily basis, and fulfilled at least four weeks of training supervised remotely. Additionally, 11 patients attended face-to-face sessions. Results: The average duration of continuous cognitive training was 18.8 weeks (SD 18.9). Each patient performed on average 363.5 minutes/week (SD 136.6). At 6-month follow-up, 82.8\% complied with their treatment plan. The average proportion of complete weeks was 0.75 (SD 0.22). Patients with dementia trained more intensively (444.6 minutes/week), followed by patients with static brain lesion (414.5 minutes/week; P=.01). The group that held face-to-face sessions performed more training overall (481.4 vs 366.9 minutes/week), achieving a stronger expression and statistical significance in the last week of training (652.6 versus 354.9 minutes/week, P=.027). Conclusions: Overall, the weekly training intensity was high. Patients with dementia and static lesions performed more cognitive training. Face-to-face sessions were associated with higher intensities. The combination of classical methods with information technology systems seems to ensure greater training intensity. ",
doi="10.2196/jmir.3377",
url="http://www.jmir.org/2014/5/e122/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24808451"
}


@Article{info:doi/10.2196/jmir.3397,
author="McNaughton, C. Emily
and Coplan, M. Paul
and Black, A. Ryan
and Weber, E. Sarah
and Chilcoat, D. Howard
and Butler, F. Stephen",
title="Monitoring of Internet Forums to Evaluate Reactions to the Introduction of Reformulated OxyContin to Deter Abuse",
journal="J Med Internet Res",
year="2014",
month="May",
day="02",
volume="16",
number="5",
pages="e119",
keywords="Internet",
keywords="opioid analgesic",
keywords="drug abuse",
keywords="prescription drug",
keywords="OxyContin",
keywords="epidemiology",
keywords="surveillance",
keywords="social media",
keywords="qualitative research",
abstract="Background: Reformulating opioid analgesics to deter abuse is one approach toward improving their benefit-risk balance. To assess sentiment and attempts to defeat these products among difficult-to-reach populations of prescription drug abusers, evaluation of posts on Internet forums regarding reformulated products may be useful. A reformulated version of OxyContin (extended-release oxycodone) with physicochemical properties to deter abuse presented an opportunity to evaluate posts about the reformulation in online discussions. Objective: The objective of this study was to use messages on Internet forums to evaluate reactions to the introduction of reformulated OxyContin and to identify methods aimed to defeat the abuse-deterrent properties of the product. Methods: Posts collected from 7 forums between January 1, 2008 and September 30, 2013 were evaluated before and after the introduction of reformulated OxyContin on August 9, 2010. A quantitative evaluation of discussion levels across the study period and a qualitative coding of post content for OxyContin and 2 comparators for the 26 month period before and after OxyContin reformulation were conducted. Product endorsement was estimated for each product before and after reformulation as the ratio of endorsing-to-discouraging posts (ERo). Post-to-preintroduction period changes in ERos (ie, ratio of ERos) for each product were also calculated. Additionally, post content related to recipes for defeating reformulated OxyContin were evaluated from August 9, 2010 through September 2013. Results: Over the study period, 45,936 posts related to OxyContin, 18,685 to Vicodin (hydrocodone), and 23,863 to Dilaudid (hydromorphone) were identified. The proportion of OxyContin-related posts fluctuated between 6.35 and 8.25 posts per 1000 posts before the reformulation, increased to 10.76 in Q3 2010 when reformulated OxyContin was introduced, and decreased from 9.14 in Q4 2010 to 3.46 in Q3 2013 in the period following the reformulation. The sentiment profile for OxyContin changed following reformulation; the post-to-preintroduction change in the ERo indicated reformulated OxyContin was discouraged significantly more than the original formulation (ratio of ERos=0.43, P<.001). A total of 37 recipes for circumventing the abuse-deterrent characteristics of reformulated OxyContin were observed; 32 were deemed feasible (ie, able to abuse). The frequency of posts reporting abuse of reformulated OxyContin via these recipes was low and decreased over time. Among the 5677 posts mentioning reformulated OxyContin, 825 posts discussed recipes and 498 reported abuse of reformulated OxyContin by such recipes (41 reported injecting and 128 reported snorting). Conclusions: After introduction of physicochemical properties to deter abuse, changes in discussion of OxyContin on forums occurred reflected by a reduction in discussion levels and endorsing content. Despite discussion of recipes, there is a relatively small proportion of reported abuse of reformulated OxyContin via recipes, particularly by injecting or snorting routes. Analysis of Internet discussion is a valuable tool for monitoring the impact of abuse-deterrent formulations. ",
doi="10.2196/jmir.3397",
url="http://www.jmir.org/2014/5/e119/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24800858"
}


@Article{info:doi/10.2196/jmir.2846,
author="Nakada, Haruka
and Yuji, Koichiro
and Tsubokura, Masaharu
and Ohsawa, Yukio
and Kami, Masahiro",
title="Development of a National Agreement on Human Papillomavirus Vaccination in Japan: An Infodemiology Study",
journal="J Med Internet Res",
year="2014",
month="May",
day="15",
volume="16",
number="5",
pages="e129",
keywords="cervical cancer",
keywords="health policy",
keywords="human papillomavirus",
keywords="public health",
keywords="vaccination",
abstract="Background: A national agreement on human papillomavirus (HPV) vaccination was achieved relatively quickly in Japan as compared to the United States and India. Objective: The objective was to identify the role of print and online media references, including references to celebrities or other informants, as factors potentially responsible for the relatively rapid national acceptance of HPV vaccination in Japan. Methods: A method of text mining was performed to select keywords, representing the context of the target documents, from articles relevant to the promotion of HPV vaccination appearing in major Japanese newspapers and Web pages between January 2009 and July 2010. The selected keywords were classified as positive, negative, or neutral, and the transition of the frequency of their appearance was analyzed. Results: The number of positive and neutral keywords appearing in newspaper articles increased sharply in early 2010 while the number of negative keywords remained low. The numbers of positive, neutral, and negative keywords appearing in Web pages increased gradually and did not significantly differ by category. Neutral keywords, such as ``vaccine'' and ``prevention,'' appeared more frequently in newspaper articles, whereas negative keywords, such as ``infertility'' and ``side effect,'' appeared more frequently in Web pages. The extraction of the positive keyword ``signature campaign'' suggests that vaccine beneficiaries cooperated with providers in promoting HPV vaccination. Conclusions: The rapid development of a national agreement regarding HPV vaccination in Japan may be primarily attributed to the advocacy of vaccine beneficiaries, supported by advocacy by celebrities and positive reporting by print and online media. ",
doi="10.2196/jmir.2846",
url="http://www.jmir.org/2014/5/e129/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24834471"
}


@Article{info:doi/10.2196/jmir.3190,
author="Bonner, Carissa
and Jansen, Jesse
and Newell, R. Ben
and Irwig, Les
and Glasziou, Paul
and Doust, Jenny
and Dhillon, Haryana
and McCaffery, Kirsten",
title="I Don't Believe It, But I'd Better Do Something About It: Patient Experiences of Online Heart Age Risk Calculators",
journal="J Med Internet Res",
year="2014",
month="May",
day="05",
volume="16",
number="5",
pages="e120",
keywords="cardiovascular disease",
keywords="prevention",
keywords="risk calculator",
keywords="risk assessment",
keywords="risk perception",
keywords="lifestyle",
keywords="behavior change",
abstract="Background: Health risk calculators are widely available on the Internet, including cardiovascular disease (CVD) risk calculators that estimate the probability of a heart attack, stroke, or death over a 5- or 10-year period. Some calculators convert this probability to ``heart age'', where a heart age older than current age indicates modifiable risk factors. These calculators may impact patient decision making about CVD risk management with or without clinician involvement, but little is known about how patients use them. Previous studies have not investigated patient understanding of heart age compared to 5-year percentage risk, or the best way to present heart age. Objective: This study aimed to investigate patient experiences and understanding of online heart age calculators that use different verbal, numerical, and graphical formats, based on 5- and 10-year Framingham risk equations used in clinical practice guidelines around the world. Methods: General practitioners in New South Wales, Australia, recruited 26 patients with CVD/lifestyle risk factors who were not taking cholesterol or blood pressure-lowering medication in 2012. Participants were asked to ``think aloud'' while using two heart age calculators in random order, with semi-structured interviews before and after. Transcribed audio recordings were coded and a framework analysis method was used. Results: Risk factor questions were often misinterpreted, reducing the accuracy of the calculators. Participants perceived older heart age as confronting and younger heart age as positive but unrealistic. Unexpected or contradictory results (eg, low percentage risk but older heart age) led participants to question the credibility of the calculators. Reasons to discredit the results included the absence of relevant lifestyle questions and impact of corporate sponsorship. However, the calculators prompted participants to consider lifestyle changes irrespective of whether they received younger, same, or older heart age results. Conclusions: Online heart age calculators can be misunderstood and disregarded if they produce unexpected or contradictory results, but they may still motivate lifestyle changes. Future research should investigate both the benefits and harms of communicating risk in this way, and how to increase the reliability and credibility of online health risk calculators. ",
doi="10.2196/jmir.3190",
url="http://www.jmir.org/2014/5/e120/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24797339"
}


@Article{info:doi/10.2196/jmir.3257,
author="Edwards, Louisa
and Thomas, Clare
and Gregory, Alison
and Yardley, Lucy
and O'Cathain, Alicia
and Montgomery, A. Alan
and Salisbury, Chris",
title="Are People With Chronic Diseases Interested in Using Telehealth? A Cross-Sectional Postal Survey",
journal="J Med Internet Res",
year="2014",
month="May",
day="08",
volume="16",
number="5",
pages="e123",
keywords="telehealth",
keywords="Internet",
keywords="technology",
keywords="cardiovascular diseases",
keywords="depression",
keywords="mental health",
keywords="chronic disease",
keywords="survey methodology",
keywords="patient acceptance of health care",
abstract="Background: There is growing interest in telehealth---the use of technology to support the remote delivery of health care and promote self-management---as a potential alternative to face-to-face care for patients with chronic diseases. However, little is known about what precipitates interest in the use of telehealth among these patients. Objective: This survey forms part of a research program to develop and evaluate a telehealth intervention for patients with two exemplar chronic diseases: depression and raised cardiovascular disease (CVD) risk. The survey was designed to explore the key factors that influence interest in using telehealth in these patient groups. Methods: Thirty-four general practices were recruited from two different regions within England. Practice records were searched for patients with (1) depression (aged 18+ years) or (2) 10-year risk of CVD ?20\% and at least one modifiable risk factor (aged 40-74 years). Within each general practice, 54 patients in each chronic disease group were randomly selected to receive a postal questionnaire. Questions assessed five key constructs: sociodemographics, health needs, difficulties accessing health care, technology-related factors (availability, confidence using technology, perceived benefits and drawbacks of telehealth), and satisfaction with prior use of telehealth. Respondents also rated their interest in using different technologies for telehealth (phone, email and Internet, or social media). Relationships between the key constructs and interest in using the three mediums of telehealth were examined using multivariable regression models. Results: Of the 3329 patients who were sent a study questionnaire, 44.40\% completed it (872/1740, 50.11\% CVD risk; 606/1589, 38.14\% depression). Overall, there was moderate interest in using phone-based (854/1423, 60.01\%) and email/Internet-based (816/1425, 57.26\%) telehealth, but very little interest in social media (243/1430, 16.99\%). After adjusting for health needs, access difficulties, technology-related factors, and prior use of telehealth, interest in telehealth had largely no association with sociodemographic variables. For both patient groups and for each of the three technology mediums, the most important constructs related to interest in telehealth were having the confidence to use the associated technology, as well as perceiving greater advantages and fewer disadvantages from using telehealth. To illustrate, greater confidence using phone technologies (b=.16, 95\% CI 0.002-0.33), while also perceiving more benefits (b=.31, 95\% CI 0.21-0.40) and fewer drawbacks (b=-.23, 95\% CI -0.28 to -0.17) to using telehealth were associated with more interest in using phone-based telehealth technologies for patients with depression. Conclusions: There is widespread interest in using phone-based and email/Internet-based telehealth among patients with chronic diseases, regardless of their health status, access difficulties, age, or many other sociodemographic factors. This interest could be increased by helping patients gain confidence using technologies and through highlighting benefits and addressing concerns about telehealth. While the same pattern exists for social media telehealth, interest in using these technologies is minimal. ",
doi="10.2196/jmir.3257",
url="http://www.jmir.org/2014/5/e123/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24811914"
}


@Article{info:doi/10.2196/jmir.3229,
author="Yuan, Patrick
and Bare, G. Michael
and Johnson, O. Mallory
and Saberi, Parya",
title="Using Online Social Media for Recruitment of Human Immunodeficiency Virus-Positive Participants: A Cross-Sectional Survey",
journal="J Med Internet Res",
year="2014",
month="May",
day="01",
volume="16",
number="5",
pages="e117",
keywords="HIV",
keywords="AIDS",
keywords="online social media",
keywords="Facebook",
keywords="Twitter",
keywords="recruitment",
keywords="Internet research",
keywords="survey retention",
keywords="online data collection software",
keywords="non-financial incentives",
abstract="Background: There are many challenges in recruiting and engaging participants when conducting research, especially with HIV-positive individuals. Some of these challenges include geographical barriers, insufficient time and financial resources, and perceived HIV-related stigma. Objective: This paper describes the methodology of a recruitment approach that capitalized on existing online social media venues and other Internet resources in an attempt to overcome some of these barriers to research recruitment and retention. Methods: From May through August 2013, a campaign approach using a combination of online social media, non-financial incentives, and Web-based survey software was implemented to advertise, recruit, and retain participants, and collect data for a survey study with a limited budget. Results: Approximately US \$5,000 was spent with a research staff designated at 20\% of full-time effort, yielding 2034 survey clicks, 1404 of which met the inclusion criteria and initiated the survey, for an average cost of US \$3.56 per survey initiation. A total of 1221 individuals completed the survey, yielding 86.97\% retention. Conclusions: These data indicate that online recruitment is a feasible and efficient tool that can be further enhanced by sophisticated online data collection software and the addition of non-financial incentives. ",
doi="10.2196/jmir.3229",
url="http://www.jmir.org/2014/5/e117/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24784982"
}


@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.3292,
author="Lalloo, Chitra
and Kumbhare, Dinesh
and Stinson, N. Jennifer
and Henry, L. James",
title="Pain-QuILT: Clinical Feasibility of a Web-Based Visual Pain Assessment Tool in Adults With Chronic Pain",
journal="J Med Internet Res",
year="2014",
month="May",
day="12",
volume="16",
number="5",
pages="e127",
keywords="chronic pain",
keywords="assessment tool",
keywords="Internet",
keywords="clinical feasibility",
abstract="Background: Chronic pain is a prevalent and debilitating problem. Accurate and timely pain assessment is critical to pain management. In particular, pain needs to be consistently tracked over time in order to gauge the effectiveness of different treatments. In current clinical practice, paper-based questionnaires are the norm for pain assessment. However, these methods are not conducive to capturing or tracking the complex sensations of chronic pain. Pain-QuILT (previously called the Iconic Pain Assessment Tool) is a Web-based tool for the visual self-report and tracking of pain (quality, intensity, location, tracker) in the form of time-stamped records. It has been iteratively developed and evaluated in adolescents and adults with chronic pain, including usability testing and content validation.  Clinical feasibility is an important stepping-stone toward widespread implementation of a new tool. Our group has demonstrated Pain-QuILT clinical feasibility in the context of a pediatric chronic pain clinic. We sought to extend these findings by evaluating Pain-QuILT clinical feasibility from the perspective of adults with chronic pain, in comparison with standard paper-based methods (McGill Pain Questionnaire [MPQ] and Brief Pain Inventory [BPI]). Objective: The goal of our study was to assess Pain-QuILT for (1) ease of use, (2) time for completion, (3) patient preferences, and (4) to explore the patterns of self-reported pain across the Pain-QuILT, MPQ, and BPI. Methods: Participants were recruited during a scheduled follow-up visit at a hospital-affiliated pain management and physical rehabilitation clinic in southwestern Ontario. Participants self-reported their current pain using the Pain-QuILT, MPQ, and BPI (randomized order). A semistructured interview format was used to capture participant preferences for pain self-report. Results: The sample consisted of 50 adults (54\% female, 27/50) with a mean age of 50 years. Pain-QuILT was rated as significantly easier to use than both the MPQ and BPI (P<.01) and was also associated with the fewest difficulties in completion. On average, the time to complete each tool was less than 5 minutes. A majority of participants (58\%, 29/50) preferred Pain-QuILT for reporting their pain over alternate methods (16\%, 8/50 for MPQ; 14\%, 7/50 for BPI; 12\%, 6/50 for ``other''). The most commonly chosen pain descriptors on MPQ were matched with Pain-QuILT across 91\% of categories. There was a moderate-to-high correlation between Pain-QuILT and BPI scores for pain intensity (r=.70, P<.01). Conclusions: The results of this clinical feasibility study in adults with chronic pain are consistent with our previously published pediatric findings. Specifically, data indicate that Pain-QuILT is (1) easy to use, (2) quick to complete, (3) preferred by a majority of patients, and (4) correlated as expected with validated pain measures. As a digital, patient-friendly method of assessing and tracking pain, we conclude that Pain-QuILT has potential to add significant value as one standard component of chronic pain management. ",
doi="10.2196/jmir.3292",
url="http://www.jmir.org/2014/5/e127/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24819478"
}


@Article{info:doi/10.2196/jmir.2684,
author="Frost, Jeana
and Vermeulen, E. Ivar
and Beekers, Nienke",
title="Anonymity Versus Privacy: Selective Information Sharing in Online Cancer Communities",
journal="J Med Internet Res",
year="2014",
month="May",
day="14",
volume="16",
number="5",
pages="e126",
keywords="online systems",
keywords="cancer",
keywords="privacy",
keywords="confidentiality",
keywords="Health 2.0",
keywords="anonymity",
abstract="Background: Active sharing in online cancer communities benefits patients. However, many patients refrain from sharing health information online due to privacy concerns. Existing research on privacy emphasizes data security and confidentiality, largely focusing on electronic medical records. Patient preferences around information sharing in online communities remain poorly understood. Consistent with the privacy calculus perspective adopted from e-commerce research, we suggest that patients approach online information sharing instrumentally, weighing privacy costs against participation benefits when deciding whether to share certain information. Consequently, we argue that patients prefer sharing clinical information over daily life and identity information that potentially compromises anonymity. Furthermore, we explore whether patients' prior experiences, age, health, and gender affect perceived privacy costs and thus willingness to share information. Objective: The goal of the present study is to document patient preferences for sharing information within online health platforms. Methods: A total of 115 cancer patients reported sharing intentions for 15 different types of information, demographics, health status, prior privacy experiences, expected community utility, and privacy concerns. Results: Factor analysis on the 15 information types revealed 3 factors coinciding with 3 proposed information categories: clinical, daily life, and identity information. A within-subject ANOVA showed a strong preference for sharing clinical information compared to daily life and identity information (F1,114=135.59, P=.001, $\eta$2=.93). Also, adverse online privacy experiences, age, and health status negatively affected information-sharing intentions. Female patients shared information less willingly. Conclusions: Respondents' information-sharing intentions depend on dispositional and situational factors. Patients share medical details more willingly than daily life or identity information. The results suggest the need to focus on anonymity rather than privacy in online communities. ",
doi="10.2196/jmir.2684",
url="http://www.jmir.org/2014/5/e126/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24828114"
}


@Article{info:doi/10.2196/jmir.3263,
author="Mart{\'i}n Ruiz, Luisa Mar{\'i}a
and Valero Duboy, {\'A}ngel Miguel
and Torcal Loriente, Carmen
and Pau de la Cruz, Iv{\'a}n",
title="Evaluating a Web-Based Clinical Decision Support System for Language Disorders Screening in a Nursery School",
journal="J Med Internet Res",
year="2014",
month="May",
day="28",
volume="16",
number="5",
pages="e139",
keywords="primary health care",
keywords="health information systems",
keywords="knowledge management",
keywords="evaluation",
keywords="early diagnosis",
keywords="eHealth",
keywords="language disorders",
abstract="Background: Early and effective identification of developmental disorders during childhood remains a critical task for the international community. The second highest prevalence of common developmental disorders in children are language delays, which are frequently the first symptoms of a possible disorder. Objective: This paper evaluates a Web-based Clinical Decision Support System (CDSS) whose aim is to enhance the screening of language disorders at a nursery school. The common lack of early diagnosis of language disorders led us to deploy an easy-to-use CDSS in order to evaluate its accuracy in early detection of language pathologies. This CDSS can be used by pediatricians to support the screening of language disorders in primary care. Methods: This paper details the evaluation results of the ``Gades'' CDSS at a nursery school with 146 children, 12 educators, and 1 language therapist. The methodology embraces two consecutive phases. The first stage involves the observation of each child's language abilities, carried out by the educators, to facilitate the evaluation of language acquisition level performed by a language therapist. Next, the same language therapist evaluates the reliability of the observed results. Results: The Gades CDSS was integrated to provide the language therapist with the required clinical information. The validation process showed a global 83.6\% (122/146) success rate in language evaluation and a 7\% (7/94) rate of non-accepted system decisions within the range of children from 0 to 3 years old. The system helped language therapists to identify new children with potential disorders who required further evaluation. This process will revalidate the CDSS output and allow the enhancement of early detection of language disorders in children. The system does need minor refinement, since the therapists disagreed with some questions from the CDSS knowledge base (KB) and suggested adding a few questions about speech production and pragmatic abilities. The refinement of the KB will address these issues and include the requested improvements, with the support of the experts who took part in the original KB development. Conclusions: This research demonstrated the benefit of a Web-based CDSS to monitor children's neurodevelopment via the early detection of language delays at a nursery school. Current next steps focus on the design of a model that includes pseudo auto-learning capacity, supervised by experts. ",
doi="10.2196/jmir.3263",
url="http://www.jmir.org/2014/5/e139/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24870413"
}


@Article{info:doi/10.2196/jmir.3195,
author="Vermeulen, Joan
and Verwey, Ren{\'e}e
and Hochstenbach, MJ Laura
and van der Weegen, Sanne
and Man, Ping Yan
and de Witte, P. Luc",
title="Experiences of Multidisciplinary Development Team Members During User-Centered Design of Telecare Products and Services: A Qualitative Study",
journal="J Med Internet Res",
year="2014",
month="May",
day="19",
volume="16",
number="5",
pages="e124",
keywords="user-centered design",
keywords="telecare",
keywords="eHealth",
keywords="participation",
keywords="multidisciplinary team",
keywords="barriers and facilitators",
abstract="Background: User-centered design (UCD) methodologies can help take the needs and requirements of potential end-users into account during the development of innovative telecare products and services. Understanding how members of multidisciplinary development teams experience the UCD process might help to gain insight into factors that members with different backgrounds consider critical during the development of telecare products and services. Objective: The primary objective of this study was to explore how members of multidisciplinary development teams experienced the UCD process of telecare products and services. The secondary objective was to identify differences and similarities in the barriers and facilitators they experienced. Methods: Twenty-five members of multidisciplinary development teams of four Research and Development (R\&D) projects participated in this study. The R\&D projects aimed to develop telecare products and services that can support self-management in elderly people or patients with chronic conditions. Seven participants were representatives of end-users (elderly persons or patients with chronic conditions), three were professional end-users (geriatrician and nurses), five were engineers, four were managers (of R\&D companies or engineering teams), and six were researchers. All participants were interviewed by a researcher who was not part of their own development team. The following topics were discussed during the interviews: (1) aim of the project, (2) role of the participant, (3) experiences during the development process, (4) points of improvement, and (5) what the project meant to the participant. Results: Experiences of participants related to the following themes: (1) creating a development team, (2) expectations regarding responsibilities and roles, (3) translating user requirements into technical requirements, (4) technical challenges, (5) evaluation of developed products and services, and (6) valorization. Multidisciplinary team members from different backgrounds often reported similar experienced barriers (eg, different members of the development team speak a ``different language'') and facilitators (eg, team members should voice expectations at the start of the project to prevent miscommunication at a later stage). However, some experienced barriers and facilitators were reported only by certain groups of participants. For example, only managers reported the experience that having different ideas about what a good business case is within one development team was a barrier, whereas only end-users emphasized the facilitating role of project management in end-user participation and the importance of continuous feedback from researchers on input of end-users. Conclusions: Many similarities seem to exist between the experienced barriers and facilitators of members of multidisciplinary development teams during UCD of telecare products and services. However, differences in experiences between team members from various backgrounds exist as well. Insights into these similarities and differences can improve understanding between team members from different backgrounds, which can optimize collaboration during the development of telecare products and services. ",
doi="10.2196/jmir.3195",
url="http://www.jmir.org/2014/5/e124/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24840245"
}


@Article{info:doi/10.2196/jmir.3393,
author="Schnall, Rebecca
and Travers, Jasmine
and Rojas, Marlene
and Carballo-Di{\'e}guez, Alex",
title="eHealth Interventions for HIV Prevention in High-Risk Men Who Have Sex With Men: A Systematic Review",
journal="J Med Internet Res",
year="2014",
month="May",
day="26",
volume="16",
number="5",
pages="e134",
keywords="HIV prevention",
keywords="eHealth",
keywords="high-risk MSM",
keywords="HIV testing",
keywords="HIV risk behaviors",
keywords="SMS",
keywords="Internet",
abstract="Background: While the human immunodeficiency virus (HIV) incidence rate has remained steady in most groups, the overall incidence of HIV among men who have sex with men (MSM) has been steadily increasing in the United States. eHealth is a platform for health behavior change interventions and provides new opportunities for the delivery of HIV prevention messages. Objective: The purpose of this systematic review was to examine the use of eHealth interventions for HIV prevention in high-risk MSM. Methods: We systematically searched PubMed, OVID, ISI Web of Knowledge, Google Scholar, and Google for articles and grey literature reporting the original results of any studies related to HIV prevention in MSM and developed a standard data collection form to extract information on study characteristics and outcome data. Results: In total, 13 articles met the inclusion criteria, of which five articles targeted HIV testing behaviors and eight focused on decreasing HIV risk behaviors. Interventions included Web-based education modules, text messaging (SMS, short message service), chat rooms, and social networking. The methodological quality of articles ranged from 49.4-94.6\%. Wide variation in the interventions meant synthesis of the results using meta-analysis would not be appropriate. Conclusions: This review shows evidence that eHealth for HIV prevention in high-risk MSM has the potential to be effective in the short term for reducing HIV risk behaviors and increasing testing rates. Given that many of these studies were short term and had other limitations, but showed strong preliminary evidence of improving outcomes, additional work needs to rigorously assess the use of eHealth strategies for HIV prevention in high-risk MSM. ",
doi="10.2196/jmir.3393",
url="http://www.jmir.org/2014/5/e134/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24862459"
}


@Article{info:doi/10.2196/jmir.3283,
author="Cho, Jaehee
and Park, Dongjin
and Lee, Erin H.",
title="Cognitive Factors of Using Health Apps: Systematic Analysis of Relationships Among Health Consciousness, Health Information Orientation, eHealth Literacy, and Health App Use Efficacy",
journal="J Med Internet Res",
year="2014",
month="May",
day="09",
volume="16",
number="5",
pages="e125",
keywords="health apps",
keywords="health consciousness",
keywords="health information orientation",
keywords="eHealth literacy",
keywords="health app use efficacy",
abstract="Background: Interest in smartphone health apps has been increasing recently. However, we have little understanding of the cognitive and motivational factors that influence the extent of health-app use. Objective: This study aimed to examine the effects of four cognitive factors---health consciousness, health information orientation, eHealth literacy, and health-app use efficacy---on the extent of health-app use. It also explored the influence of two different use patterns---information and information-behavior use of health apps---with regard to the relationships among the main study variables. Methods: We collected and analyzed 765 surveys in South Korea. According to the results, there was a negligible gender difference: males (50.6\%, 387/765) and females (49.4\%, 378/765). All participants were adults whose ages ranged from 19 to 59. In order to test the proposed hypotheses, we used a path analysis as a specific form of structural equation modeling. Results: Through a path analysis, we discovered that individuals' health consciousness had a direct effect on their use of health apps. However, unlike the initial expectations, the effects of health information orientation and eHealth literacy on health-app use were mediated by health-app use efficacy. Conclusions: The results from the path analysis addressed a significant direct effect of health consciousness as well as strong mediating effects of health-app use efficacy. These findings contribute to widening our comprehension of the new, digital dimensions of health management, particularly those revolving around mobile technology. ",
doi="10.2196/jmir.3283",
url="http://www.jmir.org/2014/5/e125/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24824062"
}


@Article{info:doi/10.2196/jmir.2948,
author="Cunningham, Alastair John",
title="Intervention Adherence is Related to Participant Retention: Implications for Research",
journal="J Med Internet Res",
year="2014",
month="May",
day="21",
volume="16",
number="5",
pages="e133",
keywords="research methods",
keywords="randomized controlled trials",
keywords="alcohol",
keywords="Internet",
keywords="brief intervention",
doi="10.2196/jmir.2948",
url="http://www.jmir.org/2014/5/e133/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24849941"
}