@Article{info:doi/10.2196/jmir.7593,
author="Rosskam, Ellen
and Hyder, A. Adnan",
title="Using mHealth to Predict Noncommunicable Diseases: A Public Health Opportunity for Low- and Middle-Income Countries",
journal="J Med Internet Res",
year="2017",
month="May",
day="05",
volume="19",
number="5",
pages="e129",
keywords="mHealth",
keywords="low- and middle-income countries",
keywords="noncommunicable diseases",
keywords="research agenda",
keywords="population health surveys",
doi="10.2196/jmir.7593",
url="http://www.jmir.org/2017/5/e129/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28476727"
}


@Article{info:doi/10.2196/jmir.7622,
author="Ellis, A. Jennifer",
title="Leveraging Mobile Phones for Monitoring Risks for Noncommunicable Diseases in the Future",
journal="J Med Internet Res",
year="2017",
month="May",
day="05",
volume="19",
number="5",
pages="e137",
keywords="mHealth",
keywords="low- and middle-income countries",
keywords="noncommunicable diseases",
keywords="health systems strengthening",
doi="10.2196/jmir.7622",
url="http://www.jmir.org/2017/5/e137/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28476721"
}


@Article{info:doi/10.2196/jmir.7310,
author="Gr{\"o}nqvist, Helena
and Olsson, Gustaf Erik Martin
and Johansson, Birgitta
and Held, Claes
and Sj{\"o}str{\"o}m, Jonas
and Lindahl Norberg, Annika
and Hov{\'e}n, Emma
and Sanderman, Robbert
and van Achterberg, Theo
and von Essen, Louise",
title="Fifteen Challenges in Establishing a Multidisciplinary Research Program on eHealth Research in a University Setting: A Case Study",
journal="J Med Internet Res",
year="2017",
month="May",
day="23",
volume="19",
number="5",
pages="e173",
keywords="organization and administration",
keywords="eHealth",
keywords="interdisciplinary studies",
abstract="Background: U-CARE is a multidisciplinary eHealth research program that involves the disciplines of caring science, clinical psychology, health economics, information systems, and medical science. It was set up from scratch in a university setting in 2010, funded by a governmental initiative. While establishing the research program, many challenges were faced. Systematic documentation of experiences from establishing new research environments is scarce. Objective: The aim of this paper was to describe the challenges of establishing a publicly funded multidisciplinary eHealth research environment. Methods: Researchers involved in developing the research program U-CARE identified challenges in the formal documentation and by reflecting on their experience of developing the program. The authors discussed the content and organization of challenges into themes until consensus was reached. Results: The authors identified 15 major challenges, some general to establishing a new research environment and some specific for multidisciplinary eHealth programs. The challenges were organized into 6 themes: Organization, Communication, Implementation, Legislation, Software development, and Multidisciplinarity. Conclusions: Several challenges were faced during the development of the program and several accomplishments were made. By sharing our experience, we hope to help other research groups embarking on a similar journey to be prepared for some of the challenges they are likely to face on their way. ",
doi="10.2196/jmir.7310",
url="http://www.jmir.org/2017/5/e173/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28536090"
}


@Article{info:doi/10.2196/jmir.7116,
author="Farmer, Andrew
and Williams, Veronika
and Velardo, Carmelo
and Shah, Ahmar Syed
and Yu, Ly-Mee
and Rutter, Heather
and Jones, Louise
and Williams, Nicola
and Heneghan, Carl
and Price, Jonathan
and Hardinge, Maxine
and Tarassenko, Lionel",
title="Self-Management Support Using a Digital Health System Compared With Usual Care for Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2017",
month="May",
day="03",
volume="19",
number="5",
pages="e144",
keywords="pulmonary disease, chronic obstructive",
keywords="telehealth",
keywords="self-care",
keywords="randomized controlled trial",
abstract="Background: We conducted a randomized controlled trial of a digital health system supporting clinical care through monitoring and self-management support in community-based patients with moderate to very severe chronic obstructive pulmonary disease (COPD). Objective: The aim of this study was to determine the efficacy of a fully automated Internet-linked, tablet computer-based system of monitoring and self-management support (EDGE? sElf-management anD support proGrammE) in improving quality of life and clinical outcomes. Methods: We compared daily use of EDGE with usual care for 12 months. The primary outcome was COPD-specific health status measured with the St George's Respiratory Questionnaire for COPD (SGRQ-C). Results: A total of 166 patients were randomized (110 EDGE, 56 usual care). All patients were included in an intention to treat analysis. The estimated difference in SGRQ-C at 12 months (EDGE?usual care) was ?1.7 with a 95\% CI of ?6.6 to 3.2 (P=.49). The relative risk of hospital admission for EDGE was 0.83 (0.56-1.24, P=.37) compared with usual care. Generic health status (EQ-5D, EuroQol 5-Dimension Questionnaire) between the groups differed significantly with better health status for the EDGE group (0.076, 95\% CI 0.008-0.14, P=.03). The median number of visits to general practitioners for EDGE versus usual care were 4 versus 5.5 (P=.06) and to practice nurses were 1.5 versus 2.5 (P=.03), respectively. Conclusions: The EDGE clinical trial does not provide evidence for an effect on COPD-specific health status?in comparison with usual care, despite uptake of the intervention. However, there appears to be an overall benefit in generic health status; and?the effect sizes for improved depression score, reductions in hospital admissions, and general practice visits warrants further evaluation?and could make an important contribution to supporting people with COPD. Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN): 40367841; http://www.isrctn.com/ISRCTN40367841 (Archived by WebCite at http://www.webcitation.org/6pmfIJ9KK) ",
doi="10.2196/jmir.7116",
url="http://www.jmir.org/2017/5/e144/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28468749"
}


@Article{info:doi/10.2196/jmir.6553,
author="Provoost, Simon
and Lau, Ming Ho
and Ruwaard, Jeroen
and Riper, Heleen",
title="Embodied Conversational Agents in Clinical Psychology: A Scoping Review",
journal="J Med Internet Res",
year="2017",
month="May",
day="09",
volume="19",
number="5",
pages="e151",
keywords="eHealth",
keywords="review",
keywords="embodied conversational agent",
keywords="human computer interaction",
keywords="clinical psychology",
keywords="mental disorders",
keywords="intelligent agent",
keywords="health behavior",
abstract="Background: Embodied conversational agents (ECAs) are computer-generated characters that simulate key properties of human face-to-face conversation, such as verbal and nonverbal behavior. In Internet-based eHealth interventions, ECAs may be used for the delivery of automated human support factors. Objective: We aim to provide an overview of the technological and clinical possibilities, as well as the evidence base for ECA applications in clinical psychology, to inform health professionals about the activity in this field of research. Methods: Given the large variety of applied methodologies, types of applications, and scientific disciplines involved in ECA research, we conducted a systematic scoping review. Scoping reviews aim to map key concepts and types of evidence underlying an area of research, and answer less-specific questions than traditional systematic reviews. Systematic searches for ECA applications in the treatment of mood, anxiety, psychotic, autism spectrum, and substance use disorders were conducted in databases in the fields of psychology and computer science, as well as in interdisciplinary databases. Studies were included if they conveyed primary research findings on an ECA application that targeted one of the disorders. We mapped each study's background information, how the different disorders were addressed, how ECAs and users could interact with one another, methodological aspects, and the study's aims and outcomes. Results: This study included N=54 publications (N=49 studies). More than half of the studies (n=26) focused on autism treatment, and ECAs were used most often for social skills training (n=23). Applications ranged from simple reinforcement of social behaviors through emotional expressions to sophisticated multimodal conversational systems. Most applications (n=43) were still in the development and piloting phase, that is, not yet ready for routine practice evaluation or application. Few studies conducted controlled research into clinical effects of ECAs, such as a reduction in symptom severity. Conclusions: ECAs for mental disorders are emerging. State-of-the-art techniques, involving, for example, communication through natural language or nonverbal behavior, are increasingly being considered and adopted for psychotherapeutic interventions in ECA research with promising results. However, evidence on their clinical application remains scarce. At present, their value to clinical practice lies mostly in the experimental determination of critical human support factors. In the context of using ECAs as an adjunct to existing interventions with the aim of supporting users, important questions remain with regard to the personalization of ECAs' interaction with users, and the optimal timing and manner of providing support. To increase the evidence base with regard to Internet interventions, we propose an additional focus on low-tech ECA solutions that can be rapidly developed, tested, and applied in routine practice. ",
doi="10.2196/jmir.6553",
url="http://www.jmir.org/2017/5/e151/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28487267"
}


@Article{info:doi/10.2196/jmir.7457,
author="Painter, Lynn Stefanie
and Ahmed, Rezwan
and Hill, O. James
and Kushner, F. Robert
and Lindquist, Richard
and Brunning, Scott
and Margulies, Amy",
title="What Matters in Weight Loss? An In-Depth Analysis of Self-Monitoring",
journal="J Med Internet Res",
year="2017",
month="May",
day="12",
volume="19",
number="5",
pages="e160",
keywords="behavior",
keywords="body mass index",
keywords="fitness trackers",
keywords="self-monitoring",
keywords="obesity",
keywords="overweight",
keywords="weight loss",
abstract="Background: Using technology to self-monitor body weight, dietary intake, and physical activity is a common practice used by consumers and health companies to increase awareness of current and desired behaviors in weight loss. Understanding how to best use the information gathered by these relatively new methods needs to be further explored. Objective: The purpose of this study was to analyze the contribution of self-monitoring to weight loss in participants in a 6-month commercial weight-loss intervention administered by Retrofit and to specifically identify the significant contributors to weight loss that are associated with behavior and outcomes. Methods: A retrospective analysis was performed using 2113 participants enrolled from 2011 to 2015 in a Retrofit weight-loss program. Participants were males and females aged 18 years or older with a starting body mass index of ?25 kg/m2, who also provided a weight measurement at the sixth month of the program. Multiple regression analysis was performed using all measures of self-monitoring behaviors involving weight measurements, dietary intake, and physical activity to predict weight loss at 6 months. Each significant predictor was analyzed in depth to reveal the impact on outcome. Results: Participants in the Retrofit Program lost a mean --5.58\% (SE 0.12) of their baseline weight with 51.87\% (1096/2113) of participants losing at least 5\% of their baseline weight. Multiple regression model (R2=.197, P<0.001) identified the following measures as significant predictors of weight loss at 6 months: number of weigh-ins per week (P<.001), number of steps per day (P=.02), highly active minutes per week (P<.001), number of food log days per week (P<.001), and the percentage of weeks with five or more food logs (P<.001). Weighing in at least three times per week, having a minimum of 60 highly active minutes per week, food logging at least three days per week, and having 64\% (16.6/26) or more weeks with at least five food logs were associated with clinically significant weight loss for both male and female participants. Conclusions: The self-monitoring behaviors of self-weigh-in, daily steps, high-intensity activity, and persistent food logging were significant predictors of weight loss during a 6-month intervention. ",
doi="10.2196/jmir.7457",
url="http://www.jmir.org/2017/5/e160/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28500022"
}


@Article{info:doi/10.2196/jmir.7274,
author="Newby, Jill
and Robins, Lisa
and Wilhelm, Kay
and Smith, Jessica
and Fletcher, Therese
and Gillis, Inika
and Ma, Trevor
and Finch, Adam
and Campbell, Lesley
and Andrews, Gavin",
title="Web-Based Cognitive Behavior Therapy for Depression in People With Diabetes Mellitus: A Randomized Controlled Trial",
journal="J Med Internet Res",
year="2017",
month="May",
day="15",
volume="19",
number="5",
pages="e157",
keywords="depression",
keywords="diabetes mellitus",
keywords="cognitive behavior therapy",
keywords="diabetes-related distress",
keywords="computer-assisted therapy",
abstract="Background: Depression is twice as common in diabetes mellitus (DM) as the general population and is associated with adverse health outcomes, but access to evidence-based therapies such as cognitive behavioral therapy (CBT) is limited in routine diabetes care. Past research has shown that generic Internet-based cognitive behavioral therapy (iCBT) is an effective treatment for depression in the general population, but it has never been evaluated in people with comorbid depression and DM. Objective: The aim of our study was to examine the efficacy of a generic 6-lesson iCBT delivered over 10 weeks in people with major depressive disorder (MDD) and DM. Methods: Participants with comorbid MDD and DM (type 1 or 2) were recruited online and randomized to an iCBT program with therapist support provided by phone and email (n=42) or a treatment as usual (TAU, n=49) control group. Outcomes were assessed through Web-based self-report questionnaires and the trial was Web-based with no face-to-face components. Primary outcomes were self-reported depression (patient health questionnaire-9, PHQ-9), diabetes-related distress (problem areas in diabetes, PAID), and self-reported glycemic control (hemoglobin A1c, HbA1c). Secondary outcomes were general distress (Kessler 10-item psychological distress scale, K-10) and disability (short form 12-item, SF-12), generalized anxiety (generalized anxiety disorder 7-item, GAD-7), and somatization (PHQ-15). The iCBT group was assessed at 3 months. Results: A total of 27 participants (66\%; 27/41) completed the iCBT program. Analyses indicated between-group superiority of iCBT over TAU at posttreatment on PHQ-9 (g=0.78), PAID (g=0.80), K-10 (g=1.06), GAD-7 (g=0.72), and SF-12 mental well-being scores (g=0.66), but no significant differences in self-reported HbA1c levels (g=0.14), SF-12 physical well-being, or PHQ-15 scores (g=0.03-0.21). Gains were maintained at 3-month follow-up in the iCBT group, and the 87\% (27/31) of iCBT participants who were interviewed no longer met criteria for MDD. Clinically significant change following iCBT on PHQ-9 scores was 51\% (21/41) versus 18\% (9/49) in TAU. Conclusions: iCBT for depression is an efficacious, accessible treatment option for people with diabetes. Future studies should explore whether tailoring of iCBT programs improves acceptability and adherence, and evaluate the long-term outcomes following iCBT. Trial Registration: Australian and New Zealand Clinical Trials Registry (ACTRN): 12613001198718; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365208\&isReview=true (Archived by WebCite at http://www.webcitation.org/6qCR8Fi9V) ",
doi="10.2196/jmir.7274",
url="http://www.jmir.org/2017/5/e157/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28506956"
}


@Article{info:doi/10.2196/jmir.7290,
author="Nicholl, I. Barbara
and Sandal, F. Louise
and Stochkendahl, J. Mette
and McCallum, Marianne
and Suresh, Nithya
and Vasseljen, Ottar
and Hartvigsen, Jan
and Mork, J. Paul
and Kjaer, Per
and S{\o}gaard, Karen
and Mair, S. Frances",
title="Digital Support Interventions for the Self-Management of Low Back Pain: A Systematic Review",
journal="J Med Internet Res",
year="2017",
month="May",
day="21",
volume="19",
number="5",
pages="e179",
keywords="low back pain",
keywords="self-management",
keywords="mHealth",
keywords="eHealth",
abstract="Background: Low back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. Self-management, including components on increased knowledge, monitoring of symptoms, and physical activity, are consistently recommended in clinical guidelines as cost-effective strategies for LBP management and there is increasing interest in the potential role of digital health. Objective: The study aimed to synthesize and critically appraise published evidence concerning the use of interactive digital interventions to support self-management of LBP. The following specific questions were examined: (1) What are the key components of digital self-management interventions for LBP, including theoretical underpinnings? (2) What outcome measures have been used in randomized trials of digital self-management interventions in LBP and what effect, if any, did the intervention have on these? and (3) What specific characteristics or components, if any, of interventions appear to be associated with beneficial outcomes? Methods: Bibliographic databases searched from 2000 to March 2016 included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, DoPHER and TRoPHI, Social Science Citation Index, and Science Citation Index. Reference and citation searching was also undertaken. Search strategy combined the following concepts: (1) back pain, (2) digital intervention, and (3) self-management. Only randomized controlled trial (RCT) protocols or completed RCTs involving adults with LBP published in peer-reviewed journals were included. Two reviewers independently screened titles and abstracts, full-text articles, extracted data, and assessed risk of bias using Cochrane risk of bias tool. An independent third reviewer adjudicated on disagreements. Data were synthesized narratively. Results: Of the total 7014 references identified, 11 were included, describing 9 studies: 6 completed RCTs and 3 protocols for future RCTs. The completed RCTs included a total of 2706 participants (range of 114-1343 participants per study) and varied considerably in the nature and delivery of the interventions, the duration/definition of LBP, the outcomes measured, and the effectiveness of the interventions. Participants were generally white, middle aged, and in 5 of 6 RCT reports, the majority were female and most reported educational level as time at college or higher. Only one study reported between-group differences in favor of the digital intervention. There was considerable variation in the extent of reporting the characteristics, components, and theories underpinning each intervention. None of the studies showed evidence of harm. Conclusions: The literature is extremely heterogeneous, making it difficult to understand what might work best, for whom, and in what circumstances. Participants were predominantly female, white, well educated, and middle aged, and thus the wider applicability of digital self-management interventions remains uncertain. No information on cost-effectiveness was reported. The evidence base for interactive digital interventions to support patient self-management of LBP remains weak. ",
doi="10.2196/jmir.7290",
url="http://www.jmir.org/2017/5/e179/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28550009"
}


@Article{info:doi/10.2196/jmir.7479,
author="Lie, Stangeland Silje
and Karlsen, Bj{\o}rg
and Oord, Renate Ellen
and Graue, Marit
and Oftedal, Bj{\o}rg",
title="Dropout From an eHealth Intervention for Adults With Type 2 Diabetes: A Qualitative Study",
journal="J Med Internet Res",
year="2017",
month="May",
day="30",
volume="19",
number="5",
pages="e187",
keywords="eHealth",
keywords="Telehealth",
keywords="type 2 diabetes",
keywords="Internet",
keywords="counseling",
keywords="qualitative research",
keywords="general practice, self-management",
keywords="self-management support",
keywords="patient dropouts",
abstract="Background: Adequate self-management is the cornerstone of type 2 diabetes treatment, as people make the majority of daily treatment measures and health decisions. The increasing prevalence of type 2 diabetes mellitus (T2DM) and the complexity of diabetes self-management demonstrate the need for innovative and effective ways to deliver self-management support. eHealth interventions are promoted worldwide and hold a great potential in future health care for people with chronic diseases such as T2DM. However, many eHealth interventions face high dropout rates. This led to our interest in the experiences of participants who dropped out of an eHealth intervention for adults with T2DM, based on the Guided Self-Determination (GSD) counseling method. Objective: In this study, we aimed to explore experiences with an eHealth intervention based on GSD in general practice from the perspective of those who dropped out and to understand their reasons for dropping out. To the best of our knowledge, no previous qualitative study has focused on participants who withdrew from an eHealth self-management support intervention for adults with T2DM. Methods: A qualitative design based on telephone interviews was used to collect data. The sample comprised 12 adults with type 2 diabetes who dropped out of an eHealth intervention. Data were collected in 2016 and subjected to qualitative content analysis. Results: We identified one overall theme: ``Losing motivation for intervention participation.'' This theme was illustrated by four categories related to the participants' experiences of the eHealth intervention: (1) frustrating technology, (2) perceiving the content as irrelevant and incomprehensible, (3) choosing other activities and perspectives, and (4) lacking face-to-face encounters. Conclusions: Our findings indicate that the eHealth intervention based on GSD without face-to-face encounters with nurses reduced participants' motivation for engagement in the intervention. To maintain motivation, our study points to the importance of combining eHealth with regular face-to-face consultations. Our study also shows that the perceived benefit of the GSD eHealth intervention intertwined with choosing to focus on other matters in complex daily lives are critical aspects in motivation for such interventions. This indicates the importance of giving potential participants tailored information about the aim, the content, and the effort needed to remain engaged in complex interventions so that eligible participants are recruited. Finally, motivation for engagement in the eHealth intervention was influenced by the technology used in this study. It seems important to facilitate more user-friendly but high-security eHealth technology. Our findings have implications for improving the eHealth intervention and to inform researchers and health care providers who are organizing eHealth interventions focusing on self-management support in order to reduce dropout rates. ",
doi="10.2196/jmir.7479",
url="http://www.jmir.org/2017/5/e187/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28559223"
}


@Article{info:doi/10.2196/jmir.7037,
author="Talboom-Kamp, PWA Esther
and Verdijk, A. Noortje
and Kasteleyn, J. Marise
and Harmans, M. Lara
and Talboom, JSH Irvin
and Numans, E. Mattijs
and Chavannes, H. Niels",
title="High Level of Integration in Integrated Disease Management Leads to Higher Usage in the e-Vita Study: Self-Management of Chronic Obstructive Pulmonary Disease With Web-Based Platforms in a Parallel Cohort Design",
journal="J Med Internet Res",
year="2017",
month="May",
day="31",
volume="19",
number="5",
pages="e185",
keywords="COPD",
keywords="eHealth",
keywords="self-management",
keywords="integrated disease management",
keywords="self-efficacy",
keywords="Web-based platform",
keywords="primary care",
keywords="chronically ill",
keywords="blended care",
abstract="Background: Worldwide, nearly 3 million people die of chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves disease-specific quality of life and exercise capacity for people with COPD, but can also reduce hospital admissions and hospital days. Self-management of COPD through eHealth interventions has shown to be an effective method to improve the quality and efficiency of IDM in several settings, but it remains unknown which factors influence usage of eHealth and change in behavior of patients. Objective: Our study, e-Vita COPD, compares different levels of integration of Web-based self-management platforms in IDM in three primary care settings. The main aim of this study is to analyze the factors that successfully promote the use of a self-management platform for COPD patients. Methods: The e-Vita COPD study compares three different approaches to incorporating eHealth via Web-based self-management platforms into IDM of COPD using a parallel cohort design. Three groups integrated the platforms to different levels. In groups 1 (high integration) and 2 (medium integration), randomization was performed to two levels of personal assistance for patients (high and low assistance); in group 3 there was no integration into disease management (none integration). Every visit to the e-Vita and Zorgdraad COPD Web platforms was tracked objectively by collecting log data (sessions and services). At the first log-in, patients completed a baseline questionnaire. Baseline characteristics were automatically extracted from the log files including age, gender, education level, scores on the Clinical COPD Questionnaire (CCQ), dyspnea scale (MRC), and quality of life questionnaire (EQ5D). To predict the use of the platforms, multiple linear regression analyses for the different independent variables were performed: integration in IDM (high, medium, none), personal assistance for the participants (high vs low), educational level, and self-efficacy level (General Self-Efficacy Scale [GSES]). All analyses were adjusted for age and gender. Results: Of the 702 invited COPD patients, 215 (30.6\%) registered to a platform. Of the 82 patients in group 1 (high integration IDM), 36 were in group 1A (personal assistance) and 46 in group 1B (low assistance). Of the 96 patients in group 2 (medium integration IDM), 44 were in group 2A (telephone assistance) and 52 in group 2B (low assistance). A total of 37 patients participated in group 3 (no integration IDM). In all, 107 users (49.8\%) visited the platform at least once in the 15-month period. The mean number of sessions differed between the three groups (group 1: mean 10.5, SD 1.3; group 2: mean 8.8, SD 1.4; group 3: mean 3.7, SD 1.8; P=.01). The mean number of sessions differed between the high-assistance and low-assistance groups in groups 1 and 2 (high: mean 11.8, SD 1.3; low: mean 6.7, SD 1.4; F1,80=6.55, P=.01). High-assistance participants used more services (mean 45.4, SD 6.2) than low-assistance participants (mean 21.2, SD 6.8; F1,80=6.82, P=.01). No association was found between educational level and usage and between GSES and usage. Conclusions: Use of a self-management platform is higher when participants receive adequate personal assistance about how to use the platform. Blended care, where digital health and usual care are integrated, will likely lead to increased use of the online program. Future research should provide additional insights into the preferences of different patient groups. Trial Registration: Nederlands Trial Register NTR4098; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4098 (Archived by WebCite at http://www.webcitation.org/6qO1hqiJ1) ",
doi="10.2196/jmir.7037",
url="http://www.jmir.org/2017/5/e185/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28566268"
}


@Article{info:doi/10.2196/jmir.7426,
author="Bastl, Katharina
and Berger, Uwe
and Kmenta, Maximilian",
title="Evaluation of Pollen Apps Forecasts: The Need for Quality Control in an eHealth Service",
journal="J Med Internet Res",
year="2017",
month="May",
day="08",
volume="19",
number="5",
pages="e152",
keywords="pollen forecast",
keywords="pollen information service",
keywords="mobile app",
keywords="pollen forecast quality",
keywords="allergen avoidance",
abstract="Background: Pollen forecasts are highly valuable for allergen avoidance and thus raising the quality of life of persons concerned by pollen allergies. They are considered as valuable free services for the public. Careful scientific evaluation of pollen forecasts in terms of accurateness and reliability has not been available till date. Objective: The aim of this study was to analyze 9 mobile apps, which deliver pollen information and pollen forecasts, with a focus on their accurateness regarding the prediction of the pollen load in the grass pollen season 2016 to assess their usefulness for pollen allergy sufferers. Methods: The following number of apps was evaluated for each location: 3 apps for Vienna (Austria), 4 apps for Berlin (Germany), and 1 app each for Basel (Switzerland) and London (United Kingdom). All mobile apps were freely available. Today's grass pollen forecast was compared throughout the defined grass pollen season at each respective location with measured grass pollen concentrations. Hit rates were calculated for the exact performance and for a tolerance in a range of {\textpm}2 and {\textpm}4 pollen per cubic meter. Results: In general, for most apps, hit rates score around 50\% (6 apps). It was found that 1 app showed better results, whereas 3 apps performed less well. Hit rates increased when calculated with tolerances for most apps. In contrast, the forecast for the ``readiness to flower'' for grasses was performed at a sufficiently accurate level, although only two apps provided such a forecast. The last of those forecasts coincided with the first moderate grass pollen load on the predicted day or 3 days after and performed even from about a month before well within the range of 3 days. Advertisement was present in 3 of the 9 analyzed apps, whereas an imprint mentioning institutions with experience in pollen forecasting was present in only three other apps. Conclusions: The quality of pollen forecasts is in need of improvement, and quality control for pollen forecasts is recommended to avoid potential harm to pollen allergy sufferers due to inadequate forecasts. The inclusion of information on reliability of provided forecasts and a similar handling regarding probabilistic weather forecasts should be considered. ",
doi="10.2196/jmir.7426",
url="http://www.jmir.org/2017/5/e152/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28483740"
}


@Article{info:doi/10.2196/jmir.7332,
author="Grist, Rebecca
and Porter, Joanna
and Stallard, Paul",
title="Mental Health Mobile Apps for Preadolescents and Adolescents: A Systematic Review",
journal="J Med Internet Res",
year="2017",
month="May",
day="25",
volume="19",
number="5",
pages="e176",
keywords="mobile apps",
keywords="smartphone apps",
keywords="mHealth",
keywords="mental health",
keywords="self-help",
keywords="child",
keywords="adolescent",
keywords="preadolescent",
keywords="review",
abstract="Background: There are an increasing number of mobile apps available for adolescents with mental health problems and an increasing interest in assimilating mobile health (mHealth) into mental health services. Despite the growing number of apps available, the evidence base for their efficacy is unclear. Objective: This review aimed to systematically appraise the available research evidence on the efficacy and acceptability of mobile apps for mental health in children and adolescents younger than 18 years. Methods: The following were systematically searched for relevant publications between January 2008 and July 2016: APA PsychNet, ACM Digital Library, Cochrane Library, Community Care Inform-Children, EMBASE, Google Scholar, PubMed, Scopus, Social Policy and Practice, Web of Science, Journal of Medical Internet Research, Cyberpsychology, Behavior and Social Networking, and OpenGrey. Abstracts were included if they described mental health apps (targeting depression, bipolar disorder, anxiety disorders, self-harm, suicide prevention, conduct disorder, eating disorders and body image issues, schizophrenia, psychosis, and insomnia) for mobile devices and for use by adolescents younger than 18 years. Results: A total of 24 publications met the inclusion criteria. These described 15 apps, two of which were available to download. Two small randomized trials and one case study failed to demonstrate a significant effect of three apps on intended mental health outcomes. Articles that analyzed the content of six apps for children and adolescents that were available to download established that none had undergone any research evaluation. Feasibility outcomes suggest acceptability of apps was good and app usage was moderate. Conclusions: Overall, there is currently insufficient research evidence to support the effectiveness of apps for children, preadolescents, and adolescents with mental health problems. Given the number and pace at which mHealth apps are being released on app stores, methodologically robust research studies evaluating their safety, efficacy, and effectiveness is promptly needed. ",
doi="10.2196/jmir.7332",
url="http://www.jmir.org/2017/5/e176/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28546138"
}


@Article{info:doi/10.2196/jmir.7385,
author="O'Brien, K. Megan
and Shawen, Nicholas
and Mummidisetty, K. Chaithanya
and Kaur, Saninder
and Bo, Xiao
and Poellabauer, Christian
and Kording, Konrad
and Jayaraman, Arun",
title="Activity Recognition for Persons With Stroke Using Mobile Phone Technology: Toward Improved Performance in a Home Setting",
journal="J Med Internet Res",
year="2017",
month="May",
day="25",
volume="19",
number="5",
pages="e184",
keywords="smartphone",
keywords="activities of daily living",
keywords="ambulatory monitoring",
keywords="machine learning",
keywords="stroke rehabilitation",
abstract="Background: Smartphones contain sensors that measure movement-related data, making them promising tools for monitoring physical activity after a stroke. Activity recognition (AR) systems are typically trained on movement data from healthy individuals collected in a laboratory setting. However, movement patterns change after a stroke (eg, gait impairment), and activities may be performed differently at home than in a lab. Thus, it is important to validate AR for gait-impaired stroke patients in a home setting for accurate clinical predictions. Objective: In this study, we sought to evaluate AR performance in a home setting for individuals who had suffered a stroke, by using different sets of training activities. Specifically, we compared AR performance for persons with stroke while varying the origin of training data, based on either population (healthy persons or persons with stoke) or environment (laboratory or home setting). Methods: Thirty individuals with stroke and fifteen healthy subjects performed a series of mobility-related activities, either in a laboratory or at home, while wearing a smartphone. A custom-built app collected signals from the phone's accelerometer, gyroscope, and barometer sensors, and subjects self-labeled the mobility activities. We trained a random forest AR model using either healthy or stroke activity data. Primary measures of AR performance were (1) the mean recall of activities and (2) the misclassification of stationary and ambulatory activities. Results: A classifier trained on stroke activity data performed better than one trained on healthy activity data, improving average recall from 53\% to 75\%. The healthy-trained classifier performance declined with gait impairment severity, more often misclassifying ambulatory activities as stationary ones. The classifier trained on in-lab activities had a lower average recall for at-home activities (56\%) than for in-lab activities collected on a different day (77\%). Conclusions: Stroke-based training data is needed for high quality AR among gait-impaired individuals with stroke. Additionally, AR systems for home and community monitoring would likely benefit from including at-home activities in the training data. ",
doi="10.2196/jmir.7385",
url="http://www.jmir.org/2017/5/e184/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28546137"
}


@Article{info:doi/10.2196/jmir.6681,
author="Kim, Jung Sunny
and Marsch, A. Lisa
and Brunette, F. Mary
and Dallery, Jesse",
title="Harnessing Facebook for Smoking Reduction and Cessation Interventions: Facebook User Engagement and Social Support Predict Smoking Reduction",
journal="J Med Internet Res",
year="2017",
month="May",
day="23",
volume="19",
number="5",
pages="e168",
keywords="social media",
keywords="social support",
keywords="behavior and behavior mechanisms",
keywords="smoking cessation",
keywords="persuasive communication",
keywords="social networking",
keywords="technology",
keywords="health promotion",
abstract="Background: Social media technologies offer a novel opportunity for scalable health interventions that can facilitate user engagement and social support, which in turn may reinforce positive processes for behavior change. Objective: By using principles from health communication and social support literature, we implemented a Facebook group--based intervention that targeted smoking reduction and cessation. This study hypothesized that participants' engagement with and perceived social support from our Facebook group intervention would predict smoking reduction. Methods: We recruited 16 regular smokers who live in the United States and who were motivated in quitting smoking at screening. We promoted message exposure as well as engagement and social support systems throughout the intervention. For message exposure, we posted prevalidated, antismoking messages (such as national antismoking campaigns) on our smoking reduction and cessation Facebook group. For engagement and social support systems, we delivered a high degree of engagement and social support systems during the second and third week of the intervention and a low degree of engagement and social support systems during the first and fourth week. A total of six surveys were conducted via Amazon Mechanical Turk (MTurk) at baseline on a weekly basis and at a 2-week follow-up. Results: Of the total 16 participants, most were female (n=13, 81\%), white (n=15, 94\%), and between 25 and 50 years of age (mean 34.75, SD 8.15). There was no study attrition throughout the 6-time-point baseline, weekly, and follow-up surveys. We generated Facebook engagement and social support composite scores (mean 19.19, SD 24.35) by combining the number of likes each participant received and the number of comments or wall posts each participant posted on our smoking reduction and cessation Facebook group during the intervention period. The primary outcome was smoking reduction in the past 7 days measured at baseline and at the two-week follow-up. Compared with the baseline, participants reported smoking an average of 60.56 fewer cigarettes per week (SD 38.83) at the follow-up, and 4 participants out of 16 (25\%) reported 7-day point prevalence smoking abstinence at the follow-up. Adjusted linear regression models revealed that a one-unit increase in the Facebook engagement and social support composite scores predicted a 0.56-unit decrease in cigarettes smoked per week (standard error =.24, P=.04, 95\% CI 0.024-1.09) when baseline readiness to quit, gender, and baseline smoking status were controlled (F4, 11=8.85, P=.002). Conclusions: This study is the first Facebook group--based intervention that systemically implemented health communication strategies and engagement and social support systems to promote smoking reduction and cessation. Our findings imply that receiving one like or posting on the Facebook-based intervention platform predicted smoking approximately one less cigarette in the past 7 days, and that interventions should facilitate user interactions to foster user engagement and social support. ",
doi="10.2196/jmir.6681",
url="http://www.jmir.org/2017/5/e168/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28536096"
}


@Article{info:doi/10.2196/jmir.6763,
author="Martinez-Millana, Antonio
and Fernandez-Llatas, Carlos
and Basagoiti Bilbao, Ignacio
and Traver Salcedo, Manuel
and Traver Salcedo, Vicente",
title="Evaluating the Social Media Performance of Hospitals in Spain: A Longitudinal and Comparative Study",
journal="J Med Internet Res",
year="2017",
month="May",
day="23",
volume="19",
number="5",
pages="e181",
keywords="public health",
keywords="delivery of health care",
keywords="Internet",
keywords="social media",
keywords="hospitals",
abstract="Background: Social media is changing the way in which citizens and health professionals communicate. Previous studies have assessed the use of Health 2.0 by hospitals, showing clear evidence of growth in recent years. In order to understand if this happens in Spain, it is necessary to assess the performance of health care institutions on the Internet social media using quantitative indicators. Objectives: The study aimed to analyze how hospitals in Spain perform on the Internet and social media networks by determining quantitative indicators in 3 different dimensions: presence, use, and impact and assess these indicators on the 3 most commonly used social media - Facebook, Twitter, YouTube. Further, we aimed to find out if there was a difference between private and public hospitals in their use of the aforementioned social networks. Methods: The evolution of presence, use, and impact metrics is studied over the period 2011- 2015. The population studied accounts for all the hospitals listed in the National Hospitals Catalog (NHC). The percentage of hospitals having Facebook, Twitter, and YouTube profiles has been used to show the presence and evolution of hospitals on social media during this time. Usage was assessed by analyzing the content published on each social network. Impact evaluation was measured by analyzing the trend of subscribers for each social network. Statistical analysis was performed using a lognormal transformation and also using a nonparametric distribution, with the aim of comparing t student and Wilcoxon independence tests for the observed variables. Results: From the 787 hospitals identified, 69.9\% (550/787) had an institutional webpage and 34.2\% (269/787) had at least one profile in one of the social networks (Facebook, Twitter, and YouTube) in December 2015. Hospitals' Internet presence has increased by more than 450.0\% (787/172) and social media presence has increased ten times since 2011. Twitter is the preferred social network for public hospitals, whereas private hospitals showed better performance on Facebook and YouTube. The two-sided Wilcoxon test and t student test at a CI of 95\% show that the use of Twitter distribution is higher (P<.001) for private and public hospitals in Spain, whereas other variables show a nonsignificant different distribution. Conclusions: The Internet presence of Spanish hospitals is high; however, their presence on the 3 main social networks is still not as high compared to that of hospitals in the United States and Western Europe. Public hospitals are found to be more active on Twitter, whereas private hospitals show better performance on Facebook and YouTube. This study suggests that hospitals, both public and private, should devote more effort to and be more aware of social media, with a clear strategy as to how they can foment new relationships with patients and citizens. ",
doi="10.2196/jmir.6763",
url="http://www.jmir.org/2017/5/e181/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28536091"
}


@Article{info:doi/10.2196/jmir.7524,
author="Gammon, Deede
and Strand, Monica
and Eng, Sofie Lillian
and B{\o}r{\o}sund, Elin
and Varsi, Cecilie
and Ruland, Cornelia",
title="Shifting Practices Toward Recovery-Oriented Care Through an E-Recovery Portal in Community Mental Health Care: A Mixed-Methods Exploratory Study",
journal="J Med Internet Res",
year="2017",
month="May",
day="02",
volume="19",
number="5",
pages="e145",
keywords="recovery",
keywords="eHealth",
keywords="mental health",
keywords="psychiatry",
keywords="user involvement",
keywords="empowerment",
keywords="working relationships",
keywords="participatory research",
keywords="secure email",
keywords="e-recovery",
abstract="Background: Mental health care is shifting from a primary focus on symptom reduction toward personal recovery-oriented care, especially for persons with long-term mental health care needs. Web-based portals may facilitate this shift, but little is known about how such tools are used or the role they may play in personal recovery. Objective: The aim was to illustrate uses and experiences with the secure e-recovery portal ``ReConnect'' as an adjunct to ongoing community mental health care and explore its potential role in shifting practices toward recovery. Methods: ReConnect was introduced into two Norwegian mental health care communities and used for 6 months. The aim was to support personal recovery and collaboration between service users and health care providers. Among inclusion criteria for participation were long-term care needs and at least one provider willing to interact with service users through ReConnect. The portal was designed to support ongoing collaboration as each service user-provider dyad/team found appropriate and consisted of (1) a toolbox of resources for articulating and working with recovery processes, such as status/goals/activities relative to life domains (eg, employment, social network, health), medications, network map, and exercises (eg, sleep hygiene, mindfulness); (2) messaging with providers who had partial access to toolbox content; and (3) a peer support forum. Quantitative data (ie, system log, questionnaires) were analyzed using descriptive statistics. Qualitative data (eg, focus groups, forum postings) are presented relative to four recovery-oriented practice domains: personally defined recovery, promoting citizenship, working relationships, and organizational commitment. Results: Fifty-six participants (29 service users and 27 providers) made up 29 service user-provider dyads. Service users reported having 11 different mental health diagnoses, with a median 2 (range 1-7) diagnoses each. The 27 providers represented nine different professional backgrounds. The forum was the most frequently used module with 1870 visits and 542 postings. Service users' control over toolbox resources (eg, defining and working toward personal goals), coupled with peer support, activated service users in their personal recovery processes and in community engagement. Some providers (30\%, 8/27) did not interact with service users through ReConnect. Dyads that used the portal resources did so in highly diverse ways, and participants reported needing more than 6 months to discover and adapt optimal uses relative to their individual and collaborative needs. Conclusions: Regardless of providers' portal use, service users' control over toolbox resources, coupled with peer support, offered an empowering common frame of reference that represented a shift toward recovery-oriented practices within communities. Although service users' autonomous use of the portal can eventually influence providers in the direction of recovery practices, a fundamental shift is unlikely without broader organizational commitments aligned with recovery principles (eg, quantified goals for service user involvement in care plans). ",
doi="10.2196/jmir.7524",
url="http://www.jmir.org/2017/5/e145/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28465277"
}


@Article{info:doi/10.2196/jmir.6815,
author="Saha, Koustuv
and Weber, Ingmar
and Birnbaum, L. Michael
and De Choudhury, Munmun",
title="Characterizing Awareness of Schizophrenia Among Facebook Users by Leveraging Facebook Advertisement Estimates",
journal="J Med Internet Res",
year="2017",
month="May",
day="08",
volume="19",
number="5",
pages="e156",
keywords="schizophrenia",
keywords="psychotic disorders",
keywords="online social networks",
keywords="health awareness",
keywords="mental health",
keywords="public health",
keywords="Facebook",
abstract="Background: Schizophrenia is a rare but devastating condition, affecting about 1\% of the world's population and resulting in about 2\% of the US health care expenditure. Major impediments to appropriate and timely care include misconceptions, high levels of stigma, and lack of public awareness. Facebook offers novel opportunities to understand public awareness and information access related to schizophrenia, and thus can complement survey-based approaches to assessing awareness that are limited in scale, robustness, and temporal and demographic granularity. Objective: The aims of this study were to (1) construct an index that measured the awareness of different demographic groups around schizophrenia-related information on Facebook; (2) study how this index differed across demographic groups and how it correlated with complementary Web-based (Google Trends) and non--Web-based variables about population well-being (mental health indicators and infrastructure), and (3) examine the relationship of Facebook derived schizophrenia index with other types of online activity as well as offline health and mental health outcomes and indicators. Methods: Data from Facebook's advertising platform was programmatically collected to compute the proportion of users in a target demographic group with an interest related to schizophrenia. On consultation with a clinical expert, several topics were combined to obtain a single index measuring schizophrenia awareness. This index was then analyzed for differences across US states, gender, age, ethnic affinity, and education level. A statistical approach was developed to model a group's awareness index based on the group's characteristics. Results: Overall, 1.03\% of Facebook users in the United States have a schizophrenia-related interest. The schizophrenia awareness index (SAI) is higher for females than for males (1.06 vs 0.97, P<.001), and it is highest for the people who are aged 25-44 years (1.35 vs 1.03 for all ages, P<.001). The awareness index drops for higher education levels (0.68 for MA or PhD vs 1.92 for no high school degree, P<.001), and Hispanics have the highest level of interest (1.57 vs 1.03 for all ethnic affinities, P<.001). A regression model fit to predict a group's interest level achieves an adjusted R2=0.55. We also observe a positive association between our SAI and mental health services (or institutions) per 100,000 residents in a US state (Pearson r=.238, P<.001), but a negative association with the state-level human development index (HDI) in United States (Pearson r=?.145, P<.001) and state-level volume of mental health issues in United States (Pearson r=?.145, P<.001). Conclusions: Facebook's advertising platform can be used to construct a plausible index of population-scale schizophrenia awareness. However, only estimates of awareness can be obtained, and the index provides no information on the quality of the information users receive online. ",
doi="10.2196/jmir.6815",
url="http://www.jmir.org/2017/5/e156/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28483739"
}


@Article{info:doi/10.2196/jmir.6914,
author="Aguilera, Adrian
and Bruehlman-Senecal, Emma
and Demasi, Orianna
and Avila, Patricia",
title="Automated Text Messaging as an Adjunct to Cognitive Behavioral Therapy for Depression: A Clinical Trial",
journal="J Med Internet Res",
year="2017",
month="May",
day="08",
volume="19",
number="5",
pages="e148",
keywords="depression",
keywords="text messaging",
keywords="cognitive behavioral therapy",
keywords="mhealth",
keywords="mental health",
keywords="Latinos",
abstract="Background: Cognitive Behavioral Therapy (CBT) for depression is efficacious, but effectiveness is limited when implemented in low-income settings due to engagement difficulties including nonadherence with skill-building homework and early discontinuation of treatment. Automated messaging can be used in clinical settings to increase dosage of depression treatment and encourage sustained engagement with psychotherapy. Objectives: The aim of this study was to test whether a text messaging adjunct (mood monitoring text messages, treatment-related text messages, and a clinician dashboard to display patient data) increases engagement and improves clinical outcomes in a group CBT treatment for depression. Specifically, we aim to assess whether the text messaging adjunct led to an increase in group therapy sessions attended, an increase in duration of therapy attended, and reductions in Patient Health Questionnaire-9 item (PHQ-9) symptoms compared with the control condition of standard group CBT in a sample of low-income Spanish speaking Latino patients. Methods: Patients in an outpatient behavioral health clinic were assigned to standard group CBT for depression (control condition; n=40) or the same treatment with the addition of a text messaging adjunct (n=45). The adjunct consisted of a daily mood monitoring message, a daily message reiterating the theme of that week's content, and medication and appointment reminders. Mood data and qualitative responses were sent to a Web-based platform (HealthySMS) for review by the therapist and displayed in session as a tool for teaching CBT skills. Results: Intent-to-treat analyses on therapy attendance during 16 sessions of weekly therapy found that patients assigned to the text messaging adjunct stayed in therapy significantly longer (median of 13.5 weeks before dropping out) than patients assigned to the control condition (median of 3 weeks before dropping out; Wilcoxon-Mann-Whitney z=?2.21, P=.03). Patients assigned to the text messaging adjunct also generally attended more sessions (median=6 sessions) during this period than patients assigned to the control condition (median =2.5 sessions), but the effect was not significant (Wilcoxon-Mann-Whitney z=?1.65, P=.10). Both patients assigned to the text messaging adjunct (B=?.29, 95\% CI ?0.38 to ?0.19, z=?5.80, P<.001) and patients assigned to the control conditions (B=?.20, 95\% CI ?0.32 to ?0.07, z=?3.12, P=.002) experienced significant decreases in depressive symptom severity over the course of treatment; however, the conditions did not significantly differ in their degree of symptom reduction. Conclusions: This study provides support for automated text messaging as a tool to sustain engagement in CBT for depression over time. There were no differences in depression outcomes between conditions, but this may be influenced by low follow-up rates of patients who dropped out of treatment. ",
doi="10.2196/jmir.6914",
url="http://www.jmir.org/2017/5/e148/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28483742"
}


@Article{info:doi/10.2196/jmir.6775,
author="Bidargaddi, Niranjan
and Musiat, Peter
and Winsall, Megan
and Vogl, Gillian
and Blake, Victoria
and Quinn, Stephen
and Orlowski, Simone
and Antezana, Gaston
and Schrader, Geoffrey",
title="Efficacy of a Web-Based Guided Recommendation Service for a Curated List of Readily Available Mental Health and Well-Being Mobile Apps for Young People: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2017",
month="May",
day="12",
volume="19",
number="5",
pages="e141",
keywords="well-being",
keywords="mental health",
keywords="young people",
keywords="online intervention",
keywords="apps",
keywords="engagement",
abstract="Background: Mental disorders are highly prevalent for the people who are aged between 16 and 25 years and can permanently disrupt the development of these individuals. Easily available mobile health (mHealth) apps for mobile phones have great potential for the prevention and early intervention of mental disorders in young adults, but interventions are required that can help individuals to both identify high-quality mobile apps and use them to change health and lifestyle behavior. Objectives: The study aimed to assess the efficacy of a Web-based self-guided app recommendation service (``The Toolbox'') in improving the well-being of young Australians aged between 16 and 25 years. The intervention was developed in collaboration with young adults and consists of a curated list of 46 readily available health and well-being apps, assessed and rated by professionals and young people. Participants are guided by an interactive quiz and subsequently receive recommendations for particular apps to download and use based on their personal goals. Methods: The study was a waitlist, parallel-arm, randomized controlled trial. Our primary outcome measure was change in well-being as measured by the Mental Health Continuum-Short Form (MHC-SF). We also employed ecological momentary assessments (EMAs) to track mood, energy, rest, and sleep. Participants were recruited from the general Australian population, via several Web-based and community strategies. The study was conducted through a Web-based platform consisting of a landing Web page and capabilities to administer study measures at different time points. Web-based measurements were self-assessed at baseline and 4 weeks, and EMAs were collected repeatedly at regular weekly intervals or ad hoc when participants interacted with the study platform. Primary outcomes were analyzed using linear mixed-models and intention-to-treat (ITT) analysis. Results: A total of 387 participants completed baseline scores and were randomized into the trial. Results demonstrated no significant effect of ``The Toolbox'' intervention on participant well-being at 4 weeks compared with the control group (P=.66). There were also no significant differences between the intervention and control groups at 4 weeks on any of the subscales of the MHC-SF (psychological: P=.95, social: P=.42, emotional: P=.95). Repeat engagement with the study platform resulted in a significant difference in mood, energy, rest, and sleep trajectories between intervention and control groups as measured by EMAs (P<.01). Conclusions: This was the first study to assess the effectiveness of a Web-based well-being intervention in a sample of young adults. The design of the intervention utilized expert rating of existing apps and end-user codesign approaches resulting in an app recommendation service. Our finding suggests that recommended readily available mental health and well-being apps may not lead to improvements in the well-being of a nonclinical sample of young people, but might halt a decline in mood, energy, rest, and sleep. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614000710628; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366145 (Archived by WebCite at http://www.webcitation.org/ 6pWDsnKme) ",
doi="10.2196/jmir.6775",
url="http://www.jmir.org/2017/5/e141/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28500020"
}


@Article{info:doi/10.2196/jmir.6694,
author="Eichenberg, Christiane
and Schott, Markus
and Decker, Oliver
and Sindelar, Brigitte",
title="Attachment Style and Internet Addiction: An Online Survey",
journal="J Med Internet Res",
year="2017",
month="May",
day="17",
volume="19",
number="5",
pages="e170",
keywords="Internet",
keywords="addictive behavior",
keywords="surveys and questionnaires",
keywords="Rorschach test",
abstract="Background: One of the clinically relevant problems of Internet use is the phenomenon of Internet addiction. Considering the fact that there is ample evidence for the relationship between attachment style and substance abuse, it stands to reason that attachment theory can also make an important contribution to the understanding of the pathogenesis of Internet addiction. Objective: The aim of this study was to examine people's tendency toward pathological Internet usage in relation to their attachment style. Methods: An online survey was conducted. Sociodemographic data, attachment style (Bielefeld questionnaire partnership expectations), symptoms of Internet addiction (scale for online addiction for adults), used Web-based services, and online relationship motives (Cyber Relationship Motive Scale, CRMS-D) were assessed. In order to confirm the findings, a study using the Rorschach test was also conducted. Results: In total, 245 subjects were recruited. Participants with insecure attachment style showed a higher tendency to pathological Internet usage compared with securely attached participants. An ambivalent attachment style was particularly associated with pathological Internet usage. Escapist and social-compensatory motives played an important role for insecurely attached subjects. However, there were no significant effects with respect to Web-based services and apps used. Results of the analysis of the Rorschach protocol with 16 subjects corroborated these results. Users with pathological Internet use frequently showed signs of infantile relationship structures in the context of social groups. This refers to the results of the Web-based survey, in which interpersonal relationships were the result of an insecure attachment style. Conclusions: Pathological Internet use was a function of insecure attachment and limited interpersonal relationships. ",
doi="10.2196/jmir.6694",
url="http://www.jmir.org/2017/5/e170/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28526662"
}


@Article{info:doi/10.2196/jmir.7381,
author="Wahle, Fabian
and Bollhalder, Lea
and Kowatsch, Tobias
and Fleisch, Elgar",
title="Toward the Design of Evidence-Based Mental Health Information Systems for People With Depression: A Systematic Literature Review and Meta-Analysis",
journal="J Med Internet Res",
year="2017",
month="May",
day="31",
volume="19",
number="5",
pages="e191",
keywords="literature review",
keywords="mental health",
keywords="design feature",
keywords="depression",
keywords="information systems",
abstract="Background: Existing research postulates a variety of components that show an impact on utilization of technology-mediated mental health information systems (MHIS) and treatment outcome. Although researchers assessed the effect of isolated design elements on the results of Web-based interventions and the associations between symptom reduction and use of components across computer and mobile phone platforms, there remains uncertainty with regard to which components of technology-mediated interventions for mental health exert the greatest therapeutic gain. Until now, no studies have presented results on the therapeutic benefit associated with specific service components of technology-mediated MHIS for depression. Objective: This systematic review aims at identifying components of technology-mediated MHIS for patients with depression. Consequently, all randomized controlled trials comparing technology-mediated treatments for depression to either waiting-list control, treatment as usual, or any other form of treatment for depression were reviewed. Updating prior reviews, this study aims to (1) assess the effectiveness of technology-supported interventions for the treatment of depression and (2) add to the debate on what components in technology-mediated MHIS for the treatment of depression should be standard of care. Methods: Systematic searches in MEDLINE, PsycINFO, and the Cochrane Library were conducted. Effect sizes for each comparison between a technology-enabled intervention and a control condition were computed using the standard mean difference (SMD). Chi-square tests were used to test for heterogeneity. Using subgroup analysis, potential sources of heterogeneity were analyzed. Publication bias was examined using visual inspection of funnel plots and Begg's test. Qualitative data analysis was also used. In an explorative approach, a list of relevant components was extracted from the body of literature by consensus between two researchers. Results: Of 6387 studies initially identified, 45 met all inclusion criteria. Programs analyzed showed a significant trend toward reduced depressive symptoms (SMD --0.58, 95\% CI --0.71 to --0.45, P<.001). Heterogeneity was large (I2?76). A total of 15 components were identified. Conclusions: Technology-mediated MHIS for the treatment of depression has a consistent positive overall effect compared to controls. A total of 15 components have been identified. Further studies are needed to quantify the impact of individual components on treatment effects and to identify further components that are relevant for the design of future technology-mediated interventions for the treatment of depression and other mental disorders. ",
doi="10.2196/jmir.7381",
url="http://www.jmir.org/2017/5/e191/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28566267"
}


@Article{info:doi/10.2196/jmir.6946,
author="Davis, A. Matthew
and Zheng, Kai
and Liu, Yang
and Levy, Helen",
title="Public Response to Obamacare on Twitter",
journal="J Med Internet Res",
year="2017",
month="May",
day="26",
volume="19",
number="5",
pages="e167",
keywords="Patient Protection and Affordable Care Act",
keywords="health care reform",
keywords="social media",
keywords="data collection",
abstract="Background: The Affordable Care Act (ACA), often called ``Obamacare,'' is a controversial law that has been implemented gradually since its enactment in 2010. Polls have consistently shown that public opinion of the ACA is quite negative. Objective: The aim of our study was to examine the extent to which Twitter data can be used to measure public opinion of the ACA over time. Methods: We prospectively collected a 10\% random sample of daily tweets (approximately 52 million since July 2011) using Twitter's streaming application programming interface (API) from July 10, 2011 to July 31, 2015. Using a list of key terms and ACA-specific hashtags, we identified tweets about the ACA and examined the overall volume of tweets about the ACA in relation to key ACA events. We applied standard text sentiment analysis to assign each ACA tweet a measure of positivity or negativity and compared overall sentiment from Twitter with results from the Kaiser Family Foundation health tracking poll. Results: Public opinion on Twitter (measured via sentiment analysis) was slightly more favorable than public opinion measured by the Kaiser poll (approximately 50\% vs 40\%, respectively) but trends over time in both favorable and unfavorable views were similar in both sources. The Twitter-based measures of opinion as well as the Kaiser poll changed very little over time: correlation coefficients for favorable and unfavorable public opinion were .43 and .37, respectively. However, we found substantial spikes in the volume of ACA-related tweets in response to key events in the law's implementation, such as the first open enrollment period in October 2013 and the Supreme Court decision in June 2012. Conclusions: Twitter may be useful for tracking public opinion of health care reform as it appears to be comparable with conventional polling results. Moreover, in contrast with conventional polling, the overall amount of tweets also provides a potential indication of public interest of a particular issue at any point in time. ",
doi="10.2196/jmir.6946",
url="http://www.jmir.org/2017/5/e167/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28550002"
}


@Article{info:doi/10.2196/jmir.4778,
author="Garvin, A. Lynn
and Simon, R. Steven",
title="Prioritizing Measures of Digital Patient Engagement: A Delphi Expert Panel Study",
journal="J Med Internet Res",
year="2017",
month="May",
day="26",
volume="19",
number="5",
pages="e182",
keywords="patient reported outcome measures",
keywords="patient engagement",
keywords="patient-centered care",
keywords="personal health record",
keywords="health information technology",
keywords="veterans health",
abstract="Background: Establishing a validated scale of patient engagement through use of information technology (ie, digital patient engagement) is the first step to understanding its role in health and health care quality, outcomes, and efficient implementation by health care providers and systems. Objective: The aim of this study was to develop and prioritize measures of digital patient engagement based on patients' use of the US Department of Veterans Affairs (VA)'s MyHealtheVet (MHV) portal, focusing on the MHV/Blue Button and Secure Messaging functions. Methods: We aligned two models from the information systems and organizational behavior literatures to create a theory-based model of digital patient engagement. On the basis of this model, we conducted ten key informant interviews to identify potential measures from existing VA studies and consolidated the measures. We then conducted three rounds of modified Delphi rating by 12 national eHealth experts via Web-based surveys to prioritize the measures. Results: All 12 experts completed the study's three rounds of modified Delphi ratings, resulting in two sets of final candidate measures representing digital patient engagement for Secure Messaging (58 measures) and MHV/Blue Button (71 measures). These measure sets map to Donabedian's three types of quality measures: (1) antecedents (eg, patient demographics); (2) processes (eg, a novel measure of Web-based care quality); and (3) outcomes (eg, patient engagement). Conclusions: This national expert panel study using a modified Delphi technique prioritized candidate measures to assess digital patient engagement through patients' use of VA's My HealtheVet portal. The process yielded two robust measures sets prepared for future piloting and validation in surveys among Veterans. ",
doi="10.2196/jmir.4778",
url="http://www.jmir.org/2017/5/e182/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28550008"
}


@Article{info:doi/10.2196/jmir.6688,
author="Hanlon, Peter
and Daines, Luke
and Campbell, Christine
and McKinstry, Brian
and Weller, David
and Pinnock, Hilary",
title="Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer",
journal="J Med Internet Res",
year="2017",
month="May",
day="17",
volume="19",
number="5",
pages="e172",
keywords="telehealth",
keywords="telemonitoring",
keywords="self-management",
keywords="chronic disease",
keywords="diabetes",
keywords="heart failure",
keywords="asthma",
keywords="COPD",
keywords="pulmonary disease, chronic obstructive",
keywords="cancer",
abstract="Background: Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. Objective: The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. Methods: We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. Results: We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma. Conclusions: While telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established. ",
doi="10.2196/jmir.6688",
url="http://www.jmir.org/2017/5/e172/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28526671"
}


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


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


@Article{info:doi/10.2196/jmir.7846,
author="Melnick, R. Edward
and Hess, P. Erik
and Guo, George
and Breslin, Maggie
and Lopez, Kevin
and Pavlo, J. Anthony
and Abujarad, Fuad
and Powsner, M. Seth
and Post, A. Lori",
title="Patient-Centered Decision Support: Formative Usability Evaluation of Integrated Clinical Decision Support With a Patient Decision Aid for Minor Head Injury in the Emergency Department",
journal="J Med Internet Res",
year="2017",
month="May",
day="19",
volume="19",
number="5",
pages="e174",
keywords="clinical decision support",
keywords="decision aids",
keywords="head injury, minor",
keywords="medical informatics",
keywords="spiral computed tomography",
keywords="health services overuse",
keywords="patient-centered outcomes research",
abstract="Background: The Canadian Computed Tomography (CT) Head Rule, a clinical decision rule designed to safely reduce imaging in minor head injury, has been rigorously validated and implemented, and yet expected decreases in CT were unsuccessful. Recent work has identified empathic care as a key component in decreasing CT overuse. Health information technology can hinder the clinician-patient relationship. Patient-centered decision tools to support the clinician-patient relationship are needed to promote evidence-based decisions. Objective: Our objective is to formatively evaluate an electronic tool that not only helps clinicians at the bedside to determine the need for CT use based on the Canadian CT Head Rule but also promotes evidence-based conversations between patients and clinicians regarding patient-specific risk and patients' specific concerns. Methods: User-centered design with practice-based and participatory decision aid development was used to design, develop, and evaluate patient-centered decision support regarding CT use in minor head injury in the emergency department. User experience and user interface (UX/UI) development involved successive iterations with incremental refinement in 4 phases: (1) initial prototype development, (2) usability assessment, (3) field testing, and (4) beta testing. This qualitative approach involved input from patients, emergency care clinicians, health services researchers, designers, and clinical informaticists at every stage. Results: The Concussion or Brain Bleed app is the product of 16 successive iterative revisions in accordance with UX/UI industry design standards. This useful and usable final product integrates clinical decision support with a patient decision aid. It promotes shared use by emergency clinicians and patients at the point of care within the emergency department context. This tablet computer app facilitates evidence-based conversations regarding CT in minor head injury. It is adaptable to individual clinician practice styles. The resultant tool includes a patient injury evaluator based on the Canadian CT Head Rule and provides patient specific risks using pictographs with natural frequencies and cues for discussion about patient concerns. Conclusions: This tool was designed to align evidence-based practices about CT in minor head injury patients. It establishes trust, empowers active participation, and addresses patient concerns and uncertainty about their condition. We hypothesize that, when implemented, the Concussion or Brain Bleed app will support---not hinder---the clinician-patient relationship, safely reduce CT use, and improve the patient experience of care. ",
doi="10.2196/jmir.7846",
url="http://www.jmir.org/2017/5/e174/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28526667"
}


@Article{info:doi/10.2196/jmir.6714,
author="Smit, Suzanne Eline
and Dima, Lelia Alexandra
and Immerzeel, Maria Stephanie Annette
and van den Putte, Bas
and Williams, Colin Geoffrey",
title="The Virtual Care Climate Questionnaire: Development and Validation of a Questionnaire Measuring Perceived Support for Autonomy in a Virtual Care Setting",
journal="J Med Internet Res",
year="2017",
month="May",
day="08",
volume="19",
number="5",
pages="e155",
keywords="questionnaire design",
keywords="validation studies",
keywords="psychometrics",
keywords="personal autonomy",
keywords="Internet",
keywords="health behavior",
keywords="health promotion",
keywords="self-determination theory",
abstract="Background: Web-based health behavior change interventions may be more effective if they offer autonomy-supportive communication facilitating the internalization of motivation for health behavior change. Yet, at this moment no validated tools exist to assess user-perceived autonomy-support of such interventions. Objective: The aim of this study was to develop and validate the virtual climate care questionnaire (VCCQ), a measure of perceived autonomy-support in a virtual care setting. Methods: Items were developed based on existing questionnaires and expert consultation and were pretested among experts and target populations. The virtual climate care questionnaire was administered in relation to Web-based interventions aimed at reducing consumption of alcohol (Study 1; N=230) or cannabis (Study 2; N=228). Item properties, structural validity, and reliability were examined with item-response and classical test theory methods, and convergent and divergent validity via correlations with relevant concepts. Results: In Study 1, 20 of 23 items formed a one-dimensional scale (alpha=.97; omega=.97; H=.66; mean 4.9 [SD 1.0]; range 1-7) that met the assumptions of monotonicity and invariant item ordering. In Study 2, 16 items fitted these criteria (alpha=.92; H=.45; omega=.93; mean 4.2 [SD 1.1]; range 1-7). Only 15 items remained in the questionnaire in both studies, thus we proceeded to the analyses of the questionnaire's reliability and construct validity with a 15-item version of the virtual climate care questionnaire. Convergent validity of the resulting 15-item virtual climate care questionnaire was confirmed by positive associations with autonomous motivation (Study 1: r=.66, P<.001; Study 2: r=.37, P<.001) and perceived competence for reducing alcohol intake (Study 1: r=.52, P<.001). Divergent validity could only be confirmed by the nonsignificant association with perceived competence for learning (Study 2: r=.05, P=.48). Conclusions: The virtual climate care questionnaire accurately assessed participants' perceived autonomy-support offered by two Web-based health behavior change interventions. Overall, the scale showed the expected properties and relationships with relevant concepts, and the studies presented suggest this first version of the virtual climate care questionnaire to be reasonably valid and reliable. As a result, the current version may cautiously be used in future research and practice to measure perceived support for autonomy within a virtual care climate. Future research efforts are required that focus on further investigating the virtual climate care questionnaire's divergent validity, on determining the virtual climate care questionnaire's validity and reliability when used in the context of Web-based interventions aimed at improving nonaddictive or other health behaviors, and on developing and validating a short form virtual climate care questionnaire. ",
doi="10.2196/jmir.6714",
url="http://www.jmir.org/2017/5/e155/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28483743"
}


@Article{info:doi/10.2196/jmir.6407,
author="Timon, M. Claire
and Blain, J. Richard
and McNulty, Breige
and Kehoe, Laura
and Evans, Katie
and Walton, Janette
and Flynn, Albert
and Gibney, R. Eileen",
title="The Development, Validation, and User Evaluation of Foodbook24: A Web-Based Dietary Assessment Tool Developed for the Irish Adult Population",
journal="J Med Internet Res",
year="2017",
month="May",
day="11",
volume="19",
number="5",
pages="e158",
keywords="diet records",
keywords="Internet",
keywords="validity",
keywords="biomarkers",
keywords="method acceptability",
keywords="adults",
abstract="Background: The application of technology in the area of dietary assessment has resulted in the development of an array of tools, which are often specifically designed for a particular country or region. Objective: The aim of this study was to describe the development, validation, and user evaluation of a Web-based dietary assessment tool ``Foodbook24.'' Methods: Foodbook24 is a Web-based, dietary assessment tool consisting of a 24-hour dietary recall (24HDR) and food frequency questionnaire (FFQ) alongside supplementary questionnaires. Validity of the 24HDR component was assessed by 40 participants, who completed 3 nonconsecutive, self-administered 24HDR using Foodbook24 and a 4-day semi-weighed food diary at separate time points. Participants also provided fasted blood samples and 24-hour urine collections for the identification of biomarkers of nutrient and food group intake during each recording period. Statistical analyses on the nutrient and food group intake data derived from each method were performed in SPSS version 20.0 (SPSS Inc). Mean nutrient intakes (and standard deviations) recorded using each method of dietary assessment were calculated. Spearman and Pearson correlations, Wilcoxon Signed Rank and Paired t test were used to investigate the agreement and differences between the nutritional output from Foodbook24 (test method) and the 4-day semi-weighed food diary (reference method). Urinary and plasma biomarkers of nutrient intake were used as an objective validation of Foodbook24. To investigate the user acceptability of Foodbook24, participants from different studies involved with Foodbook24 were asked to complete an evaluation questionnaire. Results: For nutrient intake, correlations between the dietary assessment methods were acceptable to very good in strength and statistically significant (range r=.32 to .75). There were some significant differences between reported mean intakes of micronutrients recorded by both methods; however, with the exception of protein (P=.03), there were no significant differences in the reporting of energy or macronutrient intake. Of the 19 food groups investigated in this analysis, there were significant differences between 6 food groups reported by both methods. Spearman correlations for biomarkers of nutrient and food group intake and reported intake were similar for both methods. A total of 118 participants evaluated the acceptability of Foodbook24. The tool was well-received and the majority, 67.8\% (80/118), opted for Foodbook24 as the preferred method for future dietary intake assessment when compared against a traditional interviewer led recall and semi-weighed food diary. Conclusions: The results of this study demonstrate the validity and user acceptability of Foodbook24. The results also highlight the potential of Foodbook24, a Web-based dietary assessment method, and present a viable alternative to nutritional surveillance in Ireland. ",
doi="10.2196/jmir.6407",
url="http://www.jmir.org/2017/5/e158/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28495662"
}


@Article{info:doi/10.2196/jmir.7620,
author="Kohler, Simone
and Behrens, Gundula
and Olden, Matthias
and Baumeister, E. Sebastian
and Horsch, Alexander
and Fischer, Beate
and Leitzmann, F. Michael",
title="Design and Evaluation of a Computer-Based 24-Hour Physical Activity Recall (cpar24) Instrument",
journal="J Med Internet Res",
year="2017",
month="May",
day="30",
volume="19",
number="5",
pages="e186",
keywords="web-based method",
keywords="validity",
keywords="reliability",
keywords="usability",
keywords="lifestyle behavior",
keywords="physical activity",
keywords="sedentary behavior",
abstract="Background: Widespread access to the Internet and an increasing number of Internet users offers the opportunity of using Web-based recalls to collect detailed physical activity data in epidemiologic studies. Objective: The aim of this investigation was to evaluate the validity and reliability of a computer-based 24-hour physical activity recall (cpar24) instrument with respect to the recalled 24-h period. Methods: A random sample of 67 German residents aged 22 to 70 years was instructed to wear an ActiGraph GT3X+ accelerometer for 3 days. Accelerometer counts per min were used to classify activities as sedentary (<100 counts per min), light (100-1951 counts per min), and moderate to vigorous (?1952 counts per min). On day 3, participants were also requested to specify the type, intensity, timing, and context of all activities performed during day 2 using the cpar24. Using metabolic equivalent of task (MET), the cpar24 activities were classified as sedentary (<1.5 MET), light (1.5-2.9 MET), and moderate to vigorous (?3.0 MET). The cpar24 was administered twice at a 3-h interval. The Spearman correlation coefficient (r) was used as primary measure of concurrent validity and test-retest reliability. Results: As compared with accelerometry, the cpar24 underestimated light activity by ?123 min (median difference, P difference <.001) and overestimated moderate to vigorous activity by 89 min (P difference <.001). By comparison, time spent sedentary assessed by the 2 methods was similar (median difference=+7 min, P difference=.39). There was modest agreement between the cpar24 and accelerometry regarding sedentary (r=.54), light (r=.46), and moderate to vigorous (r=.50) activities. Reliability analyses revealed modest to high intraclass correlation coefficients for sedentary (r=.75), light (r=.65), and moderate to vigorous (r=.92) activities and no statistically significant differences between replicate cpar24 measurements (median difference for sedentary activities=+10 min, for light activities=?5 min, for moderate to vigorous activities=0 min, all P difference ?.60). Conclusion: These data show that the cpar24 is a valid and reproducible Web-based measure of physical activity in adults. ",
doi="10.2196/jmir.7620",
url="http://www.jmir.org/2017/5/e186/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28559229"
}


@Article{info:doi/10.2196/jmir.6453,
author="Zhan, Xingxin
and Zhang, Zhixia
and Sun, Fang
and Liu, Qian
and Peng, Weijun
and Zhang, Heng
and Yan, Weirong",
title="Effects of Improving Primary Health Care Workers' Knowledge About Public Health Services in Rural China: A Comparative Study of Blended Learning and Pure E-Learning",
journal="J Med Internet Res",
year="2017",
month="May",
day="01",
volume="19",
number="5",
pages="e116",
keywords="blended learning",
keywords="e-learning",
keywords="primary health care workers",
keywords="public health services",
abstract="Background:  Primary health care workers (PHCWs) are a major force in delivering basic public health services (BPHS) in rural China. It is necessary to take effective training approaches to improve PHCWs' competency on BPHS. Both electronic learning (e-learning) and blended learning have been widely used in the health workers' education. However, there is limited evidence on the effects of blended learning in comparison with pure e-learning. Objective: The aim of this study was to evaluate the effects of a blended-learning approach for rural PHCWs in improving their knowledge about BPHS as well as training satisfaction in comparison with a pure e-learning approach. Methods: The study was conducted among PHCWs in 6 rural counties of Hubei Province, China, between August 2013 and April 2014. Three counties were randomly allocated blended-learning courses (29 township centers or 612 PHCWs---the experimental group), and three counties were allocated pure e-learning courses (31 township centers or 625 PHCWs---the control group). Three course modules were administered for 5 weeks, with assessments at baseline and postcourse. Primary outcomes were score changes in courses' knowledge. Secondary outcome was participant satisfaction (5-point Likert scale anchored between 1 [strongly agree] and 5 [strongly disagree]). Results: The experimental group had higher mean scores than the control group in knowledge achievement in three course modules: (1) module 1: 93.21 (95\% CI 92.49-93.93) in experimental group versus 88.29 (95\% CI 87.19-89.40) in the control group; adjusted difference, 4.92 (95\% CI 2.61-7.24; P<.001); (2) module 2: 94.05 (95\% CI 93.37-94.73) in the experimental group vs 90.22 (95\% CI 89.12-91.31) in the control group; adjusted difference, 3.67 (95\% CI 1.17-6.18; P=.004); (3) module 3: 93.88 (95\% CI 93.08-94.68) in the experimental group versus 89.09 (95\% CI 87.89-90.30) in control group; adjusted difference, 4.63 (95\% CI 2.12-7.14; P<.001). The participants in the experimental learning group gave more positive responses with the four issues than control group participants: (1) the increase of interest in learning, 1.85 (95\% CI 1.22-2.80; P=.003); (2) the increase of interaction with others, 1.77 (95\% CI 1.20-2.60; P=.004); (3) the satisfaction with learning experience, 1.78 (95\% CI 1.11-2.88; P=.02); and (4) achievement of learning objectives, 1.63 (95\% CI 1.08-2.48; P=.02). Conclusions: Among PHCWs in rural China, a blended-learning approach to BPHS training could result in a higher knowledge achievement and satisfaction level compared with a pure e-learning approach. The findings of the study will contribute knowledge to improve the competency of PHCWs in similar settings. ",
doi="10.2196/jmir.6453",
url="http://www.jmir.org/2017/5/e116/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28461286"
}


@Article{info:doi/10.2196/jmir.7175,
author="W{\"a}rnest{\aa}l, Pontus
and Svedberg, Petra
and Lindberg, Susanne
and Nygren, M. Jens",
title="Effects of Using Child Personas in the Development of a Digital Peer Support Service for Childhood Cancer Survivors",
journal="J Med Internet Res",
year="2017",
month="May",
day="18",
volume="19",
number="5",
pages="e161",
keywords="peer",
keywords="childhood",
keywords="cancer",
keywords="survivor",
keywords="participation",
keywords="user experience",
keywords="service design",
abstract="Background: Peer support services have the potential to support children who survive cancer by handling the physical, mental, and social challenges associated with survival and return to everyday life. Involving the children themselves in the design process allows for adapting services to authentic user behaviors and goals. As there are several challenges that put critical requirements on a user-centered design process, we developed a design method based on personas adapted to the particular needs of children that promotes health and handles a sensitive design context. Objective: The purpose of this study was to evaluate the effects of using child personas in the development of a digital peer support service for childhood cancer survivors. Methods: The user group's needs and behaviors were characterized based on cohort data and literature, focus group interviews with childhood cancer survivors (n=15, 8-12 years), stakeholder interviews with health care professionals and parents (n=13), user interviews, and observations. Data were interpreted and explained together with childhood cancer survivors (n=5) in three explorative design workshops and a validation workshop with children (n=7). Results: We present findings and insights on how to codesign child personas in the context of developing digital peer support services with childhood cancer survivors. The work resulted in three primary personas that model the behaviors, attitudes, and goals of three user archetypes tailored for developing health-promoting services in this particular use context. Additionally, we also report on the effects of using these personas in the design of a digital peer support service called Give Me a Break. Conclusions: By applying our progressive steps of data collection and analysis, we arrive at authentic child-personas that were successfully used to design and develop health-promoting services for children in vulnerable life stages. The child-personas serve as effective collaboration and communication aids for both internal and external purposes. ",
doi="10.2196/jmir.7175",
url="http://www.jmir.org/2017/5/e161/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28526663"
}


@Article{info:doi/10.2196/jmir.7471,
author="Lovatt, Melanie
and Bath, A. Peter
and Ellis, Julie",
title="Development of Trust in an Online Breast Cancer Forum: A Qualitative Study",
journal="J Med Internet Res",
year="2017",
month="May",
day="23",
volume="19",
number="5",
pages="e175",
keywords="trust",
keywords="online information sharing",
keywords="breast cancer",
keywords="online health communities",
keywords="qualitative research",
abstract="Background: Online health forums provide peer support for a range of medical conditions including life-threatening and terminal illnesses. Trust is an important component of peer-to-peer support, although relatively little is known about how trust forms within online health forums. Objective: The aim of this paper is to examine how trust develops and influences sharing among users of an online breast cancer forum. Methods: An interpretive qualitative approach was adopted. Data were collected from forum posts from 135 threads on 9 boards on the UK charity, Breast Cancer Care (BCC). Semistructured interviews were conducted with 14 BCC forum users. Both datasets were analyzed thematically using Braun and Clarke's approach and combined to triangulate analysis. Results: Trust operates in 3 dimensions, structural, relational, and temporal, and these intersect with each other and do not operate in isolation. The structural dimension relates to how the affordances and formal rules of the site affected trust. The relational dimension refers to how trust was necessarily experienced in interactions with other forum users: it emerged within relationships and was a social phenomenon. The temporal dimension relates to how trust changed over time and was influenced by the length of time users spent on the forum. Conclusions: Trust is a process that changes over time and which is influenced by structural features of the forum, as well as informal but collectively understood relational interactions among forum users. The study provides a better understanding of how the intersecting structural, relational, and temporal aspects that support the development of trust facilitate sharing in online environments. These findings will help organizations developing online health forums. ",
doi="10.2196/jmir.7471",
url="http://www.jmir.org/2017/5/e175/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28536093"
}


@Article{info:doi/10.2196/jmir.6887,
author="Meystre, Stephane
and Gouripeddi, Ramkiran
and Tieder, Joel
and Simmons, Jeffrey
and Srivastava, Rajendu
and Shah, Samir",
title="Enhancing Comparative Effectiveness Research With Automated Pediatric Pneumonia Detection in a Multi-Institutional Clinical Repository: A PHIS+ Pilot Study",
journal="J Med Internet Res",
year="2017",
month="May",
day="15",
volume="19",
number="5",
pages="e162",
keywords="natural language processing",
keywords="pneumonia, bacterial",
keywords="medical informatics",
keywords="comparative effectiveness research",
abstract="Background: Community-acquired pneumonia is a leading cause of pediatric morbidity. Administrative data are often used to conduct comparative effectiveness research (CER) with sufficient sample sizes to enhance detection of important outcomes. However, such studies are prone to misclassification errors because of the variable accuracy of discharge diagnosis codes. Objective: The aim of this study was to develop an automated, scalable, and accurate method to determine the presence or absence of pneumonia in children using chest imaging reports. Methods: The multi-institutional PHIS+ clinical repository was developed to support pediatric CER by expanding an administrative database of children's hospitals with detailed clinical data. To develop a scalable approach to find patients with bacterial pneumonia more accurately, we developed a Natural Language Processing (NLP) application to extract relevant information from chest diagnostic imaging reports. Domain experts established a reference standard by manually annotating 282 reports to train and then test the NLP application. Findings of pleural effusion, pulmonary infiltrate, and pneumonia were automatically extracted from the reports and then used to automatically classify whether a report was consistent with bacterial pneumonia. Results: Compared with the annotated diagnostic imaging reports reference standard, the most accurate implementation of machine learning algorithms in our NLP application allowed extracting relevant findings with a sensitivity of .939 and a positive predictive value of .925. It allowed classifying reports with a sensitivity of .71, a positive predictive value of .86, and a specificity of .962. When compared with each of the domain experts manually annotating these reports, the NLP application allowed for significantly higher sensitivity (.71 vs .527) and similar positive predictive value and specificity . Conclusions: NLP-based pneumonia information extraction of pediatric diagnostic imaging reports performed better than domain experts in this pilot study. NLP is an efficient method to extract information from a large collection of imaging reports to facilitate CER. ",
doi="10.2196/jmir.6887",
url="http://www.jmir.org/2017/5/e162/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28506958"
}


@Article{info:doi/10.2196/jmir.7164,
author="Graber, Alan Mark
and Hershkop, Eliyakim
and Graber, Ilana Rachel",
title="Pharma Websites and ``Professionals-Only'' Information: The Implications for Patient Trust and Autonomy",
journal="J Med Internet Res",
year="2017",
month="May",
day="24",
volume="19",
number="5",
pages="e178",
keywords="trust",
keywords="ethics",
keywords="personal autonomy",
keywords="readability",
abstract="Background: Access to information is critical to a patient's valid exercise of autonomy. One increasingly important source of medical information is the Internet. Individuals often turn to drug company (``pharma'') websites to look for drug information. Objective: The objective of this study was to determine whether there is information on pharma websites that is embargoed: Is there information that is hidden from the patient unless she attests to being a health care provider? We discuss the implications of our findings for health care ethics. Methods: We reviewed a convenience sample of 40 pharma websites for ``professionals-only'' areas and determined whether access to those areas was restricted, requiring attestation that the user is a health care professional in the United States. Results: Of the 40 websites reviewed, 38 had information that was labeled for health care professionals-only. Of these, 24 required the user to certify their status as a health care provider before they were able to access this ``hidden'' information. Conclusions: Many pharma websites include information in a ``professionals-only'' section. Of these, the majority require attestation that the user is a health care professional before they can access the information. This leaves patients with two bad choices: (1) not accessing the information or (2) lying about being a health care professional. Both of these outcomes are unacceptable. In the first instance, the patient's access to information is limited, potentially impairing their health and their ability to make reasonable and well-informed decisions. In the second instance, they may be induced to lie in a medical setting. ``Teaching'' patients to lie may have adverse consequences for the provider-patient relationship. ",
doi="10.2196/jmir.7164",
url="http://www.jmir.org/2017/5/e178/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28539303"
}


@Article{info:doi/10.2196/jmir.7379,
author="Siebert, N. Johan
and Ehrler, Frederic
and Gervaix, Alain
and Haddad, Kevin
and Lacroix, Laurence
and Schrurs, Philippe
and Sahin, Ayhan
and Lovis, Christian
and Manzano, Sergio",
title="Adherence to AHA Guidelines When Adapted for Augmented Reality Glasses for Assisted Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial",
journal="J Med Internet Res",
year="2017",
month="May",
day="29",
volume="19",
number="5",
pages="e183",
keywords="resuscitation",
keywords="emergency medicine",
keywords="pediatrics",
keywords="biomedical technologies",
keywords="equipment and supplies",
keywords="eyeglasses",
abstract="Background: The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) are nowadays recognized as the world's most authoritative resuscitation guidelines. Adherence to these guidelines optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite their availability, suboptimal quality of CPR is still common. Currently, the median hospital survival rate after pediatric in-hospital cardiac arrest is 36\%, whereas it falls below 10\% for out-of-hospital cardiac arrest. Among emerging information technologies and devices able to support caregivers during resuscitation and increase adherence to AHA guidelines, augmented reality (AR) glasses have not yet been assessed. In order to assess their potential, we adapted AHA Pediatric Advanced Life Support (PALS) guidelines for AR glasses. Objective: The study aimed to determine whether adapting AHA guidelines for AR glasses increased adherence by reducing deviation and time to initiation of critical life-saving maneuvers during pediatric CPR when compared with the use of PALS pocket reference cards. Methods: We conducted a randomized controlled trial with two parallel groups of voluntary pediatric residents, comparing AR glasses to PALS pocket reference cards during a simulation-based pediatric cardiac arrest scenario---pulseless ventricular tachycardia (pVT). The primary outcome was the elapsed time in seconds in each allocation group, from onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, as well as the time intervals between defibrillation attempts and drug doses, shock doses, and number of shocks. All these outcomes were assessed for deviation from AHA guidelines. Results: Twenty residents were randomized into 2 groups. Time to first defibrillation attempt (mean: 146 s) and adherence to AHA guidelines in terms of time to other critical resuscitation endpoints and drug dose delivery were not improved using AR glasses. However, errors and deviations were significantly reduced in terms of defibrillation doses when compared with the use of the PALS pocket reference cards. In a total of 40 defibrillation attempts, residents not wearing AR glasses used wrong doses in 65\% (26/40) of cases, including 21 shock overdoses >100 J, for a cumulative defibrillation dose of 18.7 Joules per kg. These errors were reduced by 53\% (21/40, P<.001) and cumulative defibrillation dose by 37\% (5.14/14, P=.001) with AR glasses. Conclusions: AR glasses did not decrease time to first defibrillation attempt and other critical resuscitation endpoints when compared with PALS pocket cards. However, they improved adherence and performance among residents in terms of administering the defibrillation doses set by AHA. ",
doi="10.2196/jmir.7379",
url="http://www.jmir.org/2017/5/e183/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28554878"
}


@Article{info:doi/10.2196/jmir.7027,
author="Coffey, T. Nathan
and Cassese, James
and Cai, Xinsheng
and Garfinkel, Steven
and Patel, Drasti
and Jones, Rebecca
and Shaewitz, Dahlia
and Weinstein, A. Ali",
title="Identifying and Understanding the Health Information Experiences and Preferences of Caregivers of Individuals With Either Traumatic Brain Injury, Spinal Cord Injury, or Burn Injury: A Qualitative Investigation",
journal="J Med Internet Res",
year="2017",
month="May",
day="10",
volume="19",
number="5",
pages="e159",
keywords="traumatic brain injury",
keywords="burns",
keywords="spinal cord injuries",
keywords="caregivers",
keywords="health information, consumer",
keywords="qualitative research",
abstract="Background: In order to meet the challenges of caring for an injured person, caregivers need access to health information. However, caregivers often feel that they lack adequate information. Previous studies of caregivers have primarily focused on either their time and emotional burdens or their health outcomes, but the information needs of caregivers have not been thoroughly investigated. Objective: The purpose of this investigation was to identify the preferred sources of health information for caregivers supporting individuals with injuries and to explore how access to this information could be improved. Methods: A total of 32 caregivers participated in semistructured interviews, which were used in order to develop a more in-depth understanding of these caregivers' information needs. Digital audio recordings of the interviews were used for analysis purposes. These audio recordings were analyzed using a thematic analysis or qualitative content analysis. All of participant's interviews were then coded using the qualitative analysis program, Nvivo 10 for Mac (QSR International). Results: The caregivers endorsed similar behaviors and preferences when seeking and accessing health information. Medical professionals were the preferred source of information, while ease of access made the Internet the most common avenue to obtain information. The challenges faced by participants were frequently a result of limited support. In describing an ideal health system, participants expressed interest in a comprehensive care website offering support network resources, instructive services about the injury and caregiving, and injury-specific materials. Conclusions: According to the participants, an ideal health information system would include a comprehensive care website that offered supportive network resources, instructive services about the injury and caregiving, and materials specific to the type of patient injury. ",
doi="10.2196/jmir.7027",
url="http://www.jmir.org/2017/5/e159/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28490418"
}


@Article{info:doi/10.2196/jmir.6317,
author="Schulz, Johannes Peter
and Fitzpatrick, Anne Mary
and Hess, Alexandra
and Sudbury-Riley, Lynn
and Hartung, Uwe",
title="Effects of eHealth Literacy on General Practitioner Consultations: A Mediation Analysis",
journal="J Med Internet Res",
year="2017",
month="May",
day="16",
volume="19",
number="5",
pages="e166",
keywords="health literacy",
keywords="eHealth literacy",
keywords="health empowerment",
keywords="information seeking",
keywords="health care utilization",
keywords="baby boomers",
abstract="Background: Most evidence (not all) points in the direction that individuals with a higher level of health literacy will less frequently utilize the health care system than individuals with lower levels of health literacy. The underlying reasons of this effect are largely unclear, though people's ability to seek health information independently at the time of wide availability of such information on the Internet has been cited in this context. Objective: We propose and test two potential mediators of the negative effect of eHealth literacy on health care utilization: (1) health information seeking and (2) gain in empowerment by information seeking. Methods: Data were collected in New Zealand, the United Kingdom, and the United States using a Web-based survey administered by a company specialized on providing online panels. Combined, the three samples resulted in a total of 996 baby boomers born between 1946 and 1965 who had used the Internet to search for and share health information in the previous 6 months. Measured variables include eHealth literacy, Internet health information seeking, the self-perceived gain in empowerment by that information, and the number of consultations with one's general practitioner (GP). Path analysis was employed for data analysis. Results: We found a bundle of indirect effect paths showing a positive relationship between health literacy and health care utilization: via health information seeking (Path 1), via gain in empowerment (Path 2), and via both (Path 3). In addition to the emergence of these indirect effects, the direct effect of health literacy on health care utilization disappeared. Conclusions: The indirect paths from health literacy via information seeking and empowerment to GP consultations can be interpreted as a dynamic process and an expression of the ability to find, process, and understand relevant information when that is necessary. ",
doi="10.2196/jmir.6317",
url="http://www.jmir.org/2017/5/e166/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28512081"
}


@Article{ref1,
url=""
}


@Article{info:doi/10.2196/jmir.7383,
author="Sj{\"o}str{\"o}m, Malin
and Lindholm, Lars
and Samuelsson, Eva",
title="Mobile App for Treatment of Stress Urinary Incontinence: A Cost-Effectiveness Analysis",
journal="J Med Internet Res",
year="2017",
month="May",
day="08",
volume="19",
number="5",
pages="e154",
keywords="mobile application",
keywords="pelvic floor",
keywords="urinary incontinence, stress",
keywords="self care",
keywords="cost-benefit analysis",
abstract="Background: Mobile apps can increase access to care, facilitate self-management, and improve adherence to treatment. Stress urinary incontinence (SUI) affects 10-35\% of women and, currently, an app with instructions for pelvic floor muscle training (PFMT) is available as first-line treatment. A previous randomized controlled study demonstrated that the app benefitted symptom severity and quality of life (QoL); in this study we investigate the cost-effectiveness of the app. Objective: The objective of this study was to evaluate the health economy of the app for treating SUI. Methods: This deterministic cost-utility analysis, with a 1-year societal perspective, compared the app treatment with no treatment. Health economic data were collected alongside a randomized controlled trial performed in Sweden from March 2013 to October 2014. This study included 123 community-dwelling women participants of 18 years and above, with stress urinary incontinence ?1 time per week. Participants were self-assessed with validated questionnaires and 2-day leakage diaries, and then randomized to 3 months of treatment (app group, n=62) or no treatment (controls, n=61). The app focused on pelvic floor muscle training, prescribed 3 times daily. We continuously registered treatment delivery costs. Data were collected on each participant's training time, incontinence aids, and laundry at baseline and at a 3-month follow-up. We measured quality of life with the International Consultation on Incontinence Modular Questionnaire on Lower Urinary Tract Symptoms and Quality of Life, and calculated the quality-adjusted life years (QALYs) gained. Data from the 3-month follow-up were extrapolated to 1 year for the calculations. Our main outcome was the incremental cost-effectiveness ratios compared between app and control groups. One-way and multiway sensitivity analyses were performed. Results: The mean age of participants was 44.7 years (SD 9.4). Annual costs were {\texteuro}547.0 for the app group and {\texteuro}482.4 for the control group. Annual gains in quality-adjusted life years for app and control groups were 0.0101 and 0.0016, respectively. Compared with controls, the extra cost per quality-adjusted life year for the app group ranged from ?{\texteuro}2425.7 to {\texteuro}14,870.6, which indicated greater gains in quality-adjusted life years at similar or slightly higher cost. Conclusions: The app for treating stress urinary incontinence is a new, cost-effective, first-line treatment with potential for increasing access to care in a sustainable way for this patient group. ",
doi="10.2196/jmir.7383",
url="http://www.jmir.org/2017/5/e154/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28483745"
}


@Article{info:doi/10.2196/jmir.7725,
author="Mohr, C. David
and Lyon, R. Aaron
and Lattie, G. Emily
and Reddy, Madhu
and Schueller, M. Stephen",
title="Accelerating Digital Mental Health Research From Early Design and Creation to Successful Implementation and Sustainment",
journal="J Med Internet Res",
year="2017",
month="May",
day="10",
volume="19",
number="5",
pages="e153",
keywords="eHealth",
keywords="mHealth",
keywords="methodology",
doi="10.2196/jmir.7725",
url="http://www.jmir.org/2017/5/e153/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28490417"
}


@Article{info:doi/10.2196/jmir.7463,
author="Muench, Frederick
and Baumel, Amit",
title="More Than a Text Message: Dismantling Digital Triggers to Curate Behavior Change in Patient-Centered Health Interventions",
journal="J Med Internet Res",
year="2017",
month="May",
day="26",
volume="19",
number="5",
pages="e147",
keywords="alerts",
keywords="digital triggers",
keywords="text messaging",
keywords="haptic triggers",
keywords="reminder systems",
keywords="push alerts",
keywords="mHealth",
keywords="mobile health",
keywords="engagement",
keywords="marketing",
keywords="behavior change",
keywords="behavioral medicine",
doi="10.2196/jmir.7463",
url="http://www.jmir.org/2017/5/e147/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28550001"
}


@Article{info:doi/10.2196/jmir.7374,
author="McGrail, Marie Kimberlyn
and Ahuja, Alyssa Megan
and Leaver, Andrew Chad",
title="Virtual Visits and Patient-Centered Care: Results of a Patient Survey and Observational Study",
journal="J Med Internet Res",
year="2017",
month="May",
day="26",
volume="19",
number="5",
pages="e177",
keywords="virtual visits",
keywords="telehealth",
keywords="primary care delivery",
keywords="patient-centered care",
abstract="Background: Virtual visits are clinical interactions in health care that do not involve the patient and provider being in the same room at the same time. The use of virtual visits is growing rapidly in health care. Some health systems are integrating virtual visits into primary care as a complement to existing modes of care, in part reflecting a growing focus on patient-centered care. There is, however, limited empirical evidence about how patients view this new form of care and how it affects overall health system use. Objective: Descriptive objectives were to assess users and providers of virtual visits, including the reasons patients give for use. The analytic objective was to assess empirically the influence of virtual visits on overall primary care use and costs, including whether virtual care is with a known or a new primary care physician. Methods: The study took place in British Columbia, Canada, where virtual visits have been publicly funded since October 2012. A survey of patients who used virtual visits and an observational study of users and nonusers of virtual visits were conducted. Comparison groups included two groups: (1) all other BC residents, and (2) a group matched (3:1) to the cohort. The first virtual visit was used as the intervention and the main outcome measures were total primary care visits and costs. Results: During 2013-2014, there were 7286 virtual visit encounters, involving 5441 patients and 144 physicians. Younger patients and physicians were more likely to use and provide virtual visits (P<.001), with no differences by sex. Older and sicker patients were more likely to see a known provider, whereas the lowest socioeconomic groups were the least likely (P<.001). The survey of 399 virtual visit patients indicated that virtual visits were liked by patients, with 372 (93.2\%) of respondents saying their virtual visit was of high quality and 364 (91.2\%) reporting their virtual visit was ``very'' or ``somewhat'' helpful to resolve their health issue. Segmented regression analysis and the corresponding regression parameter estimates suggested virtual visits appear to have the potential to decrease primary care costs by approximately Can \$4 per quarter (Can --\$3.79, P=.12), but that benefit is most associated with seeing a known provider (Can --\$8.68, P<.001). Conclusions: Virtual visits may be one means of making the health system more patient-centered, but careful attention needs to be paid to how these services are integrated into existing health care delivery systems. ",
doi="10.2196/jmir.7374",
url="http://www.jmir.org/2017/5/e177/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28550006"
}


@Article{info:doi/10.2196/jmir.7131,
author="Balaguera, U. Henri
and Wise, Diana
and Ng, Yin Chun
and Tso, Han-Wen
and Chiang, Wan-Lin
and Hutchinson, M. Aimee
and Galvin, Tracy
and Hilborne, Lee
and Hoffman, Cathy
and Huang, Chi-Cheng
and Wang, Jason C.",
title="Using a Medical Intranet of Things System to Prevent Bed Falls in an Acute Care Hospital: A Pilot Study",
journal="J Med Internet Res",
year="2017",
month="May",
day="04",
volume="19",
number="5",
pages="e150",
keywords="accidental falls",
keywords="acute care",
keywords="nursing",
keywords="patient safety",
keywords="patient-centered care",
keywords="sensor devices and platforms",
keywords="health care technology",
keywords="mobile apps",
keywords="patient monitoring",
keywords="health technology assessment",
abstract="Background: Hospitalized patients in the United States experience falls at a rate of 2.6 to 17.1 per 1000 patient-days, with the majority occurring when a patient is moving to, from, and around the bed. Each fall with injury costs an average of US \$14,000. Objective: The aim was to conduct a technology evaluation, including feasibility, usability, and user experience, of a medical sensor-based Intranet of things (IoT) system in facilitating nursing response to bed exits in an acute care hospital. Methods: Patients 18 years and older with a Morse fall score of 45 or greater were recruited from a 35-bed medical-surgical ward in a 317-bed Massachusetts teaching hospital. Eligible patients were recruited between August 4, 2015 and July 31, 2016. Participants received a sensor pad placed between the top of their mattress and bed sheet. The sensor pad was positioned to monitor movement from patients' shoulders to their thighs. The SensableCare System was evaluated for monitoring patient movement and delivering timely alerts to nursing staff via mobile devices when there appeared to be a bed-exit attempt. Sensor pad data were collected automatically from the system. The primary outcomes included number of falls, time to turn off bed-exit alerts, and the number of attempted bed-exit events. Data on patient falls were collected by clinical research assistants and confirmed with the unit nurse manager. Explanatory variables included room locations (zones 1-3), day of the week, nursing shift, and Morse Fall Scale (ie, positive fall history, positive secondary diagnosis, positive ambulatory aid, weak impaired gait/transfer, positive IV/saline lock, mentally forgets limitations). We also assessed user experience via nurse focus groups. Qualitative data regarding staff interactions with the system were collected during two focus groups with 25 total nurses, each lasting approximately 1.5 hours. Results: A total of 91 patients used the system for 234.0 patient-days and experienced no bed falls during the study period. On average, patients were assisted/returned to bed 46 seconds after the alert system was triggered. Response times were longer during the overnight nursing shift versus day shift (P=.005), but were independent of the patient's location on the unit. Focus groups revealed that nurses found the system integrated well into the clinical nursing workflow and the alerts were helpful in patient monitoring. Conclusions: A medical IoT system can be integrated into the existing nursing workflow and may reduce patient bed fall risk in acute care hospitals, a high priority but an elusive patient safety challenge. By using an alerting system that sends notifications directly to nurses' mobile devices, nurses can equally respond to unassisted bed-exit attempts wherever patients are located on the ward. Further study, including a fully powered randomized controlled trial, is needed to assess effectiveness across hospital settings. ",
doi="10.2196/jmir.7131",
url="http://www.jmir.org/2017/5/e150/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28473306"
}


@Article{info:doi/10.2196/jmir.7533,
author="Guti{\'e}rrez Garc{\'i}a, Angeles Mar{\'i}a
and Mart{\'i}n Ruiz, Luisa Mar{\'i}a
and Rivera, Diego
and Vadillo, Laura
and Valero Duboy, Angel Miguel",
title="A Smart Toy to Enhance the Decision-Making Process at Children's Psychomotor Delay Screenings: A Pilot Study",
journal="J Med Internet Res",
year="2017",
month="May",
day="19",
volume="19",
number="5",
pages="e171",
keywords="research instruments",
keywords="questionnaires and tools",
keywords="Information retrieval",
keywords="Internet of things",
keywords="clinical information and decision making",
keywords="Web-based and mobile health interventions",
keywords="developmental delays",
keywords="smart toys",
abstract="Background: EDUCERE (``Ubiquitous Detection Ecosystem to Care and Early Stimulation for Children with Developmental Disorders'') is an ecosystem for ubiquitous detection, care, and early stimulation of children with developmental disorders. The objectives of this Spanish government-funded research and development project are to investigate, develop, and evaluate innovative solutions to detect changes in psychomotor development through the natural interaction of children with toys and everyday objects, and perform stimulation and early attention activities in real environments such as home and school. Thirty multidisciplinary professionals and three nursery schools worked in the EDUCERE project between 2014 and 2017 and they obtained satisfactory results. Related to EDUCERE, we found studies based on providing networks of connected smart objects and the interaction between toys and social networks. Objective: This research includes the design, implementation, and validation of an EDUCERE smart toy aimed to automatically detect delays in psychomotor development. The results from initial tests led to enhancing the effectiveness of the original design and deployment. The smart toy, based on stackable cubes, has a data collector module and a smart system for detection of developmental delays, called the EDUCERE developmental delay screening system (DDSS). Methods: The pilot study involved 65 toddlers aged between 23 and 37 months (mean=29.02, SD 3.81) who built a tower with five stackable cubes, designed by following the EDUCERE smart toy model. As toddlers made the tower, sensors in the cubes sent data to a collector module through a wireless connection. All trials were video-recorded for further analysis by child development experts. After watching the videos, experts scored the performance of the trials to compare and fine-tune the interpretation of the data automatically gathered by the toy-embedded sensors. Results: Judges were highly reliable in an interrater agreement analysis (intraclass correlation 0.961, 95\% CI 0.937-0.967), suggesting that the process was successful to separate different levels of performance. A factor analysis of collected data showed that three factors, trembling, speed, and accuracy, accounted for 76.79\% of the total variance, but only two of them were predictors of performance in a regression analysis: accuracy (P=.001) and speed (P=.002). The other factor, trembling (P=.79), did not have a significant effect on this dependent variable. Conclusions: The EDUCERE DDSS is ready to use the regression equation obtained for the dependent variable ``performance'' as an algorithm for the automatic detection of psychomotor developmental delays. The results of the factor analysis are valuable to simplify the design of the smart toy by taking into account only the significant variables in the collector module. The fine-tuning of the toy process module will be carried out by following the specifications resulting from the analysis of the data to improve the efficiency and effectiveness of the product. ",
doi="10.2196/jmir.7533",
url="http://www.jmir.org/2017/5/e171/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28526666"
}


@Article{info:doi/10.2196/jmir.7246,
author="Hyder, A. Adnan
and Wosu, C. Adaeze
and Gibson, G. Dustin
and Labrique, B. Alain
and Ali, Joseph
and Pariyo, W. George",
title="Noncommunicable Disease Risk Factors and Mobile Phones: A Proposed Research Agenda",
journal="J Med Internet Res",
year="2017",
month="May",
day="05",
volume="19",
number="5",
pages="e133",
keywords="mHealth",
keywords="noncommunicable disease",
keywords="mobile phone",
keywords="research agenda",
keywords="survey",
doi="10.2196/jmir.7246",
url="http://www.jmir.org/2017/5/e133/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28476722"
}


@Article{info:doi/10.2196/jmir.7302,
author="Pariyo, W. George
and Wosu, C. Adaeze
and Gibson, G. Dustin
and Labrique, B. Alain
and Ali, Joseph
and Hyder, A. Adnan",
title="Moving the Agenda on Noncommunicable Diseases: Policy Implications of Mobile Phone Surveys in Low and Middle-Income Countries",
journal="J Med Internet Res",
year="2017",
month="May",
day="05",
volume="19",
number="5",
pages="e115",
keywords="NCDs",
keywords="policy",
keywords="mHealth",
keywords="policy analysis",
keywords="surveys",
doi="10.2196/jmir.7302",
url="http://www.jmir.org/2017/5/e115/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28476720"
}


@Article{info:doi/10.2196/jmir.7326,
author="Ali, Joseph
and Labrique, B. Alain
and Gionfriddo, Kara
and Pariyo, George
and Gibson, G. Dustin
and Pratt, Bridget
and Deutsch-Feldman, Molly
and Hyder, A. Adnan",
title="Ethics Considerations in Global Mobile Phone-Based Surveys of Noncommunicable Diseases: A Conceptual Exploration",
journal="J Med Internet Res",
year="2017",
month="May",
day="05",
volume="19",
number="5",
pages="e110",
keywords="ethics",
keywords="mobile phone survey",
keywords="mHealth",
keywords="noncommunicable diseases",
keywords="research ethics",
keywords="bioethics",
doi="10.2196/jmir.7326",
url="http://www.jmir.org/2017/5/e110/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28476723"
}


@Article{info:doi/10.2196/jmir.7329,
author="Labrique, Alain
and Blynn, Emily
and Ahmed, Saifuddin
and Gibson, Dustin
and Pariyo, George
and Hyder, A. Adnan",
title="Health Surveys Using Mobile Phones in Developing Countries: Automated Active Strata Monitoring and Other Statistical Considerations for Improving Precision and Reducing Biases",
journal="J Med Internet Res",
year="2017",
month="May",
day="05",
volume="19",
number="5",
pages="e121",
keywords="surveys and questionnaires",
keywords="sampling studies",
keywords="mobile health",
keywords="mobile phone",
keywords="research methodology",
doi="10.2196/jmir.7329",
url="http://www.jmir.org/2017/5/e121/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28476726"
}


@Article{info:doi/10.2196/jmir.7340,
author="Gibson, G. Dustin
and Farrenkopf, A. Brooke
and Pereira, Amanda
and Labrique, B. Alain
and Pariyo, William George",
title="The Development of an Interactive Voice Response Survey for Noncommunicable Disease Risk Factor Estimation: Technical Assessment and Cognitive Testing",
journal="J Med Internet Res",
year="2017",
month="May",
day="05",
volume="19",
number="5",
pages="e112",
keywords="interactive voice response",
keywords="noncommunicable disease",
keywords="survey methodology",
keywords="public health surveillance",
keywords="cellular phone",
keywords="risk factors",
abstract="Background: The rise in mobile phone ownership in low- and middle-income countries (LMICs) presents an opportunity to transform existing data collection and surveillance methods. Administering surveys via interactive voice response (IVR) technology---a mobile phone survey (MPS) method---has potential to expand the current surveillance coverage and data collection, but formative work to contextualize the survey for LMIC deployment is needed. Objective: The primary objectives of this study were to (1) cognitively test and identify challenging questions in a noncommunicable disease (NCD) risk factor questionnaire administered via an IVR platform and (2) assess the usability of the IVR platform. Methods: We conducted two rounds of pilot testing the IVR survey in Baltimore, MD. Participants were included in the study if they identified as being from an LMIC. The first round included individual interviews to cognitively test the participant's understanding of the questions. In the second round, participants unique from those in round 1 were placed in focus groups and were asked to comment on the usability of the IVR platform. Results: A total of 12 participants from LMICs were cognitively tested in round 1 to assess their understanding and comprehension of questions in an IVR-administered survey. Overall, the participants found that the majority of the questions were easy to understand and did not have difficulty recording most answers. The most frequent recommendation was to use country-specific examples and units of measurement. In round 2, a separate set of 12 participants assessed the usability of the IVR platform. Overall, participants felt that the length of the survey was appropriate (average: 18 min and 31 s), but the majority reported fatigue in answering questions that had a similar question structure. Almost all participants commented that they thought an IVR survey would lead to more honest, accurate responses than face-to-face questionnaires, especially for sensitive topics. Conclusions: Overall, the participants indicated a clear comprehension of the IVR-administered questionnaire and that the IVR platform was user-friendly. Formative research and cognitive testing of the questionnaire is needed for further adaptation before deploying in an LMIC. ",
doi="10.2196/jmir.7340",
url="http://www.jmir.org/2017/5/e112/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28476724"
}


@Article{info:doi/10.2196/jmir.7428,
author="Gibson, G. Dustin
and Pereira, Amanda
and Farrenkopf, A. Brooke
and Labrique, B. Alain
and Pariyo, W. George
and Hyder, A. Adnan",
title="Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review",
journal="J Med Internet Res",
year="2017",
month="May",
day="05",
volume="19",
number="5",
pages="e139",
keywords="survey methodology",
keywords="cellular phone",
keywords="interactive voice response",
keywords="short messages service",
keywords="computer-assisted telephone interview",
keywords="mobile phone surveys",
abstract="Background: National and subnational level surveys are important for monitoring disease burden, prioritizing resource allocation, and evaluating public health policies. As mobile phone access and ownership become more common globally, mobile phone surveys (MPSs) offer an opportunity to supplement traditional public health household surveys. Objective: The objective of this study was to systematically review the current landscape of MPSs to collect population-level estimates in low- and middle-income countries (LMICs). Methods: Primary and gray literature from 7 online databases were systematically searched for studies that deployed MPSs to collect population-level estimates. Titles and abstracts were screened on primary inclusion and exclusion criteria by two research assistants. Articles that met primary screening requirements were read in full and screened for secondary eligibility criteria. Articles included in review were grouped into the following three categories by their survey modality: (1) interactive voice response (IVR), (2) short message service (SMS), and (3) human operator or computer-assisted telephone interviews (CATI). Data were abstracted by two research assistants. The conduct and reporting of the review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: A total of 6625 articles were identified through the literature review. Overall, 11 articles were identified that contained 19 MPS (CATI, IVR, or SMS) surveys to collect population-level estimates across a range of topics. MPSs were used in Latin America (n=8), the Middle East (n=1), South Asia (n=2), and sub-Saharan Africa (n=8). Nine articles presented results for 10 CATI surveys (10/19, 53\%). Two articles discussed the findings of 6 IVR surveys (6/19, 32\%). Three SMS surveys were identified from 2 articles (3/19, 16\%). Approximately 63\% (12/19) of MPS were delivered to mobile phone numbers collected from previously administered household surveys. The majority of MPS (11/19, 58\%) were panel surveys where a cohort of participants, who often were provided a mobile phone upon a face-to-face enrollment, were surveyed multiple times. Conclusions: Very few reports of population-level MPS were identified. Of the MPS that were identified, the majority of surveys were conducted using CATI. Due to the limited number of identified IVR and SMS surveys, the relative advantages and disadvantages among the three survey modalities cannot be adequately assessed. The majority of MPS were sent to mobile phone numbers that were collected from a previously administered household survey. There is limited evidence on whether a random digit dialing (RDD) approach or a simple random sample of mobile network provided list of numbers can produce a population representative survey. ",
doi="10.2196/jmir.7428",
url="http://www.jmir.org/2017/5/e139/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28476725"
}


@Article{info:doi/10.2196/jmir.7331,
author="Greenleaf, R. Abigail
and Gibson, G. Dustin
and Khattar, Christelle
and Labrique, B. Alain
and Pariyo, W. George",
title="Building the Evidence Base for Remote Data Collection in Low- and Middle-Income Countries: Comparing Reliability and Accuracy Across Survey Modalities",
journal="J Med Internet Res",
year="2017",
month="May",
day="05",
volume="19",
number="5",
pages="e140",
keywords="mHealth",
keywords="developing countries",
keywords="Africa South of the Sahara",
keywords="cell phones",
keywords="health surveys",
keywords="reproducibility of results",
keywords="surveys and questionnaires",
keywords="text messaging",
keywords="interviews as topic",
keywords="humans",
keywords="research design",
keywords="data collection methods",
abstract="Background: Given the growing interest in mobile data collection due to the proliferation of mobile phone ownership and network coverage in low- and middle-income countries (LMICs), we synthesized the evidence comparing estimates of health outcomes from multiple modes of data collection. In particular, we reviewed studies that compared a mode of remote data collection with at least one other mode of data collection to identify mode effects and areas for further research. Objective: The study systematically reviewed and summarized the findings from articles and reports that compare a mode of remote data collection to at least one other mode. The aim of this synthesis was to assess the reliability and accuracy of results. Methods: Seven online databases were systematically searched for primary and grey literature pertaining to remote data collection in LMICs. Remote data collection included interactive voice response (IVR), computer-assisted telephone interviews (CATI), short message service (SMS), self-administered questionnaires (SAQ), and Web surveys. Two authors of this study reviewed the abstracts to identify articles which met the primary inclusion criteria. These criteria required that the survey collected the data from the respondent via mobile phone or landline. Articles that met the primary screening criteria were read in full and were screened using secondary inclusion criteria. The four secondary inclusion criteria were that two or more modes of data collection were compared, at least one mode of data collection in the study was a mobile phone survey, the study had to be conducted in a LMIC, and finally, the study should include a health component. Results: Of the 11,568 articles screened, 10 articles were included in this study. Seven distinct modes of remote data collection were identified: CATI, SMS (singular sitting and modular design), IVR, SAQ, and Web surveys (mobile phone and personal computer). CATI was the most frequent remote mode (n=5 articles). Of the three in-person modes (face-to-face [FTF], in-person SAQ, and in-person IVR), FTF was the most common (n=11) mode. The 10 articles made 25 mode comparisons, of which 12 comparisons were from a single article. Six of the 10 articles included sensitive questions. Conclusions: This literature review summarizes the existing research about remote data collection in LMICs. Due to both heterogeneity of outcomes and the limited number of comparisons, this literature review is best positioned to present the current evidence and knowledge gaps rather than attempt to draw conclusions. In order to advance the field of remote data collection, studies that employ standardized sampling methodologies and study designs are necessary to evaluate the potential for differences by survey modality. ",
doi="10.2196/jmir.7331",
url="http://www.jmir.org/2017/5/e140/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28476728"
}


@Article{info:doi/10.2196/jmir.6812,
author="Haskins, L. Brianna
and Davis-Martin, Rachel
and Abar, Beau
and Baumann, M. Brigitte
and Harralson, Tina
and Boudreaux, D. Edwin",
title="Health Evaluation and Referral Assistant: A Randomized Controlled Trial of a Web-Based Screening, Brief Intervention, and Referral to Treatment System to Reduce Risky Alcohol Use Among Emergency Department Patients",
journal="J Med Internet Res",
year="2017",
month="May",
day="01",
volume="19",
number="5",
pages="e119",
keywords="alcohol consumption",
keywords="intervention study",
keywords="emergency medicine",
keywords="referral and consultation",
abstract="Background: Computer technologies hold promise for implementing alcohol screening, brief intervention, and referral to treatment (SBIRT). Questions concerning the most effective and appropriate SBIRT model remain. Objective: The aim of this study was to evaluate the impact of a computerized SBIRT system called the Health Evaluation and Referral Assistant (HERA) on risky alcohol use treatment initiation. Methods: Alcohol users (N=319) presenting to an emergency department (ED) were considered for enrollment. Those enrolled (n=212) were randomly assigned to the HERA, to complete a patient-administered assessment using a tablet computer, or a minimal-treatment control, and were followed for 3 months. Analyses compared alcohol treatment provider contact, treatment initiation, treatment completion, and alcohol use across condition using univariate comparisons, generalized estimating equations (GEEs), and post hoc chi-square analyses. Results: HERA participants (n=212; control=115; intervention=97) did not differ between conditions on initial contact with an alcohol treatment provider, treatment initiation, treatment completion, or change in risky alcohol use behavior. Subanalyses indicated that HERA participants, who accepted a faxed referral, were more likely to initiate contact with a treatment provider and initiate treatment for risky alcohol use, but were not more likely to continue engaging in treatment, or to complete treatment and change risky alcohol use behavior over the 3-month period following the ED visit. Conclusions: The HERA promoted initial contact with an alcohol treatment provider and initiation of treatment for those who accepted the faxed referral, but it did not lead to reduced risky alcohol use behavior. Factors which may have limited the HERA's impact include lack of support for the intervention by clinical staff, the low intensity of the brief and stand-alone design of the intervention, and barriers related to patient follow-through, (eg, a lack of transportation or childcare, fees for services, or schedule conflicts). Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): NCT01153373; https://clinicaltrials.gov/ct2/show/NCT01153373 (Archived by WebCite at http://www.webcitation.org/6pHQEpuIF) ",
doi="10.2196/jmir.6812",
url="http://www.jmir.org/2017/5/e119/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28461283"
}


@Article{info:doi/10.2196/jmir.6816,
author="Boudreaux, D. Edwin
and Brown, K. Gregory
and Stanley, Barbara
and Sadasivam, S. Rajani
and Camargo, A. Carlos
and Miller, W. Ivan",
title="Computer Administered Safety Planning for Individuals at Risk for Suicide: Development and Usability Testing",
journal="J Med Internet Res",
year="2017",
month="May",
day="15",
volume="19",
number="5",
pages="e149",
keywords="technology",
keywords="safety",
keywords="health planning",
keywords="suicide",
keywords="computers",
keywords="telemedicine",
abstract="Background: Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan. Objective: The aim of this study was to design, build, and test the usability of a Web-based, self-administered safety planning application. Methods: We employed a user-centered software design strategy led by a multidisciplinary team. The application was tested for usability with a target sample of suicidal patients. Detailed observations, structured usability ratings, and Think Aloud procedures were used. Suicidal ideation intensity and perceived ability to cope were assessed pre-post engagement with the Web application. Results: A total of 30 participants were enrolled. Usability ratings were generally strong, and all patients successfully built a safety plan. However, the completeness of the safety plan varied. The mean number of steps completed was 5.5 (SD 0.9) out of 6, with 90\% (27/30) of participants completing at least 5 steps and 67\% (20/30) completing all 6 steps. Some safety planning steps were viewed as inapplicable to some individuals. Some confusion in instructions led to modifications to improve understandability of each step. Ratings of suicide intensity after completion of the application were significantly lower than preratings, pre: mean 5.11 (SD 2.9) versus post: mean 4.46 (SD 3.0), t27=2.49, P=.02. Ratings of ability to cope with suicidal thoughts after completion of the application were higher than preratings, with the difference approaching statistical significance, pre: mean 5.93 (SD 2.9), post: mean 6.64 (SD 2.4), t27=?2.03, P=.05. Conclusions: We have taken the first step toward identifying the components needed to maximize usability of a self-administered, Web-based safety planning application. Results support initial consideration of the application as an adjunct to clinical contact. This allows for the clinician or other personnel to provide clarification, when needed, to help the patient build the plan, and to help review and revise the draft. ",
doi="10.2196/jmir.6816",
url="http://www.jmir.org/2017/5/e149/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28506957"
}