%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66530 %T Diagnosis Test Accuracy of Artificial Intelligence for Endometrial Cancer: Systematic Review and Meta-Analysis %A Wang,Longyun %A Wang,Zeyu %A Zhao,Bowei %A Wang,Kai %A Zheng,Jingying %A Zhao,Lijing %+ Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, No.4026, Yatai Street, Changchun, 130000, China, 86 15704313636, zheng_jy@jlu.edu.cn %K artificial intelligence %K endometrial cancer %K diagnostic test accuracy %K systematic review %K meta-analysis %K machine learning %K deep learning %D 2025 %7 18.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Endometrial cancer is one of the most common gynecological tumors, and early screening and diagnosis are crucial for its treatment. Research on the application of artificial intelligence (AI) in the diagnosis of endometrial cancer is increasing, but there is currently no comprehensive meta-analysis to evaluate the diagnostic accuracy of AI in screening for endometrial cancer. Objective: This paper presents a systematic review of AI-based endometrial cancer screening, which is needed to clarify its diagnostic accuracy and provide evidence for the application of AI technology in screening for endometrial cancer. Methods: A search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases to include studies published in English, which evaluated the performance of AI in endometrial cancer screening. A total of 2 independent reviewers screened the titles and abstracts, and the quality of the selected studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies—2 (QUADAS-2) tool. The certainty of the diagnostic test evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: A total of 13 studies were included, and the hierarchical summary receiver operating characteristic model used for the meta-analysis showed that the overall sensitivity of AI-based endometrial cancer screening was 86% (95% CI 79%-90%) and specificity was 92% (95% CI 87%-95%). Subgroup analysis revealed similar results across AI type, study region, publication year, and study type, but the overall quality of evidence was low. Conclusions: AI-based endometrial cancer screening can effectively detect patients with endometrial cancer, but large-scale population studies are needed in the future to further clarify the diagnostic accuracy of AI in screening for endometrial cancer. Trial Registration: PROSPERO CRD42024519835; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024519835 %M 40249940 %R 10.2196/66530 %U https://www.jmir.org/2025/1/e66530 %U https://doi.org/10.2196/66530 %U http://www.ncbi.nlm.nih.gov/pubmed/40249940 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e51524 %T Targeted Behavior Change Communication Using a Mobile Health Platform to Increase Uptake of Long-Lasting Insecticidal Nets Among Pregnant Women in Tanzania: Hati Salama “Secure Voucher” Study Cluster Randomized Controlled Trial %A Vey,Trinity %A Kinnicutt,Eleonora %A Day,Andrew G %A West,Nicola %A Sleeth,Jessica %A Nchimbi,Kenneth Bernard %A Yeates,Karen %+ Department of Medicine, Queen's University, 99 University Avenue, Kingston, ON, K7L 3N6, Canada, 1 613 533 2000, 16tv7@queensu.ca %K malaria prevention %K pregnant %K mHealth %K mobile health %K short message service %K behaviour change communication %K long-lasting insecticidal nets %K protozoan infections %K parasitic diseases %K vector borne diseases %K randomized controlled trial %K morbidity %K mortality %K intervention %D 2025 %7 19.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Malaria remains a significant cause of maternal and neonate morbidity and mortality in sub-Saharan Africa. Long-lasting insecticidal nets (LLINs) represent an important component of malaria prevention and can decrease the adverse health outcomes associated with malaria infection during pregnancy. Voucher programs have been successfully implemented for a variety of initiatives across sub-Saharan Africa, including the distribution of subsidized LLINs in Tanzania. However, mobile messaging for behavior change communication (BCC), in combination with an e-voucher program, has not been explored for malaria prevention. Objective: This study aimed to assess the efficacy of mobile messaging in increasing the redemption of e-vouchers for LLINs for pregnant women and adolescents in Tanzania. Methods: This study was a blinded, 2-arm, cluster randomized controlled trial implemented in 100 antenatal health facilities in Tanzania (both urban and rural settings), with 50 clusters in both intervention and control groups. Clusters were antenatal clinics with e-voucher capabilities, with randomization stratified such that 25 urban and 25 rural clinics were randomized to each arm. Participants were pregnant females aged 13 years or older. Participants in both intervention and control groups were issued e-vouchers on their mobile phones that could be redeemed for LLINs at registered retailers within a 14-day redemption period. Participants in the intervention group received targeted BCC messages about the importance of malaria prevention and LLIN use during pregnancy, while participants in the control group did not receive BCC messages. Analyses were by intention to treat. The primary outcome was the redemption rate of e-vouchers for LLINs from retailers. Outcome measures pertain to clinic sites and individual participant-level data. Results: The study enrolled 5449 participants; the analysis included 2708 participants in the intervention arm and 2740 participants in the control arm (49 clusters in each group analyzed). There was no significant difference in the raw redemption rate of e-vouchers between pregnant participants in the intervention group (70%) and the control group (67%). Younger participants were less likely to redeem e-vouchers. Conclusions: The use of a BCC mobile messaging intervention did not result in a significant increase in LLIN uptake for pregnant individuals. However, the study shows that e-voucher distribution through nurses in antenatal clinics in partnership with local retailers is feasible on a large scale. Consideration of women and adolescents who are low-income and live in rural areas is needed for future interventions leveraging e-vouchers or mHealth technology in low-resource settings. Trial Registration: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624 %M 40106816 %R 10.2196/51524 %U https://www.jmir.org/2025/1/e51524 %U https://doi.org/10.2196/51524 %U http://www.ncbi.nlm.nih.gov/pubmed/40106816 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e51517 %T Exploration of Reproductive Health Apps’ Data Privacy Policies and the Risks Posed to Users: Qualitative Content Analysis %A Zadushlivy,Nina %A Biviji,Rizwana %A Williams,Karmen S %+ Department of Health Policy and Management, Graduate School of Public Health and Health Policy, City University of New York, 55 W. 125th Street, New York, NY, 10027, United States, 1 918 816 0915, Karmen.Williams@sph.cuny.edu %K data privacy policy %K reproductive health apps %K Transparency, Health Content, Excellent Technical Content, Security/Privacy, Usability, Subjective %K THESIS %K THESIS evaluation %K women’s health %K menstrual health %K mobile health %K mHealth %K menstruating persons’ health %K mobile phone %D 2025 %7 5.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health apps often require the collection of identifiable information. Subsequently, this places users at significant risk of privacy breaches when the data are misused or not adequately stored and secured. These issues are especially concerning for users of reproductive health apps in the United States as protection of sensitive user information is affected by shifting governmental regulations such as the overruling of Roe v Wade and varying state-level abortion laws. Limited studies have analyzed the data privacy policies of these apps and considered the safety issues associated with a lack of user transparency and protection. Objective: This study aimed to evaluate popular reproductive health apps, assess their individual privacy policies, analyze federal and state data privacy laws governing these apps in the United States and the European Union (EU), and recommend best practices for users and app developers to ensure user data safety. Methods: In total, 4 popular reproductive health apps—Clue, Flo, Period Tracker by GP Apps, and Stardust—as identified from multiple web sources were selected through convenience sampling. This selection ensured equal representation of apps based in the United States and the EU, facilitating a comparative analysis of data safety practices under differing privacy laws. A qualitative content analysis of the apps and a review of the literature on data use policies, governmental data privacy regulations, and best practices for mobile app data privacy were conducted between January 2023 and July 2023. The apps were downloaded and systematically evaluated using the Transparency, Health Content, Excellent Technical Content, Security/Privacy, Usability, Subjective (THESIS) evaluation tool to assess their privacy and security practices. Results: The overall privacy and security scores for the EU-based apps, Clue and Flo, were both 3.5 of 5. In contrast, the US-based apps, Period Tracker by GP Apps and Stardust, received scores of 2 and 4.5, respectively. Major concerns regarding privacy and data security primarily involved the apps’ use of IP address tracking and the involvement of third parties for advertising and marketing purposes, as well as the potential misuse of data. Conclusions: Currently, user expectations for data privacy in reproductive health apps are not being met. Despite stricter privacy policies, particularly with state-specific adaptations, apps must be transparent about data storage and third-party sharing even if just for marketing or analytical purposes. Given the sensitivity of reproductive health data and recent state restrictions on abortion, apps should minimize data collection, exceed encryption and anonymization standards, and reduce IP address tracking to better protect users. %M 40053713 %R 10.2196/51517 %U https://www.jmir.org/2025/1/e51517 %U https://doi.org/10.2196/51517 %U http://www.ncbi.nlm.nih.gov/pubmed/40053713 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60667 %T Oura Ring as a Tool for Ovulation Detection: Validation Analysis %A Thigpen,Nina %A Patel,Shyamal %A Zhang,Xi %+ , Oura Ring, 60 Francisco St, San Francisco, CA, 94133, United States, 1 358 50 4668390, nnt7845@gmail.com %K ovulation %K digital medicine %K physiology %K body temperature %K menstrual cycles %K wearable %K fertility %K nonhormonal contraception %K reproductive health %K women’s health %K calendar method %K mHealth %K mobile health %K detection %D 2025 %7 31.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Oura Ring is a wearable device that estimates ovulation dates using physiology data recorded from the finger. Estimating the ovulation date can aid fertility management for conception or nonhormonal contraception and provides insights into follicular and luteal phase lengths. Across the reproductive lifespan, changes in these phase lengths can serve as a biomarker for reproductive health. Objective: We assessed the strengths, weaknesses, and limitations of using physiology from the Oura Ring to estimate the ovulation date. We compared performance across cycle length, cycle variability, and participant age. In each subgroup, we compared the algorithm’s performance with the traditional calendar method, which estimates the ovulation date based on an individual’s last period start date and average menstrual cycle length. Methods: The study sample contained 1155 ovulatory menstrual cycles from 964 participants recruited from the Oura Ring commercial database. Ovulation prediction kits served as a benchmark to evaluate the performance. The Fisher test was used to determine an odds ratio to assess if ovulation detection rate significantly differed between methods or subgroups. The Mann-Whitney U test was used to determine if the accuracy of the estimated ovulation date differed between the estimated and reference ovulation dates. Results: The physiology method detected 1113 (96.4%) of 1155 ovulations with an average error of 1.26 days, which was significantly lower (U=904942.0, P<.001) than the calendar method’s average error of 3.44 days. The physiology method had significantly better accuracy across all cycle lengths, cycle variability groups, and age groups compared with the calendar method (P<.001). The physiology method detected fewer ovulations in short cycles (odds ratio 3.56, 95% CI 1.65-8.06; P=.008) but did not differ between typical and long or abnormally long cycles. Abnormally long cycle lengths were associated with decreased accuracy (U=22,383, P=.03), with a mean absolute error of 1.7 (SEM .09) days compared with 1.18 (SEM .02) days. The physiology method was not associated with differences in accuracy across age or typical cycle variability, while the calendar method performed significantly worse in participants with irregular cycles (U=21,643, P<.001). Conclusions: The physiology method demonstrated superior accuracy over the calendar method, with approximately 3-fold improvement. Calendar-based fertility tracking could be used as a backup in cases of insufficient physiology data but should be used with caution, particularly for individuals with irregular menstrual cycles. Our analyses suggest the physiology method can reliably estimate ovulation dates for adults aged 18-52 years, across a variety of cycle lengths, and in users with regular or irregular cycles. This method may be used as a tool to improve fertile window estimation, which can aid in conceiving or preventing pregnancies. This method also offers a low-effort solution for follicular and luteal phase length tracking, which are key biomarkers for reproductive health. %M 39889300 %R 10.2196/60667 %U https://www.jmir.org/2025/1/e60667 %U https://doi.org/10.2196/60667 %U http://www.ncbi.nlm.nih.gov/pubmed/39889300 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e63334 %T Optimization of a Web-Based Self-Assessment Tool for Preconception Health in People of Reproductive Age in Australia: User Feedback and User-Experience Testing Study %A Dorney,Edwina %A Hammarberg,Karin %A Rodgers,Raymond %A Black,Kirsten I %K technology %K internet %K eHealth %K user experience %K patient engagement %K self-assessment tool %K preconception %K health communication %D 2024 %7 24.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Good preconception health reduces the incidence of preventable morbidity and mortality for women, their babies, and future generations. In Australia, there is a need to increase health literacy and awareness about the importance of good preconception health. Digital health tools are a possible enabler to increase this awareness at a population level. The Healthy Conception Tool (HCT) is an existing web-based, preconception health self-assessment tool, that has been developed by academics and clinicians. Objective: This study aims to optimize the HCT and to seek user feedback to increase the engagement and impact of the tool. Methods: In-depth interviews were held with women and men aged 18‐41 years, who spoke and read English and were residing in Australia. Interview transcripts were analyzed, and findings were used to inform an enhanced HCT prototype. This prototype underwent user-experience testing and feedback from users to inform a final round of design changes to the tool. Results: A total of 20 women and 5 men were interviewed; all wanted a tool that was quick and easy to use with personalized results. Almost all participants were unfamiliar with the term “preconception care” and stated they would not have found this tool on the internet with its current title. User-experience testing with 6 women and 5 men identified 11 usability issues. These informed further changes to the tool’s title, the information on how to use the tool, and the presentation of results. Conclusions: Web-based self-assessment tools need to be easy to find and should communicate health messages effectively. End users’ feedback informed changes to improve the tool’s acceptability, engagement, and impact. We expect that the revised tool will have greater reach and prompt more people to prepare well for pregnancy. %R 10.2196/63334 %U https://humanfactors.jmir.org/2024/1/e63334 %U https://doi.org/10.2196/63334 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56680 %T Communal Load Sharing of Miscarriage Experiences: Thematic Analysis of Social Media Community Support %A Dubbelman,Julia %A Ooms,Jonelle %A Havgry,Laura %A Simonse,Lianne %+ Department of Design, Organization, and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 616844170, L.W.L.Simonse@tudelft.nl %K miscarriage %K miscarriage grief %K online health communities %K thematic analysis %K social support %K communal load sharing %K peer-to-peer support %D 2024 %7 10.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Miscarriage is a common experience, affecting 15% of recognized pregnancies, but societal ignorance and taboos often downplay the mental distress and personal impact following a miscarriage. Emerging stories on social media in which women express their miscarriage grief are breaking such taboos. Research in the area of online health communities is increasingly focused on studying how people share their health experiences on social media. However, a clear understanding on the social support involved in this type of sharing of health experiences is lacking. Objective: This study explored the use of Instagram in sharing miscarriage experiences, guided by the following research question: How is social community support given to women who share their miscarriage experiences on social media? Considering that social media is increasingly used as a source of social support, in this study, we chose Instagram as the social media platform. The purpose of this research was to create a better understanding of how social media provides support in expressing personal miscarriage experiences and how people engage with such posts. Methods: This study used a qualitative inductive research method in which a phenomenological strategy and thematic analysis were followed to create a comprehensive understanding of the social community support phenomenon. The dataset was established from a sample of 258 Instagram posts and 736 comments collected over a period of 6 months after initial posts and from 6 different women. These data were categorized and clustered through a thematic analysis. Results: Three themes were identified: (1) storytelling of emotional turmoil and grief after miscarriage, (2) sharing positivity amidst miscarriage grief, and (3) mentioning personal medical information about miscarriage. Theme 1 represents the emotional experience of women who have had a miscarriage. It encompasses the initial posts that included miscarriage storytelling that express deep grief and mental distress and the emotional impact on both the posters and the commenters. Theme 2 highlights the importance of finding moments of joy and positivity in the midst of mental distress and pain. The posts shared with the online community convey a sense of moving forward and a refusal to let grief become the defining aspect of one’s life. Theme 3 focuses on sharing medical and practical advice. This theme includes posts and comments about medications, in vitro fertilization procedures, hospital experiences, and personal physical symptoms. Conclusions: As an overarching theme for this social support phenomenon, we introduce the term communal load sharing to describe the therapeutic role of social media in helping women cope with miscarriage by providing a platform for sharing similar experiences, breaking social taboos, and fostering load sharing. %M 39656509 %R 10.2196/56680 %U https://www.jmir.org/2024/1/e56680 %U https://doi.org/10.2196/56680 %U http://www.ncbi.nlm.nih.gov/pubmed/39656509 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e63143 %T Optimizing a Novel Smartphone App to Prevent Postpartum Depression Adapted From an Evidence-Based Cognitive Behavioral Therapy Program: Qualitative Study %A Lewkowitz,Adam K %A Guillen,Melissa %A Ursino,Katrina %A Baker,Rackeem %A Lum,Liana %A Battle,Cynthia L %A Ware,Crystal %A Ayala,Nina K %A Clark,Melissa %A Ranney,Megan L %A Miller,Emily S %A Guthrie,Kate M %K cognitive behavioral therapy %K mothers and babies program %K digital health %K postpartum depression %K smartphone application %K FRAME for intervention adaptation %K Framework for Modification and Adaptation %K behavioral therapy %K mental health apps %D 2024 %7 9.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Low-income pregnant patients are at high risk of postpartum depression (PPD). Mothers and Babies (MB) is a cognitive behavioral therapy–based program that prevents up to 50% of de novo PPD when provided in person to low-income Spanish- and English-speaking people who are pregnant without depression. MB is limited by the need for trained personnel to support it. Transforming MB into a smartphone app may mitigate this key barrier. Objective: We aimed to use qualitative data from target end users to create and optimize MBapp, a novel app centered on the MB program. Methods: Draft wireframes of MBapp were created in English and Spanish with cognitive behavioral therapy–based modules adapted from MB. These wireframes included several features shown previously to sustain app engagement: (1) push notifications delivered at participant-preferred times; (2) text-, graphic-, and video-based content; and (3) gamification with digital rewards for app engagement. English- or Spanish-speaking individuals with public health insurance who were between 32 weeks gestation and 6 months post partum and owned smartphones were eligible to consent for individual in-depth interviews. Individuals with prior or current depression were excluded. Interviews were recorded, transcribed, and analyzed using deductive and inductive codes to characterize opinions about MBapp and perceptions of challenges and facilitators of use of MBapp or other perinatal or mental health apps. End user feedback led to major modifications to the wireframes. Each of these changes was categorized according to the FRAME (Framework for Modification and Adaptation), an established method of systematically reporting adaptations and modifications to evidence-based interventions via end user feedback. Recruitment ceased with content saturation, defined as 3 successive participants providing only positive feedback on MBapp’s wireframe, without further suggestions for improvement. Results: A total of 25 interviews were completed. Participants were racially and ethnically diverse, generally representing our target end user population, and 48% (n=12) of interviews were conducted in Spanish. Participants’ suggestions to improve MBapp were categorized within the FRAME as adaptations that improved either content or context to optimize reach, retention, engagement, and fit for end users. Specifically, the following features were added to MBapp secondary to end user feedback: (1) audio narration; (2) “ask a clinician” nonurgent questions; (3) on-demand module summaries accessible upon module completion; and (4) choice to defer assessments and start the next module. Participants also provided insights into features of perinatal or mental health apps they found appealing or unappealing to understand preferences, challenges, and negotiables or nonnegotiables for MBapp. Conclusions: Adapting MBapp to incorporate end users’ perspectives optimized our digital PPD prevention intervention, ideally increasing its appeal to future users. Our team’s next steps will confirm that MBapp is a feasible, acceptable intervention among English- and Spanish-speaking perinatal people at risk of PPD. %R 10.2196/63143 %U https://humanfactors.jmir.org/2024/1/e63143 %U https://doi.org/10.2196/63143 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50099 %T Accuracy, Quality, and Misinformation of YouTube Abortion Procedural Videos: Cross-Sectional Study %A Acero,Nicole %A Herrero,Emma %A Foncham,Juanita %A McIlvaine,Jamie %A Kayaalp,Emre %A Figueora,Melissa %A Oladipo,Antonia Francis %+ Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Dowling Bldg, 5th Fl, One Boston Medical Center Pl, Boston, MA, 02116, United States, 1 617 638 8000, nicole.acero@bmc.org %K abortion %K YouTube %K social media %K accuracy %K quality %K misinformation %K reliability %K obstetrics %K women's health %K reproductive %K patient education %K health information %K prochoice %D 2024 %7 22.10.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: The internet is often the first source patients turn to for medical information. YouTube is a commonly used internet-based resource for patients seeking to learn about medical procedures, including their risks, benefits, and safety profile. Abortion is a common yet polarizing medical procedure. People interested in obtaining an abortion are likely to use the internet to learn more about abortion procedures and may encounter misinformed and biased information. This is troubling as information found on the internet can significantly alter perceptions and understanding of these procedures. There is no current research that evaluates the accuracy, quality, and misinformation of instructional abortion videos available to patients. Objective: The purpose of this study was to assess if any given video can deliver accurate and quality information about this topic in an unbiased manner and to assess the level of factually incorrect, distorted, or medically irrelevant information in any given video. Methods: Procedural methods of abortion were queried on YouTube on August 22, 2022. The videos were screened with strict exclusion criteria. Videos were categorized into “video slants” based on the language and attitudes expressed in each video. Video accuracy was calculated using the Surgical Curriculum in Obstetrics and Gynecology (SCOG) checklist for each corresponding procedure. Video quality was calculated using the Laparoscopic Surgery Video Educational Guidelines (LAP-VEGaS) criteria. The level of misinformation was assessed with the evidence-based Anti-Choice Rubric, which scores the amount of factually incorrect, distorted, or medically irrelevant information in each video. Results: A total of 32 videos were analyzed and categorized into 3 “video slant” groups: neutral (n=23, 72%), antichoice (n=4, 12%), and prochoice (n=5, 16%). Using the SCOG checklist, neutral videos had the highest median accuracy (45.9%), followed by antichoice videos (24.6%) and prochoice videos (18.5%). None of the videos met the LAP-VEGaS quality control criteria, (score>11, indicating adequate quality). Neutral videos had a median score of 8.8 out of 18, with antichoice videos scoring 10.75 and prochoice videos scoring 6.2. Using the Anti-Choice Rubric, neutral videos mentioned only 1 factually incorrect piece of information. Antichoice videos mentioned 12 factually incorrect pieces of information, 8 distortions, and 3 medically irrelevant pieces of information. Prochoice videos did not mention any of the 3 themes. Conclusions: Using the SCOG checklist, the accuracy of instructional videos were inconsistent across the 3 identified “video slants.” Using LAP-VEGaS criteria, the quality of educational videos were also inconsistent across the 3 “video slants.” Prochoice videos had the lowest level of misinformation, with no mentions of any of the 3 themes. Antichoice videos had the highest levels of misinformation, with mentions in all 3 themes. Health care professionals should consider this when counseling patients who may watch YouTube videos for information regarding abortion procedures. %M 39437380 %R 10.2196/50099 %U https://www.jmir.org/2024/1/e50099 %U https://doi.org/10.2196/50099 %U http://www.ncbi.nlm.nih.gov/pubmed/39437380 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60434 %T Intention to Use a Mental Health App for Menopause: Health Belief Model Approach %A Martin-Key,Nayra A %A Funnell,Erin L %A Benacek,Jiri %A Spadaro,Benedetta %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K menopause %K menopause transition %K mental health %K perimenopause %K women’s health %K psychological framework %K symptom tracking %K app usage %K app %K Health Belief Model %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Menopause presents a period of heightened vulnerability for mental health issues. Despite this, mental health screening is not consistently integrated into menopausal health care, and access to psychological interventions is limited. Digital technologies, such as web and smartphone apps, may offer a way to facilitate and improve mental health care provision throughout menopause. However, little is known about potential users’ intention to use such technologies during this critical phase of life. Objective: To examine the factors that impact the intention of potential users to use a mental health app during menopause, we used the Health Belief Model (HBM), a psychological framework widely used to understand and predict individuals’ health-related behaviors. Methods: An online survey was generated. Convenience sampling was used, with participants recruited via social media and email, through relevant foundations and support groups, and by word of mouth. Structural equation modeling with maximum likelihood estimation was conducted to explore whether the factor structure of the HBM is a good fit for predicting the intention to use a mental health app for menopause. A Cronbach α value of .05 was used for determining statistical significance. Results: A total of 1154 participants commenced the survey, of which 82.49% (n=952) completed at least 97% of the survey. Of these, 86.76% (n=826) expressed that their menopausal symptoms had negatively affected their mental health, and went on to answer questions regarding their experiences and interest in using a web or smartphone app for mental health symptoms related to menopause. Data from this subgroup (N=826) were analyzed. In total, 74.09% (n=612) of respondents sought online help for mental health symptoms related to menopause. The most common topics searched for were symptom characteristics (n=435, 52.66%) and treatment or therapy options (n=210, 25.42%). Psychoeducation (n=514, 62.23%) was the most desired mental health app feature, followed by symptom tracking (n=499, 60.41%) and self-help tips (n=469, 56.78%). In terms of the intention to use a mental health app, the Satorra-Bentler–scaled fit statistics indicated a good fit for the model (χ2278=790.44, P<.001; comparative fit index=0.933, root mean square error of approximation=0.047, standardized root mean square residual=0.056), with cues to action emerging as the most significant predictor of intention (β=.48, P<.001). This was followed by perceived barriers (β=–.25, P<.001), perceived susceptibility (β=.15, P<.001), and perceived benefits (β=.13, P<.001). Perceived severity (β=.01, P=.869) and self-efficacy (β=.03, P=.286) were not significantly associated with behavioral intention. Conclusions: This study reveals important factors that influence the intention to use a mental health app during menopause. It emphasizes the need to address barriers to app usage, while highlighting the impact of credible endorsements and psychoeducation. Furthermore, the study underscores the significance of improving accessibility for users with lower digital literacy or limited resources. %M 39412868 %R 10.2196/60434 %U https://formative.jmir.org/2024/1/e60434 %U https://doi.org/10.2196/60434 %U http://www.ncbi.nlm.nih.gov/pubmed/39412868 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53146 %T Menstrual Cycle Management and Period Tracker App Use in Millennial and Generation Z Individuals: Mixed Methods Study %A Hong,Minji %A Rajaguru,Vasuki %A Kim,KyungYi %A Jang,Suk-Yong %A Lee,Sang Gyu %+ Department of Preventive Medicine, College of Medicine, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 02 2228 1500, Leevan@yuhs.ac %K menstruation %K dysmenorrhea %K period tracker app, menstrual cycle management, health care application, millennial %K Gen Z %K mobile phone %D 2024 %7 10.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Menstruation is a physical symptom that occurs in women of reproductive age. It has a significant impact on the daily life and health of women when their academic and social activities are most active. Since many women experience difficulties in daily life because of premenstrual syndrome and dysmenorrhea, it is important to identify, prepare for, and manage the menstrual cycle in advance. Objective: This study aimed to investigate the relationship between menstruation-related experiences and the use of mobile-based period tracker apps by millennial and generation Z (gen Z) individuals. The objectives of this study are to investigate (1) menstrual cycle management, (2) factors affecting app usage (3) factors affecting cycle management, and (4) motivators and barriers to using period tracker apps, in millennial and gen Z women. Methods: A mixed methods design was used for this study. The participants were young women aged 20-39 years and recruited via the Ovey application. Data were collected through surveys and focus group interviews. The survey was conducted among 700 women, and 8 of them participated in the focus group interviews. Results: In total, 431 (62.3%) participants used period tracker apps primarily to predict their next menstrual cycle. Factors affecting app usage included childbirth experience (odds ratio [OR] 0.475, P<.05), number of dysmenorrhea symptoms (OR 1.136, P<.05), and cycle management level (OR 2.279, P<.001). Additionally, education level (OR 1.122, P<.05 [university level compared high school level]) and the number of dysmenorrhea symptoms (OR 1.024, P<.05) showed a positive association with the cycle management level. However, childbirth experience (OR 0.902, P<.05) and period irregularity (OR 0.929, P<.001) were negatively associated with the cycle management level. Conclusions: Period tracker apps are becoming the new normal among millennials and gen Z individuals for managing their menstrual cycles. The use of a period tracker app empowers women by helping them gain a better understanding of their bodies, ultimately enhancing their social, academic, and health-related lives. Improving the accuracy and literacy of the app is an ongoing task for period-tracking apps, and it is important to provide added value tailored to users’ needs. Therefore, the findings of this study should be considered when designing or upgrading period tracker apps to facilitate the adoption of digital technology among young women, thereby promoting their overall well-being and reproductive health. %M 39388687 %R 10.2196/53146 %U https://www.jmir.org/2024/1/e53146 %U https://doi.org/10.2196/53146 %U http://www.ncbi.nlm.nih.gov/pubmed/39388687 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e48465 %T Needs of Patients With Gynecologic Cancer and Their Caregivers for Obtaining mHealth-Supported Self-Management: Focus Group Study %A Campbell,Grace B %A Kim,Hansol %A Klinedinst,Tara C %A Klinger,Julie %A Lee,Young Ji %A Donovan,Heidi S %+ School of Nursing, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15282, United States, 1 412 417 8804, campbellg2@duq.edu %K gynecologic oncology %K gynecologic cancer %K self-management support %K user-centered design %K cancer distress %K self-management %K caregiver support %K cancer information %K women's health %K family support %K informal caregivers %K informal care %K mhealth %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Family caregivers of individuals with gynecologic cancer experience high levels of distress. Web-based caregiver support interventions have demonstrated efficacy in improving caregiver outcomes. However, the lack of portability could be a limitation. Mobile health (mHealth) apps could fill this gap and facilitate communication between patient-caregiver dyads. Objective: We sought to obtain information on desired usage and features to be used to design an mHealth self-management support app targeting both patients with gynecologic cancer and their caregivers. Methods: We conducted Zoom focus groups with women who had been treated for gynecologic cancers (ovarian, fallopian, primary peritoneal, uterine, endometrial, cervical, and vulvar); patients were also asked to invite a self-identified “closest support person” (caregiver). A semistructured focus group guide was used to elicit information on patients’ and caregivers’ perceived gaps in information and support, desired features of an mHealth app, and interest in and preferences for app usage. After transcription, rapid qualitative analysis using a thematic matrix was used to identify common themes across groups. Results: A total of 8 groups were held. The final sample included 41 individuals with gynecologic cancer and 22 support persons or caregivers (total n=63). Patients were aged between 32 and 84 years, and most (38/41, 93%) were White and married. For caregivers (n=22), 15 (68%) identified as male and 7 (32%) as female, with ages ranging between 19 and 81 years. Overall, 59% (n=13) of caregivers were spouses. Questions geared at eliciting 3 a priori topics yielded the following themes: topic 1—gaps in information and support: finding relevant information is time-consuming; patients and caregivers lack confidence in deciding the urgency of problems that arise and from whom to seek information and guidance; topic 2—desired features of the mHealth app: patients and caregivers desire centralized, curated, trustworthy information; they desire timely recommendations tailored to specific personal and cancer-related needs; they desire opportunities to interact with clinical and peer experts through the app; and topic 3—interest and preferences for app usage: need for private space in the app for patients and caregivers to get information and support without the others’ knowledge; patients and caregivers desire having control over sharing of information with other family members. Conclusions: Designing a single mHealth app to be used by patients and caregivers presents unique challenges for intervention designers and app developers. Implications of the study suggest that app developers need to prioritize flexibility in app functionality and provide individuals the ability to control information sharing between patients and caregivers. %M 39361371 %R 10.2196/48465 %U https://cancer.jmir.org/2024/1/e48465 %U https://doi.org/10.2196/48465 %U http://www.ncbi.nlm.nih.gov/pubmed/39361371 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57936 %T The WeThrive App and Its Impact on Adolescents Who Menstruate: Qualitative Study %A MacNeil,Nora %A Price,Victoria %A Pike,Meghan %+ Division of Hematology/Oncology, Department of Pediatrics, Izaak Walton Killam Health Centre, PO Box 9700, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada, 1 9024708643, meghan.pike@iwk.nshealth.ca %K heavy menstrual bleeding %K adolescents %K menorrhagia %K quality of life %K mobile applications %K mobile health application %K mobile phone %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Heavy menstrual bleeding (HMB) affects up to 37% of adolescents. Without recognition, HMB can lead to other medical conditions resulting in diminished health-related quality of life. WeThrive, a new mobile health (mHealth) app, implements the pictorial bleeding assessment chart to identify HMB, and the adolescent Menstrual Bleeding Questionnaire to measure the effects of HMB on adolescents’ health-related quality of life. If HMB is identified, WeThrive will connect users to local clinics for further assessment of their menstrual bleeding with a health care provider. Objective: This study aimed to describe adolescents’ experiences using WeThrive app. Methods: This qualitative study was approved by the local Research Ethics Board in Halifax, Nova Scotia, and informed consent was provided by all participants. Individual semistructured interviews were held via videoconference with adolescents younger than 18 years, who had at least 1 menstrual period and had used WeThrive at least once. Interview transcripts were thematically analyzed by 2 investigators (MP and NMN) independently, and the κ statistic was calculated to determine the strength of correlation in themes. Results: Five adolescents (mean age 15.5, range 13-18 years), participated in the interviews. All participants stated that WeThrive helps them better understand their menstrual periods by predicting period onset, recognizing menstrual symptoms, and identifying HMB. Four themes were identified: (1) the importance of visual features and usability, (2) newly obtained knowledge using WeThrive, (3) feature use depends on menstrual health, and (4) trustworthiness. There was substantial agreement on the identified themes (κ=0.73). Conclusions: WeThrive is visually appealing, and trustworthy, and helps users better understand their menstrual periods, including identifying HMB. By identifying HMB early, WeThrive has the potential to improve the recognition of bleeding disorders and iron deficiency in adolescents. WeThrive is a useful tool to help adolescents better understand their menstrual periods. %M 39361373 %R 10.2196/57936 %U https://formative.jmir.org/2024/1/e57936 %U https://doi.org/10.2196/57936 %U http://www.ncbi.nlm.nih.gov/pubmed/39361373 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59269 %T Shaping Adoption and Sustained Use Across the Maternal Journey: Qualitative Study on Perceived Usability and Credibility in Digital Health Tools %A Ng,Wei Ying %A Lau,Ni Yin %A Lee,V Vien %A Vijayakumar,Smrithi %A Leong,Qiao Ying %A Ooi,Shu Qin Delicia %A Su,Lin Lin %A Lee,Yung Seng %A Chan,Shiao-Yng %A Blasiak,Agata %A Ho,Dean %+ The N.1 Institute for Health, National University of Singapore, 28 Medical Drive, #05-COR, Singapore, 117456, Singapore, 65 66017766, biedh@nus.edu.sg %K maternal and child health %K conception %K pregnancy %K perinatal care %K postpartum %K maternal care %K obstetric care %K user engagement %K Unified Theory of Acceptance and Use of Technology %K femtech %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Maternal and child health outcomes are positively influenced by early intervention, and digital health (DH) tools provide the potential for a low-cost and scalable solution such as informational platforms or digital tracking tools. Despite the wide availability of DH tools out there for women from before to after pregnancy, user engagement remains low. Objective: This study aims to explore the factors that shape women’s DH adoption and sustained use across the maternal journey from preconception to postbirth, to improve user engagement with DH tools. Methods: One-hour semistructured qualitative interviews were conducted with 44 women from before to after pregnancy (age range 21-40 years) about their experiences with DH. This study is part of a larger study on women’s maternal experiences with health care and DH and focuses on the factors that affected women’s DH adoption and sustained use. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Results: Five main themes and 10 subthemes were identified that affected women’s adoption and sustained use of DH tools. These included themes on their preexisting attitudes to DH, perceived ease of use, perceived usefulness, perceived credibility, and perceived value of the tool. Conclusions: The themes that emerged were fully or partially mapped according to the Unified Theory of Acceptance and Use of Technology 2 model. The applicability of the model and the need to consider specific cultural nuances in the Asian context (such as the importance of trust and social influence) are discussed. The interaction of the 5 themes with DH adoption and sustained use are explored with different themes being relevant at various points of the DH adoption journey. The insights gained serve to inform future DH design and implementation of tools for women to optimize their DH engagement and the benefits they derive from it. Trial Registration: ClinicalTrials.gov NCT05099900; https://clinicaltrials.gov/study/NCT05099900 %M 39352732 %R 10.2196/59269 %U https://humanfactors.jmir.org/2024/1/e59269 %U https://doi.org/10.2196/59269 %U http://www.ncbi.nlm.nih.gov/pubmed/39352732 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46531 %T The Portrayal of Cesarean Section on Instagram: Mixed Methods Social Media Analysis %A Zahroh,Rana Islamiah %A Cheong,Marc %A Hazfiarini,Alya %A Vazquez Corona,Martha %A Ekawati,Fitriana Murriya %A Emilia,Ova %A Homer,Caroline SE %A Betrán,Ana Pilar %A Bohren,Meghan A %+ Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3053, Australia, 61 481386220, r.zahroh@unimelb.edu.au %K cesarean section %K social media analysis %K maternal health %K childbirth %K mode of birth %K instagram %D 2024 %7 6.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cesarean section (CS) rates in Indonesia are rapidly increasing for both sociocultural and medical reasons. However, there is limited understanding of the role that social media plays in influencing preferences regarding mode of birth (vaginal or CS). Social media provides a platform for users to seek and exchange information, including information on the mode of birth, which may help unpack social influences on health behavior. Objective: This study aims to explore how CS is portrayed on Instagram in Indonesia. Methods: We downloaded public Instagram posts from Indonesia containing CS hashtags and extracted their attributes (image, caption, hashtags, and objects and texts within images). Posts were divided into 2 periods—before COVID-19 and during COVID-19—to examine changes in CS portrayal during the pandemic. We used a mixed methods approach to analysis using text mining, descriptive statistics, and qualitative content analysis. Results: A total of 9978 posts were analyzed quantitatively, and 720 (7.22%) posts were sampled and analyzed qualitatively. The use of text (527/5913, 8.91% vs 242/4065, 5.95%; P<.001) and advertisement materials (411/5913, 6.95% vs 83/4065, 2.04%; P<.001) increased during the COVID-19 pandemic compared to before the pandemic, indicating growth of information sharing on CS over time. Posts with CS hashtags primarily promoted herbal medicine for faster recovery and services for choosing auspicious childbirth dates, encouraging elective CS. Some private health facilities offered discounts on CS for special events such as Mother’s Day and promoted techniques such as enhanced recovery after CS for comfortable, painless birth, and faster recovery after CS. Hashtags related to comfortable or painless birth (2358/5913, 39.88% vs 278/4065, 6.84%; P<.001), enhanced recovery after CS (124/5913, 2.1% vs 0%; P<.001), feng shui services (110/5913, 1.86% vs 56/4065, 1.38%; P=.03), names of health care providers (2974/5913, 50.3% vs 304/4065, 7.48%; P<.001), and names of hospitals (1460/5913, 24.69% vs 917/4065, 22.56%; P=.007) were more prominent during compared to before the pandemic. Conclusions: This study highlights the necessity of enforcing advertisement regulations regarding birth-related medical services in the commercial and private sectors. Enhanced health promotion efforts are crucial to ensure that women receive accurate, balanced, and appropriate information about birth options. Continuous and proactive health information dissemination from government organizations is essential to counteract biases favoring CS over vaginal birth. %M 39241228 %R 10.2196/46531 %U https://formative.jmir.org/2024/1/e46531 %U https://doi.org/10.2196/46531 %U http://www.ncbi.nlm.nih.gov/pubmed/39241228 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46455 %T Effective Privacy Protection Strategies for Pregnancy and Gestation Information From Electronic Medical Records: Retrospective Study in a National Health Care Data Network in China %A Liu,Chao %A Jiao,Yuanshi %A Su,Licong %A Liu,Wenna %A Zhang,Haiping %A Nie,Sheng %A Gong,Mengchun %+ School of Biomedical Engineering, Guangdong Medical University, No 2, Wenming East Road, Xiashan District, Zhanjiang, 524000, China, 86 18611768672, gmc@nrdrs.org %K pregnancy %K electronic medical record %K privacy protection %K risk stratification %K rule-based %D 2024 %7 20.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Pregnancy and gestation information is routinely recorded in electronic medical record (EMR) systems across China in various data sets. The combination of data on the number of pregnancies and gestations can imply occurrences of abortions and other pregnancy-related issues, which is important for clinical decision-making and personal privacy protection. However, the distribution of this information inside EMR is variable due to inconsistent IT structures across different EMR systems. A large-scale quantitative evaluation of the potential exposure of this sensitive information has not been previously performed, ensuring the protection of personal information is a priority, as emphasized in Chinese laws and regulations. Objective: This study aims to perform the first nationwide quantitative analysis of the identification sites and exposure frequency of sensitive pregnancy and gestation information. The goal is to propose strategies for effective information extraction and privacy protection related to women’s health. Methods: This study was conducted in a national health care data network. Rule-based protocols for extracting pregnancy and gestation information were developed by a committee of experts. A total of 6 different sub–data sets of EMRs were used as schemas for data analysis and strategy proposal. The identification sites and frequencies of identification in different sub–data sets were calculated. Manual quality inspections of the extraction process were performed by 2 independent groups of reviewers on 1000 randomly selected records. Based on these statistics, strategies for effective information extraction and privacy protection were proposed. Results: The data network covered hospitalized patients from 19 hospitals in 10 provinces of China, encompassing 15,245,055 patients over an 11-year period (January 1, 2010-December 12, 2020). Among women aged 14-50 years, 70% were randomly selected from each hospital, resulting in a total of 1,110,053 patients. Of these, 688,268 female patients with sensitive reproductive information were identified. The frequencies of identification were variable, with the marriage history in admission medical records being the most frequent at 63.24%. Notably, more than 50% of female patients were identified with pregnancy and gestation history in nursing records, which is not generally considered a sub–data set rich in reproductive information. During the manual curation and review process, 1000 cases were randomly selected, and the precision and recall rates of the information extraction method both exceeded 99.5%. The privacy-protection strategies were designed with clear technical directions. Conclusions: Significant amounts of critical information related to women’s health are recorded in Chinese routine EMR systems and are distributed in various parts of the records with different frequencies. This requires a comprehensive protocol for extracting and protecting the information, which has been demonstrated to be technically feasible. Implementing a data-based strategy will enhance the protection of women’s privacy and improve the accessibility of health care services. %M 39163593 %R 10.2196/46455 %U https://www.jmir.org/2024/1/e46455 %U https://doi.org/10.2196/46455 %U http://www.ncbi.nlm.nih.gov/pubmed/39163593 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e45291 %T Impact of a New Gynecologic Oncology Hashtag During Virtual-Only ASCO Annual Meetings: An X (Twitter) Social Network Analysis %A Bhandoria,Geetu %A Bilir,Esra %A Uwins,Christina %A Vidal-Alaball,Josep %A Fuster-Casanovas,Aïna %A Ahmed,Wasim %K social media %K academic tweeting %K hashtag %K gynecologic oncology %K Twitter %K ASCO %K gynecology %K oncology %K virtual %K engagement %K software application %K users %K cancer %K social network %K health promotion %D 2024 %7 14.8.2024 %9 %J JMIR Med Educ %G English %X Background: Official conference hashtags are commonly used to promote tweeting and social media engagement. The reach and impact of introducing a new hashtag during an oncology conference have yet to be studied. The American Society of Clinical Oncology (ASCO) conducts an annual global meeting, which was entirely virtual due to the COVID-19 pandemic in 2020 and 2021. Objective: This study aimed to assess the reach and impact (in the form of vertices and edges generated) and X (formerly Twitter) activity of the new hashtags #goASCO20 and #goASCO21 in the ASCO 2020 and 2021 virtual conferences. Methods: New hashtags (#goASCO20 and #goASCO21) were created for the ASCO virtual conferences in 2020 and 2021 to help focus gynecologic oncology discussion at the ASCO meetings. Data were retrieved using these hashtags (#goASCO20 for 2020 and #goASCO21 for 2021). A social network analysis was performed using the NodeXL software application. Results: The hashtags #goASCO20 and #goASCO21 had similar impacts on the social network. Analysis of the reach and impact of the individual hashtags found #goASCO20 to have 150 vertices and 2519 total edges and #goASCO20 to have 174 vertices and 2062 total edges. Mentions and tweets between 2020 and 2021 were also similar. The circles representing different users were spatially arranged in a more balanced way in 2021. Tweets using the #goASCO21 hashtag received significantly more responses than tweets using #goASCO20 (75 times in 2020 vs 360 times in 2021; z value=16.63 and P<.001). This indicates increased engagement in the subsequent year. Conclusions: Introducing a gynecologic oncology specialty–specific hashtag (#goASCO20 and #goASCO21) that is related but different from the official conference hashtag (#ASCO20 and #ASCO21) helped facilitate discussion on topics of interest to gynecologic oncologists during a virtual pan-oncology meeting. This impact was visible in the social network analysis. %R 10.2196/45291 %U https://mededu.jmir.org/2024/1/e45291 %U https://doi.org/10.2196/45291 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48997 %T Five-Feature Models to Predict Preeclampsia Onset Time From Electronic Health Record Data: Development and Validation Study %A Ballard,Hailey K %A Yang,Xiaotong %A Mahadevan,Aditya D %A Lemas,Dominick J %A Garmire,Lana X %+ Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Room 3366, Building 520, NCRC, 1600 Huron Parkway, Ann Arbor, MI, 48105, United States, 1 734 615 0514, lgarmire@gmail.com %K preeclampsia %K survival analysis %K risk prediction %K pregnancy %K prognosis %K survival %K risk %K mortality %K EHR %K health records %K maternal %K machine learning %K electronic health records %D 2024 %7 14.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background:  Preeclampsia is a potentially fatal complication during pregnancy, characterized by high blood pressure and the presence of excessive proteins in the urine. Due to its complexity, the prediction of preeclampsia onset is often difficult and inaccurate. Objective:  This study aimed to create quantitative models to predict the onset gestational age of preeclampsia using electronic health records. Methods:  We retrospectively collected 1178 preeclamptic pregnancy records from the University of Michigan Health System as the discovery cohort, and 881 records from the University of Florida Health System as the validation cohort. We constructed 2 Cox-proportional hazards models: 1 baseline model using maternal and pregnancy characteristics, and the other full model with additional laboratory findings, vitals, and medications. We built the models using 80% of the discovery data, tested the remaining 20% of the discovery data, and validated with the University of Florida data. We further stratified the patients into high- and low-risk groups for preeclampsia onset risk assessment. Results:  The baseline model reached Concordance indices of 0.64 and 0.61 in the 20% testing data and the validation data, respectively, while the full model increased these Concordance indices to 0.69 and 0.61, respectively. For preeclampsia diagnosed at 34 weeks, the baseline and full models had area under the curve (AUC) values of 0.65 and 0.70, and AUC values of 0.69 and 0.70 for preeclampsia diagnosed at 37 weeks, respectively. Both models contain 5 selective features, among which the number of fetuses in the pregnancy, hypertension, and parity are shared between the 2 models with similar hazard ratios and significant P values. In the full model, maximum diastolic blood pressure in early pregnancy was the predominant feature. Conclusions:  Electronic health records data provide useful information to predict the gestational age of preeclampsia onset. Stratification of the cohorts using 5-predictor Cox-proportional hazards models provides clinicians with convenient tools to assess the onset time of preeclampsia in patients. %M 39141914 %R 10.2196/48997 %U https://www.jmir.org/2024/1/e48997 %U https://doi.org/10.2196/48997 %U http://www.ncbi.nlm.nih.gov/pubmed/39141914 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50749 %T Virtual Clinic Telehealth Abortion Services in the United States One Year After Dobbs: Landscape Review %A Koenig,Leah R %A Ko,Jennifer %A Upadhyay,Ushma D %+ Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, United States, 1 415 353 4626, ushma.upadhyay@ucsf.edu %K medication abortion %K telehealth %K virtual clinics %K abortion %K access %K policy %K health equity %D 2024 %7 5.8.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: Telehealth abortion has taken on a vital role in maintaining abortion access since the Dobbs v. Jackson Women’s Health Organization Supreme Court decision. However, little remains known about the landscape of new telehealth-only virtual clinic abortion providers that have expanded since telehealth abortion first became widely available in the United States in 2021. Objective: This study aimed to (1) document the landscape of telehealth-only virtual clinic abortion care in the United States, (2) describe changes in the presence of virtual clinic abortion services between September 2022, following the Dobbs decision, and June 2023, and (3) identify structural factors that may perpetuate inequities in access to virtual clinic abortion care. Methods: We conducted a repeated cross-sectional study by reviewing web search results and abortion directories to identify virtual abortion clinics in September 2022 and June 2023 and described changes in the presence of virtual clinics between these 2 periods. In June 2023, we also described each virtual clinic’s policies, including states served, costs, patient age limits, insurance acceptance, financial assistance available, and gestational limits. Results: We documented 11 virtual clinics providing telehealth abortion care in 26 states and Washington DC in September 2022. By June 2023, 20 virtual clinics were providing services in 27 states and Washington DC. Most (n=16) offered care to minors, 8 provided care until 10 weeks of pregnancy, and median costs were US $259. In addition, 2 accepted private insurance and 1 accepted Medicaid, within a limited number of states. Most (n=16) had some form of financial assistance available. Conclusions: Virtual clinic abortion providers have proliferated since the Dobbs decision. We documented inequities in the availability of telehealth abortion care from virtual clinics, including age restrictions that exclude minors, gestational limits for care, and limited insurance and Medicaid acceptance. Notably, virtual clinic abortion care was not permitted in 11 states where in-person abortion is available. %M 39102679 %R 10.2196/50749 %U https://www.jmir.org/2024/1/e50749 %U https://doi.org/10.2196/50749 %U http://www.ncbi.nlm.nih.gov/pubmed/39102679 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47484 %T Understanding Symptom Self-Monitoring Needs Among Postpartum Black Patients: Qualitative Interview Study %A Benda,Natalie %A Woode,Sydney %A Niño de Rivera,Stephanie %A Kalish,Robin B %A Riley,Laura E %A Hermann,Alison %A Masterson Creber,Ruth %A Costa Pimentel,Eric %A Ancker,Jessica S %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 212 305 9547, nb3115@cumc.columbia.edu %K maternal mortality %K patient-reported outcomes %K patient-reported outcome %K health equity %K qualitative research %K mobile health %K mHealth %K qualitative %K postpartum %K postnatal %K maternity %K maternal %K Black %K women’s health %K ethnic %K design need %K mortality %K death %K decision support %K information need %K informational need %K obstetric %K obstetrics %K mental health %K mobile phone %D 2024 %7 26.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Pregnancy-related death is on the rise in the United States, and there are significant disparities in outcomes for Black patients. Most solutions that address pregnancy-related death are hospital based, which rely on patients recognizing symptoms and seeking care from a health system, an area where many Black patients have reported experiencing bias. There is a need for patient-centered solutions that support and encourage postpartum people to seek care for severe symptoms. Objective: We aimed to determine the design needs for a mobile health (mHealth) patient-reported outcomes and decision-support system to assist Black patients in assessing when to seek medical care for severe postpartum symptoms. These findings may also support different perinatal populations and minoritized groups in other clinical settings. Methods: We conducted semistructured interviews with 36 participants—15 (42%) obstetric health professionals, 10 (28%) mental health professionals, and 11 (31%) postpartum Black patients. The interview questions included the following: current practices for symptom monitoring, barriers to and facilitators of effective monitoring, and design requirements for an mHealth system that supports monitoring for severe symptoms. Interviews were audio recorded and transcribed. We analyzed transcripts using directed content analysis and the constant comparative process. We adopted a thematic analysis approach, eliciting themes deductively using conceptual frameworks from health behavior and human information processing, while also allowing new themes to inductively arise from the data. Our team involved multiple coders to promote reliability through a consensus process. Results: Our findings revealed considerations related to relevant symptom inputs for postpartum support, the drivers that may affect symptom processing, and the design needs for symptom self-monitoring and patient decision-support interventions. First, participants viewed both somatic and psychological symptom inputs as important to capture. Second, self-perception; previous experience; sociocultural, financial, environmental, and health systems–level factors were all perceived to impact how patients processed, made decisions about, and acted upon their symptoms. Third, participants provided recommendations for system design that involved allowing for user control and freedom. They also stressed the importance of careful wording of decision-support messages, such that messages that recommend them to seek care convey urgency but do not provoke anxiety. Alternatively, messages that recommend they may not need care should make the patient feel heard and reassured. Conclusions: Future solutions for postpartum symptom monitoring should include both somatic and psychological symptoms, which may require combining existing measures to elicit symptoms in a nuanced manner. Solutions should allow for varied, safe interactions to suit individual needs. While mHealth or other apps may not be able to address all the social or financial needs of a person, they may at least provide information, so that patients can easily access other supportive resources. %M 38669066 %R 10.2196/47484 %U https://www.jmir.org/2024/1/e47484 %U https://doi.org/10.2196/47484 %U http://www.ncbi.nlm.nih.gov/pubmed/38669066 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e48218 %T Effective Communication Supported by an App for Pregnant Women: Quantitative Longitudinal Study %A Kötting,Lukas %A Anand-Kumar,Vinayak %A Keller,Franziska Maria %A Henschel,Nils Tobias %A Lippke,Sonia %+ Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Campus Ring 1, Bremen, 28759, Germany, 49 421 200 4730, s.lippke@jacobs-university.de %K clinical care %K health action process approach %K HAPA %K intention %K communication behavior %K patient safety %K patient education %K internet intervention %K dropout %K digital health %K behavior change %K prediction %K obstetric %K pregnant women %K pregnancy %K safe communication %K health behaviors %K obstetric care %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In the medical field of obstetrics, communication plays a crucial role, and pregnant women, in particular, can benefit from interventions improving their self-reported communication behavior. Effective communication behavior can be understood as the correct transmission of information without misunderstanding, confusion, or losses. Although effective communication can be trained by patient education, there is limited research testing this systematically with an app-based digital intervention. Thus, little is known about the success of such a digital intervention in the form of a web-app, potential behavioral barriers for engagement, as well as the processes by which such a web-app might improve self-reported communication behavior. Objective: This study fills this research gap by applying a web-app aiming at improving pregnant women’s communication behavior in clinical care. The goals of this study were to (1) uncover the potential risk factors for early dropout from the web-app and (2) investigate the social-cognitive factors that predict self-reported communication behavior after having used the web-app. Methods: In this study, 1187 pregnant women were recruited. They all started to use a theory-based web-app focusing on intention, planning, self-efficacy, and outcome expectancy to improve communication behavior. Mechanisms of behavior change as a result of exposure to the web-app were explored using stepwise regression and path analysis. Moreover, determinants of dropout were tested using logistic regression. Results: We found that dropout was associated with younger age (P=.014). Mechanisms of behavior change were consistent with the predictions of the health action process approach. The stepwise regression analysis revealed that action planning was the best predictor for successful behavioral change over the course of the app-based digital intervention (β=.331; P<.001). The path analyses proved that self-efficacy beliefs affected the intention to communicate effectively, which in turn, elicited action planning and thereby improved communication behavior (β=.017; comparative fit index=0.994; Tucker–Lewis index=0.971; root mean square error of approximation=0.055). Conclusions: Our findings can guide the development and improvement of apps addressing communication behavior in the following ways in obstetric care. First, such tools would enable action planning to improve communication behavior, as action planning is the key predictor of behavior change. Second, younger women need more attention to keep them from dropping out. However, future research should build upon the gained insights by conducting similar internet interventions in related fields of clinical care. The focus should be on processes of behavior change and strategies to minimize dropout rates, as well as replicating the findings with patient safety measures. Trial Registration: ClinicalTrials.gov identifier: NCT03855735; https://classic.clinicaltrials.gov/ct2/show/NCT03855735 %M 38669073 %R 10.2196/48218 %U https://humanfactors.jmir.org/2024/1/e48218 %U https://doi.org/10.2196/48218 %U http://www.ncbi.nlm.nih.gov/pubmed/38669073 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48793 %T User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study %A Wahl,Kate J %A Brooks,Melissa %A Trenaman,Logan %A Desjardins-Lorimer,Kirsten %A Bell,Carolyn M %A Chokmorova,Nazgul %A Segall,Romy %A Syring,Janelle %A Williams,Aleyah %A Li,Linda C %A Norman,Wendy V %A Munro,Sarah %+ Department of Obstetrics and Gynecology, University of British Columbia, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada, 1 4165231923, kate.wahl@cw.bc.ca %K family planning %K abortion %K shared decision-making %K patient decision aid %K qualitative %K evaluation %K Canada %K health equity %D 2024 %7 16.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive—there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. Objective: We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. Methods: We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers’ decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy (“patient” participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. Results: A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100%; health care professionals: n=22, 88%), was not missing information (patients: n=21, 84%; health care professionals: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care professionals: n=23, 92%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. Conclusions: We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making. %M 38625731 %R 10.2196/48793 %U https://www.jmir.org/2024/1/e48793 %U https://doi.org/10.2196/48793 %U http://www.ncbi.nlm.nih.gov/pubmed/38625731 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48493 %T Mitigating Health-Related Uncertainties During Pregnancy: The Role of Smart Health Monitoring Technologies %A Tretter,Max %+ Chair of Systematic Theology (Ethics), Seminar for Systematic Theology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kochstr 6, Erlangen, 91054, Germany, 49 9131 85 26078, max.tretter@fau.de %K stress %K anxiety %K reproductive technologies %K fetal health %K epistemology %K ethics %D 2024 %7 25.3.2024 %9 Viewpoint %J J Med Internet Res %G English %X Pregnancy is a time filled with uncertainties, which can be challenging and lead to fear or anxiety for expectant parents. Health monitoring technologies that allow monitoring of the vital signs of both the mother and fetus offer a way to address health-related uncertainties. But are smart health monitoring technologies (SHMTs) actually an effective means to reduce uncertainties during pregnancy, or do they have the opposite effect? Using conceptual reasoning and phenomenological approaches grounded in existing literature, this Viewpoint explores the effects of SHMTs on health-related uncertainties during pregnancy. The argument posits that while SHMTs can alleviate some health-related uncertainties, they may also create new ones. This is particularly the case when the abundance of vital data overwhelms pregnant persons, leads to false-positive diagnoses, or raises concerns about the accuracy and analysis of data. Consequently, it is concluded that the use of SHMTs is not a cure-all for overcoming health-related uncertainties during pregnancy. Since the use of such monitoring technologies can introduce new uncertainties, it is important to carefully consider where and for what purpose they are used, use them sparingly, and promote a pragmatic approach to uncertainties.Using conceptual reasoning and phenomenological approaches grounded in existing literature, the effects of SHMTs on health-related uncertainties during pregnancy are explored. The argument posits that while SHMTs can alleviate some health-related uncertainties, they may also create new ones. This is particularly the case when the abundance of vital data overwhelms pregnant persons, leads to false-positive diagnoses, or raises concerns about the accuracy and analysis of data. Consequently, it is concluded that the use of SHMTs is not a cure-all for overcoming health-related uncertainties during pregnancy. Since the use of such monitoring technologies can introduce new uncertainties, it is important to carefully consider where and for what purpose they are used, use them sparingly, and promote a pragmatic approach to uncertainties. %M 38526554 %R 10.2196/48493 %U https://www.jmir.org/2024/1/e48493 %U https://doi.org/10.2196/48493 %U http://www.ncbi.nlm.nih.gov/pubmed/38526554 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46758 %T Chatbots That Deliver Contraceptive Support: Systematic Review %A Mills,Rhiana %A Mangone,Emily Rose %A Lesh,Neal %A Jayal,Gayatri %A Mohan,Diwakar %A Baraitser,Paula %+ SH24, 35A Westminster Bridge Road, London, SE1 7JB, United Kingdom, 44 7742932445, rhiana@sh24.org.uk %K chatbot %K contraceptives %K digital health %K AI %K systematic review %K conversational agent %K development best practices %K development %K counseling %K communication %K user feedback %K users %K feedback %K attitudes %K behavior %D 2024 %7 27.2.2024 %9 Review %J J Med Internet Res %G English %X Background: A chatbot is a computer program that is designed to simulate conversation with humans. Chatbots may offer rapid, responsive, and private contraceptive information; counseling; and linkages to products and services, which could improve contraceptive knowledge, attitudes, and behaviors. Objective: This review aimed to systematically collate and interpret evidence to determine whether and how chatbots improve contraceptive knowledge, attitudes, and behaviors. Contraceptive knowledge, attitudes, and behaviors include access to contraceptive information, understanding of contraceptive information, access to contraceptive services, contraceptive uptake, contraceptive continuation, and contraceptive communication or negotiation skills. A secondary aim of the review is to identify and summarize best practice recommendations for chatbot development to improve contraceptive outcomes, including the cost-effectiveness of chatbots where evidence is available. Methods: We systematically searched peer-reviewed and gray literature (2010-2022) for papers that evaluated chatbots offering contraceptive information and services. Sources were included if they featured a chatbot and addressed an element of contraception, for example, uptake of hormonal contraceptives. Literature was assessed for methodological quality using appropriate quality assessment tools. Data were extracted from the included sources using a data extraction framework. A narrative synthesis approach was used to collate qualitative evidence as quantitative evidence was too sparse for a quantitative synthesis to be carried out. Results: We identified 15 sources, including 8 original research papers and 7 gray literature papers. These sources included 16 unique chatbots. This review found the following evidence on the impact and efficacy of chatbots: a large, robust randomized controlled trial suggests that chatbots have no effect on intention to use contraception; a small, uncontrolled cohort study suggests increased uptake of contraception among adolescent girls; and a development report, using poor-quality methods, suggests no impact on improved access to services. There is also poor-quality evidence to suggest increased contraceptive knowledge from interacting with chatbot content. User engagement was mixed, with some chatbots reaching wide audiences and others reaching very small audiences. User feedback suggests that chatbots may be experienced as acceptable, convenient, anonymous, and private, but also as incompetent, inconvenient, and unsympathetic. The best practice guidance on the development of chatbots to improve contraceptive knowledge, attitudes, and behaviors is consistent with that in the literature on chatbots in other health care fields. Conclusions: We found limited and conflicting evidence on chatbots to improve contraceptive knowledge, attitudes, and behaviors. Further research that examines the impact of chatbot interventions in comparison with alternative technologies, acknowledges the varied and changing nature of chatbot interventions, and seeks to identify key features associated with improved contraceptive outcomes is needed. The limitations of this review include the limited evidence available on this topic, the lack of formal evaluation of chatbots in this field, and the lack of standardized definition of what a chatbot is. %M 38412028 %R 10.2196/46758 %U https://www.jmir.org/2024/1/e46758 %U https://doi.org/10.2196/46758 %U http://www.ncbi.nlm.nih.gov/pubmed/38412028 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45139 %T Innovative Approaches to Menstruation and Fertility Tracking Using Wearable Reproductive Health Technology: Systematic Review %A Lyzwinski,Lynnette %A Elgendi,Mohamed %A Menon,Carlo %+ Menrva Research Group, School of Mechatronics Systems Engineering and Engineering Science, Simon Fraser University, 2540-1340 102 Avenue, Metro Vancouver, Vancouver, BC, V3TOA3, Canada, 1 778 302 1151, lnl2@sfu.ca %K fertility cycle %K fertility monitoring %K ovulation %K menstruation %K wearable devices %K mHealth %K reproductive health %K wearable %K fertility %K menstrual %K women’s health %K ovulate %K sexual health %K scoping %K review method %D 2024 %7 15.2.2024 %9 Review %J J Med Internet Res %G English %X Background: Emerging digital health technology has moved into the reproductive health market for female individuals. In the past, mobile health apps have been used to monitor the menstrual cycle using manual entry. New technological trends involve the use of wearable devices to track fertility by assessing physiological changes such as temperature, heart rate, and respiratory rate. Objective: The primary aims of this study are to review the types of wearables that have been developed and evaluated for menstrual cycle tracking and to examine whether they may detect changes in the menstrual cycle in female individuals. Another aim is to review whether these devices are effective for tracking various stages in the menstrual cycle including ovulation and menstruation. Finally, the secondary aim is to assess whether the studies have validated their findings by reporting accuracy and sensitivity. Methods: A review of PubMed or MEDLINE was undertaken to evaluate wearable devices for their effectiveness in predicting fertility and differentiating between the different stages of the menstrual cycle. Results: Fertility cycle–tracking wearables include devices that can be worn on the wrists, on the fingers, intravaginally, and inside the ear. Wearable devices hold promise for predicting different stages of the menstrual cycle including the fertile window and may be used by female individuals as part of their reproductive health. Most devices had high accuracy for detecting fertility and were able to differentiate between the luteal phase (early and late), fertile window, and menstruation by assessing changes in heart rate, heart rate variability, temperature, and respiratory rate. Conclusions: More research is needed to evaluate consumer perspectives on reproductive technology for monitoring fertility, and ethical issues around the privacy of digital data need to be addressed. Additionally, there is also a need for more studies to validate and confirm this research, given its scarcity, especially in relation to changes in respiratory rate as a proxy for reproductive cycle staging. %M 38358798 %R 10.2196/45139 %U https://www.jmir.org/2024/1/e45139 %U https://doi.org/10.2196/45139 %U http://www.ncbi.nlm.nih.gov/pubmed/38358798 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47408 %T Analyzing Reddit Forums Specific to Abortion That Yield Diverse Dialogues Pertaining to Medical Information Seeking and Personal Worldviews: Data Mining and Natural Language Processing Comparative Study %A Valdez,Danny %A Mena-Meléndez,Lucrecia %A Crawford,Brandon L %A Jozkowski,Kristen N %+ Department of Applied Health Science, Indiana University School of Public Health, 1025 E 7th Street, Bloomington, IN, 47403, United States, 1 8128038955, danvald@iu.edu %K abortion %K social media %K Reddit %K natural language processing %K NLP %K neural networks %D 2024 %7 14.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Attitudes toward abortion have historically been characterized via dichotomized labels, yet research suggests that these labels do not appropriately encapsulate beliefs on abortion. Rather, contexts, circumstances, and lived experiences often shape views on abortion into more nuanced and complex perspectives. Qualitative data have also been shown to underpin belief systems regarding abortion. Social media, as a form of qualitative data, could reveal how attitudes toward abortion are communicated publicly in web-based spaces. Furthermore, in some cases, social media can also be leveraged to seek health information. Objective: This study applies natural language processing and social media mining to analyze Reddit (Reddit, Inc) forums specific to abortion, including r/Abortion (the largest subreddit about abortion) and r/AbortionDebate (a subreddit designed to discuss and debate worldviews on abortion). Our analytical pipeline intends to identify potential themes within the data and the affect from each post. Methods: We applied a neural network–based topic modeling pipeline (BERTopic) to uncover themes in the r/Abortion (n=2151) and r/AbortionDebate (n=2815) subreddits. After deriving the optimal number of topics per subreddit using an iterative coherence score calculation, we performed a sentiment analysis using the Valence Aware Dictionary and Sentiment Reasoner to assess positive, neutral, and negative affect and an emotion analysis using the Text2Emotion lexicon to identify potential emotionality per post. Differences in affect and emotion by subreddit were compared. Results: The iterative coherence score calculation revealed 10 topics for both r/Abortion (coherence=0.42) and r/AbortionDebate (coherence=0.35). Topics in the r/Abortion subreddit primarily centered on information sharing or offering a source of social support; in contrast, topics in the r/AbortionDebate subreddit centered on contextualizing shifting or evolving views on abortion across various ethical, moral, and legal domains. The average compound Valence Aware Dictionary and Sentiment Reasoner scores for the r/Abortion and r/AbortionDebate subreddits were 0.01 (SD 0.44) and −0.06 (SD 0.41), respectively. Emotionality scores were consistent across the r/Abortion and r/AbortionDebate subreddits; however, r/Abortion had a marginally higher average fear score of 0.36 (SD 0.39). Conclusions: Our findings suggest that people posting on abortion forums on Reddit are willing to share their beliefs, which manifested in diverse ways, such as sharing abortion stories including how their worldview changed, which critiques the value of dichotomized abortion identity labels, and information seeking. Notably, the style of discourse varied significantly by subreddit. r/Abortion was principally leveraged as an information and outreach source; r/AbortionDebate largely centered on debating across various legal, ethical, and moral abortion domains. Collectively, our findings suggest that abortion remains an opaque yet politically charged issue for people and that social media can be leveraged to understand views and circumstances surrounding abortion. %M 38354044 %R 10.2196/47408 %U https://www.jmir.org/2024/1/e47408 %U https://doi.org/10.2196/47408 %U http://www.ncbi.nlm.nih.gov/pubmed/38354044 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50191 %T Acceptability of Telelactation Services for Breastfeeding Support Among Black Parents: Semistructured Interview Study %A Howell,Khadesia %A Alvarado,Gabriela %A Waymouth,Molly %A Demirci,Jill %A Rogers,Rhianna %A Ray,Kristin %A Uscher-Pines,Lori %+ RAND Corporation, Arlington, VA, 22202, United States, 1 7034131100, luscherp@rand.org %K acceptance %K barrier %K black parent %K black %K breastfeeding %K concordance %K consultant %K consultation %K digital divide %K digital equity %K disparity %K ethnic %K health equity %K lactation %K mother %K parent %K racial %K telehealth %K telelactation %K user %D 2023 %7 29.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: While breastfeeding rates have increased in the United States in recent years, racial and ethnic disparities persist. Telelactation may help reduce disparities by increasing access to lactation consultants, but there is limited research on acceptability among minoritized individuals. Objective: We aimed to explore experiences with telelactation among Black parents and identify strategies to make services more culturally appropriate. Methods: We selected 20 Black parents who were given access to telelactation services from an ongoing National Institutes of Health–funded randomized controlled trial (the Tele-MILC trial) to participate in semistructured interviews. Interviews addressed birth experiences, use and opinions about telelactation, comparison of telelactation to in-person lactation support, and recommendations to improve telelactation services. The thematic analysis was informed by a previously reported theoretical framework of acceptability and RAND Corporation’s equity-centered model. Results: Users appreciated the convenience of telelactation and reported that lactation consultants were knowledgeable and helpful. Participants wanted more options to engage with lactation consultants outside of video visits (eg, SMS text messaging and asynchronous resources). Users who had a lactation consultant of color mentioned that racial concordance improved the experience; however, few felt that racial concordance was needed for high-quality telelactation support. Conclusions: While Black parents in our sample found telelactation services to be acceptable, telelactation could not, in isolation, address the myriad barriers to long-duration breastfeeding. Several changes could be made to telelactation services to increase their use by minoritized populations. %M 38157241 %R 10.2196/50191 %U https://www.jmir.org/2023/1/e50191 %U https://doi.org/10.2196/50191 %U http://www.ncbi.nlm.nih.gov/pubmed/38157241 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47131 %T Analyzing User Reviews of the First Digital Contraceptive: Mixed Methods Study %A Ciolfi Felice,Marianela %A Søndergaard,Marie Louise Juul %A Balaam,Madeline %+ Division of Media Technology and Interaction Design, KTH Royal Institute of Technology, Brinellvägen 8, Stockholm, 11428, Sweden, 46 087906000, ciolfi@kth.se %K digital contraception %K reproductive health %K digital health %K women’s health %K intimate health %K computational methods %K natural language processing %K NLP %K user experience %K health informatics %D 2023 %7 14.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: People in Western countries are increasingly rejecting hormone-based birth control and expressing a preference for hormone-free methods. Digital contraceptives have emerged as nonhormonal medical devices that make use of self-tracked data and algorithms to find a user’s fertile window. However, there is little knowledge about how people experience this seemingly new form of contraception, whose failure may result in unwanted pregnancies, high health risks, and life-changing consequences. As digital contraception becomes more widely adopted, examining its user experience is crucial to inform the design of technologies that not only are medically effective but also meet users’ preferences and needs. Objective: We examined the user experience offered by Natural Cycles—the first digital contraceptive—through an analysis of app reviews written by its users worldwide. Methods: We conducted a mixed methods analysis of 3265 publicly available reviews written in English by users of Natural Cycles on the Google Play Store. We combined computational and human techniques, namely, topic modeling and reflexive thematic analysis. Results: For some users of digital contraception, the hormone-free aspect of the experience can be more salient than its digital aspect. Cultivating self-knowledge through the use of the technology can, in turn, feel empowering. Users also pointed to an algorithmic component that allows for increased accuracy over time as long as user diligence is applied. The interactivity of the digital contraceptive supports mutual learning and is experienced as agential and rewarding. Finally, a digital contraceptive can facilitate sharing the burden of contraceptive practices or highlight single-sided responsibilities while creating points of friction in the required daily routines. Conclusions: Digital contraception is experienced by users as a tamed natural approach—a natural method contained and regulated by science and technology. This means that users can experience a method based on a digital product as “natural,” which positions digital contraceptives as a suitable option for people looking for evidence-based nonhormonal contraceptive methods. We point to interactivity as core to the user experience and highlight that a digital contraceptive might allow for collaboration between partners around contraceptive practices and responsibilities. We note that the user diligence required for the digital contraceptive to provide accurate and frequent data is sometimes not enough. Future research could look at designing (and redesigning) digital contraceptives with primary users and intimate partners, enhancing the experience of tamed naturalness; exploring how trust fluctuates among involved actors and in interactions with the technology; and, ultimately, designing more inclusive approaches to digital contraception. %M 37962925 %R 10.2196/47131 %U https://www.jmir.org/2023/1/e47131 %U https://doi.org/10.2196/47131 %U http://www.ncbi.nlm.nih.gov/pubmed/37962925 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e42810 %T Reproductive Health Experiences Shared on TikTok by Young People: Content Analysis %A Nair,Isha %A Patel,Sophia P %A Bolen,Ashley %A Roger,Samantha %A Bucci,Kayla %A Schwab-Reese,Laura %A DeMaria,Andrea L %+ Department of Public Health, Purdue University, 812 W State St, W Lafayette, IN, 47907-2060, United States, 1 765 494 8300, ademaria@purdue.edu %K TikTok %K social media %K reproductive health %K women's health %K health outcome %K content analysis %K health information %K sexual health %K web-based information %K COVID-19 %K health message %D 2023 %7 13.11.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: TikTok is a popular social media platform that allows users to create and share content through short videos. It has become a place for everyday users, especially Generation Z users, to share experiences about their reproductive health. Owing to its growing popularity and easy accessibility, TikTok can help raise awareness for reproductive health issues as well as help destigmatize these conversations. Objective: We aimed to identify and understand the visual, audio, and written components of content that TikTok users create about their reproductive health experiences. Methods: A sampling framework was implemented to narrow down the analytic data set. The top 6 videos from each targeted hashtag (eg, #BirthControl, #MyBodyMyChoice, and #LoveYourself) were extracted biweekly for 16 weeks (July-November 2020). During data collection, we noted video characteristics such as captioning, music, likes, and cited sources. Qualitative content analysis was performed on the extracted videos. Results: The top videos in each hashtag were consistent over time; for example, only 11 videos appeared in the top 6 category for #BirthControl throughout the data collection. Most videos fell into 2 primary categories: personal experiences and informational content. Among the personal experiences, people shared stories (eg, intrauterine device removal experiences), crafts (eg, painting their pill case), or humor (eg, celebrations of the arrival of their period). Dancing and demonstrations were commonly used in informational content. Conclusions: TikTok is used to share messages on myriad reproductive health topics. Understanding users’ exposure provides important insights into their beliefs and knowledge of sexual and reproductive health. The study findings can be used to generate valuable information for teenagers and young adults, their health care providers, and their communities. Producing health messages that are both meaningful and accessible will contribute to the cocreation of critical health information for professional and personal use. %M 37831780 %R 10.2196/42810 %U https://infodemiology.jmir.org/2023/1/e42810 %U https://doi.org/10.2196/42810 %U http://www.ncbi.nlm.nih.gov/pubmed/37831780 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50304 %T Creating an Intercultural User-Centric Design for a Digital Sexual Health Education App for Young Women in Resource-Poor Regions of Kenya: Qualitative Self-Extended Double Diamond Model for Requirements Engineering Analysis %A Soehnchen,Clarissa %A Rietz,Annika %A Weirauch,Vera %A Meister,Sven %A Henningsen,Maike %+ HealthCare Department, Fraunhofer Institute for Software and System Engineering, Speicherstraße 6, Dortmund, 44147, Germany, 49 2302926, clarissa.soehnchen@uni-wh.de %K sexual health information %K sexual health education %K sub-Saharan Africa %K women %K semistructured interviews %K requirements engineering analysis %K user-centered design %K youth, slum %K health education %K sexual health %K digital health %K stigmatization %K reproductive health services %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The stigmatization around sexual health due to culture, religious traditions, and norms leads to myths and a lack of available information and resources related to universal access to sexual and reproductive health services. Additional sexual health education not being part of the Kenya school curriculum leads to insufficient access to knowledge about safe contraception, menstruation, and female genital mutilation. A digital app could support and provide education and information for universal equal access, addressing United Nations Sustainable Development Goals 3, 4, and 5. Objective: The study targeted the requirements for establishing a reusable framework to develop a successful accessible web-based sexual health education app and the behavioral intention to use it to obtain sexual health information by mainly young women in Kenya. Methods: The double diamond model, with a problem room including the discover and define phases, enriched with cultural aspects and modeled to a self-expanded intercultural research model was used in a user-centered design thinking approach to develop a framework for requirements engineering analysis. For problem identification, semistructured pilot phase interviews based on Consolidated Criteria for Reporting Qualitative Research guidelines were conducted, followed by expert interviews for qualitative content analysis. A sample size of 12 pilot phase interviews and 5 expert interviews was determined using data saturation. The responses were coded and analyzed according to the affinity mapping method. Results: The requirements engineering analysis showed potential enablers of and barriers to the use of a digital sexual health education app. Through this qualitative study, a conservative cultural background, classic text communication, and the influence of social affiliation within society were identified as barriers, which should be enhanced through visual and auditory channels as well as a fictional character in the app. Conclusions: The developed intercultural research model provides an impetus to providing digital sexual health education, integrating culture-specific aspects in the design process, while focusing on cultural and religious stigmata. The reusable framework enables identifying and overcoming hurdles in providing information about taboo and intimate topics. The overall use of online education tools focusing on intimate topics is correlated with accessibility and understanding specific cultural needs while delivering content on a basic and comprehensive level. It helps the target user from a social conservative background and in resource-poor circumstances to benefit from a digital educational solution. %M 37921860 %R 10.2196/50304 %U https://formative.jmir.org/2023/1/e50304 %U https://doi.org/10.2196/50304 %U http://www.ncbi.nlm.nih.gov/pubmed/37921860 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42164 %T Evaluation of Menstrual Cycle Tracking Behaviors in the Ovulation and Menstruation Health Pilot Study: Cross-Sectional Study %A Adnan,Tatheer %A Li,Huichu %A Peer,Komal %A Peebles,Elizabeth %A James,Kaitlyn %A Mahalingaiah,Shruthi %+ Massachusetts General Hospital, 677 Huntington Ave, Boston, MA, 02115, United States, 1 617 432 4381, shruthi@hsph.harvard.edu %K reproductive informatics %K menstrual health tracking apps %K digital epidemiology %K women's health %K mobile health %K mHealth %K gynecology %K health application %K tracking health app %K menstrual health %K reproductive health %D 2023 %7 27.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Menstrual cycle tracking apps (MCTAs) have potential in epidemiological studies of women’s health, facilitating real-time tracking of bleeding days and menstrual-associated signs and symptoms. However, information regarding the characteristics of MCTA users versus cycle nontrackers is limited, which may inform generalizability. Objective: We compared characteristics among individuals using MCTAs (app users), individuals who do not track their cycles (nontrackers), and those who used other forms of menstrual tracking (other trackers). Methods: The Ovulation and Menstruation Health Pilot Study tested the feasibility of a digitally enabled evaluation of menstrual health. Recruitment occurred between September 2017 and March 2018. Menstrual cycle tracking behavior, demographic, and general and reproductive health history data were collected from eligible individuals (females aged 18-45 years, comfortable communicating in English). Menstrual cycle tracking behavior was categorized in 3 ways: menstrual cycle tracking via app usage, that via other methods, and nontracking. Demographic factors, health conditions, and menstrual cycle characteristics were compared across the menstrual tracking method (app users vs nontrackers, app users vs other trackers, and other trackers vs nontrackers) were assessed using chi-square or Fisher exact tests. Results: In total, 263 participants met the eligibility criteria and completed the digital survey. Most of the cohort (n=191, 72.6%) was 18-29 years old, predominantly White (n=170, 64.6%), had attained 4 years of college education or higher (n= 209, 79.5%), and had a household income below US $50,000 (n=123, 46.8%). Among all participants, 103 (39%) were MCTA users (app users), 97 (37%) did not engage in any tracking (nontrackers), and 63 (24%) used other forms of tracking (other trackers). Across all groups, no meaningful differences existed in race and ethnicity, household income, and education level. The proportion of ever-use of hormonal contraceptives was lower (n=74, 71.8% vs n=87, 90%, P=.001), lifetime smoking status was lower (n=6, 6% vs n=15, 17%, P=.04), and diagnosis rate of gastrointestinal reflux disease (GERD) was higher (n=25, 24.3% vs n=12, 12.4%, P=.04) in app users than in nontrackers. The proportions of hormonal contraceptives ever used and lifetime smoking status were both lower (n=74, 71.8% vs n=56, 88.9%, P=.01; n=6, 6% vs n=11, 17.5%, P=.02) in app users than in other trackers. Other trackers had lower proportions of ever-use of hormonal contraceptives (n=130, 78.3% vs n=87, 89.7%, P=.02) and higher diagnostic rates of heartburn or GERD (n=39, 23.5% vs n=12, 12.4%, P.03) and anxiety or panic disorder (n=64, 38.6% vs n=25, 25.8%, P=.04) than nontrackers. Menstrual cycle characteristics did not differ across all groups. Conclusions: Our results suggest that app users, other trackers, and nontrackers are largely comparable in demographic and menstrual cycle characteristics. Future studies should determine reasons for tracking and tracking-related behaviors to further understand whether individuals who use MCTAs are comparable to nontrackers. %M 37889545 %R 10.2196/42164 %U https://www.jmir.org/2023/1/e42164 %U https://doi.org/10.2196/42164 %U http://www.ncbi.nlm.nih.gov/pubmed/37889545 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46852 %T Perinatal Women’s Perspectives of, and Engagement in, Digital Emotional Well-Being Training: Mixed Methods Study %A Davis,Jacqueline A %A Ohan,Jeneva L %A Gregory,Sonia %A Kottampally,Keerthi %A Silva,Desiree %A Prescott,Susan L %A Finlay-Jones,Amy L %+ Telethon Kids Institute, 15 Hospital Avenue, Nedlands, 6009, Australia, 61 478173989, jackie.davis@telethonkids.org.au %K perinatal %K digital mental health interventions %K well-being %K mindfulness %K self-compassion %K engagement %K ORIGINS %D 2023 %7 17.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychological distress in the early postpartum period can have long-lasting deleterious effects on a mother’s well-being and negatively affect her infant’s development. Intervention approaches based in contemplative practices such as mindfulness and loving-kindness and compassion are intended to alleviate distress and cultivate well-being and can be delivered effectively as digital mental health interventions (DMHIs). Objective: To understand the feasibility of engaging perinatal women in digital interventions, this study aimed to document participants’ experiences in the Mums Minds Matter (MMM) study, a pilot randomized controlled trial comparing mindfulness, loving-kindness and compassion, and progressive muscle relaxation training delivered in a digital format and undertaken during pregnancy. To assess the different stages of engagement during and after the intervention, we adapted the connect, attend, participate, enact (CAPE) framework that is based on the idea that individuals go through different stages of engagement before they are able to enact change. Methods: The MMM study was nested within a longitudinal birth cohort, The ORIGINS Project. We aimed to recruit 25 participants per randomization arm. Data were collected sequentially during the intervention through regular web-based surveys over 8 weeks, with opportunities to provide regular feedback. In the postintervention phase, qualitative data were collected through purposive sampling. Results: Of 310 eligible women, 84 (27.1% [connect rate]) enrolled to participate in MMM. Of the remaining 226 women who did not proceed to randomization, 223 (98.7%) failed to complete the baseline surveys and timed out of eligibility (after 30 weeks’ gestation), and 3 (1.3%) displayed high psychological distress scores. Across all program groups, 17 (20% [attend rate]) of the 84 participants actively opted out, although more may have disengaged from the intervention but did not withdraw. The main reasons for withdrawal were busy life and other priorities. In this study, we assessed active engagement and ongoing skills use (participate and enact) through postintervention interviews. We undertook 15 participant interviews, conducted 1 month to 3 months after the intervention. Our results provide insights into participant barriers and enablers as well as app changes, such as the ability to choose topics, daily reminders, case studies, and diversity in sounds. Implementing a DMHI that is brief, includes frequent prompts or nudges, and is easily accessible is a key strategy to target perinatal women. Conclusions: Our research will enable future app designs that are sufficiently nuanced to maximize the uptake, engagement, and application of mental health skills and contemplative practices in the perinatal period. Providing convenient access to engaging and effective prevention programs is critical and should be part of prenatal self-care. Our research underscores the appeal and feasibility of digital intervention approaches based in contemplative practices for perinatal women. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) 12620000672954p; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000672954p International Registered Report Identifier (IRRID): RR2-10.2196/19803 %M 37847537 %R 10.2196/46852 %U https://www.jmir.org/2023/1/e46852 %U https://doi.org/10.2196/46852 %U http://www.ncbi.nlm.nih.gov/pubmed/37847537 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44170 %T Evaluating the Acceptability and Feasibility of a Sexual Health–Focused Contraceptive Decision Aid for Diverse Young Adults: User-Centered Usability Study %A Goueth,Rose %A Darney,Blair %A Hoffman,Aubri %A Eden,Karen B %+ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States, 1 5034944502, gouethr@ochin.org %K decision aid %K contraception %K decision-making %K user-centered design %K young adults %K pilot study %K feasibility %K acceptability %K development %K support %K tool %K survey %K sexual health %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults with low sexual health literacy levels may find it difficult to make informed decisions about contraceptive methods. We developed and pilot-tested a web-based decision aid—Healthy Sex Choices—designed to support diverse young adults with their contraceptive decision-making. Objective: This pilot study aimed to evaluate whether the Healthy Sex Choices decision aid is acceptable and feasible to patients and clinicians. Methods: We used the Ottawa Decision Support Framework and the International Patient Decision Aid Standards to develop and pilot the decision tool. We first conducted a needs assessment with our advisory panel (5 clinicians and 2 patients) that informed decision aid development. All panelists participated in semistructured interviews about their experience with contraceptive counseling. Clinicians also completed a focus group session centered around the development of sex education content for the tool. Before commencing the pilot study, 5 participants from ResearchMatch (Vanderbilt University Medical Center) assessed the tool and suggested improvements. Results: Participants were satisfied with the tool, rating the acceptability as “good.” Interviewees revealed that the tool made contraceptive decision-making easier and would recommend the tool to a family member or friend. Participants had a nonsignificant change in knowledge scores (53% before vs 45% after; P=.99). Overall, decisional conflict scores significantly decreased (16.1 before vs 2.8 after; P<.001) with the informed subscale (patients feeling more informed) having the greatest decline (23.1 vs 4.7; mean difference 19.0, SD 27.1). Subanalyses of contraceptive knowledge and decisional conflict illustrated that participants of color had lower knowledge scores (48% vs 55%) and higher decisional conflict (20.0 vs 14.5) at baseline than their white counterparts. Conclusions: Participants found Healthy Sex Choices to be acceptable and reported reduced decisional conflict after using the tool. The development and pilot phases of this study provided a foundation for creating reproductive health decision aids that acknowledge and provide guidance for diverse patient populations. %M 37788070 %R 10.2196/44170 %U https://formative.jmir.org/2023/1/e44170 %U https://doi.org/10.2196/44170 %U http://www.ncbi.nlm.nih.gov/pubmed/37788070 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45132 %T Implementing Smartphone-Based Telemedicine for Cervical Cancer Screening in Uganda: Qualitative Study of Stakeholders’ Perceptions %A Kabukye,Johnblack K %A Namugga,Jane %A Mpamani,Collins Jackson %A Katumba,Andrew %A Nakatumba-Nabende,Joyce %A Nabuuma,Hanifa %A Musoke,Stephen Senkomago %A Nankya,Esther %A Soomre,Edna %A Nakisige,Carolyn %A Orem,Jackson %+ SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Borgarfjordsgatan 12 (NOD Building), Campus Kista, PO Box 7003 Kista, Stockholm, SE-164 07, Sweden, 46 8 16 20 00, kabukye@dsv.su.se %K telemedicine %K cervical cancer %K screening %K visual inspection with acetic acid %K cervicography %K Uganda %K digital health %D 2023 %7 2.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In Uganda, cervical cancer (CaCx) is the commonest cancer, accounting for 35.7% of all cancer cases in women. The rates of human papillomavirus vaccination and CaCx screening remain low. Digital health tools and interventions have the potential to improve different aspects of CaCx screening and control in Uganda. Objective: This study aimed to describe stakeholders’ perceptions of the telemedicine system we developed to improve CaCx screening in Uganda. Methods: We developed and implemented a smartphone-based telemedicine system for capturing and sharing cervical images and other clinical data, as well as an artificial intelligence model for automatic analysis of images. We conducted focus group discussions with health workers at the screening clinics (n=27) and women undergoing screening (n=15) to explore their perceptions of the system. The focus group discussions were supplemented with field observations and an evaluation survey of the health workers on system usability and the overall project. Results: In general, both patients and health workers had positive opinions about the system. Highlighted benefits included better cervical visualization, the ability to obtain a second opinion, improved communication between nurses and patients (to explain screening findings), improved clinical data management, performance monitoring and feedback, and modernization of screening service. However, there were also some negative perceptions. For example, some health workers felt the system is time-consuming, especially when it had just been introduced, while some patients were apprehensive about cervical image capture and sharing. Finally, commonplace challenges in digital health (eg, lack of interoperability and problems with sustainability) and challenges in cancer screening in general (eg, arduous referrals, inadequate monitoring and quality control) also resurfaced. Conclusions: This study demonstrates the feasibility and value of digital health tools in CaCx screening in Uganda, particularly with regard to improving patient experience and the quality of screening services. It also provides examples of potential limitations that must be addressed for successful implementation. %M 37782541 %R 10.2196/45132 %U https://www.jmir.org/2023/1/e45132 %U https://doi.org/10.2196/45132 %U http://www.ncbi.nlm.nih.gov/pubmed/37782541 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46488 %T Sexuality and Sexual and Reproductive Health Depiction in Social Media: Content Analysis of Kinyarwanda YouTube Channels %A Uhawenimana,Thierry Claudien %A Musabwasoni,Marie Grace Sandra %A Nsengiyumva,Richard %A Mukamana,Donatilla %+ Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, KG 11 Ave, PO Box: 3286, Kigali, Rwanda, 250 788586768, tcuhawenimana@gmail.com %K sexuality %K sexual and reproductive health %K Kinyarwanda YouTube channels %K content analysis %K social media %K media platform %K COVID-19 %D 2023 %7 27.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms such as YouTube can be used to educate people of reproductive age about healthy and nonrisky sexual and reproductive health (SRH) practices and behaviors. However, there is a paucity of evidence to ascertain the authenticity of sexuality and SRH content on Kinyarwanda YouTube, making it difficult to determine the extent to which these topics are covered, the characteristics of available videos, and the themes covered by these videos. Objective: The aims of this study were (1) to determine the extent to which YouTube channels in Kinyarwanda-language videos address sexuality and SRH issues, identify the general characteristics of the available videos (type of video, when published, intention for the audience, and content focus), and the aspects of sexuality and SRH covered; and (2) to identify the themes covered by retrieved Kinyarwanda videos, and the extent to which the channels have been used to communicate issues of sexuality and SRH during the COVID-19 pandemic. Methods: Using a content analysis approach, we searched Kinyarwanda YouTube channels to analyze videos about sexuality and SRH. The adopted framework for data collection from social media platforms builds on three key steps: (1) development, (2) application, and (3) assessment of search filters. To be included, an audio and/or visual video had to be in Kinyarwanda and the video had to be directed to the general public. Descriptive statistics (frequency and percentages) were computed to characterize the basic characteristics of retrieved channels, portrayal of the videos, and presentation of sexuality and SRH themes that emerged from retrieved videos. Further analysis involved cross-tabulations to explore associations between the focus of the channel and the date when the channel was opened and the focus of the channel and who was involved in the video. Results: The YouTube search retrieved 21,506 videos that tackled sexuality and SRH topics. During the COVID-19 pandemic, there was a 4-fold increase (from 7.2% to 30.6%) in channels that solely focused on sexually explicit content. The majority of the 1369 retrieved channels (n=1150, 84.0%) tackled the topic of sexuality, with sexually explicit content predominantly found in the majority of these videos (n=1082, 79%), and only 16% (n=287) of the videos covered SRH topics. Conclusions: This is the first study to analyze the use of YouTube in communicating about sexuality and SRH in the Kinyarwanda language. This study relied on videos that appeared online. Further research should gather information about who accesses the videos, and how channel owners and individuals involved in the videos perceive the impact of their videos on the Rwandan community’s sexuality and SRH. %M 37756040 %R 10.2196/46488 %U https://www.jmir.org/2023/1/e46488 %U https://doi.org/10.2196/46488 %U http://www.ncbi.nlm.nih.gov/pubmed/37756040 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46663 %T Perceptions and Challenges of Telehealth Obstetric Clinics Among Pregnant Women in Hong Kong: Cross-Sectional Questionnaire Study %A Cheung,Ka Wang %A Au,Tiffany Sin-Tung %A Wai,Joan Kar On %A Seto,Mimi Tin-Yan %+ Department of Obstetrics & Gynaecology, The University of Hong Kong, 6/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China (Hong Kong), 852 22554517, kelvincheung82@hotmail.com %K delivery %K digital %K portable electronic applications %K smartphone %K pregnancy %K virtual clinics %K telehealth %K telemedicine %D 2023 %7 19.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Integrating telehealth in an obstetric care model is important to prepare for possible infection outbreaks that require social distancing and limit in-person consultations. To ensure the successful implementation of obstetric telehealth in Hong Kong, it is essential to understand and address pregnant women’s concerns. Objective: This study aimed to assess pregnant women’s attitudes, concerns, and perceptions regarding telehealth obstetric clinic services in Hong Kong. Methods: We conducted a prospective cross-sectional questionnaire study at Queen Mary Hospital between November 2021 and August 2022. Utilizing a 5-point rating scale, the questionnaire aimed to capture pregnant women’s preferences, expectations, feasibility perceptions, and privacy concerns related to telehealth clinic services. We used statistical analyses, including chi-square tests and multinomial logistic regression, to compare questionnaire responses and investigate the association between advancing gestation and attitudes toward telehealth clinics. Results: The study included 664 participants distributed across different pregnancy stages: 269 (40.5%) before 18 gestational weeks, 198 (29.8%) between 24 and 31 weeks, and 197 (29.7%) after delivery. Among them, 49.8% (329/664) favored face-to-face consultations over telehealth clinics, and only 7.3% (48/664) believed the opposite. Additionally, 24.2% (161/664) agreed that telehealth clinics should be launched for obstetric services. However, the overall preference for telehealth clinics was <20% for routine prenatal checkups (81/664, 12.2%) and addressing pregnancy-related concerns, such as vaginal bleeding (76/664, 11.5%), vaginal discharge (128/664, 19.4%), reduced fetal movement (64/664, 9.7%), uterine contractions (62/664, 9.4%), and suspected leakage of amniotic fluid (54/664, 8.2%). Conversely, 76.4% (507/664) preferred telehealth clinics to in-person visits for prenatal education talks, prenatal and postpartum exercise, and addressing breastfeeding problems. Participants were more comfortable with telehealth clinic tasks for tasks like explaining pregnancy exam results (418/664, 63.1%), self-administering urinary dipsticks at home (373/664, 56.4%), medical history-taking (341/664, 51.5%), and self-monitoring blood pressure using an electronic machine (282/664, 42.8%). %). During the postpartum period, compared to before 18 weeks of gestation, significantly more participants agreed that telehealth clinics could be an option for assessing physical symptoms such as vaginal bleeding (aOR 2.105, 95% CI 1.448-3.059), reduced fetal movement (aOR 1.575, 95% CI 1.058-2.345), uterine contractions (aOR 2.906, 95% CI 1.945-4.342), suspected leakage of amniotic fluid (aOR 2.609, 95% CI 1.721-3.954), fever (aOR 1.526, 95% CI 1.109-2.100), and flu-like symptoms (aOR 1.412, 95% CI 1.030-1.936). They were also more confident with measuring the symphysis-fundal height, arranging further investigations, and making diagnoses with the doctor via the telehealth clinic. The main perceived public health advantage of telehealth clinics was the shorter traveling and waiting time (526/664, 79.2%), while the main concern was legal issues from wrong diagnosis and treatment (511/664, 77.4%). Conclusions: Face-to-face consultation remained the preferred mode of consultation among the participants. However, telehealth clinics could be an alternative for services that do not require physical examination or contact. An increased acceptance of and confidence in telehealth was found with advancing gestation and after delivery. Enforcing stricter laws and guidelines could facilitate the implementation of telehealth clinics and increase confidence in their use among pregnant women for obstetric care. %M 37725425 %R 10.2196/46663 %U https://www.jmir.org/2023/1/e46663 %U https://doi.org/10.2196/46663 %U http://www.ncbi.nlm.nih.gov/pubmed/37725425 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42686 %T Changes in Intrapersonal Factors of Participants in the Pregnancy Remote Monitoring Study Who Are at Risk for Pregnancy-Induced Hypertension: Descriptive Quantitative Study %A Lanssens,Dorien %A Vandenberk,Thijs %A Storms,Valerie %A Thijs,Inge %A Grieten,Lars %A Bamelis,Lotte %A Gyselaers,Wilfried %A Tang,Eileen %A Luyten,Patrick %+ Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt, 3500, Belgium, 32 494919476, dorien.lanssens@uhasselt.be %K intrapersonal factors %K peripartum period %K pregnancy %K pregnancy-induced hypertension %K remote monitoring %D 2023 %7 6.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The peripartum period, defined as the period from the beginning of the gestation until 1 year after the delivery, has long been shown to be potentially associated with increased levels of stress and anxiety with regard to one’s transition to the status of parent and the accompanying parental tasks. Yet, no research to date has investigated changes in intrapersonal factors during the peripartum period in women at risk for pregnancy-induced hypertension (PIH). Objective: The aim of this study is to explore and describe changes in intrapersonal factors in participants at risk for PIH. Methods: We used an explorative design in which 3 questionnaires were sent by email to 110 participants the day following enrollment in the Pregnancy Remote Monitoring program for pregnant women at risk for PIH. Women were invited to complete the questionnaires at the beginning of their participation in the Pregnancy Remote Monitoring project (mostly at 14 weeks of gestation) and after approaching 32 weeks of gestational age (GA). The Generalized Anxiety Disorder-7 Scale (GAD-7) and the Patient Health Questionnaire-9 were used to assess anxiety and depression, and adaptation of the Pain Catastrophizing Scale was used to measure trait pain catastrophizing. Results: Scores were significantly higher at 32 weeks of GA than at the moment of enrollment (GAD-7 score=7, range 4-11 vs 5, range 3-8; P=.01; and Patient Health Questionnaire-9 score=6, range 4-10 vs 4, range 2-7; P<.001). The subscale scores of the Pain Catastrophizing Scale were all lower at 32 weeks of GA compared with 14 weeks of GA (rumination: 4, range 1-6 vs 5, range 2-9.5; P=.11; magnification: 3, range 1-5.5 vs 4, range 3-7; P=.04; and helplessness: 5, range 2-9 vs 6, range 3.5-12; P=.06). The proportion of women with a risk for depression (GAD-7 score >10) was 13.3% (10/75) at enrollment and had increased to 35.6% (26/75) at 32 weeks of GA. Conclusions: This study shows that pregnant women at risk for PIH have higher levels of stress and anxiety at 32 weeks of GA than at the moment of enrollment. Further research is recommended to investigate potential strategies to help pregnant women at risk for PIH manage feelings of stress and anxiety. Trial Registration: ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/study/NCT03246737 %M 37672324 %R 10.2196/42686 %U https://www.jmir.org/2023/1/e42686 %U https://doi.org/10.2196/42686 %U http://www.ncbi.nlm.nih.gov/pubmed/37672324 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43995 %T Using Clinician-Patient WeChat Group Communication Data to Identify Symptom Burdens in Patients With Uterine Fibroids Under Focused Ultrasound Ablation Surgery Treatment: Qualitative Study %A Zhang,Jiayuan %A Xu,Wei %A Lei,Cheng %A Pu,Yang %A Zhang,Yubo %A Zhang,Jingyu %A Yu,Hongfan %A Su,Xueyao %A Huang,Yanyan %A Gong,Ruoyan %A Zhang,Lijun %A Shi,Qiuling %+ School of Public Health, Chongqing Medical University, No 1, Medical College Road, Yuzhong District, Chongqing, 400016, China, 86 18290585397, qshi@cqmu.edu.cn %K social media %K group chats %K text mining %K free texts %K symptom burdens %K WeChat %K natural language processing %K NLP %D 2023 %7 1.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Unlike research project–based health data collection (questionnaires and interviews), social media platforms allow patients to freely discuss their health status and obtain peer support. Previous literature has pointed out that both public and private social platforms can serve as data sources for analysis. Objective: This study aimed to use natural language processing (NLP) techniques to identify concerns regarding the postoperative quality of life and symptom burdens in patients with uterine fibroids after focused ultrasound ablation surgery. Methods: Screenshots taken from clinician-patient WeChat groups were converted into free texts using image text recognition technology and used as the research object of this study. From 408 patients diagnosed with uterine fibroids in Chongqing Haifu Hospital between 2010 and 2020, we searched for symptom burdens in over 900,000 words of WeChat group chats. We first built a corpus of symptoms by manually coding 30% of the WeChat texts and then used regular expressions in Python to crawl symptom information from the remaining texts based on this corpus. We compared the results with a manual review (gold standard) of the same records. Finally, we analyzed the relationship between the population baseline data and conceptual symptoms; quantitative and qualitative results were examined. Results: A total of 408 patients with uterine fibroids were included in the study; 190,000 words of free text were obtained after data cleaning. The mean age of the patients was 39.94 (SD 6.81) years, and their mean BMI was 22.18 (SD 2.78) kg/m2. The median reporting times of the 7 major symptoms were 21, 26, 57, 2, 18, 30, and 49 days. Logistic regression models identified preoperative menstrual duration (odds ratio [OR] 1.14, 95% CI 5.86-6.37; P=.009), age of menophania (OR –1.02 , 95% CI 11.96-13.47; P=.03), and the number (OR 2.34, 95% CI 1.45-1.83; P=.04) and size of fibroids (OR 0.12, 95% CI 2.43-3.51; P=.04) as significant risk factors for postoperative symptoms. Conclusions: Unstructured free texts from social media platforms extracted by NLP technology can be used for analysis. By extracting the conceptual information about patients’ health-related quality of life, we can adopt personalized treatment for patients at different stages of recovery to improve their quality of life. Python-based text mining of free-text data can accurately extract symptom burden and save considerable time compared to manual review, maximizing the utility of the extant information in population-based electronic health records for comparative effectiveness research. %M 37656501 %R 10.2196/43995 %U https://formative.jmir.org/2023/1/e43995 %U https://doi.org/10.2196/43995 %U http://www.ncbi.nlm.nih.gov/pubmed/37656501 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46346 %T Assessing the Readability of Online Patient Education Materials in Obstetrics and Gynecology Using Traditional Measures: Comparative Analysis and Limitations %A Nattam,Anunita %A Vithala,Tripura %A Wu,Tzu-Chun %A Bindhu,Shwetha %A Bond,Gregory %A Liu,Hexuan %A Thompson,Amy %A Wu,Danny T Y %+ Department of Computer Science, University of Cincinnati, 2610 University Circle, Cincinnati, OH, 45221, United States, 1 5135564307, wutz@ucmail.uc.edu %K obstetrics and gynecology %K online patient education materials %K readability %K online education %K education %K health literacy %K literature %K medical documents %K tool %K utilization %K online content %K health education %K education material %K assessment %K obstetrics %K gynecology %D 2023 %7 30.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient education materials (PEMs) can be vital sources of information for the general population. However, despite American Medical Association (AMA) and National Institutes of Health (NIH) recommendations to make PEMs easier to read for patients with low health literacy, they often do not adhere to these recommendations. The readability of online PEMs in the obstetrics and gynecology (OB/GYN) field, in particular, has not been thoroughly investigated. Objective: The study sampled online OB/GYN PEMs and aimed to examine (1) agreeability across traditional readability measures (TRMs), (2) adherence of online PEMs to AMA and NIH recommendations, and (3) whether the readability level of online PEMs varied by web-based source and medical topic. This study is not a scoping review, rather, it focused on scoring the readability of OB/GYN PEMs using the traditional measures to add empirical evidence to the literature. Methods: A total of 1576 online OB/GYN PEMs were collected via 3 major search engines. In total 93 were excluded due to shorter content (less than 100 words), yielding 1483 PEMs for analysis. Each PEM was scored by 4 TRMs, including Flesch-Kincaid grade level, Gunning fog index, Simple Measure of Gobbledygook, and the Dale-Chall. The PEMs were categorized based on publication source and medical topic by 2 research team members. The readability scores of the categories were compared statistically. Results: Results indicated that the 4 TRMs did not agree with each other, leading to the use of an averaged readability (composite) score for comparison. The composite scores across all online PEMs were not normally distributed and had a median at the 11th grade. Governmental PEMs were the easiest to read amongst source categorizations and PEMs about menstruation were the most difficult to read. However, the differences in the readability scores among the sources and the topics were small. Conclusions: This study found that online OB/GYN PEMs did not meet the AMA and NIH readability recommendations and would be difficult to read and comprehend for patients with low health literacy. Both findings connected well to the literature. This study highlights the need to improve the readability of OB/GYN PEMs to help patients make informed decisions. Research has been done to create more sophisticated readability measures for medical and health documents. Once validated, these tools need to be used by web-based content creators of health education materials. %M 37647115 %R 10.2196/46346 %U https://www.jmir.org/2023/1/e46346 %U https://doi.org/10.2196/46346 %U http://www.ncbi.nlm.nih.gov/pubmed/37647115 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42559 %T Telephone-Based Intervention to Improve Family Planning Care in Pregnancies of Unknown Location: Retrospective Pre-Post Study %A Flynn,Anne Nichols %A Koelper,Nathanael C %A Sonalkar,Sarita %+ University of California, Davis, 4860 Y St, Sacramento, CA, 95817, United States, 1 916 734 6900, aenflynn@ucdavis.edu %K contraception %K electronic medical record %K family planning %K pregnancy intendedness %K pregnancy of unknown location %K pre-post study %K telephone-based intervention %D 2023 %7 28.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients followed for a pregnancy of unknown location are generally followed by a team of clinicians through telephone calls, and their contraceptive needs at the time of pregnancy resolution may not be addressed. Objective: This study aimed to assess contraceptive counseling and contraceptive uptake before and after a telephone-based intervention. Methods: This was a retrospective pre-post study assessing pregnancy intendedness in patients with a pregnancy of unknown location and the proportion of patients who received contraceptive counseling and a contraceptive prescription before and after the initiation of a telephone-based intervention. We reviewed medical records 1 year before and 1 year after implementation of our intervention for demographic characteristics, pregnancy intendedness, pregnancy outcome, contraceptive counseling documentation, receipt of contraception, and repeat pregnancy within 6 months. We assessed the effects of an implementation strategy to address family planning needs once pregnancy was resolved by comparing the proportions of patients who were counseled and received contraception before and after our intervention was implemented. We performed logistic regression to identify associations between covariates and the outcomes of contraceptive counseling documentation and receipt of contraception. Results: Of the 220 patients in the combined cohort, the majority were Black (161/220, 73%) and ultimately had a resolved pregnancy of unknown location (162/220, 74%), and the proportion of pregnancies documented as unintended was 60% (132/220). Before our intervention, 27 of 100 (27%) patients received contraceptive counseling, compared with 94 of 120 (78%) patients after the intervention (odds ratio [OR] 9.77, 95% CI 5.26-18.16). Before the intervention, 17 of 90 (19%) patients who did not desire repeat pregnancy received contraception, compared with 32 of 86 (37%) patients after the intervention (OR 2.54, 95% CI 1.28-5.05). Our postintervention cohort had an increased odds of receiving contraceptive counseling (OR 9.77, 95% CI 5.26-18.16) and of receiving a contraceptive prescription (OR 2.54, 95% CI 1.28-5.05) compared with our preintervention cohort. Conclusions: We found that over half of patients with a pregnancy of unknown location have an unintended pregnancy, and standardization of care through a telephone-based intervention improves contraceptive counseling and prescribing in patients with a resolved pregnancy of unknown location. This intervention could be used at any institution that follows patients with a pregnancy of unknown location remotely to improve care. %M 37639302 %R 10.2196/42559 %U https://www.jmir.org/2023/1/e42559 %U https://doi.org/10.2196/42559 %U http://www.ncbi.nlm.nih.gov/pubmed/37639302 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43837 %T Novel At-Home Mother’s Milk Conductivity Sensing Technology as an Identification System of Delay in Milk Secretory Activation Progress and Early Breastfeeding Problems: Feasibility Assessment %A Haramati,Sharon %A Firsow,Anastasia %A Navarro,Daniela Abigail %A Shechter,Ravid %+ MyMilk Laboratories Ltd, Glil Yam, Kibbutz, Glil Yam, 4690500, Israel, 972 526166705, shechter.ravid@gmail.com %K breastfeeding %K feasibility %K human milk %K biomarker %K remote sensing technology %K mobile health %K retrospective %K secretory activation %K lactogenesis %K milk supply %K milk %K sensing technology %K monitoring tool %K lactation %K exclusive breastfeeding %K breastfeed %K maternal health %K maternal and infant health %K infant health %K maternal and child health %K prolactin %K lactation consultant %K lactation support provider %K mother %K milk maturation %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prolonged exclusive breastfeeding is a public health priority and a personal desire by mothers; however, rates are low with milk supply challenges as a predominant cause. Early breastfeeding management at home is key. Milk electrolytes, mainly sodium ions, are accepted as biomarkers of secretory activation processes throughout the first weeks after birth and predictors for prolonged breastfeeding success, although they are not incorporated into routine care practice. Objective: The aim of this study was to test the feasibility of a novel handheld smartphone-operated milk conductivity sensing system that was designed to compute a novel parameter, milk maturation percent (MM%), calculated from milk sample conductivity for tracking individual secretory activation progress in a real-world home setting. Methods: System performance was initially evaluated in data collected from laboratory-based milk analysis, followed by a retrospective analysis of observational real-world data gathered with the system, on the spot in an at-home setting, implemented by lactation support providers or directly by mothers (N=592). Data collected included milk sample sensing data, baby age, and self-reported breastfeeding status and breastfeeding-related conditions. The data were retroactively classified in a day after birth–dependent manner. Results were compared between groups classified according to breastfeeding exclusivity and breastfeeding problems associated with ineffective breastfeeding and low milk supply. Results: Laboratory analysis in a set of breast milk samples demonstrated a strong correlation between the system’s results and sodium ion levels. In the real-world data set, a total of 1511 milk sensing records were obtained on the spot with over 592 real-world mothers. Data gathered with the system revealed a typical time-dependent increase in the milk maturation parameter (MM%), characterized by an initial steep increase, followed by a moderate increase, and reaching a plateau during the first weeks postpartum. Additionally, MM% levels captured by the system were found to be sensitive to breastfeeding status classifications of exclusive breastfeeding and breastfeeding problems, manifested by differences in group means in the several-day range after birth, predominantly during the first weeks postpartum. Differences could also be demonstrated for the per-case time after birth–dependent progress in individual mothers. Conclusions: This feasibility study demonstrates that the use of smart milk conductivity sensing technology can provide a robust, objective measure of individual breastfeeding efficiency, facilitating remote data collection within a home setting. This system holds considerable potential to augment both self-monitoring and remote breastfeeding management capabilities, as well as to refine clinical classifications. To further validate the clinical relevance and potential of this home milk monitoring tool, future controlled clinical studies are necessary, which will provide insights into its impact on user and care provider satisfaction and its potential to meet breastfeeding success goals. %M 37464893 %R 10.2196/43837 %U https://pediatrics.jmir.org/2023/1/e43837 %U https://doi.org/10.2196/43837 %U http://www.ncbi.nlm.nih.gov/pubmed/37464893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45381 %T Users’ Concerns About Endometriosis on Social Media: Sentiment Analysis and Topic Modeling Study %A Goel,Rahul %A Modhukur,Vijayachitra %A Täär,Katrin %A Salumets,Andres %A Sharma,Rajesh %A Peters,Maire %+ Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, Tartu, 50406, Estonia, 372 7330401, maire.peters@ut.ee %K endometriosis %K latent Dirichlet allocation %K pain %K Reddit %K sentiment analysis %K social media %K surgery %K topic modeling %K user engagement %D 2023 %7 15.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Endometriosis is a debilitating and difficult-to-diagnose gynecological disease. Owing to limited information and awareness, women often rely on social media platforms as a support system to engage in discussions regarding their disease-related concerns. Objective: This study aimed to apply computational techniques to social media posts to identify discussion topics about endometriosis and to identify themes that require more attention from health care professionals and researchers. We also aimed to explore whether, amid the challenging nature of the disease, there are themes within the endometriosis community that gather posts with positive sentiments. Methods: We retrospectively extracted posts from the subreddits r/Endo and r/endometriosis from January 2011 to April 2022. We analyzed 45,693 Reddit posts using sentiment analysis and topic modeling–based methods in machine learning. Results: Since 2011, the number of posts and comments has increased steadily. The posts were categorized into 11 categories, and the highest number of posts were related to either asking for information (Question); sharing the experiences (Rant/Vent); or diagnosing and treating endometriosis, especially surgery (Surgery related). Sentiment analysis revealed that 92.09% (42,077/45,693) of posts were associated with negative sentiments, only 2.3% (1053/45,693) expressed positive feelings, and there were no categories with more positive than negative posts. Topic modeling revealed 27 major topics, and the most popular topics were Surgery, Questions/Advice, Diagnosis, and Pain. The Survey/Research topic, which brought together most research-related posts, was the last in terms of posts. Conclusions: Our study shows that posts on social media platforms can provide insights into the concerns of women with endometriosis symptoms. The analysis of the posts confirmed that women with endometriosis have to face negative emotions and pain daily. The large number of posts related to asking questions shows that women do not receive sufficient information from physicians and need community support to cope with the disease. Health care professionals should pay more attention to the symptoms and diagnosis of endometriosis, discuss these topics with patients to reduce their dissatisfaction with doctors, and contribute more to the overall well-being of women with endometriosis. Researchers should also become more involved in social media and share new science-based knowledge regarding endometriosis. %M 37581905 %R 10.2196/45381 %U https://www.jmir.org/2023/1/e45381 %U https://doi.org/10.2196/45381 %U http://www.ncbi.nlm.nih.gov/pubmed/37581905 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45054 %T A Web-Based Sexual Health Intervention to Prevent Sexually Transmitted Infections in Hong Kong: Model-Based Cost-Effectiveness Analysis %A Zhang,Wen %A Wong,Carlos K H %A Xin,Yiqiao %A Fong,Daniel Y T %A Wong,Janet Y H %+ School of Nursing and Health Studies, Hong Kong Metropolitan University, 11/F, Jockey Club Institute of Healthcare, 1 Sheung Shing Street, Ho Man Tin, Kowloon, Hong Kong, China (Hong Kong), 852 3970 2988, jyhwong@hkmu.edu.hk %K economic evaluation %K web-based intervention %K young adult %K cost-effectiveness %K sexual health %K sexually transmitted infection %K STI %K digital intervention %D 2023 %7 10.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexually transmitted infections (STIs) remain a significant public health concern, particularly among young adults, and Chlamydia trachomatis (CT) infections are the most common STIs in young women. One of the most effective ways to prevent STIs is the consistent use of condoms during sexual intercourse. There has been no economic evaluation of the interactive web-based sexual health program, Smart Girlfriend, within the Chinese population. Objective: This study aimed to evaluate the long-term cost-effectiveness of Smart Girlfriend in preventing STIs in the Chinese population. The evaluation compared the program with a control intervention that used a 1-page information sheet on condom use. Methods: A decision-analytic model that included a decision tree followed by a Markov structure of CT infections was developed since CT is the most prevalent STI among young women. The model represents the long-term experience of individuals who received either the intervention or the control. One-way and probabilistic sensitivity analyses were conducted. The main outcomes were the number of CT infections and the incremental cost as per quality-adjusted life year (QALY). Results: A cohort of 10,000 sexually active nonpregnant young women initially entered the model in a noninfectious state (ie, “well”). In the base-case analysis, the implementation of the Smart Girlfriend program resulted in the prevention of 0.45% of CT infections, 0.3% of pelvic inflammatory disease, and 0.04% of chronic pelvic pain, leading to a gain of 70 discounted QALYs and cost savings over a 4-year time horizon, compared to the control group. With more than 4548 users, the intervention would be cost-effective, and with more than 8315 users, the intervention would be cost saving. A 99% probability of being cost-effective was detected with a willingness to pay US $17,409 per QALY. Conclusions: Smart Girlfriend is a cost-effective and possibly cost-saving program over a 4-year time horizon. This result was particularly sensitive to the number of website users; launching the website would be cost-effective if more than 4548 people used it. Further work is warranted to explore if the findings could be expanded to apply to women who have sex with women and in the context of other STIs. Trial Registration: ClinicalTrial.gov NCT03695679; https://clinicaltrials.gov/study/NCT03695679 %M 37561571 %R 10.2196/45054 %U https://www.jmir.org/2023/1/e45054 %U https://doi.org/10.2196/45054 %U http://www.ncbi.nlm.nih.gov/pubmed/37561571 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46761 %T Chatbots to Improve Sexual and Reproductive Health: Realist Synthesis %A Mills,Rhiana %A Mangone,Emily Rose %A Lesh,Neal %A Mohan,Diwakar %A Baraitser,Paula %+ SH24, 35A Westminster Bridge Road, London, SE1 7JB, United Kingdom, 44 7742932445, rhiana@sh24.org.uk %K chatbot %K sexual and reproductive health %K realist synthesis %K social networks %K service networks %K disclosure %K artificial intelligence %K sexual %K reproductive %K social media %K counseling %K treatment %K development %K theory %K digital device %K device %D 2023 %7 9.8.2023 %9 Review %J J Med Internet Res %G English %X Background: Digital technologies may improve sexual and reproductive health (SRH) across diverse settings. Chatbots are computer programs designed to simulate human conversation, and there is a growing interest in the potential for chatbots to provide responsive and accurate information, counseling, linkages to products and services, or a companion on an SRH journey. Objective: This review aimed to identify assumptions about the value of chatbots for SRH and collate the evidence to support them. Methods: We used a realist approach that starts with an initial program theory and generates causal explanations in the form of context, mechanism, and outcome configurations to test and develop that theory. We generated our program theory, drawing on the expertise of the research team, and then searched the literature to add depth and develop this theory with evidence. Results: The evidence supports our program theory, which suggests that chatbots are a promising intervention for SRH information and service delivery. This is because chatbots offer anonymous and nonjudgmental interactions that encourage disclosure of personal information, provide complex information in a responsive and conversational tone that increases understanding, link to SRH conversations within web-based and offline social networks, provide immediate support or service provision 24/7 by automating some tasks, and provide the potential to develop long-term relationships with users who return over time. However, chatbots may be less valuable where people find any conversation about SRH (even with a chatbot) stigmatizing, for those who lack confidential access to digital devices, where conversations do not feel natural, and where chatbots are developed as stand-alone interventions without reference to service contexts. Conclusions: Chatbots in SRH could be developed further to automate simple tasks and support service delivery. They should prioritize achieving an authentic conversational tone, which could be developed to facilitate content sharing in social networks, should support long-term relationship building with their users, and should be integrated into wider service networks. %M 37556194 %R 10.2196/46761 %U https://www.jmir.org/2023/1/e46761 %U https://doi.org/10.2196/46761 %U http://www.ncbi.nlm.nih.gov/pubmed/37556194 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e38706 %T A Health App for Evidence-Based Postpartum Information: Development and Validation Study %A Silva de Medeiros,Máyra Cármem %A de Oliveira,Maiara Costa %A Gurgel,Leonandro Valério Barbosa %A Ribeiro Rodrigues,Anna Giselle Câmara Dantas %A Micussi,Maria Thereza Albuquerque Barbosa Cabral %A Magalhães,Adriana Gomes %+ Faculty of Health Sciences, Universidade Federal do Rio Grande do Norte, R. Passos de Miranda, Santa Cruz, RN, 59200-000, Brazil, 55 (84) 3291 2411, mayracmed@gmail.com %K women's health %K postpartum period %K comprehensive health care %K health technology %K mobile applications %D 2023 %7 13.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: After childbirth, women undergo substantial physical and emotional changes. Therefore, it is important to provide them with information that helps them identify what is expected during this stage, as well as signs and symptoms that indicate complications after they have been discharged from the hospital. Objective: This study aimed to develop a health app—Towards Motherhood—that provides evidence-based information about the postpartum period and evaluate the usability of the app with the target population. Methods: This was a validation study involving 80 participants, including 24 professionals from the obstetric health field, 15 professionals from the technology field, and 41 postpartum women. The app was developed using React Native technology. Health professionals evaluated the app’s content using the Content Validity Index, technology professionals completed a validated evaluation to assess the appearance of the app, and postpartum women completed the System Usability Scale (SUS) to measure the usability of the app. Results: The measurement of content validity using a Likert scale obtained an approval score of 99%. Regarding the app’s appearance, 92% of responses were positive, reflecting favorable approval. The SUS usability score was 86.2, which represents excellent acceptance. Conclusions: The Towards Motherhood mobile app is a valid tool for promoting self-care during the postpartum period. The app’s evidence-based information, user-friendly design, and high usability make it an essential resource for women during this critical stage of their live. %M 37440288 %R 10.2196/38706 %U https://humanfactors.jmir.org/2023/1/e38706 %U https://doi.org/10.2196/38706 %U http://www.ncbi.nlm.nih.gov/pubmed/37440288 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46342 %T Exploring Language Used in Posts on r/birthcontrol: Case Study Using Data From Reddit Posts and Natural Language Processing to Advance Contraception Research %A Pleasants,Elizabeth %A Ryan,Julia Holmes %A Ren,Cheng %A Prata,Ndola %A Gomez,Anu Manchikanti %A Marshall,Cassondra %+ School of Public Health, University of California, 2121 Berkeley Way West, Berkeley, CA, 94704, United States, 1 9197248993, b_pleasants@berkeley.edu %K contraception %K big data %K Reddit %K social networking site %K contraceptive side effects %K natural language processing %K reproductive autonomy %D 2023 %7 30.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Contraceptive choice is central to reproductive autonomy. The internet, including social networking sites like Reddit, is an important resource for people seeking contraceptive information and support. A subreddit dedicated to contraception, r/birthcontrol, provides a platform for people to post about contraception. Objective: This study explored the use of r/birthcontrol, from the inception of the subreddit through the end of 2020. We describe the web-based community, identify distinctive interests and themes based upon the textual content of posts, and explore the content of posts with the most user engagement (ie, “popular” posts). Methods: Data were obtained from the PushShift Reddit application programming interface from the establishment of r/birthcontrol to the start date of analysis (July 21, 2011, to December 31, 2020). User interactions within the subreddit were analyzed to describe community use over time, specifically the commonality of use based on the volume of posts, the length of posts (character count), and the proportion of posts with any and each flair applied. “Popular” posts on r/birthcontrol were determined based on the number of comments and “scores,” or upvotes minus downvotes; popular posts had 9 comments and a score of ≥3. Term Frequency-Inverse Document Frequency (TF-IDF) analyses were run on all posts with flairs applied, posts within each flair group, and popular posts within each flair group to characterize and compare the distinctive language used in each group. Results: There were 105,485 posts to r/birthcontrol during the study period, with the volume of posts increasing over time. Within the time frame for which flairs were available on r/birthcontrol (after February 4, 2016), users applied flairs to 78% (n=73,426) of posts. Most posts contained exclusively textual content (n=66,071, 96%), had comments (n=59,189, 86%), and had a score (n=66,071, 96%). Posts averaged 731 characters in length (median 555). “SideEffects!?” was the most frequently used flair overall (n=27,530, 40%), while “Experience” (n=719, 31%) and “SideEffects!?” (n=672, 29%) were most common among popular posts. TF-IDF analyses of all posts showed interest in contraceptive methods, menstrual experiences, timing, feelings, and unprotected sex. While TF-IDF results for posts with each flair varied, the contraceptive pill, menstrual experiences, and timing were discussed across flair groups. Among popular posts, intrauterine devices and contraceptive use experiences were often discussed. Conclusions: People commonly wrote about contraceptive side effects and experiences using methods, highlighting the value of r/birthcontrol as a space to post about aspects of contraceptive use that are not well addressed by clinical contraceptive counseling. The value of real-time, open-access data on contraceptive users’ interests is especially high given the shifting landscape of and increasing constraints on reproductive health care in the United States. %M 37389907 %R 10.2196/46342 %U https://www.jmir.org/2023/1/e46342 %U https://doi.org/10.2196/46342 %U http://www.ncbi.nlm.nih.gov/pubmed/37389907 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47869 %T Pain Reduction With an Immersive Digital Therapeutic in Women Living With Endometriosis-Related Pelvic Pain: At-Home Self-Administered Randomized Controlled Trial %A Merlot,Benjamin %A Elie,Valéry %A Périgord,Adrien %A Husson,Zoé %A Jubert,Amandine %A Chanavaz-Lacheray,Isabella %A Dennis,Thomas %A Cotty-Eslous,Maryne %A Roman,Horace %+ Lucine, 223 rue Emile Counord, Bordeaux, 33300, France, 33 636226605, valery.elie@lucine.care %K randomized controlled trial %K virtual reality %K digital therapeutics %K digital health %K endometriosis %K chronic pain %K pelvic pain %K women's health %K digital health intervention %K patient outcome %D 2023 %7 28.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The management of chronic pelvic pain in women with endometriosis is complex and includes the long-term use of opioids. Patients not fully responsive to drugs or ineligible for surgical treatments need efficient alternatives to improve their quality of life and avoid long-term sequelae. Objective: This randomized controlled trial aimed to assess the effects of repeated at-home administrations of a 20-minute virtual reality (VR) solution (Endocare) compared with a sham condition on pain in women experiencing pelvic pain due to endometriosis. Methods: Patients were instructed to use the VR headsets twice daily for at least 2 days and for up to 5 days starting on their first day of painful periods. Pain perception was measured using a numerical scale (0-10) before and 60, 120, and 180 minutes after each treatment administration. General pain, stress, fatigue, medication intake, and quality of life were reported daily by patients. Results: A total of 102 patients with endometriosis were included in the final analysis (Endocare group: n=51, 50%; sham group: n=51, 50%). The mean age was 32.88 years (SD 6.96) and the mean pain intensity before treatment was 6.53 (SD 1.74) and 6.22 (SD 1.69) for the Endocare group and the sham control group, respectively (P=.48). Pain intensity decreased in both groups from day 1 to day 5 along with a decrease in medication use. Maximum pain intensity reduction of 51.58% (SD 35.33) occurred at day 2, 120 minutes after treatment for the Endocare group and of 27.37% (SD 27.23) at day 3, 180 minutes after treatment for the control group. Endocare was significantly superior to the sham on day 1 (120 minutes, P=.04; 180 minutes, P=.001), day 2 (0 minutes, P=.02; 60, 120, and 180 minutes, all P<.001), and day 3 (60 minutes, P=.01; 120 minutes, P=.005; 180 minutes, P=.001). Similarly, the mean perceived pain relief was significantly higher with Endocare on day 1 (120 and 180 minutes P=.004 and P=.001, respectively) and day 2 (60, 120, and 180 minutes P=.003, P=.004, and P=.007, respectively) compared to the control. No adverse event was reported. Conclusions: This study confirmed the effectiveness and safety of self-repeated administrations of a VR immersive treatment used at home while reducing overall pain medication intake in women diagnosed with endometriosis experiencing moderate-to-severe pelvic pain. Trial Registration: ClinicalTrials.gov NCT05172492; https://clinicaltrials.gov/ct2/show/NCT05172492 %M 37260160 %R 10.2196/47869 %U https://www.jmir.org/2023/1/e47869 %U https://doi.org/10.2196/47869 %U http://www.ncbi.nlm.nih.gov/pubmed/37260160 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43528 %T Effect of a Mobile App–Based Urinary Incontinence Self-Management Intervention Among Pregnant Women in China: Pragmatic Randomized Controlled Trial %A Chen,Ling %A Zhang,Danli %A Li,Tiantian %A Liu,Sha %A Hua,Jie %A Cai,Wenzhi %+ Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoán District Shenzhen, Guangdong, Shenzhen, 518101, China, 86 13078484316, caiwzh@smu.edu.cn %K mobile health %K mHealth %K mobile apps %K urinary incontinence %K pregnancy %K pragmatic randomized controlled trial %K mobile phone %D 2023 %7 27.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Urinary incontinence (UI) is a highly prevalent health concern commonly observed during and after pregnancy that can substantially impact women’s physical and psychological well-being and quality of life. Owing to its numerous advantages, mobile health may be a promising solution; however, it is unclear whether the app-based intervention can effectively improve UI symptoms during and after pregnancy. Objective: This study aimed to evaluate the effectiveness of the Urinary Incontinence for Women (UIW) app–based intervention for UI symptom improvement among pregnant women in China. Methods: Singleton pregnant women without incontinence before pregnancy who were aged ≥18 years and between 24 and 28 weeks of gestation were recruited from a tertiary public hospital in China and were randomly allocated (1:1) to either an experimental group (n=63) or a control group (n=63). The experimental group received the UIW app intervention and oral pelvic floor muscle training (PFMT) instructions, whereas the control group received oral PFMT instructions alone. Neither the participants nor the researchers were blinded to the intervention. The primary outcome was UI severity. The secondary outcomes included quality of life, self-efficacy with PFMT, and knowledge of UI. All data were collected at baseline, 2 months after randomization, and 6 weeks post partum through electronic questionnaires or by checking the electronic medical record system. Data analysis followed the intention-to-treat principle. A linear mixed model was used to examine the intervention effect on primary and secondary outcomes. Results: Participants in the experimental and control groups were comparable at baseline. Of the 126 overall participants, 117 (92.9%) and 103 (81.7%) women completed follow-up visits at 2 months after randomization and 6 weeks after delivery, respectively. A statistically significant difference in UI symptom severity was observed between the experimental group and control group (2 months after randomization: mean difference −2.86, 95% CI −4.09 to −1.64, P<.001; 6 weeks post partum: mean difference −2.68, 95% CI −3.87 to −1.49, P<.001). For the secondary outcomes, a statistically significant intervention effect on the quality of life, self-efficacy, and UI knowledge was found at the 2-month follow-up (all P<.05) and 6 weeks post partum (all P<.001). Conclusions: The app-based UI self-management intervention (UIW) effectively improved UI symptom severity, quality of life, self-efficacy with PFMT, and knowledge of UI during the late pregnancy and early postnatal periods. Larger multicenter studies with a longer postpartum follow-up are required to further extend these findings. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455 International Registered Report Identifier (IRRID): RR2-10.2196/22771 %M 37368465 %R 10.2196/43528 %U https://www.jmir.org/2023/1/e43528 %U https://doi.org/10.2196/43528 %U http://www.ncbi.nlm.nih.gov/pubmed/37368465 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e40802 %T Content Quality of YouTube Videos About Pain Management After Cesarean Birth: Content Analysis %A Squires,Natalie A %A Soyemi,Elizabeth %A Yee,Lynn M %A Birch,Eleanor M %A Badreldin,Nevert %+ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Suite 05-2149, 250 E. Superior Street, Chicago, IL, 60611, United States, 1 312 472 4685, nevert.badreldin@northwestern.edu %K health information %K internet %K YouTube %K cesarean section %K cesarean %K C-section %K postpartum %K social media %K web-based video %K maternal %K postnatal %K pain %K systematic search %K patient education %K information quality %K accuracy %K credibility %K health education %K educational video %K education resource %K health video %D 2023 %7 23.6.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: YouTube is an increasingly common source of health information; however, the reliability and quality of the information are inadequately understood. Several studies have evaluated YouTube as a resource during pregnancy and found the available information to be of poor quality. Given the increasing attention to postpartum health and the importance of promoting safe opioid use after birth, YouTube may be a source of information for birthing individuals. However, little is known about the available information on YouTube regarding postpartum pain. Objective: The purpose of this study is to systematically evaluate the quality of YouTube videos as an educational resource for postpartum cesarean pain management. Methods: A systematic search of YouTube videos was conducted on June 25, 2021, using 36 postpartum cesarean pain management–related keywords, which were identified by clinical experts. The search replicated a default YouTube search via a public account. The first 60 results from each keyword search were reviewed, and unique videos were analyzed. An overall content score was developed based on prior literature and expert opinion to evaluate the video’s relevance and comprehensiveness. The DISCERN instrument, a validated metric to assess consumer health information, was used to evaluate the reliability of video information. Videos with an overall content score of ≥5 and a DISCERN score of ≥39 were classified as high-quality health education resources. Descriptive analysis and intergroup comparisons by video source and quality were conducted. Results: Of 73 unique videos, video sources included medical videos (n=36, 49%), followed by personal video blogs (vlogs; n=32, 44%), advertisements (n=3, 4%), and media (n=2, 3%). The average overall content score was 3.6 (SD 2.0) out of 9, and the average DISCERN score was 39.2 (SD 8.1) out of 75, indicating low comprehensiveness and fair information reliability, respectively. High-quality videos (n=22, 30%) most frequently addressed overall content regarding pain duration (22/22, 100%), pain types (20/22, 91%), return-to-activity instructions (19/22, 86%), and nonpharmacologic methods for pain control (19/22, 86%). There were differences in the overall content score (P=.02) by video source but not DISCERN score (P=.45). Personal vlogs had the highest overall content score at 4.0 (SD 2.1), followed by medical videos at 3.3 (SD 2.0). Longer video duration and a greater number of comments and likes were significantly correlated with the overall content score, whereas the number of video comments was inversely correlated with the DISCERN score. Conclusions: Individuals seeking information from YouTube regarding postpartum cesarean pain management are likely to encounter videos that lack adequate comprehensiveness and reliability. Clinicians should counsel patients to exercise caution when using YouTube as a health information resource. %M 37351938 %R 10.2196/40802 %U https://infodemiology.jmir.org/2023/1/e40802 %U https://doi.org/10.2196/40802 %U http://www.ncbi.nlm.nih.gov/pubmed/37351938 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44047 %T A Machine Learning Approach for the Prediction of Testicular Sperm Extraction in Nonobstructive Azoospermia: Algorithm Development and Validation Study %A Bachelot,Guillaume %A Dhombres,Ferdinand %A Sermondade,Nathalie %A Haj Hamid,Rahaf %A Berthaut,Isabelle %A Frydman,Valentine %A Prades,Marie %A Kolanska,Kamila %A Selleret,Lise %A Mathieu-D’Argent,Emmanuelle %A Rivet-Danon,Diane %A Levy,Rachel %A Lamazière,Antonin %A Dupont,Charlotte %+ Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, 27 Rue Chaligny, Paris, 75012, France, 33 1 49 28 46 87, guillaume.bachelot@aphp.fr %K machine learning %K azoospermia %K prediction model %K biomedical informatics %K model %K predict %K sperm %K men's health %K infertility %K infertile %D 2023 %7 21.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Testicular sperm extraction (TESE) is an essential therapeutic tool for the management of male infertility. However, it is an invasive procedure with a success rate up to 50%. To date, no model based on clinical and laboratory parameters is sufficiently powerful to accurately predict the success of sperm retrieval in TESE. Objective: The aim of this study is to compare a wide range of predictive models under similar conditions for TESE outcomes in patients with nonobstructive azoospermia (NOA) to identify the correct mathematical approach to apply, most appropriate study size, and relevance of the input biomarkers. Methods: We analyzed 201 patients who underwent TESE at Tenon Hospital (Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris), distributed in a retrospective training cohort of 175 patients (January 2012 to April 2021) and a prospective testing cohort (May 2021 to December 2021) of 26 patients. Preoperative data (according to the French standard exploration of male infertility, 16 variables) including urogenital history, hormonal data, genetic data, and TESE outcomes (representing the target variable) were collected. A TESE was considered positive if we obtained sufficient spermatozoa for intracytoplasmic sperm injection. After preprocessing the raw data, 8 machine learning (ML) models were trained and optimized on the retrospective training cohort data set: The hyperparameter tuning was performed by random search. Finally, the prospective testing cohort data set was used for the model evaluation. The metrics used to evaluate and compare the models were the following: sensitivity, specificity, area under the receiver operating characteristic curve (AUC-ROC), and accuracy. The importance of each variable in the model was assessed using the permutation feature importance technique, and the optimal number of patients to include in the study was assessed using the learning curve. Results: The ensemble models, based on decision trees, showed the best performance, especially the random forest model, which yielded the following results: AUC=0.90, sensitivity=100%, and specificity=69.2%. Furthermore, a study size of 120 patients seemed sufficient to properly exploit the preoperative data in the modeling process, since increasing the number of patients beyond 120 during model training did not bring any performance improvement. Furthermore, inhibin B and a history of varicoceles exhibited the highest predictive capacity. Conclusions: An ML algorithm based on an appropriate approach can predict successful sperm retrieval in men with NOA undergoing TESE, with promising performance. However, although this study is consistent with the first step of this process, a subsequent formal prospective multicentric validation study should be undertaken before any clinical applications. As future work, we consider the use of recent and clinically relevant data sets (including seminal plasma biomarkers, especially noncoding RNAs, as markers of residual spermatogenesis in NOA patients) to improve our results even more. %M 37342078 %R 10.2196/44047 %U https://www.jmir.org/2023/1/e44047 %U https://doi.org/10.2196/44047 %U http://www.ncbi.nlm.nih.gov/pubmed/37342078 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44081 %T Issue of Data Imbalance on Low Birthweight Baby Outcomes Prediction and Associated Risk Factors Identification: Establishment of Benchmarking Key Machine Learning Models With Data Rebalancing Strategies %A Ren,Yang %A Wu,Dezhi %A Tong,Yan %A López-DeFede,Ana %A Gareau,Sarah %+ Department of Integrated Information Technology, University of South Carolina, 550 Assembly Street, Columbia, SC, 29298, United States, 1 8033774691, dezhiwu@cec.sc.edu %K low birthweight %K machine learning %K risk factor %K benchmark %K data rebalance %D 2023 %7 31.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Low birthweight (LBW) is a leading cause of neonatal mortality in the United States and a major causative factor of adverse health effects in newborns. Identifying high-risk patients early in prenatal care is crucial to preventing adverse outcomes. Previous studies have proposed various machine learning (ML) models for LBW prediction task, but they were limited by small and imbalanced data sets. Some authors attempted to address this through different data rebalancing methods. However, most of their reported performances did not reflect the models’ actual performance in real-life scenarios. To date, few studies have successfully benchmarked the performance of ML models in maternal health; thus, it is critical to establish benchmarks to advance ML use to subsequently improve birth outcomes. Objective: This study aimed to establish several key benchmarking ML models to predict LBW and systematically apply different rebalancing optimization methods to a large-scale and extremely imbalanced all-payer hospital record data set that connects mother and baby data at a state level in the United States. We also performed feature importance analysis to identify the most contributing features in the LBW classification task, which can aid in targeted intervention. Methods: Our large data set consisted of 266,687 birth records across 6 years, and 8.63% (n=23,019) of records were labeled as LBW. To set up benchmarking ML models to predict LBW, we applied 7 classic ML models (ie, logistic regression, naive Bayes, random forest, extreme gradient boosting, adaptive boosting, multilayer perceptron, and sequential artificial neural network) while using 4 different data rebalancing methods: random undersampling, random oversampling, synthetic minority oversampling technique, and weight rebalancing. Owing to ethical considerations, in addition to ML evaluation metrics, we primarily used recall to evaluate model performance, indicating the number of correctly predicted LBW cases out of all actual LBW cases, as false negative health care outcomes could be fatal. We further analyzed feature importance to explore the degree to which each feature contributed to ML model prediction among our best-performing models. Results: We found that extreme gradient boosting achieved the highest recall score—0.70—using the weight rebalancing method. Our results showed that various data rebalancing methods improved the prediction performance of the LBW group substantially. From the feature importance analysis, maternal race, age, payment source, sum of predelivery emergency department and inpatient hospitalizations, predelivery disease profile, and different social vulnerability index components were important risk factors associated with LBW. Conclusions: Our findings establish useful ML benchmarks to improve birth outcomes in the maternal health domain. They are informative to identify the minority class (ie, LBW) based on an extremely imbalanced data set, which may guide the development of personalized LBW early prevention, clinical interventions, and statewide maternal and infant health policy changes. %M 37256674 %R 10.2196/44081 %U https://www.jmir.org/2023/1/e44081 %U https://doi.org/10.2196/44081 %U http://www.ncbi.nlm.nih.gov/pubmed/37256674 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43180 %T Association Between the Use of a Digital Health Platform During Pregnancy and Helping Users Avoid Emergency and In-Person Care: Retrospective Observational Study %A Jahnke,Hannah R %A Rubin-Miller,Lily %A Henrich,Natalie %A Moss,Christa %A Shah,Neel %A Peahl,Alex %+ Maven Clinic, 160 Varick Street, New York, NY, 10013, United States, 1 5083979329, hannah.jahnke@mavenclinic.com %K pregnancy %K telehealth %K web-based care %K emergency room %K value-based care %K digital care %K prenatal care %D 2023 %7 15.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Almost one-third of pregnant people visit the emergency room during pregnancy. Although some emergency care is necessary, gaps in patient education and inaccessibility of preventive services have been identified as key reasons for high-cost, low-value care in pregnancy. Digital platforms present a promising solution for providing resources to supplement routine prenatal care, thereby reducing the use of low-value in-person services. Objective: This study aimed to describe the relationship between the use of Maven and in-person care avoidance (emergency room or office visits) during pregnancy. Maven is a digital prenatal health platform that supplements routine prenatal care. Maven offers educational content (articles, videos, and classes), care coordination (through a care advocate), and provider services (web-based appointments and communication with providers) designed to complement prenatal care. Specifically, the aims of this study were to examine whether the use of Maven is associated with in-person care avoidance overall and whether improvements in pregnancy-related knowledge facilitate in-person care avoidance. To assess aim 2, we tested if the use of Maven is associated with improvements in self-reported understanding of warning signs and medically accurate information and if self-reported understanding of medically accurate information and warning signs is associated with in-person care avoidance in a population of Maven users. Methods: In this retrospective study, we used adjusted logistic regression to examine the relationship between digital platform use, avoidance of in-person care, and the platform’s influence on pregnancy-related knowledge (learning medically accurate information and recognizing warning signs). Demographics, medical history, and in-person care avoidance were self-reported. Results: Of the 5263 users, 280 (5.32%) reported that Maven helped them avoid in-person care during pregnancy. More users who reported avoiding in-person care also reported that the digital platform helped them understand warning signs (231/280, 82.5%) and learned medically accurate information (185/280, 66.1%). In the adjusted models, all modes of digital service use (assessed as quartiles) were associated with avoiding in-person care in a dose-response manner (eg, web-based provider appointments: Q2 adjusted odds ratio [aOR] 1.57, 95% CI 1.00-2.41; Q3 aOR 2.53, 95% CI 1.72-3.72; Q4 aOR 5.26, 95% CI 3.76-7.42). Users were more likely to avoid in-person care if they reported that Maven helped them recognize warning signs (aOR 3.55, 95% CI 2.60-4.94) or learn medically accurate information (aOR 2.05, 95% CI 1.59-2.67). Conclusions: These results suggest that digital platforms can be effective in helping patients to avoid in-person care. The educational pathway suggests that digital platforms can be particularly effective in helping patients recognize warning signs and learn medically accurate information, which may help them avoid in-person care by recognizing when in-person care is medically appropriate. Future work is needed to assess other pathways through which digital resources can support pregnant people and improve perinatal care use. %M 37184930 %R 10.2196/43180 %U https://www.jmir.org/2023/1/e43180 %U https://doi.org/10.2196/43180 %U http://www.ncbi.nlm.nih.gov/pubmed/37184930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46655 %T Effect of Recent Abortion Legislation on Twitter User Engagement, Sentiment, and Expressions of Trust in Clinicians and Privacy of Health Information: Content Analysis %A Swanson,Karl %A Ravi,Akshay %A Saleh,Sameh %A Weia,Benjamin %A Pleasants,Elizabeth %A Arvisais-Anhalt,Simone %+ Department of Laboratory Medicine, University of California San Francisco, 185 Berry Street, Suite 100, San Francisco, CA, 94143-0134, United States, 1 (415) 353 1667, simone.arvisais-anhalt@ucsf.edu %K Roe v Wade %K Dobbs v Jackson’s Women’s Health Organization %K abortion %K family planning %K sentiment analysis %K women’s rights %K twitter %K trust %K sentiment analysis %K natural language processing %K legislation %K social media %K reproductive health care %K health information %K users %D 2023 %7 12.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The Supreme Court ruling in Dobbs v Jackson Women’s Health Organization (Dobbs) overrules precedents established by Roe v Wade and Planned Parenthood v Casey and allows states to individually regulate access to abortion care services. While many states have passed laws to protect access to abortion services since the ruling, the ruling has also triggered the enforcement of existing laws and the creation of new ones that ban or restrict abortion. In addition to denying patients the full spectrum of reproductive health care, one major concern in the medical community is how the ruling will undermine trust in the patient-clinician relationship by influencing perceptions of the privacy of patient health information. Objective: This study aimed to study the effect of recent abortion legislation on Twitter user engagement, sentiment, expressions of trust in clinicians, and privacy of health information. Methods: We scraped tweets containing keywords of interest between January 1, 2020, and October 17, 2022, to capture tweets posted before and after the leak of the Supreme Court decision. We then trained a Latent Dirichlet Allocation model to select tweets pertinent to the topic of interest and performed a sentiment analysis using Robustly Optimized Bidirectional Encoder Representations from Transformers Pre-training Approach model and a causal impact time series analysis to examine engagement and sentiment. In addition, we used a Word2Vec model to study the terms of interest against a latent trust dimension to capture how expressions of trust for our terms of interest changed over time and used term frequency, inverse-document frequency to measure the volume of tweets before and after the decision with respect to the negative and positive sentiments that map to our terms of interest. Results: Our study revealed (1) a transient increase in the number of daily users by 576.86% (95% CI 545.34%-607.92%; P<.001), tweeting about abortion, health care, and privacy of health information postdecision leak; (2) a sustained and statistically significant decrease in the average daily sentiment on these topics by 19.81% (95% CI −22.98% to −16.59%; P=.001) postdecision leak; (3) a decrease in the association of the latent dimension of trust across most clinician-related and health information–related terms of interest; (4) an increased frequency of tweets with these clinician-related and health information–related terms and concomitant negative sentiment in the postdecision leak period. Conclusions: The study suggests that the Dobbs ruling has consequences for health systems and reproductive health care that extend beyond denying patients access to the full spectrum of reproductive health services. The finding of a decrease in the expression of trust in clinicians and health information–related terms provides evidence to support advocacy and initiatives that proactively address concerns of trust in health systems and services. %M 37171873 %R 10.2196/46655 %U https://www.jmir.org/2023/1/e46655 %U https://doi.org/10.2196/46655 %U http://www.ncbi.nlm.nih.gov/pubmed/37171873 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42582 %T The Next Infodemic: Abortion Misinformation %A Pagoto,Sherry L %A Palmer,Lindsay %A Horwitz-Willis,Nate %+ UConn Center for mHealth and Social Media, UConn Institute for Collaboration in Health, Interventions, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Room 22, Storrs, CT, 06268, United States, 1 6178779023, sherry.pagoto@uconn.edu %K abortion %K reproductive health %K misinformation %K online %K infodemic %K misleading information %K online health information %K health authority %K public health %K abortion %K women's health %D 2023 %7 4.5.2023 %9 Viewpoint %J J Med Internet Res %G English %X The World Health Organization (WHO) defines an infodemic as the proliferation of false or misleading information that leads to confusion, mistrust in health authorities, and the rejection of public health recommendations. The devastating impacts of an infodemic on public health were felt during the COVID-19 pandemic. We are now on the precipice of another infodemic, this one regarding abortion. On June 24, 2022, the Supreme Court of the United States (SCOTUS) decision in Dobbs v. Jackson Women’s Health Organization resulted in the reversal of Roe v. Wade, which had protected a woman’s right to have an abortion for nearly 50 years. The reversal of Roe v. Wade has given way to an abortion infodemic that is being exacerbated by a confusing and rapidly changing legislative landscape, the proliferation of abortion disinformants on the web, lax efforts by social media companies to abate abortion misinformation, and proposed legislation that threatens to prohibit the distribution of evidence-based abortion information. The abortion infodemic threatens to worsen the detrimental effects of the Roe v. Wade reversal on maternal morbidity and mortality. It also comes with unique barriers to traditional abatement efforts. In this piece, we lay out these challenges and urgently call for a public health research agenda on the abortion infodemic to stimulate the development of evidence-based public health efforts to mitigate the impact of misinformation on the increased maternal morbidity and mortality that is expected to result from abortion restrictions, particularly among marginalized populations. %M 37140975 %R 10.2196/42582 %U https://www.jmir.org/2023/1/e42582 %U https://doi.org/10.2196/42582 %U http://www.ncbi.nlm.nih.gov/pubmed/37140975 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41900 %T Addressing Preconception Behavior Change Through Mobile Phone Apps: Systematic Review and Meta-analysis %A Musgrave,Loretta %A Cheney,Kate %A Dorney,Edwina %A Homer,Caroline S E %A Gordon,Adrienne %+ Centre for Midwifery, Child and Family Health, University of Technology Sydney, 235 Jones St, NSW, Sydney, 2007, Australia, 61 9514 5069, loretta.musgrave@uts.edu.au %K apps %K mobile %K preconception %K prenatal care %K perinatal %K reproductive health %K reproductive age %K maternal %K interconception %K behavior change %K mobile phone %D 2023 %7 19.4.2023 %9 Review %J J Med Internet Res %G English %X Background: Positive health behavior changes before pregnancy can optimize perinatal outcomes for mothers, babies, and future generations. Women are often motivated to positively change their behavior in preparation for pregnancy to enhance their health and well-being. Mobile phone apps may provide an opportunity to deliver public health interventions during the preconception period. Objective: This review aimed to synthesize the evidence of the effectiveness of mobile phone apps in promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods), which may improve future outcomes for mothers and babies. Methods: Five databases were searched in February 2022 for studies exploring mobile phone apps as a prepregnancy intervention to promote positive behavior change. The identified studies were retrieved and exported to EndNote (Thomson Reuters). Using Covidence (Veritas Health Innovation), a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study flow diagram was generated to map the number of records identified, included, and excluded. Three independent reviewers assessed the risk of bias and conducted data extraction using the Review Manager software (version 5.4, The Cochrane Collaboration), and the data were then pooled using a random-effects model. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess the certainty of the evidence. Results: Of the 2973 publications identified, 7 (0.24%) were included. The total number of participants across the 7 trials was 3161. Of the 7 studies, 4 (57%) included participants in the interconception period, and 3 (43%) included women in the preconception period. Of the 7 studies, 5 (71%) studies focused on weight reduction, assessing the outcomes of reductions in adiposity and weight. Of the 7 studies, nutrition and dietary outcomes were evaluated in 2 (29%) studies, blood pressure outcomes were compared in 4 (57%) studies, and biochemical and marker outcomes associated with managing disease symptoms were included in 4 (57%) studies. Analysis showed that there were no statistically significant differences in energy intake; weight loss; body fat; and biomarkers such as glycated hemoglobin, total cholesterol, fasting lipid profiles, or blood pressure when compared with standard care. Conclusions: Owing to the limited number of studies and low certainty of the evidence, no firm conclusions can be drawn on the effects of mobile phone app interventions on promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods). Trial Registration: PROSPERO CRD42017065903; https://tinyurl.com/2p9dwk4a International Registered Report Identifier (IRRID): RR2-10.1186/s13643-019-0996-6 %M 37074767 %R 10.2196/41900 %U https://www.jmir.org/2023/1/e41900 %U https://doi.org/10.2196/41900 %U http://www.ncbi.nlm.nih.gov/pubmed/37074767 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42777 %T Translating Research Evidence Into Marketplace Application: Cohort Study of Internet-Based Intervention Platforms for Perinatal Depression %A Zeng,Zhen %A Peng,Jiale %A Liu,Lu %A Gong,Wenjie %+ HER Team and XiangYa School of Public Health, Central South University, 238 shangmayuanling, XiangYa Rd, Kaifu District, Changsha, Hunan, 410078, China, 86 13607445252, gongwenjie@csu.edu.cn %K cohort %K digital health %K internet-based intervention platform %K mhealth %K perinatal depression %K quality assessment %D 2023 %7 17.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based intervention platforms may improve access to mental health care for women with perinatal depression (PND). Though the majority of platforms in the market lack an evidence base, a small number of them are supported by research evidence. Objective: This study aims to assess the current status of internet-based PND intervention platforms supported by published evidence, understand the reasons behind the disappearance of any of these previously accessible platforms, examine adjustments made by those active platforms between research trials and market implementation, and evaluate their current quality. Methods: A cohort of internet-based PND intervention platforms was first identified by systematic searches in multiple academic databases from database inception until March 26, 2021. We searched on the World Wide Web and the iOS and Android app stores to assess which of these were available in the marketplace between April and May 2021. The basic characteristics of all platforms were collected. For inaccessible platforms, inquiries were made via email to the authors of publications to determine the reasons for their unavailability. We compared the intervention-related information of accessible platforms in the marketplace with that reported in original publications and conducted quality assessments using the App Evaluation Model of the American Psychiatric Association. Fisher exact tests were used to compare the functional characteristics in publications of available and unavailable platforms and to investigate potential associations between functional adjustments or quality indices and platform survival time. Results: Out of 35 platforms supported by research evidence, only 19 (54%) were still accessible in the marketplace. The main reason for platforms disappearing was the termination of research projects. No statistically significant differences were found in functional characteristics between available and unavailable platforms. A total of 18 (95%) platforms adapted their core functions from what was reported in related publications. The adjustments included changes to intervention methods (11/19, 58%), target population (10/19, 53%), human resources for intervention support (9/19, 47%), mood assessment and monitoring (8/19, 42%), communication modality (4/19, 21%), and platform type (2/19, 11%). Quality issues across platforms included low frequency of update, lack of crisis management mechanism, poor user interactivity, and weak evidence base or absence of citation of supporting evidence. Platforms that survived longer than 10 years had a higher tendency to use external resources from third parties compared to those that survived less than 10 years (P=.04). No significant differences were found for functional adjustments or other quality indices. Conclusions: Internet-based platforms supported by evidence were not effectively translated into real-world practice. It is unclear if adjustments to accessible platforms made during actual operation may undermine the proven validity of the original research. Future research to explore the reasons behind the success of the implementation of evidence-based platforms in the marketplace is warranted. %M 37067855 %R 10.2196/42777 %U https://www.jmir.org/2023/1/e42777 %U https://doi.org/10.2196/42777 %U http://www.ncbi.nlm.nih.gov/pubmed/37067855 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41937 %T An Assessment of Perspectives and Concerns Among Research Participants of Childbearing Age Regarding the Health-Relatedness of Data, Online Data Privacy, and Donating Data to Researchers: Survey Study %A Hendricks-Sturrup,Rachele %A Lu,Christine Y %+ Duke-Margolis Center for Health Policy, 1201 Pennsylvania Avenue NW, 5th Floor, Washington, DC, 20004, United States, 1 2026212800, rachele.hendricks.sturrup@duke.edu %K privacy %K digital data %K research %K abortion %K women's health %K reproductive health %K reproductive informatics %K digital footprint %K family planning %D 2023 %7 10.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The June 2022 US Supreme Court decision to ban abortion care in Dobbs v Jackson Women’s Health Organization sparked ominous debate about the privacy and safety of women and families of childbearing age with digital footprints who actively engage in family planning, including abortion and miscarriage care. Objective: To assess the perspectives of a subpopulation of research participants of childbearing age regarding the health-relatedness of their digital data, their concerns about the use and sharing of personal data online, and their concerns about donating data from various sources to researchers today or in the future. Methods: An 18-item electronic survey was developed using Qualtrics and administered to adults (aged ≥18 years) registered in the ResearchMatch database in April 2021. Individuals were invited to participate in the survey regardless of health status, race, gender, or any other mutable or immutable characteristics. Descriptive statistical analyses were conducted using Microsoft Excel and manual queries (single layer, bottom-up topic modeling) and used to categorize illuminating quotes from free-text survey responses. Results: A total of 470 participants initiated the survey and 402 completed and submitted the survey (for an 86% completion rate). Nearly half the participants (189/402, 47%) self-reported to be persons of childbearing age (18 to 50 years). Most participants of childbearing age agreed or strongly agreed that social media data, email data, text message data, Google search history data, online purchase history data, electronic medical record data, fitness tracker and wearable data, credit card statement data, and genetic data are health-related. Most participants disagreed or strongly disagreed that music streaming data, Yelp review and rating data, ride-sharing history data, tax records and other income history data, voting history data, and geolocation data are health-related. Most (164/189, 87%) participants were concerned about fraud or abuse based on their personal information, online companies and websites sharing information with other parties without consent, and online companies and websites using information for purposes that are not explicitly stated in their privacy policies. Free-text survey responses showed that participants were concerned about data use beyond scope of consent; exclusion from health care and insurance; government and corporate mistrust; and data confidentiality, security, and discretion. Conclusions: Our findings in light of Dobbs and other related events indicate there are opportunities to educate research participants about the health-relatedness of their digital data. Developing strategies and best privacy practices for discretion regarding digital-footprint data related to family planning should be a priority for companies, researchers, families, and other stakeholders. %M 36897637 %R 10.2196/41937 %U https://www.jmir.org/2023/1/e41937 %U https://doi.org/10.2196/41937 %U http://www.ncbi.nlm.nih.gov/pubmed/36897637 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42660 %T Aboriginal and Torres Strait Islander Women’s Access to and Interest in mHealth: National Web-based Cross-sectional Survey %A Perkes,Sarah Jane %A Bonevski,Billie %A Hall,Kerry %A Mattes,Joerg %A Chamberlain,Catherine %A Bennett,Jessica %A Whittaker,Robyn %A Palazzi,Kerrin %A Lambkin,David %A Kennedy,Michelle %+ College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, 5042, Australia, 61 0451994827, sarah.perkes@newcastle.edu.au %K mHealth %K Aboriginal %K Torres Strait Islander %K public health %K health literacy %K digital literacy %K Australia %K native %K cross-sectional %K national survey %K technology use %K technology ownership %K digital device %K mobile device %K usage %K adoption %K acceptance %K digital divide %D 2023 %7 6.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Health programs delivered through digital devices such as mobile phones (mobile health [mHealth]) have become an increasingly important component of the health care tool kit. Aboriginal and Torres Strait Islander women of reproductive age are likely to be caring for children and family members and needing health care, but little is known about their access to and interest in mHealth. Objective: The objectives of this study were to investigate Aboriginal and Torres Strait Islander women’s ownership of digital devices, access to the internet, current mHealth use, and interest and preferences for future mHealth. We examined the factors (age, remoteness, caring for a child younger than 5 years, and level of education) associated with the ownership of digital devices, use of internet, and interest in using a mobile phone to improve health. This study also examines if women are more likely to use mHealth for topics that they are less confident to talk about face-to-face with a health professional. Methods: A national web-based cross-sectional survey targeting Aboriginal and Torres Strait Islander women of reproductive age (16-49 years) was performed. Descriptive statistics were reported, and logistic regressions were used to examine the associations. Results: In total, 379 women completed the survey; 89.2% (338/379) owned a smartphone, 53.5% (203/379) a laptop or home computer, 35.6% (135/379) a tablet, and 93.1% (353/379) had access to the internet at home. Most women used social media (337/379, 88.9%) or the internet (285/379, 75.2%) everyday. The most common modality used on the mobile phone for health was Google (232/379, 61.2%), followed by social media (195/379, 51.5%). The most preferred modality for future programs was SMS text messaging (211/379, 55.7%) and social media (195/379, 51.4%). The most preferred topics for future mHealth programs were healthy eating (210/379, 55.4%) and cultural engagement (205/379, 54.1%). Women who were younger had greater odds of owning a smartphone, and women with tertiary education were more likely to own a tablet or laptop. Older age was associated with interest to use telehealth, and higher educational attainment was associated with interest for videoconferencing. Most women (269/379, 70.9%) used an Aboriginal medical service and overall reported high rates of confidence to discuss health topics with a health professional. Overall, women showed a similar likelihood of selecting a topic in mHealth whether they were or were not confident to talk to a health professional about that. Conclusions: Our study found that Aboriginal and Torres Strait Islander women were avid users of the internet and had strong interest in mHealth. Future mHealth programs for these women should consider utilizing SMS text messaging and social media modalities and including content on nutrition and culture. A noteworthy limitation of this study was that participant recruitment was web-based (due to COVID-19 restrictions). %M 36877565 %R 10.2196/42660 %U https://www.jmir.org/2023/1/e42660 %U https://doi.org/10.2196/42660 %U http://www.ncbi.nlm.nih.gov/pubmed/36877565 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41892 %T Alarming Trends of Cesarean Section—Time to Rethink: Evidence From a Large-Scale Cross-sectional Sample Survey in India %A Pandey,Anuj Kumar %A Raushan,Mukesh Ravi %A Gautam,Diksha %A Neogi,Sutapa Bandyopadhyay %+ Department of Health Research, International Institute of Health Management Research, Plot-3, Sector-18A, Dwarka, New Delhi, 110075, India, 91 30418901, sutapa@iihmrdelhi.edu.in %K cesarean section %K surgical obstetric procedure %K abdominal delivery %K reproductive health service %K women health services %K obstetrics %K health promotion %D 2023 %7 13.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Cesarean section (CS) delivery rate has increased significantly both globally and in India, thereby posing a burden on overstretched health systems. Objective: This study plans to understand the factors associated with CS rate with an objective to (1) analyze the trends of CS delivery from 1998-99 to 2019-21 and (2) understand the proximate determinants of CS deliveries in India. Methods: Analysis of secondary data (National Family Health Survey) of a nationally representative sample of 230,870 women (year 2019-21) was undertaken to explore the trends, distribution, and determinants of CS deliveries in India and within states. Multivariable analyses were performed to determine the proximate variables associated with CS and elective CS. The relative interaction effect of confounding factors, such as number of antenatal care (ANC) visits, place of residence, and wealth status, on cesarean delivery was assessed. A composite index was generated using trust, support, and intimate partner violence variables (termed the partner human capital index [PHI]) to study its influence on CS deliveries, with a low PHI indicating abusive partner and a high PHI indicating supportive partner. Statewise spatial distribution of the most significantly associated factors, namely, wealth quintile and ANC checkups, were also analyzed. Results: The overall prevalence of CS was 21.50% (49,634/230,870) which had risen from 16.72% (2312/13,829) in 1998-99. The adjusted odds of CS deliveries were significantly higher among women who were highly educated (odds ratio [OR] 7.30, 95% CI 7.02-7.60; P<.001), had 4 or more ANC visits (OR 2.28, 95% CI 2.15-2.42; P<.001), belonging to the high-wealth quintile (OR 7.87, 95% CI 7.57-8.18; P<.001), and from urban regions. Increasing educational level of the head of the household (OR 3.05, 95% CI 2.94-3.16; P<.001) was also found to be a significant determinant of CS deliveries. The odds of selection of elective and emergency CS were also significantly higher among women from richer families (OR 1.66, 95% CI 1.25-2.21; P<.001) and those belonging to Christian religion (OR 1.67, 95% CI 1.14-2.43; P=.008). Adjusting the cesarean delivery by PHI, the odds of outcome were significantly higher among women with moderate and high PHI compared with those with low PHI (OR 1.46, 95% CI 1.36-1.56 and OR 1.61, 95% CI 1.49-1.74, respectively; P<.001 for both). The interaction effect result reiterates that women with more than 4 ANC checkups, high PHI, and belonging to the richer wealth quintile were more likely to undergo cesarean delivery (OR 22.22, 95% CI 14.99-32.93; P<.001) compared with those with no ANC visit, low PHI, and poorest women. Conclusions: The increasing trend of CS deliveries across India is raising concerns. Better education, wealth, and good support from the partner have been incriminated as the contributory factors. There is a need to institute proper monitoring mechanisms to assess the need for CS, especially when performed electively. %R 10.2196/41892 %U https://www.jmir.org/2023/1/e41892/ %U https://doi.org/10.2196/41892 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e41417 %T The Post-Roe Political Landscape Demands a Morality of Caution for Women’s Health %A Goodday,Sarah %A Karlin,Daniel %A Suver,Christine %A Friend,Stephen %+ 4YouandMe, 2901 Third Avenue, Ste 330, Seattle, WA, 98121, United States, 1 9022374235, sarah@4youandme.org %K women's health %K reproductive health %K wearable %K abortion rights, confidentiality and privacy %K Roe v. Wade %K health policy %K health research %K reproductive information %K privacy %K women's rights %K health rights %K abortion %K eHealth %K digital health %K mHealth %K safety %K ethic %D 2022 %7 20.10.2022 %9 Viewpoint %J J Med Internet Res %G English %X The recent Supreme Court decision (ie, Dobbs v. Jackson Women’s Health Organization), revoking the constitutional right to abortion in the United States, has the potential to dramatically disrupt progress in women’s health research. The typical safeguards to ensure confidentiality and privacy of research participants in studies that collect certain types of personal health information may not hold against criminal investigations surrounding suspected pregnancy terminations. There are additional risks to participants in digital health research studies involving the use of wearable devices capable of tracking physiological measures, such as body temperature and heart rate, as these have shown promise for tracking conception and could be used to identify pregnancy termination signatures. There are strategies researchers can use to protect the safety of participants in health research who could get pregnant, while also maintaining integrity of research methods. The objective of this viewpoint is to discuss potential strategies to protect research participants’ privacy that include the minimization of nonessential sensitive personal health information and anonymization protocols in the event of miscarriage or termination of pregnancy. We invite others to join this discussion so as to not let the current political landscape impede progress in women’s health and reproductive research, while also protecting research participants. %M 36264611 %R 10.2196/41417 %U https://www.jmir.org/2022/10/e41417 %U https://doi.org/10.2196/41417 %U http://www.ncbi.nlm.nih.gov/pubmed/36264611