%0 Journal Article %@ 2817-1705 %I JMIR Publications %V 4 %N %P e66741 %T The Elastic Electronic Health Record: A Five-Tiered Framework for Applying Artificial Intelligence to Electronic Health Record Maintenance, Configuration, and Use %A Uptegraft,Colby %A Black,Kameron Collin %A Gale,Jonathan %A Marshall,Andrew %A He,Shuhan %K semi-autonomous database %K back-end EHR %K self-configuring database %K machine learning %K health care %K generative artificial intelligence %K elastic EHR %K electronic record %K electronic health record %K artificial intelligence %K AI %K EHR %K database %D 2025 %7 9.5.2025 %9 %J JMIR AI %G English %X Properly configuring modern electronic health records (EHRs) has become increasingly challenging for human operators, failing to fully meet the efficiency and cost-saving potential seen with the digitization of other sectors. The integration of artificial intelligence (AI) offers a promising solution, particularly through a comprehensive governance approach that moves beyond front-end enhancements such as user- and patient-facing copilots. These copilots, although useful, are limited by the underlying EHR configuration, leading to inefficiencies and high maintenance costs. To address this, we propose the concept of an “Elastic EHR,” which proactively suggests and validates optimal content and configuration changes, significantly reducing governance costs and enhancing user experience, as well as reducing many of the common frustrations including the documentation burden, alert fatigue, system responsiveness, outdated content, and unintuitive design. Our five-tiered model details a structured approach to AI integration within EHRs. Tier I focuses on autonomous database reconfiguration, akin to Oracle Autonomous Database functionalities, to ensure continuous system improvements without direct edits to the production environment. Tier II empowers EHR clients to shape system performance according to predefined strategies and standards, ensuring coordinated and efficient EHR solution builds. Tier III optimizes EHR choice architecture by analyzing user behaviors and suggesting content and configuration changes that minimize clicks and keystrokes, thereby enhancing workflow efficiency. Tier IV maintains the currency of EHR clinical content and decision support by linking content and configuration to updated guidelines and literature, ensuring the EHR remains evidence-based and compliant with evolving standards. Finally, Tier V incorporates context-dependent AI copilots to enhance care efficiency, quality, and user experience. Despite the potential benefits, major limitations exist. The market dominance of a few major EHR vendors—Epic Systems, Oracle Health, and MEDITECH—poses a challenge, as any enhancements require their cooperation and financial motivation. Furthermore, the diverse and complex nature of health care environments demands a flexible yet robust AI system that can adapt to various institutional needs that has not yet been developed, researched, or tested. The Elastic EHR model proposes a five-tiered framework for optimizing EHR systems and user experience with AI. By overcoming the identified limitations through vendor-led, collaborative efforts, AI-enabled EHRs could improve the efficiency, quality, and user experience of health care delivery, fully delivering on the promises of digitization within health care. %R 10.2196/66741 %U https://ai.jmir.org/2025/1/e66741 %U https://doi.org/10.2196/66741 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e54484 %T Knowledge Sharing Maturity Model for Medical Imaging Departments: Development Study %A Almashmoum,Maryam %A Cunningham,James %A Ainsworth,John %+ Division of Informatics Imaging and Data Sciences, School of Health Sciences Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Vaughan House, Portsmouth St, Manchester, M13 9GB, United Kingdom, 44 07949062010, Maryam_jassem@yahoo.com %K knowledge management %K knowledge sharing %K medical imaging departments %K cancer centers %K the Christie %K Kuwait Cancer Control Center %K KCCC %K maturity model %K factors %K indicators %K measurement %D 2025 %7 6.5.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Knowledge sharing in medical imaging departments is driven by the need to improve health care services, develop health care professionals’ skills, and reduce repetitive mistakes. It is considered an important step in the implementation of knowledge management solutions. By following a maturity model of knowledge sharing, knowledge-sharing practices can be improved. Objective: This study aimed to develop a maturity model for knowledge sharing in the medical imaging department to help managers to assess the level of maturity of knowledge-sharing practices. In modern health care institutions, improvements in health care professionals’ skills and health care services are often driven through practicing knowledge-sharing behaviors. Managers can follow the indicators of maturity model of knowledge sharing and its measurements to identify the current level and move to the next level. Methods: This study was conducted in 4 stages: an overview stage that highlighted the factors that affect knowledge-sharing practices in medical imaging departments; an analysis factor stage that was designed to assess the factors that affect knowledge sharing using a concurrent mixed methods approach (questionnaires and semistructured interviews) in 2 medical imaging departments; a structuring maturity model knowledge sharing stage, where a maturity model of knowledge sharing was developed based on the findings of the first and second stages; and finally, an assessment of reliability and validity stage, where a modified Delphi method was used to obtain consensus among experts on model components to be ready for implantation. Results: The model presented in this study includes 17 indicators, divided into 11 components. Those components were derived from the findings of the questionnaires and semistructured interviews that were applied in the medical imaging departments. It consisted of 5 maturity levels: initial, aware, defined, managed, and optimized. In each level, measurements were included to help managers assess the current level by answering the questions. On the basis of reliability, the experts reached a consensus agreement on the model’s components in 2 rounds with SD <1. Conclusions: This maturity model of knowledge sharing in medical imaging departments allows managers and policy makers to measure the maturity level of knowledge sharing in those departments. Although the model has been applied to medical imaging departments, it could easily be modified for application in other institutions. %M 40328442 %R 10.2196/54484 %U https://humanfactors.jmir.org/2025/1/e54484 %U https://doi.org/10.2196/54484 %U http://www.ncbi.nlm.nih.gov/pubmed/40328442 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60884 %T Viability of Web-Based Respondent-Driven Sampling of Belgian Men Who Have Sex With Men: Process Evaluation %A Thunnissen,Estrelle %A Buffel,Veerle %A Campbell,Linda %A Vuylsteke,Bea %A Bos,Philippe %A Wouters,Edwin %+ Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Prinsstraat 13, Antwerp, 2000, Belgium, 32 032654111, estrelle.thunnissen@uantwerpen.be %K web-based respondent-driven sampling %K men who have sex with men %K Medical Resource Council framework %K population inference %K nonparticipation %K overresearch %K survey fatigue %D 2025 %7 5.5.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Obtaining a representative sample is a substantial challenge when undertaking health research among hidden and hard-to-reach populations such as men who have sex with men Web-based respondent-driven sampling (WEB RDS) was developed to overcome such sampling challenges and to create population estimates based on network and sampling characteristics. Despite a decade of research, it remains unclear whether WEB RDS is suitable for sampling hidden populations such as men who have sex with men. Objective: This study aims to evaluate how viable the WEB RDS methodology is for obtaining a nationwide sample of men who have sex with men, suitable for population inference of sexual health characteristics, in Belgium. Methods: We adapted the Medical Resource Council process evaluation framework for interventions, to evaluate an empirical WEB RDS. Viewing “WEB RDS” as a complex intervention with respondent-driven recruitment as the aim, we evaluated indicators of context, implementation, mechanisms of impact, and performance. We analyzed the data using a mixed methods approach that integrated findings from quantitative analysis, such as RDS diagnostics, and qualitative thematic analysis. Results: Sampling did not reach a sufficient sample size (n=193) to compensate for an RDS design effect of 3 and the number of recruitment waves was low (waves=7). A visual examination of the convergence and bottleneck plots indicates that many more waves of recruitment would be needed for population estimates to become independent of the seeds. However, producing further waves was impeded by challenges inherent to the research context and process. Men who have sex with men and their community organization representatives indicated that, in Belgium, men who have sex with men are overresearched, with low motivation for the topic of sexual health and digital etiquette dictating not sharing survey links. A moderate reward of €10-€30 (US $11.2-$33.6) with a dual incentive structure was insufficient to overcome these barriers. Conclusions: This study indicates that WEB RDS, even with a moderate incentive, is not a viable sampling strategy for obtaining valid population estimates of sexual health traits of men who have sex with men in Belgium. The study emphasizes the need to understand men who have sex with men research motivation and topic saliency. Additionally, the study highlights the importance of digital etiquette. Finally, the study showcases the use of the adapted Medical Research Council framework for evaluating WEB RDS methodology. %M 40324174 %R 10.2196/60884 %U https://www.jmir.org/2025/1/e60884 %U https://doi.org/10.2196/60884 %U http://www.ncbi.nlm.nih.gov/pubmed/40324174 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69465 %T Enhancing Interoperability for a Sustainable, Patient-Centric Health Care Value Chain: Systematic Review for Taxonomy Development %A Marino,Carlos Antonio %A Diaz Paz,Claudia %+ CENTRUM Católica Graduate Business School, Lima, Peru, Pontifical Catholic University of Peru, Jirón Daniel Alomía Robles 125, Santiago de Surco, Lima, 15023, Peru, 51 01 6267100, cmarino@pucp.pe %K interoperability %K health care %K electronic health record (EHR) %K Fast Healthcare Interoperability Resources (FHIR) %K value chain %D 2025 %7 25.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Creating a sustainable, patient-centered health care system necessitates integrated supply chains supported by information technologies. However, achieving interoperability among various devices and systems remains a significant hurdle. Our research highlights the need for systematic reviews that address health care interoperability as a holistic knowledge domain. Notably, we observed a lack of studies that outline its structure or develop a comprehensive, high-order facet-based taxonomy from the perspective of supply or value chains. This study aims to address that gap. Objective: The primary aim of this study is to elucidate the knowledge structure within the extensive domain of health care interoperability, with an emphasis on trending topics, critical hot spots, and the categorization of significant issues. Furthermore, we aim to model the higher-order elements of a taxonomy for health care interoperability within the context of the health care value chain framework. Methods: We used both quantitative and qualitative methodologies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework guided our selection process. We examined 6 databases—Scopus, Web of Science, IEEE Xplore, Embase, Cochrane, and PubMed—focusing on journal articles and gray literature published from 2011 onward. Articles were screened using predefined eligibility criteria. Quantitative bibliometric techniques—including cluster, factor, and network analyses—were applied to explore the structure of the knowledge. A subset of articles was selected for qualitative synthesis using an iterative coding process to develop a higher-order facet-based taxonomy. Results: We identified 370 articles for quantitative analysis. The bibliometric analysis revealed 2 major clusters. Key terms in the first cluster included interoperability, electronic health record, and eHealth—with betweenness centralities of 70.971, 59.460, and 12.000, respectively, and closeness centralities of 0.047, 0.043, and 0.034, respectively. In the second cluster, the most relevant terms were IoT, blockchain, and health care—with betweenness centralities of 6.765, 2.581, and 1.283, respectively, and closeness centralities of 0.034, 0.030, and 0.030, respectively. Factor analysis explained 59.46% of the variance in a 2-factor model, with the first dimension accounting for 36.78% and the second dimension for 22.68%. The qualitative review of 79 articles yielded a taxonomy with 4 higher-order facets: object (what is shared), source (what mechanism is used), ambit (space covered), and content (technology primarily involved). Each facet extended to a third level of classification. Conclusions: The comprehensive domain of health care interoperability, viewed through the lens of a sustainable value chain, encompasses studies that highlight various facets or attributes. These studies underscore the relevance of eHealth within this knowledge domain and reflect a strong focus on 2 key health information technologies: electronic health records and the Internet of Things. %M 40279640 %R 10.2196/69465 %U https://www.jmir.org/2025/1/e69465 %U https://doi.org/10.2196/69465 %U http://www.ncbi.nlm.nih.gov/pubmed/40279640 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67855 %T Compatibility of the CEN-ISO/TS 82304-2 Health App Assessment Framework With Catalan and Italian Health Authorities’ Needs: Qualitative Interview Study %A Hoogendoorn,Petra %A Shokralla,Mariam %A Willemsen,Romy %A Guldemond,Nick %A Villalobos-Quesada,María %+ National eHealth Living Lab, Public Health and Primary Care Department, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands, 31 654341785, a.p.y.hoogendoorn@lumc.nl %K assessment frameworks %K mobile health %K mHealth %K health apps %K wellness apps %K digital transformation %K Italy %K Catalonia %K diffusion of innovations %K value proposition canvas %D 2025 %7 21.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Health authorities of European Union (EU) member states are increasingly working to integrate quality health apps into their health care systems. Given the current lack of unified EU assessment criteria, the European Commission initiated Technical Specification (TS) CEN-ISO 82304-2:2021—Health and wellness apps—Quality and reliability (hereinafter the “TS”) to address the scattered EU landscape of assessment frameworks (AFs) for health apps. The adoption of an AF, such as the TS, falls within member state competence and is considered an uncertainty-reduction process. Evaluations by peers as well as ensuring the compatibility of the TS with the needs of health authorities can reduce uncertainty and mediate harmonization. Objective: This study aims to examine the compatibility of the TS with the needs of Catalan and Italian health authorities. Methods: Semistructured interviews were conducted with key informants from a regional (Catalonia in Spain) and national (Italy) health authority, and a thematic analysis was carried out. Main themes were established deductively, following the aspects defined by the value proposition canvas: (1) health authorities’ needs (“gains,” “pains,” and “jobs”) and (2) the TS “products and services” and their distinct characteristics (“gain creators” and “pain relievers”). Subthemes were generated inductively. The compatibility of the needs with the TS was theoretically determined by the researchers. The results were visualized using the value proposition canvas. Two participant validation steps confirmed that the most relevant aspects of the predefined themes had been captured. Results: Despite the diversity of the 2 health authorities, subthemes were common and categorized into 9 gains, 9 pains, and 11 jobs. Key findings include the health authorities’ perceived value of, and need for, integrating quality health apps and using an AF (gains), along with the related policy, implementation, and operational activities (jobs). The lack of enabling EU legislation and standardization, resulting in a need for the multiple authorities involved to consent, made achieving an AF challenging (pains). Nine products and services related to the TS and 17 distinct characteristics (eg, its multistakeholder evidence base) were found to be compatible with 3 gains (eg, stimulating the prescription and use of apps), 7 pains (eg, legislation and harmonization issues), and 6 jobs (eg, assessing apps). Indirect effects, 3 anticipated future services, and 1 anticipated gain creator and pain reliever increase this compatibility. Conclusions: Our results suggest that the health authorities share common fundamental needs, and that the TS is compatible with these needs. The identified needs and compatibility can potentially reduce peer authorities’ uncertainties in adopting an AF in general and the TS in particular. More research is recommended to confirm and translate our results in other contexts and further fine-tune compatibility to achieve wide adoption of the TS and accelerate the uptake of health apps. %M 40258272 %R 10.2196/67855 %U https://formative.jmir.org/2025/1/e67855 %U https://doi.org/10.2196/67855 %U http://www.ncbi.nlm.nih.gov/pubmed/40258272 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e59514 %T Considering Theory-Based Gamification in the Co-Design and Development of a Virtual Reality Cognitive Remediation Intervention for Depression (bWell-D): Mixed Methods Study %A Hewko,Mark %A Gagnon Shaigetz,Vincent %A Smith,Michael S %A Kohlenberg,Elicia %A Ahmadi,Pooria %A Hernandez Hernandez,Maria Elena %A Proulx,Catherine %A Cabral,Anne %A Segado,Melanie %A Chakrabarty,Trisha %A Choudhury,Nusrat %+ National Research Council, 435 Ellice Avenue, Winnipeg, MB, R3B 1Y6, Canada, 1 204 984 4625, mark.hewko@nrc-cnrc.gc.ca %K virtual reality %K clinical psychology %K cognitive assessment %K neuropsychology %K mental health %K cognitive training %K cognitive remediation %K cognitive rehabilitation %K digital therapeutics %D 2025 %7 31.3.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: In collaboration with clinical domain experts, we developed a prototype of immersive virtual reality (VR) cognitive remediation for major depressive disorder (bWell-D). In the development of a new digital intervention, there is a need to determine the effective components and clinical relevance using systematic methodologies. From an implementation perspective, the effectiveness of digital intervention delivery is challenged by low uptake and high noncompliance rates. Gamification may play a role in addressing this as it can boost adherence. However, careful consideration is required in its application to promote user motivation intrinsically. Objective: We aimed to address these challenges through an iterative process for development that involves co-design for developing content as well as in the application of gamification while also taking into consideration behavior change theories. This effort followed the methodological framework guidelines outlined by an international working group for development of VR therapies. Methods: In previously reported work, we collected qualitative data from patients and care providers to understand end-user perceptions on the use of VR technologies for cognitive remediation, reveal insights on the drivers for behavior change, and obtain suggestions for changes specific to the VR program. In this study, we translated these findings into concrete representative software functionalities or features and evaluated them against behavioral theories to characterize gamification elements in terms of factors that drive behavior change and intrinsic engagement, which is of particular importance in the context of cognitive remediation. The implemented changes were formally evaluated through user trials. Results: The results indicated that feedback from end users centered on using gamification to add artificial challenges, personalization and customization options, and artificial assistance while focusing on capability as the behavior change driver. It was also found that, in terms of promoting intrinsic engagement, the need to meet competence was most frequently raised. In user trials, bWell-D was well tolerated, and preliminary results suggested an increase in user experience ratings with high engagement reported throughout a 4-week training program. Conclusions: In this paper, we present a process for the application of gamification that includes characterizing what was applied in a standardized way and identifying the underlying mechanisms that are targeted. Typical gamification elements such as points and scoring and rewards and prizes target motivation in an extrinsic fashion. In this work, it was found that modifications suggested by end users resulted in the inclusion of gamification elements less commonly observed and that tend to focus more on individual ability. It was found that the incorporation of end-user feedback can lead to the application of gamification in broader ways, with the identification of elements that are potentially better suited for mental health domains. %M 40163852 %R 10.2196/59514 %U https://games.jmir.org/2025/1/e59514 %U https://doi.org/10.2196/59514 %U http://www.ncbi.nlm.nih.gov/pubmed/40163852 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65786 %T Mindfulness-Based Cognitive Therapy–Game: An Ironic Way to Treat Internet Gaming Disorder %A Kim,Jaehyun %A Oh,Hayoung %A Yoon,Anderson Sungmin %+ , College of Computing and Informatics, Sungkyunkwan University, 25-2, Sungkyunkwan-ro, Jongno-gu, Seoul, 03063, Republic of Korea, 82 01053895996, hyoh79@skku.edu %K cognitive behavior therapy %K psychosocial intervention %K video games %K internet gaming disorder %K internet addiction %K mindfulness %K mental health %D 2025 %7 27.3.2025 %9 Viewpoint %J J Med Internet Res %G English %X Internet gaming disorder (IGD) affects 3% of the global population and poses an increasing risk due to advancements in technology. However, there is currently no definitive treatment for this condition. IGD is not a primary disorder but rather a result of “self-prescription” in response to emotional stressors. Unlike conventional mental health treatments that focus on the disorder itself, it is crucial to provide alternative activities that can alleviate negative emotions. This paper extends the concept of the self-medication hypothesis and integrates it with cognitive models of cognitive behavioral therapy and mindfulness-based cognitive therapy. In addition, it introduces the mindfulness-based cognitive therapy–game (MBCT-G), a program designed to explore alternative activities through gaming, focusing on the processes of response and reward, which are not typically emphasized in traditional treatments. This study serves as the theoretical foundation for the development of MBCT-G. MBCT-G aims to train individuals in positive coping strategies that alleviate psychological distress, offering a novel approach to treating self-prescription disorders such as IGD. %M 40146992 %R 10.2196/65786 %U https://www.jmir.org/2025/1/e65786 %U https://doi.org/10.2196/65786 %U http://www.ncbi.nlm.nih.gov/pubmed/40146992 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70483 %T New Perspective on Digital Well-Being by Distinguishing Digital Competency From Dependency: Network Approach %A Chen,Si %A Ebrahimi,Omid V %A Cheng,Cecilia %+ Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong, China (Hong Kong), 852 39174224, ceci-cheng@hku.hk %K digital wellness %K affective well-being %K emotional regulation %K coping %K digital competence %K digital autonomy %K artificial intelligence %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: In the digital age, there is an emerging area of research focusing on digital well-being (DWB), yet conceptual frameworks of this novel construct are lacking. The current conceptualization either approaches the concept as the absence of digital ill-being, running the risk of pathologizing individual digital use, or follows the general subjective well-being framework, failing to highlight the complex digital nature at play. Objective: This preregistered study aimed to address this gap by using a network analysis, which examined the strength of the relationships among affective (digital stress and web-based hedonic well-being), cognitive (online intrinsic needs satisfaction), and social (online social connectedness and state empathy) dimensions of DWB and their associations with some major DWB protective and risk factors (ie, emotional regulation, nomophobia, digital literacy, self-control, problematic internet use, coping styles, and online risk exposure). Methods: The participants were 578 adults (mean age 38.7, SD 13.14 y; 277/578, 47.9% women) recruited from the United Kingdom and the United States who completed an online survey. Two network models were estimated. The first one assessed the relationships among multiple dimensions of DWB, and the second examined the relationships between DWB dimensions and related protective and risk factors. Results: The 2 resulting network structures demonstrated high stability, with the correlation stability coefficients being 0.67 for the first and 0.75 for the second regularized Gaussian graphical network models. The first network indicated that all DWB variables were positively related, except for digital stress, which was negatively correlated with the most central node—online intrinsic needs satisfaction. The second network revealed 2 distinct communities: digital competency and digital dependency. Emotional regulation emerged as the most central node with the highest bridge expected influence, positively associated with emotion-focused coping in the digital competency cluster and negatively associated with avoidant coping in the digital dependency cluster. In addition, some demographic differences were observed. Women scored higher on nomophobia (χ24=10.7; P=.03) and emotion-focused coping (χ24=14.9; P=.01), while men scored higher on digital literacy (χ24=15.2; P=.01). Compared with their older counterparts, younger individuals scored lower on both emotional regulation (Spearman ρ=0.27; P<.001) and digital self-control (Spearman ρ=0.35; P<.001) and higher on both digital stress (Spearman ρ=−0.14; P<.001) and problematic internet use (Spearman ρ=−0.25; P<.001). Conclusions: The network analysis revealed how different aspects of DWB were interconnected, with the cognitive component being the most influential. Emotional regulation and adaptive coping strategies were pivotal in distinguishing digital competency from dependency. %M 40132188 %R 10.2196/70483 %U https://www.jmir.org/2025/1/e70483 %U https://doi.org/10.2196/70483 %U http://www.ncbi.nlm.nih.gov/pubmed/40132188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59738 %T Stakeholder Consensus on an Interdisciplinary Terminology to Enable the Development and Uptake of Medication Adherence Technologies Across Health Systems: Web-Based Real-Time Delphi Study %A Dima,Alexandra Lelia %A Nabergoj Makovec,Urska %A Ribaut,Janette %A Haupenthal,Frederik %A Barnestein-Fonseca,Pilar %A Goetzinger,Catherine %A Grant,Sean %A Jácome,Cristina %A Smits,Dins %A Tadic,Ivana %A van Boven,Job %A Tsiligianni,Ioanna %A Herdeiro,Maria Teresa %A Roque,Fátima %A , %+ , Avedis Donabedian Research Institute (FAD), Universitat Autònoma de Barcelona (UAB), Provença, 293, Barcelona, 08037, Spain, 34 683163092, adima@fadq.org %K health technology %K medication adherence %K Delphi study %K stakeholder engagement %K digital health %K behavioral science %K implementation science %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology-mediated medication adherence interventions have proven useful, yet implementation in clinical practice is low. The European Network to Advance Best Practices and Technology on Medication Adherence (ENABLE) European Cooperation in Science and Technology Action (CA19132) online repository of medication adherence technologies (MATechs) aims to provide an open access, searchable knowledge management platform to facilitate innovation and support medication adherence management across health systems. To provide a solid foundation for optimal use and collaboration, the repository requires a shared interdisciplinary terminology. Objective: We consulted stakeholders on their views and level of agreement with the terminology proposed to inform the ENABLE repository structure. Methods: A real-time web-based Delphi study was conducted with stakeholders from 39 countries active in research, clinical practice, patient representation, policy making, and technology development. Participants rated terms and definitions of MATech and of 21 attribute clusters on product and provider information, medication adherence descriptors, and evaluation and implementation. Relevance, clarity, and completeness criteria were rated on 9-point scales, and free-text comments were provided interactively. Participants could reconsider their ratings based on real-time aggregated feedback and revisit the survey throughout the study period. We quantified agreement and process indicators for the complete sample and per stakeholder group and performed content analysis on comments. Consensus was considered reached for ratings with a disagreement index of <1. Median ratings guided decisions on whether attributes were considered mandatory, optional, or not relevant. We used the results to improve the terminology and repository structure. Results: Of 250 stakeholders invited, 117 (46.8%) rated the MATech definition, of whom 83 (70.9%) rated all attributes. Consensus was reached for all items. The definition was considered appropriate and clear (median ratings 7.02, IPR 6.10-7.69, and 7.26, IPR 6.73-7.90, respectively). Most attributes were considered relevant, mandatory, and sufficiently clear to remain unchanged except for ISO certification (considered optional; median relevance rating 6.34, IPR 5.50-7.24) and medication adherence phase, medication adherence measurement, and medication adherence intervention (candidates for optional changes; median clarity ratings 6.07, IPR 4.86-7.17; 6.37, IPR 4.80-6.67; and 5.67, IPR 4.66-6.61, respectively). Subgroup analyses found several attribute clusters considered moderately clear by some stakeholder groups. Results were consistent across stakeholder groups and time, yet response variation was found within some stakeholder groups for selected clusters, suggesting targets for further discussion. Comments highlighted issues for further debate and provided suggestions informing modifications to improve comprehensiveness, relevance, and clarity. Conclusions: By reaching agreement on a comprehensive MATech terminology developed following state-of-the-art methodology, this study represents a key step in the ENABLE initiative to develop an information architecture capable of structuring and facilitating the development and implementation of MATech across Europe. The debates and challenges highlighted in stakeholders’ comments outline a potential road map for further development of the terminology and the ENABLE repository. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-059674 %M 40132192 %R 10.2196/59738 %U https://www.jmir.org/2025/1/e59738 %U https://doi.org/10.2196/59738 %U http://www.ncbi.nlm.nih.gov/pubmed/40132192 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e67119 %T Understanding Interventions to Address Infodemics Through Epidemiological, Socioecological, and Environmental Health Models: Framework Analysis %A John,Jennifer N %A Gorman,Sara %A Scales,David %K infodemics %K misinformation %K disinformation %K Covid-19 %K infodemic management %K health communication %K pandemic preparedness %D 2025 %7 24.3.2025 %9 %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic was accompanied by a barrage of false, misleading, and manipulated information that inhibited effective pandemic response and led to thousands of preventable deaths. Recognition of the urgent public health threat posed by this infodemic led to the development of numerous infodemic management interventions by a wide range of actors. The need to respond rapidly and with limited information sometimes came at the expense of strategy and conceptual rigor. Given limited funding for public health communication and growing politicization of countermisinformation efforts, responses to future infodemics should be informed by a systematic and conceptually grounded evaluation of the successes and shortcomings of existing interventions to ensure credibility of the field and evidence-based action. Objectives: This study sought to identify gaps and opportunities in existing infodemic management interventions and to assess the use of public health frameworks to structure responses to infodemics. Methods: We expanded a previously developed dataset of infodemic management interventions, spanning guidelines, policies, and tools from governments, academic institutions, nonprofits, media companies, and other organizations, with 379 interventions included in total. We applied framework analysis to describe and interpret patterns within these interventions through their alignment with codes derived from 3 frameworks selected for their prominence in public health and infodemic-related scholarly discourse: the epidemiological model, the socioecological model, and the environmental health framework. Results: The epidemiological model revealed the need for rigorous, transparent risk assessments to triage misinformation. The socioecological model demonstrated an opportunity for greater coordination across levels of influence, with only 11% of interventions receiving multiple socioecological codes, and more robust partnerships with existing organizations. The environmental health framework showed that sustained approaches that comprehensively address all influences on the information environment are needed, representing only 19% of the dataset. Conclusions: Responses to future infodemics would benefit from cross-sector coordination, adoption of measurable and meaningful goals, and alignment with public health frameworks, which provide critical conceptual grounding for infodemic response approaches and ensure comprehensiveness of approach. Beyond individual interventions, a funded coordination mechanism can provide overarching strategic direction and promote collaboration. %R 10.2196/67119 %U https://infodemiology.jmir.org/2025/1/e67119 %U https://doi.org/10.2196/67119 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56836 %T Enhancing the Innovation Ecosystem: Overcoming Challenges to Introducing Information-Driven Technologies in Health Care %A Reed,Julie %A Svedberg,Petra %A Nygren,Jens %+ , School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 035167100, jens.nygren@hh.se %K artificial intelligence %K ecosystem %K health care %K implementation %K technology adoption %K improvement %K complex-systems %D 2025 %7 24.3.2025 %9 Viewpoint %J J Med Internet Res %G English %X As health care demands rise and resources remain constrained, optimizing health care systems has become critical. Information-driven technologies, such as data analytics and artificial intelligence (AI), offer significant potential to inform and enhance health care delivery at various levels. However, a persistent gap exists between the promise of these technologies and their implementation in routine practice. In this paper, we propose that fragmentation of the innovation ecosystem is behind the failure of new information-driven technologies to be taken up into practice and that these goals can be achieved by increasing the cohesion of the ecosystem. Drawing on our experiences and published literature, we explore five challenges that underlie current ecosystem fragmentation: (1) technology developers often focus narrowly on perfecting the technical specifications of products without sufficiently considering the broader ecosystem in which these innovations will operate; (2) lessons from academic studies on technology implementation are underused, and existing knowledge is not being built upon; (3) the perspectives of healthcare professionals and organizations are frequently overlooked, resulting in misalignment between technology developments and health care needs; (4) ecosystem members lack incentives to collaborate, leading to strong individual efforts but collective ecosystem failure; and (5) investment in enhancing cohesion between ecosystem members is insufficient, with limited recognition of the time and effort required to build effective collaborations. To address these challenges, we propose a series of recommendations: adopting a wide-lens perspective on the ecosystem; developing a shared-value proposition; fostering ecosystem leadership; and promoting local ownership of ecosystem investigation and enhancement. We conclude by proposing practical steps for ecosystem members to self-assess, diagnose, and improve collaboration and knowledge sharing. The recommendations presented in this paper are intended to be broadly applicable across various types of innovation and improvement efforts in diverse ecosystems. %M 40127434 %R 10.2196/56836 %U https://www.jmir.org/2025/1/e56836 %U https://doi.org/10.2196/56836 %U http://www.ncbi.nlm.nih.gov/pubmed/40127434 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e60548 %T Effective Recruitment or Bot Attack? The Challenge of Internet-Based Research Surveys and Recommendations to Reduce Risk and Improve Robustness %A Donkin,Liesje %A Henry,Nathan %A Kercher,Amy %A Pedersen,Mangor %A Wilson,Holly %A Chan,Amy Hai Yan %+ Department of Psychology and Neuroscience, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand, 64 21847886, liesje.donkin@aut.ac.nz %K internet-based research %K research methodology %K surveys %K data integrity %K bot attacks %K technology %K data manipulation %K spam %K false %K falsification %K fraudulent %K fraud %K bots %K research methods %K data collection %K verify %K verification %K participants %D 2025 %7 14.3.2025 %9 Viewpoint %J Interact J Med Res %G English %X Internet-based research has exploded in popularity in recent years, enabling researchers to offer both investigations and interventions to broader participant populations than ever before. However, challenges associated with internet-based research have also increased—notably, difficulties verifying participant data and deliberate data manipulation by bot and spam responses. This study presents a viewpoint based on 2 case studies where internet-based research was affected by bot and spam attacks. We aim to share the learnings from these experiences with recommendations for future research practice that may reduce the likelihood or impact of future attacks. The screening and verification processes used are presented and discussed, including the limitations of these. Based on our experience, security and screening within internet-based research platforms are partly effective, but no solution is available to protect researchers completely against bot attacks. Implications for future research and advice for health researchers are discussed. %M 40086470 %R 10.2196/60548 %U https://www.i-jmr.org/2025/1/e60548 %U https://doi.org/10.2196/60548 %U http://www.ncbi.nlm.nih.gov/pubmed/40086470 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70112 %T eHealth Literacy 3.0: Updating the Norman and Skinner 2006 Model %A Milanti,Ariesta %A Norman,Cameron %A Chan,Dorothy Ngo Sheung %A So,Winnie Kwok Wei %A Skinner,Harvey %+ The Nethersole School of Nursing, The Chinese University of Hong Kong, 7/F, Esther Lee Building, Hong Kong, China (Hong Kong), 852 3943 1072, winnieso@cuhk.edu.hk %K eHealth literacy %K eHealth literacy definition %K eHealth literacy model %K eHealth literacy measurement %D 2025 %7 11.3.2025 %9 Research Letter %J J Med Internet Res %G English %X This paper advances the “eHealth Literacy 3.0” model following Norman and Skinner’s 2006 original eHealth literacy 1.0 model and Norman’s 2011 2.0 update, and introduces a corresponding revision to the eHealth Literacy Scale (eHEALS) measurement instrument (eHEALS-R). %M 40068166 %R 10.2196/70112 %U https://www.jmir.org/2025/1/e70112 %U https://doi.org/10.2196/70112 %U http://www.ncbi.nlm.nih.gov/pubmed/40068166 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64307 %T Ubiquitous News Coverage and Its Varied Effects in Communicating Protective Behaviors to American Adults in Infectious Disease Outbreaks: Time-Series and Longitudinal Panel Study %A Shao,Anqi %A Chen,Kaiping %A Johnson,Branden %A Miranda,Shaila %A Xing,Qidi %+ Department of Life Sciences Communication, University of Wisconsin - Madison, 1545 Observatory Drive, Madison, WI, 53706, United States, 1 6083389939, anqi.shao@wisc.edu %K risk communication %K panel study %K computational method %K intermedia agenda setting %K protective behaviors %K infectious disease %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective communication is essential for promoting preventive behaviors during infectious disease outbreaks like COVID-19. While consistent news can better inform the public about these health behaviors, the public may not adopt them. Objective: This study aims to explore the role of different media platforms in shaping public discourse on preventive measures to infectious diseases such as quarantine and vaccination, and how media exposure influences individuals’ intentions to adopt these behaviors in the United States. Methods: This study uses data from 3 selected top national newspapers in the United States, Twitter discussions, and a US nationwide longitudinal panel survey from February 2020 to April 2021. We used the Intermedia Agenda-Setting Theory and the Protective Action Decision Model to develop the theoretical framework. Results: We found a 2-way agenda flow between selected national newspapers and the social media platform Twitter, particularly in controversial topics like vaccination (F1,426=16.39; P<.001 for newspapers; F1,426=44.46; P<.001 for Twitter). Exposure to media coverage increased individuals’ perceived benefits of certain behaviors like vaccination but did not necessarily translate into behavioral adoption. For example, while individuals’ media exposure increased perceived benefits of mask-wearing (β=.057; P<.001 for household benefits; β=.049; P<.001 for community benefits), it was not consistently linked to higher intentions to wear masks (β=–.026; P=.04). Conclusions: This study integrates media flow across platforms with US national panel survey data, offering a comprehensive view of communication dynamics during the early stage of an infectious disease outbreak. The findings caution against a one-size-fits-all approach in communicating different preventive behaviors, especially where individual and community benefits may not always align. %M 40063934 %R 10.2196/64307 %U https://www.jmir.org/2025/1/e64307 %U https://doi.org/10.2196/64307 %U http://www.ncbi.nlm.nih.gov/pubmed/40063934 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63482 %T Facilitators and Barriers to the Implementation of Digital Health Technologies in Hospital Settings in Lower- and Middle-Income Countries Since the Onset of the COVID-19 Pandemic: Scoping Review %A Yew,Sheng Qian %A Trivedi,Daksha %A Adanan,Nurul Iman Hafizah %A Chew,Boon How %+ Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertforshire, AL10 9AB, United Kingdom, 44 01707286389, d.trivedi@herts.ac.uk %K digital health implementation %K facilitators %K barriers %K digital health classification framework %K lower- and middle-income countries %D 2025 %7 6.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Although the implementation process of digital health technologies (DHTs) has been extensively documented in high-income countries, the factors that facilitate and prevent their implementation in lower- and middle-income countries (LMICs) may differ for various reasons. Objective: To address this gap in research, this scoping review aims to determine the facilitators and barriers to implementing DHTs in LMIC hospital settings following the onset of the COVID-19 pandemic. Additionally, the review outlined the types of DHTs that have been implemented in LMICs’ hospitals during this pandemic and finally developed a classification framework to categorize the landscape of DHTs. Methods: Systematic searches were conducted on PubMed, Scopus, Web of Science, and Google Scholar for studies published from March 2020 to December 2023. We extracted data on authors, publication years, study objectives, study countries, disease conditions, types of DHTs, fields of clinical medicine where the DHTs are applied, study designs, sample sizes, characteristics of the study population, study location, and data collection methods of the included studies. Both quantitative and qualitative data were utilized to conduct a thematic analysis, using a deductive method based on the Practical, Robust Implementation and Sustainability Model (PRISM), to identify facilitators and barriers to DHT implementation. Finally, all accessible DHTs were identified and organized to create a novel classification framework. Results: Twelve studies were included from 292 retrieved articles. Telemedicine (n=5) was the most commonly used DHT in LMICs’ hospitals, followed by hospital information systems (n=4), electronic medical records (n=2), and mobile health (n=1). These 4 DHTs, among the other existing DHTs, allowed us to develop a novel classification framework for DHTs. The included studies used qualitative methods (n=4), which included interviews and focus groups, quantitative methods (n=5), or a combination of both (n=2). Among the 64 facilitators of DHT implementation, the availability of continuous on-the-job training (n=3), the ability of DHTs to prevent cross-infection (n=2), and positive previous experiences using DHTs (n=2) were the top 3 reported facilitators. However, of the 44 barriers to DHT implementation, patients with poor digital literacy and skills in DHTs (n=3), inadequate awareness regarding DHTs among health care professionals and stakeholders (n=2), and concerns regarding the accuracy of disease diagnosis and treatment through DHTs (n=2) were commonly reported. Conclusions: In the postpandemic era, telemedicine, along with other DHTs, has seen increased implementation in hospitals within LMICs. All facilitators and barriers can be categorized into 6 themes, namely, (1) Aspects of the Health Care System; (2) Perspectives of Patients; (3) External Environment; (4) Implementation of Sustainable Infrastructure; (5) Characteristics of Health Care Organization; and (6) Characteristics of Patients. %M 40053793 %R 10.2196/63482 %U https://www.jmir.org/2025/1/e63482 %U https://doi.org/10.2196/63482 %U http://www.ncbi.nlm.nih.gov/pubmed/40053793 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66032 %T Health Communication on the Internet: Promoting Public Health and Exploring Disparities in the Generative AI Era %A Uddin,Jamal %A Feng,Cheng %A Xu,Junfang %+ Department of Pharmacy, Second Affiliated Hospital, School of Public health, Zhejiang University School of Medicine, 866 Yuhangtang road, Xihu district, Hangzhou, 310058, China, 86 18801230482 ext 000, junfangxuhappy1987@163.com %K internet %K generative AI %K artificial intelligence %K ChatGPT %K health communication %K health promotion %K health disparity %K health %K communication %K internet %K AI %K generative %K tool %K genAI %K gratification theory %K gratification %K public health %K inequity %K disparity %D 2025 %7 6.3.2025 %9 Viewpoint %J J Med Internet Res %G English %X Health communication and promotion on the internet have evolved over time, driven by the development of new technologies, including generative artificial intelligence (GenAI). These technological tools offer new opportunities for both the public and professionals. However, these advancements also pose risks of exacerbating health disparities. Limited research has focused on combining these health communication mediums, particularly those enabled by new technologies like GenAI, and their applications for health promotion and health disparities. Therefore, this viewpoint, adopting a conceptual approach, provides an updated overview of health communication mediums and their role in understanding health promotion and disparities in the GenAI era. Additionally, health promotion and health disparities associated with GenAI are briefly discussed through the lens of the Technology Acceptance Model 2, the uses and gratifications theory, and the knowledge gap hypothesis. This viewpoint discusses the limitations and barriers of previous internet-based communication mediums regarding real-time responses, personalized advice, and follow-up inquiries, highlighting the potential of new technology for public health promotion. It also discusses the health disparities caused by the limitations of GenAI, such as individuals’ inability to evaluate information, restricted access to services, and the lack of skill development. Overall, this study lays the groundwork for future research on how GenAI could be leveraged for public health promotion and how its challenges and barriers may exacerbate health inequities. It underscores the need for more empirical studies, as well as the importance of enhancing digital literacy and increasing access to technology for socially disadvantaged populations. %M 40053755 %R 10.2196/66032 %U https://www.jmir.org/2025/1/e66032 %U https://doi.org/10.2196/66032 %U http://www.ncbi.nlm.nih.gov/pubmed/40053755 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64721 %T Emerging Domains for Measuring Health Care Delivery With Electronic Health Record Metadata %A Tawfik,Daniel %A Rule,Adam %A Alexanian,Aram %A Cross,Dori %A Holmgren,A Jay %A Lou,Sunny S %A McPeek Hinz,Eugenia %A Rose,Christian %A Viswanadham,Ratnalekha V N %A Mishuris,Rebecca G %A Rodríguez-Fernández,Jorge M %A Ford,Eric W %A Florig,Sarah T %A Sinsky,Christine A %A Apathy,Nate C %+ Department of Pediatrics, Stanford University School of Medicine, 770 Welch Road, Suite 435, Palo Alto, CA, 94304, United States, 1 6507239902, dtawfik@stanford.edu %K metadata %K health services research %K audit logs %K event logs %K electronic health record data %K health care delivery %K patient care %K healthcare teams %K clinician-patient relationship %K cognitive environment %D 2025 %7 6.3.2025 %9 Viewpoint %J J Med Internet Res %G English %X This article aims to introduce emerging measurement domains made feasible through the electronic health record (EHR) use metadata, to inform the changing landscape of health care delivery. We reviewed emerging domains in which EHR metadata may be used to measure health care delivery, outlining a framework for evaluating measures based on desirability, feasibility, and viability. We argue that EHR use metadata may be leveraged to develop and operationalize novel measures in the domains of team structure and dynamics, workflows, and cognitive environment to provide a clearer understanding of modern health care delivery. Examples of measures feasible using metadata include quantification of teamwork and collaboration, patient continuity measures, workflow conformity measures, and attention switching. By enabling measures that can be used to inform the next generation of health care delivery, EHR metadata may be used to improve the quality of patient care and support clinician well-being. Careful attention is needed to ensure that these measures are desirable, feasible, and viable. %M 40053814 %R 10.2196/64721 %U https://www.jmir.org/2025/1/e64721 %U https://doi.org/10.2196/64721 %U http://www.ncbi.nlm.nih.gov/pubmed/40053814 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e48955 %T Legitimacy as Social Infrastructure: A Critical Interpretive Synthesis of the Literature on Legitimacy in Health and Technology %A Howe,Sydney %A Uyl-de Groot,Carin %A Wehrens,Rik %+ Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, The Netherlands, 31 107547119, howe@eshpm.eur.nl %K legitimacy %K health technology %K infrastructure %K literature review %K technology adoption %K health care governance %K technology acceptance %K health care delivery %K social infrastructure %K critical interpretive synthesis %D 2025 %7 5.3.2025 %9 Review %J JMIR Hum Factors %G English %X Background: As technology is integrated into health care delivery, research on adoption and acceptance of health technologies leaves large gaps in practice and provides limited explanation of how and why certain technologies are adopted and others are not. In these discussions, the concept of legitimacy is omnipresent but often implicit and underdeveloped. There is no agreement about what legitimacy is or how it works across social science disciplines, despite a prolific volume of the literature centering legitimacy. Objective: This study aims to explore the meaning of legitimacy in health and technology as conceptualized in the distinctive disciplines of organization and management studies, science and technology studies, and medical anthropology and sociology, including how legitimacy is produced and used. This allows us to critically combine insights across disciplines and generate new theory. Methods: We conducted a critical interpretive synthesis literature review. Searches were conducted iteratively and were guided by preset eligibility criteria determined through thematic analysis, beginning with the selection of disciplines, followed by journals, and finally articles. We selected disciplines and journals in organization and management studies, science and technology studies, and medical anthropology and sociology using results from the Scopus and Web of Science databases and disciplinary expert–curated journal lists, focusing on the depth of legitimacy conceptualization. We selected 30 journals, yielding 796 abstracts. Results: A total of 97 articles were included. The synthesis of the literature allowed us to produce a novel conceptualization of legitimacy as a form of social infrastructure, approaching legitimacy as a binding fabric of relationships, narratives, and materialities. We argue that the notion of legitimacy as social infrastructure is a flexible and adaptable framework for working with legitimacy both theoretically and practically. Conclusions: The legitimacy as social infrastructure framework can aid both academics and decision makers by providing more coherent and holistic explanations for how and why new technologies are adopted or not in health care practice. For academics, our framework makes legitimacy and technology adoption empirically approachable from an ethnographic perspective; for decision makers, legitimacy as social infrastructure allows for a practical, action-oriented focus that can be assessed iteratively at any stage of the technology development and implementation process. %M 40053717 %R 10.2196/48955 %U https://humanfactors.jmir.org/2025/1/e48955 %U https://doi.org/10.2196/48955 %U http://www.ncbi.nlm.nih.gov/pubmed/40053717 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e49507 %T Implementation of a Web-Based Program for Advance Care Planning and Evaluation of its Complexity With the Nonadoption, Abandonment, Scale-Up, Spread, And Sustainability (NASSS) Framework: Qualitative Evaluation Study %A van der Smissen,Doris %A Schreijer,Maud A %A van Gemert-Pijnen,Lisette J E W C %A Verdaasdonk,Rudolf M %A van der Heide,Agnes %A Korfage,Ida J %A Rietjens,Judith A C %+ Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands, 31 107038460, i.korfage@erasmusmc.nl %K eHealth %K web-based intervention %K implementation %K sustainability %K advance care planning %K NASSS framework %K nonadoption, abandonment, scale-up, spread, and sustainability framework %K health communication %K patient education %K patient-centered care %D 2025 %7 4.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: The implementation of eHealth applications often fails. The NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework aims to identify complexities in eHealth applications; the more complex, the more risk of implementation failure. Objective: This study aimed to analyze the implementation of the web-based advance care planning (ACP) program “Explore Your Preferences for Treatment and Care” using the NASSS framework. Methods: The NASSS framework enables a systematic approach to improve the implementation of eHealth tools. It is aimed at generating a rich and situated analysis of complexities in multiple domains, based on thematic analysis of existing and newly collected data. It also aims at supporting individuals and organizations to handle these complexities. We used 6 of 7 domains of the NASSS framework (ie, condition, technology, value proposition, adopters, external context, and embedding and adaptation over time) leaving out “organization,” and analyzed the multimodal dataset of a web-based ACP program, its development and evaluation, including peer-reviewed publications, notes of stakeholder group meetings, and interviews with stakeholders. Results: This study showed that the web-based ACP program uses straightforward technology, is embedded in a well-established web-based health platform, and in general appears to generate a positive value for stakeholders. A complexity is the rather broad target population of the program. A potential complexity considers the limited insight into the extent to which health care professionals adopt the program. Awareness of the relevance of the web-based ACP program may still be improved among target populations of ACP and among health care professionals. Furthermore, the program may especially appeal to those who value individual autonomy, self-management, and an explicit and direct communicative approach. Conclusions: Relatively few complexities were identified considering the implementation of the web-based ACP program “Explore Your Preferences for Treatment and Care.” The program is evidence-based, freestanding, and well-maintained, with straightforward, well-understood technology. The program is expected to generate a positive value for different stakeholders. Complexities include the broad target population of the program and sociocultural factors. People with limited digital literacy may need support to use the program. Its uptake might be improved by increasing awareness of ACP and the program among a wider population of potential users and among health care professionals. Addressing these issues may guide future use and sustainability of the program. %M 40053753 %R 10.2196/49507 %U https://aging.jmir.org/2025/1/e49507 %U https://doi.org/10.2196/49507 %U http://www.ncbi.nlm.nih.gov/pubmed/40053753 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56306 %T Finding Consensus on Trust in AI in Health Care: Recommendations From a Panel of International Experts %A Starke,Georg %A Gille,Felix %A Termine,Alberto %A Aquino,Yves Saint James %A Chavarriaga,Ricardo %A Ferrario,Andrea %A Hastings,Janna %A Jongsma,Karin %A Kellmeyer,Philipp %A Kulynych,Bogdan %A Postan,Emily %A Racine,Elise %A Sahin,Derya %A Tomaszewska,Paulina %A Vold,Karina %A Webb,Jamie %A Facchini,Alessandro %A Ienca,Marcello %+ Institute for History and Ethics of Medicine, Technical University of Munich, Ismaninger Str. 22, Munich, 81675, Germany, 49 8941404041, georg.starke@tum.de %K expert consensus %K trust %K artificial intelligence %K clinical decision support %K assistive technologies %K public health surveillance %K framework analysis %D 2025 %7 19.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The integration of artificial intelligence (AI) into health care has become a crucial element in the digital transformation of health systems worldwide. Despite the potential benefits across diverse medical domains, a significant barrier to the successful adoption of AI systems in health care applications remains the prevailing low user trust in these technologies. Crucially, this challenge is exacerbated by the lack of consensus among experts from different disciplines on the definition of trust in AI within the health care sector. Objective: We aimed to provide the first consensus-based analysis of trust in AI in health care based on an interdisciplinary panel of experts from different domains. Our findings can be used to address the problem of defining trust in AI in health care applications, fostering the discussion of concrete real-world health care scenarios in which humans interact with AI systems explicitly. Methods: We used a combination of framework analysis and a 3-step consensus process involving 18 international experts from the fields of computer science, medicine, philosophy of technology, ethics, and social sciences. Our process consisted of a synchronous phase during an expert workshop where we discussed the notion of trust in AI in health care applications, defined an initial framework of important elements of trust to guide our analysis, and agreed on 5 case studies. This was followed by a 2-step iterative, asynchronous process in which the authors further developed, discussed, and refined notions of trust with respect to these specific cases. Results: Our consensus process identified key contextual factors of trust, namely, an AI system’s environment, the actors involved, and framing factors, and analyzed causes and effects of trust in AI in health care. Our findings revealed that certain factors were applicable across all discussed cases yet also pointed to the need for a fine-grained, multidisciplinary analysis bridging human-centered and technology-centered approaches. While regulatory boundaries and technological design features are critical to successful AI implementation in health care, ultimately, communication and positive lived experiences with AI systems will be at the forefront of user trust. Our expert consensus allowed us to formulate concrete recommendations for future research on trust in AI in health care applications. Conclusions: This paper advocates for a more refined and nuanced conceptual understanding of trust in the context of AI in health care. By synthesizing insights into commonalities and differences among specific case studies, this paper establishes a foundational basis for future debates and discussions on trusting AI in health care. %M 39969962 %R 10.2196/56306 %U https://www.jmir.org/2025/1/e56306 %U https://doi.org/10.2196/56306 %U http://www.ncbi.nlm.nih.gov/pubmed/39969962 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63396 %T Exploring Metadata Catalogs in Health Care Data Ecosystems: Taxonomy Development Study %A Scheider,Simon %A Mallick,Mostafa Kamal %+ Fraunhofer Institute for Software and Systems Engineering, Speicherstraße 6, Dortmund, 44147, Germany, 49 231976774, simon.scheider@isst.fraunhofer.de %K data catalogs %K data ecosystems %K findability, accessibility, interoperability, and reusability %K FAIR %K health care %K metadata %K taxonomy %D 2025 %7 18.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: In the European health care industry, recent years have seen increasing investments in data ecosystems to “FAIRify” and capitalize the ever-rising amount of health data. Within such networks, health metadata catalogs (HMDCs) assume a key function as they enable data allocation, sharing, and use practices. By design, HMDCs orchestrate health information for the purpose of findability, accessibility, interoperability, and reusability (FAIR). However, despite various European initiatives pushing health care data ecosystems forward, actionable design knowledge about HMDCs is scarce. This impedes both their effective development in practice and their scientific exploration, causing huge unused innovation potential of health data. Objective: This study aims to explore the structural design elements of HMDCs, classifying them alongside empirically reasonable dimensions and characteristics. In doing so, the development of HMDCs in practice is facilitated while also closing a crucial gap in theory (ie, the literature about actionable HMDC design knowledge). Methods: We applied a rigorous methodology for taxonomy building following well-known and established guidelines from the domain of information systems. Within this methodological framework, inductive and deductive research methods were applied to iteratively design and evaluate the evolving set of HMDC dimensions and characteristics. Specifically, a systematic literature review was conducted to identify and analyze 38 articles, while a multicase study was conducted to examine 17 HMDCs from practice. These findings were evaluated and refined in 2 extensive focus group sessions by 7 interdisciplinary experts with deep knowledge about HMDCs. Results: The artifact generated by the study is an iteratively conceptualized and empirically grounded taxonomy with elaborate explanations. It proposes 20 dimensions encompassing 101 characteristics alongside which FAIR HMDCs can be structured and classified. The taxonomy describes basic design characteristics that need to be considered to implement FAIR HMDCs effectively. A major finding was that a particular focus in developing HMDCs is on the design of their published dataset offerings (ie, their metadata assets) as well as on data security and governance. The taxonomy is evaluated against the background of 4 use cases, which were cocreated with experts. These illustrative scenarios add depth and context to the taxonomy as they underline its relevance and applicability in real-world settings. Conclusions: The findings contribute fundamental, yet actionable, design knowledge for building HMDCs in European health care data ecosystems. They provide guidance for health care practitioners, while allowing both scientists and policy makers to navigate through this evolving research field and anchor their work. Therefore, this study closes the research gap outlined earlier, which has prevailed in theory and practice. %M 39964739 %R 10.2196/63396 %U https://formative.jmir.org/2025/1/e63396 %U https://doi.org/10.2196/63396 %U http://www.ncbi.nlm.nih.gov/pubmed/39964739 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58956 %T A Hierarchical Framework for Selecting Reference Measures for the Analytical Validation of Sensor-Based Digital Health Technologies %A Bakker,Jessie P %A McClenahan,Samantha J %A Fromy,Piper %A Turner,Simon %A Peterson,Barry T %A Vandendriessche,Benjamin %A Goldsack,Jennifer C %+ Digital Medicine Society, 90 Canal Street, Boston, MA, 02114, United States, 1 7652343463, benjamin.vandendriessche@dimesociety.org %K digital health technologies %K analytical validation %K digital medicine %K reference measures %K fit-for-purpose digital clinical measures %D 2025 %7 7.2.2025 %9 Viewpoint %J J Med Internet Res %G English %X Sensor-based digital health technologies (sDHTs) are increasingly used to support scientific and clinical decision-making. The digital clinical measures they generate offer enormous benefits, including providing more patient-relevant data, improving patient access, reducing costs, and driving inclusion across health care ecosystems. Scientific best practices and regulatory guidance now provide clear direction to investigators seeking to evaluate sDHTs for use in different contexts. However, the quality of the evidence reported for analytical validation of sDHTs—evaluation of algorithms converting sample-level sensor data into a measure that is clinically interpretable—is inconsistent and too often insufficient to support a particular digital measure as fit-for-purpose. We propose a hierarchical framework to address challenges related to selecting the most appropriate reference measure for conducting analytical validation and codify best practices and an approach that will help capture the greatest value of sDHTs for public health, patient care, and medical product development. %M 39918870 %R 10.2196/58956 %U https://www.jmir.org/2025/1/e58956 %U https://doi.org/10.2196/58956 %U http://www.ncbi.nlm.nih.gov/pubmed/39918870 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67485 %T AI for IMPACTS Framework for Evaluating the Long-Term Real-World Impacts of AI-Powered Clinician Tools: Systematic Review and Narrative Synthesis %A Jacob,Christine %A Brasier,Noé %A Laurenzi,Emanuele %A Heuss,Sabina %A Mougiakakou,Stavroula-Georgia %A Cöltekin,Arzu %A Peter,Marc K %+ FHNW, University of Applied Sciences and Arts Northwestern Switzerland, Bahnhofstrasse 6, Windisch, 5210, Switzerland, 41 62 957 29 78, christine.k.jacob@gmail.com %K eHealth %K assessment %K adoption %K implementation %K artificial intelligence %K clinician %K efficiency %K health technology assessment %K clinical practice %D 2025 %7 5.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) has the potential to revolutionize health care by enhancing both clinical outcomes and operational efficiency. However, its clinical adoption has been slower than anticipated, largely due to the absence of comprehensive evaluation frameworks. Existing frameworks remain insufficient and tend to emphasize technical metrics such as accuracy and validation, while overlooking critical real-world factors such as clinical impact, integration, and economic sustainability. This narrow focus prevents AI tools from being effectively implemented, limiting their broader impact and long-term viability in clinical practice. Objective: This study aimed to create a framework for assessing AI in health care, extending beyond technical metrics to incorporate social and organizational dimensions. The framework was developed by systematically reviewing, analyzing, and synthesizing the evaluation criteria necessary for successful implementation, focusing on the long-term real-world impact of AI in clinical practice. Methods: A search was performed in July 2024 across the PubMed, Cochrane, Scopus, and IEEE Xplore databases to identify relevant studies published in English between January 2019 and mid-July 2024, yielding 3528 results, among which 44 studies met the inclusion criteria. The systematic review followed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines and the Cochrane Handbook for Systematic Reviews. Data were analyzed using NVivo through thematic analysis and narrative synthesis to identify key emergent themes in the studies. Results: By synthesizing the included studies, we developed a framework that goes beyond the traditional focus on technical metrics or study-level methodologies. It integrates clinical context and real-world implementation factors, offering a more comprehensive approach to evaluating AI tools. With our focus on assessing the long-term real-world impact of AI technologies in health care, we named the framework AI for IMPACTS. The criteria are organized into seven key clusters, each corresponding to a letter in the acronym: (1) I—integration, interoperability, and workflow; (2) M—monitoring, governance, and accountability; (3) P—performance and quality metrics; (4) A—acceptability, trust, and training; (5) C—cost and economic evaluation; (6) T—technological safety and transparency; and (7) S—scalability and impact. These are further broken down into 28 specific subcriteria. Conclusions: The AI for IMPACTS framework offers a holistic approach to evaluate the long-term real-world impact of AI tools in the heterogeneous and challenging health care context and lays the groundwork for further validation through expert consensus and testing of the framework in real-world health care settings. It is important to emphasize that multidisciplinary expertise is essential for assessment, yet many assessors lack the necessary training. In addition, traditional evaluation methods struggle to keep pace with AI’s rapid development. To ensure successful AI integration, flexible, fast-tracked assessment processes and proper assessor training are needed to maintain rigorous standards while adapting to AI’s dynamic evolution. Trial Registration: reviewregistry1859; https://tinyurl.com/ysn2d7sh %M 39909417 %R 10.2196/67485 %U https://www.jmir.org/2025/1/e67485 %U https://doi.org/10.2196/67485 %U http://www.ncbi.nlm.nih.gov/pubmed/39909417 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e51785 %T Why AI Monitoring Faces Resistance and What Healthcare Organizations Can Do About It: An Emotion-Based Perspective %A Werder,Karl %A Cao,Lan %A Park,Eun Hee %A Ramesh,Balasubramaniam %+ , Digital Business Innovation, IT University of Copenhagen, Rued Langgaards Vej 7, Copenhagen, 2300, Denmark, 45 72185386, karw@itu.dk %K artificial intelligence %K AI monitoring %K emotion %K resistance %K health care %D 2025 %7 31.1.2025 %9 Viewpoint %J J Med Internet Res %G English %X Continuous monitoring of patients’ health facilitated by artificial intelligence (AI) has enhanced the quality of health care, that is, the ability to access effective care. However, AI monitoring often encounters resistance to adoption by decision makers. Healthcare organizations frequently assume that the resistance stems from patients’ rational evaluation of the technology’s costs and benefits. Recent research challenges this assumption and suggests that the resistance to AI monitoring is influenced by the emotional experiences of patients and their surrogate decision makers. We develop a framework from an emotional perspective, provide important implications for healthcare organizations, and offer recommendations to help reduce resistance to AI monitoring. %M 39889282 %R 10.2196/51785 %U https://www.jmir.org/2025/1/e51785 %U https://doi.org/10.2196/51785 %U http://www.ncbi.nlm.nih.gov/pubmed/39889282 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60138 %T Designing Health Recommender Systems to Promote Health Equity: A Socioecological Perspective %A Figueroa,Caroline A %A Torkamaan,Helma %A Bhattacharjee,Ananya %A Hauptmann,Hanna %A Guan,Kathleen W %A Sedrakyan,Gayane %+ Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, Delft, 2628, Netherlands, 31 621378688, c.figueroa@tudelft.nl %K digital health %K health promotion %K health recommender systems %K artificial intelligence %K health equity %K AI %K digital devices %K socioecological %K health inequities %K health behavior %K health behaviors %K patient centric %K digital health intervention %D 2025 %7 30.1.2025 %9 Viewpoint %J J Med Internet Res %G English %X Health recommender systems (HRS) have the capability to improve human-centered care and prevention by personalizing content, such as health interventions or health information. HRS, an emerging and developing field, can play a unique role in the digital health field as they can offer relevant recommendations, not only based on what users themselves prefer and may be receptive to, but also using data about wider spheres of influence over human behavior, including peers, families, communities, and societies. We identify and discuss how HRS could play a unique role in decreasing health inequities. We use the socioecological model, which provides representations of how multiple, nested levels of influence (eg, community, institutional, and policy factors) interact to shape individual health. This perspective helps illustrate how HRS could address not just individual health factors but also the structural barriers—such as access to health care, social support, and access to healthy food—that shape health outcomes at various levels. Based on this analysis, we then discuss the challenges and future research priorities. We find that despite the potential for targeting more complex systemic challenges to obtaining good health, current HRS are still focused on individual health behaviors, often do not integrate the lived experiences of users in the design, and have had limited reach and effectiveness for individuals from low socioeconomic status and racial or ethnic minoritized backgrounds. In this viewpoint, we argue that a new design paradigm is necessary in which HRS focus on incorporating structural barriers to good health in addition to user preferences. HRS should be designed with an emphasis on health systems, which also includes incorporating decolonial perspectives of well-being that challenge prevailing medical models. Furthermore, potential lies in evaluating the health equity effects of HRS and leveraging collected data to influence policy. With changes in practices and with an intentional equity focus, HRS could play a crucial role in health promotion and decreasing health inequities. %M 39883934 %R 10.2196/60138 %U https://www.jmir.org/2025/1/e60138 %U https://doi.org/10.2196/60138 %U http://www.ncbi.nlm.nih.gov/pubmed/39883934 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65446 %T Harnessing Human-Centered Design for Evidence-Based Psychosocial Interventions and Implementation Strategies in Community Settings: Protocol for Redesign to Improve Usability, Engagement, and Appropriateness %A Lyon,Aaron R %A Munson,Sean A %A Pullmann,Michael D %A Mosser,Brittany %A Aung,Tricia %A Fortney,John %A Dopp,Alex %A Osterhage,Katie P %A Haile,Helen G %A Bruzios,Kathryn E %A Blanchard,Brittany E %A Allred,Ryan %A Fuller,Macey R %A Raue,Patrick J %A Bennett,Ian %A Locke,Jill %A Bearss,Karen %A Walker,Denise %A Connors,Elizabeth %A Bruns,Eric %A Van Draanen,Jenna %A Darnell,Doyanne %A Areán,Patricia A %+ Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560, United States, 1 2062218604, lyona@uw.edu %K implementation science %K human-centered design %K evidence-based psychosocial interventions %K mental health %D 2025 %7 29.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although substantial progress has been made in establishing evidence-based psychosocial clinical interventions and implementation strategies for mental health, translating research into practice—particularly in more accessible, community settings—has been slow. Objective: This protocol outlines the renewal of the National Institute of Mental Health–funded University of Washington Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness Center, which draws from human-centered design (HCD) and implementation science to improve clinical interventions and implementation strategies. The Center’s second round of funding (2023-2028) focuses on using the Discover, Design and Build, and Test (DDBT) framework to address 3 priority clinical intervention and implementation strategy mechanisms (ie, usability, engagement, and appropriateness), which we identified as challenges to implementation and scalability during the first iteration of the center. Local redesign teams work collaboratively and share decision-making to carry out DDBT. Methods: All 4 core studies received institutional review board approval by June 2024, and each pilot project will pursue institutional review board approval when awarded. We will provide research infrastructure to 1 large effectiveness study and 3 exploratory pilot studies as part of the center grant. At least 4 additional small pilot studies will be solicited and funded by the center. All studies will explore the use of DDBT for clinical interventions and implementation strategies to identify modification targets to improve usability, engagement, and appropriateness in accessible nonspecialty settings (Discover phase); develop redesign solutions with local teams to address modification targets (Design and Build phase); and determine if redesign improves usability, engagement, and appropriateness (Test phase), as well as implementation outcomes. Center staff will collaborate with local redesign teams to develop and test clinical interventions and implementation strategies for community settings. We will collaborate with teams to use methods and centerwide measures that facilitate cross-project analysis of the effects of DDBT-driven redesign on outcomes of interest. Results: As of January 2025, three of the 4 core studies are underway. We will generate additional evidence on the robustness of DDBT and whether combining HCD and implementation science is an asset for improving clinical interventions and implementation strategies. Conclusions: During the first round of the center, we established that DDBT is a useful approach to systematically identify and address chronic challenges of implementing clinical interventions and implementation strategies. In this subsequent grant, we expect to increase evidence of DDBT’s impact on clinical interventions and implementation strategies by expanding a list of common challenges that could benefit from modification, a list of exemplary solutions to address these challenges, and guidance on using the DDBT framework. These resources will contribute to broader discourse on how to enhance implementation of clinical interventions and implementation strategies that integrate HCD and implementation science. International Registered Report Identifier (IRRID): PRR1-10.2196/65446 %M 39879590 %R 10.2196/65446 %U https://www.researchprotocols.org/2025/1/e65446 %U https://doi.org/10.2196/65446 %U http://www.ncbi.nlm.nih.gov/pubmed/39879590 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69742 %T Advantages and Inconveniences of a Multi-Agent Large Language Model System to Mitigate Cognitive Biases in Diagnostic Challenges %A Bousquet,Cedric %A Beltramin,Divà %+ Laboratory of Medical Informatics and Knowledge Engineering in e-Health, Inserm, Sorbonne University, 15 rue de l'école de Médecine, Paris, F-75006, France, 33 0477127974, cedric.bousquet@chu-st-etienne.fr %K large language model %K multi-agent system %K diagnostic errors %K cognition %K clinical decision-making %K cognitive bias %K generative artificial intelligence %D 2025 %7 20.1.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39832364 %R 10.2196/69742 %U https://www.jmir.org/2025/1/e69742 %U https://doi.org/10.2196/69742 %U http://www.ncbi.nlm.nih.gov/pubmed/39832364 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58546 %T Evaluating the Impacts of Community-Campus Engagement on Population Health in Ottawa and Thunder Bay, Canada: Protocol for a Mixed Methods Contribution Analysis %A Buetti,David %A Larche,Cynthia %A Fitzgerald,Michael %A Bourgeois,Isabelle %A Cameron,Erin %A Carr,Kady %A Aubry,Tim %A Persaud,Sydney %A Kendall,Claire E %+ Bruyère Health Research Institute, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada, 1 6135626262 ext 1614, ckendall@uottawa.ca %K community-campus engagement %K population health %K contribution analysis %K mixed methods %K health determinants %K community health %K CityStudio %K theory of change %K impact evaluation %D 2025 %7 17.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Municipalities play a crucial role in population health due to their community connections and influence on health determinants. Community-campus engagement (CCE), that is, collaboration between academic institutions and communities, is a promising approach to addressing community health priorities. However, evidence of CCE’s impact on population health remains limited. Measuring the impacts of CCE is inherently complex due to factors such as diverse stakeholders, context-specific variables, and dynamic interactions within a community. Objective: This study aims to develop robust evidence on the impacts of CCE on population health outcomes in Ottawa and Thunder Bay, Ontario, Canada, focusing on 5 shared health priorities: housing, discrimination, poverty, violence, and mental health. Methods: We will use a proven CCE model called CityStudio, which has been implemented in both cities. We will use Mayne's mixed methods contribution analysis in three stages: (1) formulating a theory of change that outlines the expected contributions of CCE to population health outcomes; (2) gathering qualitative and quantitative data in line with the established Theory of Change; the data will be collected from various sources, including case studies of existing CityStudio projects, a web-based CCE stakeholder survey, a literature review, and population and community health data; and (3) reviewing the gathered evidence to determine the extent of CCE impacts on population health. Results: Ethical approval for this project was granted in May 2023. We have since initiated stage 1 by reviewing the literature to inform the development of the theory of change. We expect to complete this study by May 2026. Conclusions: This study will address two critical gaps about how improving health outcomes depends on CCE: (1) how academic institutions can best engage with their communities to improve population health outcomes, and (2) how municipalities can engage with academic institutions to address their community health priorities. Conducting our work in differing contexts will allow us to consider a broader range of other influences on outcomes, thus making our work applicable to various settings and outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/58546 %M 39819858 %R 10.2196/58546 %U https://www.researchprotocols.org/2025/1/e58546 %U https://doi.org/10.2196/58546 %U http://www.ncbi.nlm.nih.gov/pubmed/39819858 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64258 %T Assessment, Decision, Adaptation, Production, Topical Experts-Integration, Training, and Testing (ADAPT-ITT) Framework to Tailor Evidence-Based Posttraumatic Stress Disorder Treatment for People With HIV to Enhance Engagement and Adherence: Qualitative Results from a Feasibility Randomized Controlled Trial %A Lopez,Cristina M %A Moreland,Angela D %A Amaya,Stephanie %A Bisca,Erin %A Mujica,Christin %A Wilson,Tayler %A Baker,Nathaniel %A Richey,Lauren %A Eckard,Allison Ross %A Resick,Patricia A %A Safren,Steven A %A Danielson,Carla Kmett %+ Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC, 29425-5712, United States, 1 843 792 2945, lopezcm@musc.edu %K PTSD %K HIV %K adherence %K minoritized populations %K adaptation %K evidence-based %K treatment %K engagement %K posttraumatic stress disorder %K stress %K trauma %K antiretroviral therapy %K therapy %K symptoms %K acceptability %K self-efficacy %D 2025 %7 16.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with co-occurring posttraumatic stress disorder (PTSD) and HIV are at high-risk for negative HIV-related outcomes, including low adherence to antiretroviral therapy, faster disease progression, more hospitalizations, and almost twice the rate of death. Despite high rates of PTSD in persons with HIV (PWH) and poor HIV-related health outcomes associated with PTSD, an effective evidence-based treatment for PTSD symptoms in PWH does not exist. Objective: This study aimed to describe the adaptation and theater testing of an evidence-based intervention designed for people with co-occurring PTSD and HIV. Methods: The Assessment, Decision, Adaptation, Production, Topical experts-integration, Training, and Testing (ADAPT-ITT) framework guided the formative process used to modify an evidence-based PTSD treatment (cognitive processing therapy; CPT) to meet the unique needs of PWH experiencing PTSD. With the integration of Life-Steps for Medication Adherence (Life-Steps), the adapted protocol (CPT-Life-Steps for integration of adherence; CPT-L) targeted HIV-related stigma and HIV medication adherence within a trauma-informed framework. Theater testing was completed with 7 participants to evaluate acceptability of CPT-L for PWH. The qualitative data (N=54 recordings) used to evaluate and adapt CPT-L emerged from individual interviews conducted with participants after each therapy session as well as exit interviews conducted at posttreatment data collection. Results: After challenging stigma-related appraisals, participants expressed feeling less constrained by maladaptive thoughts. These shifts translated to increased self-efficacy with both HIV-related care and mental health. Conclusions: These results indicate that trauma-informed work with PWH should consider the impact of HIV on trauma-related stuck points, intersecting identities (including living with HIV), and challenging internalized stigma. Findings provide evidence that CPT-L is acceptable and effective in addressing internalized HIV stigma that impacts PTSD symptom maintenance and HIV treatment engagement. Trial Registration: ClinicalTrials.gov; NCT05275842; https://clinicaltrials.gov/study/NCT05275842?id=NCT05275842&rank=1 International Registered Report Identifier (IRRID): RR2-10.1016/j.conctc.2023.101150 %M 39819749 %R 10.2196/64258 %U https://formative.jmir.org/2025/1/e64258 %U https://doi.org/10.2196/64258 %U http://www.ncbi.nlm.nih.gov/pubmed/39819749 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e55235 %T A Holistic Digital Health Framework to Support Health Prevention Strategies in the First 1000 Days %A Gabrielli,Silvia %A Mayora Ibarra,Oscar %A Forti,Stefano %K digital health %K digital therapeutics %K behavioral intervention technology %K prevention %K citizen science %K first 1000 days %D 2025 %7 16.1.2025 %9 %J JMIR Pediatr Parent %G English %X The first 1000 days of a child’s life, spanning from the time of conception until 2 years of age, are a key period of laying down the foundations of optimum health, growth, and development across the lifespan. Although the role of health prevention programs targeting families and children in the first 1000 days of life is well recognized, investments in this key period are scarce, and the provision of adequate health care services is insufficient. The aim of this viewpoint is to provide a holistic digital health framework cocreated with policy makers, health care professionals, and families to support more effective efforts and health care programs dedicated to the first 1000 days of life as the first line of prevention. The framework provides recommendations for leveraging on behavioral intervention technology and digital therapeutics solutions augmented by artificial intelligence to support the effective deployment of health prevention programs to families. The framework also encourages the adoption of a citizen science approach to co-design and evolve the digital health interventions with all relevant stakeholders in a real-world research perspective. %R 10.2196/55235 %U https://pediatrics.jmir.org/2025/1/e55235 %U https://doi.org/10.2196/55235 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57363 %T Enhancing HIV Cognitive Abilities and Self-Management Through Information Technology–Assisted Interventions: Scoping Review %A Huang,Hao %A Xie,MeiLian %A Yang,Zhen %A Wang,AiPing %+ First Hospital of China Medical University, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, China, 86 1399889 0800, apwang@cmu.edu.cn %K digital media %K self-management %K HIV %K AIDS %K scoping review %K technology-assisted interventions %K information technology %K behaviors %K patient %K electronic database %K information systems %K smartphone %K app %K SMS text messaging %K effectiveness %K mobile phone %D 2025 %7 13.1.2025 %9 Review %J J Med Internet Res %G English %X Background: HIV/AIDS remains a significant global challenge, and with the rapid advancement of technology, there has been an increasing number of interventions aimed at improving HIV/AIDS cognition and self-management behaviors among patients. However, there is still a lack of detailed literature integrating relevant evidence. Objective: This study aims to comprehensively review existing research on interventions using modern information methods to improve HIV/AIDS cognition and enhance self-management behaviors among patients. It systematically reports the theoretical frameworks and specific intervention strategies used in current research, providing a comprehensive overview of the development status of relevant studies. We aim to compile existing evidence through this scoping review to identify potential avenues for future research. Methods: We followed the scoping review framework proposed by the Joanna Briggs Institute for the synthesis and reporting of evidence. Relevant literature was searched using electronic databases, including PubMed, Web of Science, Embase, CINAHL, and Cochrane Library. The time frame for inclusion was from 2018 to December 1, 2023. Inclusion criteria were (1) interventions using modern information technology or new digital media, (2) studies focusing on improving HIV awareness or self-management behaviors among people living with HIV, (3) intervention studies or evaluations of intervention effects, and (4) studies published within the last five years. Two reviewers (HH and MX) independently assessed each study at both the title and abstract screening stage and the full-text review stage, resolving any disagreements through discussion. Results: A total of 55 studies that met the inclusion criteria were included. The Information-Motivation-Behavioral Skills model, Social Cognitive Theory, Health Belief Model, Theory of Planned Behavior, and Information Systems Research Framework are among the most commonly used theoretical frameworks. Modern information technology interventions are mainly constructed using smartphone apps, SMS text messaging, internet-based platforms, audiovisual materials, and digital health education platforms, with smartphone apps and SMS text messaging being the most widely used intervention media. Conclusions: Modern information technology is becoming an important tool for health interventions among people living with HIV/AIDS. However, future research should focus on integrating theoretical framework guidance with intervention design, further exploring the diversity of intervention implementations, the applicability of different technological methods, their long-term effects, and how to more effectively combine traditional intervention strategies to maximize intervention outcomes. %M 39805101 %R 10.2196/57363 %U https://www.jmir.org/2025/1/e57363 %U https://doi.org/10.2196/57363 %U http://www.ncbi.nlm.nih.gov/pubmed/39805101 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59601 %T The CeHRes Roadmap 2.0: Update of a Holistic Framework for Development, Implementation, and Evaluation of eHealth Technologies %A Kip,Hanneke %A Beerlage-de Jong,Nienke %A van Gemert-Pijnen,Lisette J E W C %A Kelders,Saskia M %+ Section of Psychology, Health & Technology, Centre for eHealth and Wellbeing, University of Twente, Drienerlolaan 5, Enschede, 7522, Netherlands, 31 534896536, h.kip@utwente.nl %K eHealth development %K eHealth implementation %K CeHRes Roadmap %K participatory development %K human-centered design %K persuasive design %K eHealth framework %D 2025 %7 13.1.2025 %9 Viewpoint %J J Med Internet Res %G English %X To ensure that an eHealth technology fits with its intended users, other stakeholders, and the context within which it will be used, thorough development, implementation, and evaluation processes are necessary. The CeHRes (Centre for eHealth and Wellbeing Research) Roadmap is a framework that can help shape these processes. While it has been successfully used in research and practice, new developments and insights have arisen since the Roadmap’s first publication in 2011, not only within the domain of eHealth but also within the different disciplines in which the Roadmap is grounded. Because of these new developments and insights, a revision of the Roadmap was imperative. This paper aims to present the updated pillars and phases of the CeHRes Roadmap 2.0. The Roadmap was updated based on four types of sources: (1) experiences with its application in research; (2) literature reviews on eHealth development, implementation, and evaluation; (3) discussions with eHealth researchers; and (4) new insights and updates from relevant frameworks and theories. The updated pillars state that eHealth development, implementation, and evaluation (1) are ongoing and intertwined processes; (2) have a holistic approach in which context, people, and technology are intertwined; (3) consist of continuous evaluation cycles; (4) require active stakeholder involvement from the start; and (5) are based on interdisciplinary collaboration. The CeHRes Roadmap 2.0 consists of 5 interrelated phases, of which the first is the contextual inquiry, in which an overview of the involved stakeholders, the current situation, and points of improvement is created. The findings from the contextual inquiry are specified in the value specification, in which the foundation for the to-be-developed eHealth technology is created by formulating values and requirements, preliminarily selecting behavior change techniques and persuasive features, and initiating a business model. In the Design phase, the requirements are translated into several lo-fi and hi-fi prototypes that are iteratively tested with end users and other stakeholders. A version of the technology is rolled out in the Operationalization phase, using the business model and an implementation plan. In the Summative Evaluation phase, the impact, uptake, and working mechanisms are evaluated using a multimethod approach. All phases are interrelated by continuous formative evaluation cycles that ensure coherence between outcomes of phases and alignment with stakeholder needs. While the CeHRes Roadmap 2.0 consists of the same phases as the first version, the objectives and pillars have been updated and adapted, reflecting the increased emphasis on behavior change, implementation, and evaluation as a process. There is a need for more empirical studies that apply and reflect on the CeHRes Roadmap 2.0 to provide points of improvement because just as with any eHealth technology, the Roadmap has to be constantly improved based on the input of its users. %M 39805104 %R 10.2196/59601 %U https://www.jmir.org/2025/1/e59601 %U https://doi.org/10.2196/59601 %U http://www.ncbi.nlm.nih.gov/pubmed/39805104 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e63054 %T Factors Associated With Digital Capacity for Health Promotion Among Primary Care Workers: Cross-Sectional Survey Study %A Wang,Yining %A Ren,Hui %A Xiao,Shaotan %A Meng,Tian %A Sun,Shuyue %A Yu,Siyu %A Liu,Qing %A Wang,Fan %+ Fudan Development Institute, Fudan University, 220 Handan Road, Shanghai, 200433, China, 86 21 55664081, wangfan512@126.com %K health promotion %K digital capacity %K primary care workers %K Digital Capabilities Framework %K online survey %D 2024 %7 20.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Health education and promotion are recognized as effective strategies for fostering healthy ageing, reducing the disease burden, and addressing health inequalities, particularly when delivered through digital media. Primary care workers are often regarded as the key providers of these interventions. Despite the strong practical significance and substantial individual demand, the use of digital media for delivering health promotion practices was not widespread in China. One of the main challenges identified is the providers’ inadequate capacities. However, little is known about the digital capacity for health promotion among primary care workers. Objective: This study aimed to investigate the levels of digital capacity for health promotion and its associated factors among community health workers. Methods: A total of 1346 community health workers were recruited from across 47 communities in Shanghai, China, through cluster-stratified random sampling. The digital capacity for health promotion was measured using the revised version of the Digital Capabilities Framework. Web-based questionnaires were distributed to collect data from March 20 to March 29, 2024. Data were analyzed using descriptive statistics, independent t tests, one-way ANOVA, and linear hierarchical regression using Stata MP (version 17.0; StataCorp). Results: We included 1199 participants. Among them, 47.5% (570/1199) had high digital media use for more than 19.6 hours per week, whereas 31.8% (381/1199) demonstrated high digital media trust. The average level of digital capacity for health promotion was 16.71 (SD 2.94) out of 25 points. Demographics, digital media usage–related characteristics, perceived usefulness and usability, attitudes, and behaviors were significant predictors of the capacities, explaining 44.4% of the total variance. Master’s degree or above (β=.077; P=.013), perceived usability (β=.235; P<.001), attitudes toward digital media health promotion (β=.095; P=.002), and past digital media health promotion practices (β=.377; P<.001) had significantly positive associations with digital capacities for health promotion. However, senior (β=–.076; P=.008) or median (β=–.074; P=.01) titles had a significant negative association with capacity levels. Conclusions: A digitally capable workforce is required for primary health care systems to take full advantage of digital media health promotion. Therefore, solutions are necessary to achieve enhanced capacities among health professionals, including public health policy making, community empowerment, and individual practices. %M 39705686 %R 10.2196/63054 %U https://www.jmir.org/2024/1/e63054 %U https://doi.org/10.2196/63054 %U http://www.ncbi.nlm.nih.gov/pubmed/39705686 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57786 %T Dimensions and Subcategories of Digital Maturity in General Practice: Qualitative Study %A Neunaber,Timo %A Mortsiefer,Achim %A Meister,Sven %+ Health Care Informatics, Faculty of Health, School of Medicine, Witten/Herdecke University, Pferdebachstr. 11, Witten, 58448, Germany, 49 230292678629, sven.meister@uni-wh.de %K digital health %K eHealth %K digital maturity %K maturity assessment %K primary care %K general practice %K general practitioner %K qualitative research %K expert interviews %K interview %K explorative %K dimension %K subcategory %K expert %K care provider %K content analysis %D 2024 %7 19.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The status of the digitalization of companies and institutions is usually measured using maturity models. However, the concept of maturity in general practice is currently unclear, and herewith we examine the question of how maturity can be measured. There is a lack of empirical work on the dimensions and subcategories of digital maturity that provide information on the assessment framework. Objective: The aim of the study was to answer the question of how many and which dimensions and subcategories describe digital maturity in general practice. Methods: An explorative, qualitative research design based on semistructured expert interviews was used to investigate the dimensions of digital maturity. Twenty experts from various areas of the health care sector (care providers, interest groups, health care industry, and patient organizations) were interviewed. The interviews were analyzed based on a content-structuring analysis according to Kuckartz and Rädiker using MAXQDA software (VERBI GmbH). Results: In total, 6 dimensions with a total of 26 subcategories were identified. Of these, 4 dimensions with a total of 16 subcategories (1) digitally supported processes, (2) practice staff, (3) organizational structures and rules, and (4) technical infrastructure and were deductively linked to digital maturity. In addition to the use of digital solutions, digital maturity included, for example, individual, organizational, and technical capabilities and resources of the medical practice. The 2 further dimensions, (5) benefits and outcomes and (6) external framework conditions of the medical practice, were identified inductively with a total of 10 subcategories. Digital maturity was associated with the beneficial use of digitalization, for example, with efficiency benefits for the practice, and external framework conditions were associated with influencing factors such as the local patient situation in the medical practice. Conclusions: The results indicate that digital maturity is a multidimensional construct that is associated with many dimensions and variables. It is a holistic approach with human, organizational, and technical factors and concerns the way digitalization is used to shape patient care and processes. Furthermore, it is related to the maturity of the organizational environment as well as the benefits of a digitalized medical practice; however, this still needs to be confirmed. To measure the level of digital maturity in outpatient care as accurately as possible, maturity models should therefore be multilayered and take external influencing factors into account. Future research should statistically validate the identified dimensions. At the same time, correlations and dependencies between the measurement dimensions and their subcategories should be analyzed. %M 39699948 %R 10.2196/57786 %U https://www.jmir.org/2024/1/e57786 %U https://doi.org/10.2196/57786 %U http://www.ncbi.nlm.nih.gov/pubmed/39699948 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 8 %N %P e67928 %T Emotional Touch Nursing Competencies Model of the Fourth Industrial Revolution: Instrument Validation Study %A Jung,Sun-Young %A Lee,Ji-Hyeon %+ College of Nursing, Daegu University, Seongdang-ro 50-gil 33, Nam-gu, Daegu, 42601, Republic of Korea, 82 536508016, jihyeonnlee@naver.com %K nurse %K therapeutic touch %K clinical competence %K factor analysis %K statistical %K reliability %K scale %K tool %K nursing %K industrial revolution %K competencies %K health care %K emotional %K interview %K collaborative practice %K learning agility %K professional commitment %K positive self-worth %K compliance %K ethics %K practice ability %K relationship ability %K nursing sensitivity %D 2024 %7 16.12.2024 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: The Fourth Industrial Revolution is transforming the health care sector through advanced technologies such as artificial intelligence, the Internet of Things, and big data, leading to new expectations for rapid and accurate treatment. While the integration of technology in nursing tasks is on the rise, there remains a critical need to balance technological efficiency with empathy and emotional connection. This study aims to develop and validate a competency model for emotional touch nursing that responds to the evolving demands of the changing health care environment. Objective: The aims of our study are to develop an emotional touch nursing competencies model and to verify its reliability and validity. Methods: A conceptual framework and construct factors were developed based on an extensive literature review and in-depth interviews with nurses. The potential competencies were confirmed by 20 experts, and preliminary questions were prepared. The final version of the scale was verified through exploratory factor analysis (n=255) and confirmatory factor analysis (n=256) to assess its validity and reliability. Results: From the exploratory analysis, 8 factors and 38 items (client-centered collaborative practice, learning agility for nursing, nursing professional commitment, positive self-worth, compliance with ethics and roles, nursing practice competence, nurse-client relationship, and nursing sensitivity) were extracted. These items were verified through convergent and discriminant validity testing. The internal consistency reliability was acceptable (Cronbach α=0.95). Conclusions: The findings from this study confirmed that this scale has sufficient validity and reliability to measure emotional touch nursing competencies. It is expected to be used to build a knowledge and educational system for emotional touch nursing. %M 39680900 %R 10.2196/67928 %U https://apinj.jmir.org/2024/1/e67928 %U https://doi.org/10.2196/67928 %U http://www.ncbi.nlm.nih.gov/pubmed/39680900 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e63476 %T Discovering Time-Varying Public Interest for COVID-19 Case Prediction in South Korea Using Search Engine Queries: Infodemiology Study %A Ahn,Seong-Ho %A Yim,Kwangil %A Won,Hyun-Sik %A Kim,Kang-Min %A Jeong,Dong-Hwa %+ Department of Artificial Intelligence, The Catholic University of Korea, Jibong-Ro 43 3-1, Bucheon-Si, Republic of Korea, 82 2 2164 5564, kangmin89@catholic.ac.kr %K COVID-19 %K confirmed case prediction %K search engine queries %K query expansion %K word embedding %K public health %K case prediction %K South Korea %K search engine %K infodemiology %K infodemiology study %K policy %K lifestyle %K machine learning %K machine learning techniques %K utilization %K temporal variation %K novel framework %K temporal %K web-based search %K temporal semantics %K prediction model %K model %D 2024 %7 16.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of confirmed COVID-19 cases is a crucial indicator of policies and lifestyles. Previous studies have attempted to forecast cases using machine learning techniques that use a previous number of case counts and search engine queries predetermined by experts. However, they have limitations in reflecting temporal variations in queries associated with pandemic dynamics. Objective: This study aims to propose a novel framework to extract keywords highly associated with COVID-19, considering their temporal occurrence. We aim to extract relevant keywords based on pandemic variations using query expansion. Additionally, we examine time-delayed web-based search behavior related to public interest in COVID-19 and adjust for better prediction performance. Methods: To capture temporal semantics regarding COVID-19, word embedding models were trained on a news corpus, and the top 100 words related to “Corona” were extracted over 4-month windows. Time-lagged cross-correlation was applied to select optimal time lags correlated to confirmed cases from the expanded queries. Subsequently, ElasticNet regression models were trained after reducing the feature dimensions using principal component analysis of the time-lagged features to predict future daily case counts. Results: Our approach successfully extracted relevant keywords depending on the pandemic phase, encompassing keywords directly related to COVID-19, such as its symptoms, and its societal impact. Specifically, during the first outbreak, keywords directly linked to COVID-19 and past infectious disease outbreaks similar to those of COVID-19 exhibited a high positive correlation. In the second phase of the pandemic, as community infections emerged, keywords related to the government’s pandemic control policies were frequently observed with a high positive correlation. In the third phase of the pandemic, during the delta variant outbreak, keywords such as “economic crisis” and “anxiety” appeared, reflecting public fatigue. Consequently, prediction models trained by the extracted queries over 4-month windows outperformed previous methods for most predictions 1-14 days ahead. Notably, our approach showed significantly higher Pearson correlation coefficients than models based solely on the number of past cases for predictions 9-11 days ahead (P=.02, P<.01, and P<.01), in contrast to heuristic- and symptom-based query sets. Conclusions: This study proposes a novel COVID-19 case-prediction model that automatically extracts relevant queries over time using word embedding. The model outperformed previous methods that relied on static symptom-based or heuristic queries, even without prior expert knowledge. The results demonstrate the capability of our approach to track temporal shifts in public interest regarding changes in the pandemic. %M 39680913 %R 10.2196/63476 %U https://www.jmir.org/2024/1/e63476 %U https://doi.org/10.2196/63476 %U http://www.ncbi.nlm.nih.gov/pubmed/39680913 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53344 %T Reflections From the Pandemic: Is Connectivism the Panacea for Clinicians? %A Benjamin,Jennifer %A Pillow,Tyson %A MacNeill,Heather %A Masters,Ken %A Agrawal,Anoop %A Mehta,Neil %+ Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street, Houston, TX, 77030, United States, 1 832 824 1000 ext 3436, jennifer.benjamin@bcm.edu %K learning theory %K learning framework %K connectivism %K panacea %K COVID-19 %K generative artificial intelligence %K GAI %K health care community %K clinician %K health care %K airborne disease %K learning %K information %K misinformation %K autonomy %K diversity %D 2024 %7 3.12.2024 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19 pandemic and the recent increased interest in generative artificial intelligence (GenAI) highlight the need for interprofessional communities’ collaboration to find solutions to complex problems. A personal narrative experience of one of the authors compels us to reflect on current approaches to learning and knowledge acquisition and use solutions to the challenges posed by GenAI through social learning contexts using connectivism. We recognize the need for constructivism and experiential learning for knowledge acquisition to establish foundational understanding. We explore how connectivist approaches can enhance traditional constructivist paradigms amid rapidly changing learning environments and online communities. Learning in connectivism includes interacting with experts from other disciplines and creating nodes of accurate and accessible information while distinguishing between misinformation and accurate facts. Autonomy, connectedness, diversity, and openness are foundational for learners to thrive in this learning environment. Learning in this environment is not just acquiring new knowledge as individuals but being connected to networks of knowledge, enabling health professionals to stay current and up-to-date. Existing online communities with accessible GenAI solutions allow for the application of connectivist principles for learning and knowledge acquisition. %M 39625749 %R 10.2196/53344 %U https://www.jmir.org/2024/1/e53344 %U https://doi.org/10.2196/53344 %U http://www.ncbi.nlm.nih.gov/pubmed/39625749 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58007 %T A Cross-Disciplinary Analysis of the Complexities of Scaling Up eHealth Innovation %A Allers,Sanne %A Carboni,Chiara %A Eijkenaar,Frank %A Wehrens,Rik %+ Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester van Oudlaan 50, Rotterdam, 3062PA, Netherlands, 31 104081213, allers@eshpm.eur.nl %K innovation %K eHealth %K remote patient monitoring %K scale-up %K cross-disciplinary %K qualitative case study %K health care systems %K adaptation %K complexity %K health care %K framework %K ecological perspective %K barriers and facilitators %D 2024 %7 2.12.2024 %9 Viewpoint %J J Med Internet Res %G English %X Innovative eHealth technologies are becoming increasingly common worldwide, with researchers and policy makers advocating their scale-up within and across health care systems. However, examples of successful scale-up remain extremely rare. Although this issue is widely acknowledged, there is still only a limited understanding of why scaling up eHealth technologies is so challenging. This article aims to contribute to a better understanding of the complexities innovators encounter when attempting to scale up eHealth technologies and their strategies for addressing these complexities. We draw on different theoretical perspectives as well as the findings of an interview-based case study of a prominent remote patient monitoring (RPM) innovation in the Netherlands. Specifically, we create a cross-disciplinary theoretical framework bringing together 3 perspectives on scale-up: a structural perspective (focusing on structural barriers and facilitators), an ecological perspective (focusing on local complexities), and a critical perspective (focusing on mutual adaptation between innovation and setting). We then mobilize these perspectives to analyze how various stakeholders (n=14) experienced efforts to scale up RPM technology. We provide 2 key insights: (1) the complexities and strategies associated with local eHealth scale-up are disconnected from those that actors encounter at a broader level scale-up, and this translates into a simultaneous need for stability and malleability, which catches stakeholders in an impasse, and (2) pre-existing circumstances and associated path dependencies shape the complexities of the local context and facilitate or constrain opportunities for the scale-up of eHealth innovation. The 3 theoretical perspectives used in this article, with their diverging assumptions about innovation scale-up, should be viewed as complementary and highlight different aspects of the complexities perceived as playing an important role. Using these perspectives, we conclude that the level at which scale-up is envisaged and the pre-existing local circumstances (2 factors whose importance is often neglected) contribute to an impasse in the scale-up of eHealth innovation at the broader level of scale. %M 39622044 %R 10.2196/58007 %U https://www.jmir.org/2024/1/e58007 %U https://doi.org/10.2196/58007 %U http://www.ncbi.nlm.nih.gov/pubmed/39622044 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59904 %T Impact of Reverse Empowerment and Proactive Motivations on Physicians’ Online Knowledge Sharing in Digital Platforms: Survey Study %A Su,Jingyuan %A Shen,Kathy Ning %A Guo,Xitong %+ College of Business and Economics, Human Capital Research Center, United Arab Emirates University, PO Box 15551, Al Ain, United Arab Emirates, 971 556543825, ningshen@uaeu.ac.ae %K physician behavior %K online knowledge sharing %K proactivity %K patient empowerment %K digital platforms %K health communication %D 2024 %7 29.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital platforms offer a venue for patients and physicians to exchange health information and provide health care services outside traditional organizational contexts. Previous studies have seldom focused on the factors that drive the proactivity of physicians’ online behavior. Additionally, there is limited research exploring the influence of patients on physicians’ online behavior, particularly from the perspective of patients possessing power. Objective: This study aims to investigate the effect of patient-empowering behaviors on physicians’ online knowledge sharing and uncover the potential mechanisms of proactivity. Based on the proactive motivational model and empowerment theory, we propose the existence of a reverse empowerment process, where empowerment flows from patients to physicians. We suggest that patient-empowering behaviors may drive physicians’ online knowledge sharing as a form of proactivity. Specifically, 3 proactive motivational states—knowledge-sharing self-efficacy, sharing meaning, and positive professional affect—mediate this relationship. Additionally, platform extrinsic rewards, as a contextual factor, have a moderating effect. Methods: To validate our proposed research model, we conducted a survey in China using the WJX platform, targeting physicians engaged in online knowledge sharing. The measurement instrument utilizes validated items adapted from prior research, using a 5-point Likert scale. We collected 257 valid responses, ensuring that participation was both anonymous and voluntary. Data analysis was performed in 2 stages. The first stage assessed the measurement model for reliability and validity, using the Harman 1-factor test and confirmatory factor analysis. The second stage used partial least squares-structural equation modeling to examine the direct, moderation, and mediation effects among the constructs, with bootstrapping used for significance testing. This comprehensive approach ensures a robust analysis of the proposed hypotheses and contributes to the overall validity of our research model. Results: Perceived patient-empowering behaviors significantly and positively influence physicians’ online knowledge sharing (β=0.27, P<.001). Knowledge-sharing self-efficacy (effect=0.06, P=.04), sharing meaning (effect=0.12, P<.001), and positive professional affect (effect=0.10, P=.003) each partially mediate the effect of patient-empowering behaviors on physicians’ online knowledge sharing. The overall proactive motivational states play a complete mediation role, meaning the entire indirect effect of the model is significant (effect=0.29, P<.001), while the direct effect in the model is nonsignificant (effect=0.07, P=.26). Additionally, platform extrinsic rewards significantly and negatively moderate the effect of sharing meaning on physicians’ online knowledge sharing (β=–0.13, P=.001). Conclusions: This study is the first to recognize and examine proactivity as an alternative mediating mechanism for physicians’ online knowledge sharing, highlighting the active role of patients in empowering physicians. It makes a significant contribution to the existing literature on empowerment, eHealth, and proactive behavior. Additionally, the findings offer valuable guidance for designing and managing digital platforms to ensure service sustainability. %R 10.2196/59904 %U https://www.jmir.org/2024/1/e59904 %U https://doi.org/10.2196/59904 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53986 %T A Taxonomy and Archetypes of AI-Based Health Care Services: Qualitative Study %A Blaß,Marlene %A Gimpel,Henner %A Karnebogen,Philip %+ FIM Research Center for Information Management, University of Hohenheim, Branch Business & Information Systems Engineering of the Fraunhofer FIT, Schloss Hohenheim 1, Stuttgart, 70599, Germany, 49 0711 459 24051, marlene.blass@fit.fraunhofer.de %K healthcare %K artificial intelligence %K AI %K taxonomy %K services %K cluster analysis %K archetypes %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: To cope with the enormous burdens placed on health care systems around the world, from the strains and stresses caused by longer life expectancy to the large-scale emergency relief actions required by pandemics like COVID-19, many health care companies have been using artificial intelligence (AI) to adapt their services. Nevertheless, conceptual insights into how AI has been transforming the health care sector are still few and far between. This study aims to provide an overarching structure with which to classify the various real-world phenomena. A clear and comprehensive taxonomy will provide consensus on AI-based health care service offerings and sharpen the view of their adoption in the health care sector. Objective: The goal of this study is to identify the design characteristics of AI-based health care services. Methods: We propose a multilayered taxonomy created in accordance with an established method of taxonomy development. In doing so, we applied 268 AI-based health care services, conducted a structured literature review, and then evaluated the resulting taxonomy. Finally, we performed a cluster analysis to identify the archetypes of AI-based health care services. Results: We identified 4 critical perspectives: agents, data, AI, and health impact. Furthermore, a cluster analysis yielded 13 archetypes that demonstrate our taxonomy’s applicability. Conclusions: This contribution to conceptual knowledge of AI-based health care services enables researchers as well as practitioners to analyze such services and improve their theory-led design. %M 39602787 %R 10.2196/53986 %U https://www.jmir.org/2024/1/e53986 %U https://doi.org/10.2196/53986 %U http://www.ncbi.nlm.nih.gov/pubmed/39602787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52498 %T Technology Acceptance Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis %A DeLange Martinez,Pauline %A Tancredi,Daniel %A Pavel,Misha %A Garcia,Lorena %A Young,Heather M %+ Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th St, Sacramento, CA, 95817, United States, 1 916 426 2862, pdmartinez@ucdavis.edu %K aged %K older adults %K Asian American %K immigrant %K vulnerable populations %K internet %K information and communications technology %K ICT %K digital divide %K technology acceptance model %K mobile phone %D 2024 %7 22.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Studies show that the use of information and communications technologies (ICTs), including smartphones, tablets, computers, and the internet, varies by demographic factors such as age, gender, and educational attainment. However, the connections between ICT use and factors such as ethnicity and English proficiency, especially among Asian American older adults, remain less explored. The technology acceptance model (TAM) suggests that 2 key attitudinal factors, perceived usefulness (PU) and perceived ease of use (PEOU), influence technology acceptance. While the TAM has been adapted for older adults in China, Taiwan, Singapore, and Korea, it has not been tested among Asian American older adults, a population that is heterogeneous and experiences language barriers in the United States. Objective: This study aims to examine the relationships among demographics (age, gender, educational attainment, ethnicity, and English proficiency), PU, PEOU, and ICT use among low-income Asian American older adults. Two outcomes were examined: smartphone use and ICT use, each measured by years of experience and current frequency of use. Methods: This was a secondary data analysis from a cross-sectional baseline survey of the Lighthouse Project, which provided free broadband, ICT devices, and digital literacy training to residents living in 8 affordable senior housing communities across California. This analysis focused on Asian participants aged ≥62 years (N=392), specifically those of Korean, Chinese, Vietnamese, Filipino, and other Asian ethnicities (eg, Hmong and Japanese). Hypotheses were examined using descriptive statistics, correlation analysis, and hierarchical regression analysis. Results: Younger age, higher education, and greater English proficiency were positively associated with smartphone use (age: β=–.202; P<.001; education: β=.210; P<.001; and English proficiency: β=.124; P=.048) and ICT use (age: β=–.157; P=.002; education: β=.215; P<.001; and English proficiency: β=.152; P=.01). Male gender was positively associated with PEOU (β=.111; P=.047) but not with PU (β=–.031; P=.59), smartphone use (β=.023; P=.67), or ICT use (β=.078; P=.16). Ethnicity was a significant predictor of PU (F4,333=5.046; P<.001), PEOU (F4,345=4.299; P=.002), and ICT use (F4,350=3.177; P=.01), with Chinese participants reporting higher levels than Korean participants, who were the reference group (β=.143; P=.007). PU and PEOU were positively correlated with each other (r=0.139, 95% CI=0.037-0.237; P=.007), and both were significant predictors of smartphone use (PU: β=.158; P=.002 and PEOU: β=.166; P=.002) and ICT use (PU: β=.117; P=.02 and PEOU: β=0.22; P<.001), even when controlling for demographic variables. Conclusions: The findings support the use of the TAM among low-income Asian American older adults. In addition, ethnicity and English proficiency are significant predictors of smartphone and ICT use among this population. Future interventions should consider heterogeneity and language barriers of this population to increase technology acceptance and use. %M 39576987 %R 10.2196/52498 %U https://www.jmir.org/2024/1/e52498 %U https://doi.org/10.2196/52498 %U http://www.ncbi.nlm.nih.gov/pubmed/39576987 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e64681 %T Mobile App for Improving the Mental Health of Youth in Out-of-Home Care: Development Study Using an Intervention Mapping Approach %A Park,Jinyoung %A Lee,Jungeun %A Noh,Dabok %+ College of Nursing, Eulji University, 553 Sanseong-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do, 13135, Republic of Korea, 82 31 740 7415, daboknoh@eulji.ac.kr %K out-of-home youth %K mental health intervention %K mobile app %K intervention mapping %K youth %K mental health %K mHealth %K mobile health %K app %K interview %K need %K focus group %K emotion %K emotional %K young adult %K independent living %K emotional support %K tool %K emotion regulation %K user %K app usage %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Youth in out-of-home care encounter substantial mental health challenges because of the absence of stable family and social support systems. Their vulnerability is heightened by trauma, neglect, and abuse. They struggle, especially when transitioning to independent living, coping with loneliness, anxiety, and pressure. Objective: This study aimed to develop a mobile app with high accessibility and long-term continuous effects to support independent living and improve mental health among youth in out-of-home care. The approach used was the systematic and step-by-step intervention mapping (IM) framework. Methods: The program was created using the IM framework and had 6 steps. Drawing from data from individual and focus group interviews and literature reviews, we developed a logical model of the problem. We established program outcomes and objectives, defining performance objectives and variable determinants. We identified theoretical and evidence-based methods that influence determinants. The app design integrated these methods into practical applications, allowing for the creation of self-management and emotional support tools. The development process included ongoing discussions between app designers and the research team to ensure that user needs and preferences were addressed. Results: Individual interviews and focus group discussions revealed challenges in managing daily routines and regulating emotions. The program design was based on the transtheoretical model, social cognitive theory, and elaboration likelihood model. Key features included goal setting, structured routines, emotion recognition flashcards, character models demonstrating emotion regulation strategies, verbal persuasion, and self-monitoring tools to support habit formation and emotion regulation. An implementation plan was developed to facilitate the app’s adoption, execution, and maintenance, while an evaluation plan was established, including app usage analytics, user logs, and feedback surveys. A randomized controlled trial will be conducted to assess the app’s impact on mental health outcomes, focusing on reducing anxiety and depressive symptoms, improving emotion regulation, and enhancing daily living skills. Conclusions: The IM framework was beneficial in developing a mobile app to enhance the mental health of youth in out-of-home care. The study produced a program grounded in theory and evidence that caters to the needs of these individuals. Further research should aim to verify the app’s effectiveness in real-world settings and refine it continuously based on user input. %M 39571152 %R 10.2196/64681 %U https://humanfactors.jmir.org/2024/1/e64681 %U https://doi.org/10.2196/64681 %U http://www.ncbi.nlm.nih.gov/pubmed/39571152 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58088 %T Toward Guidelines for Designing Holistic Integrated Information Visualizations for Time-Critical Contexts: Systematic Review %A Patel,Ahmed Mohammed %A Baxter,Weston %A Porat,Talya %+ Dyson School of Design Engineering, Imperial College London, Imperial College Rd, South Kensington, London, SW7 2DB, United Kingdom, 44 07990035581, ap19@ic.ac.uk %K visualization %K design %K holistic %K integrated %K time-critical %K guidelines %K pre-attentive processing %K gestalt theory %K situation awareness %K decision-making %K mobile phone %D 2024 %7 20.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: With the extensive volume of information from various and diverse data sources, it is essential to present information in a way that allows for quick understanding and interpretation. This is particularly crucial in health care, where timely insights into a patient’s condition can be lifesaving. Holistic visualizations that integrate multiple data variables into a single visual representation can enhance rapid situational awareness and support informed decision-making. However, despite the existence of numerous guidelines for different types of visualizations, this study reveals that there are currently no specific guidelines or principles for designing holistic integrated information visualizations that enable quick processing and comprehensive understanding of multidimensional data in time-critical contexts. Addressing this gap is essential for enhancing decision-making in time-critical scenarios across various domains, particularly in health care. Objective: This study aims to establish a theoretical foundation supporting the argument that holistic integrated visualizations are a distinct type of visualization for time-critical contexts and identify applicable design principles and guidelines that can be used to design for such cases. Methods: We systematically searched the literature for peer-reviewed research on visualization strategies, guidelines, and taxonomies. The literature selection followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was conducted across 6 databases: ACM Digital Library, Google Scholar, IEEE Xplore, PubMed, Scopus, and Web of Science. The search was conducted up to August 2024 using the terms (“visualisations” OR “visualizations”) AND (“guidelines” OR “taxonomy” OR “taxonomies”), with studies restricted to the English language. Results: Of 936 papers, 46 (4.9%) were included in the final review. In total, 48% (22/46) related to providing a holistic understanding and overview of multidimensional data; 28% (13/46) focused on integrated presentation, that is, integrating or combining multidimensional data into a single visual representation; and 35% (16/46) pertained to time and designing for rapid information processing. In total, 65% (30/46) of the papers presented general information visualization or visual communication guidelines and principles. No specific guidelines or principles were found that addressed all the characteristics of holistic, integrated visualizations in time-critical contexts. A summary of the key guidelines and principles from the 46 papers was extracted, collated, and categorized into 60 guidelines that could aid in designing holistic integrated visualizations. These were grouped according to different characteristics identified in the systematic review (eg, gestalt principles, reduction, organization, abstraction, and task complexity) and further condensed into 5 main proposed guidelines. Conclusions: Holistic integrated information visualizations in time-critical domains are a unique use case requiring a unique set of design guidelines. Our proposed 5 main guidelines, derived from existing design theories and guidelines, can serve as a starting point to enable both holistic and rapid processing of information, facilitating better-informed decisions in time-critical contexts. %M 39566050 %R 10.2196/58088 %U https://www.jmir.org/2024/1/e58088 %U https://doi.org/10.2196/58088 %U http://www.ncbi.nlm.nih.gov/pubmed/39566050 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59439 %T Mitigating Cognitive Biases in Clinical Decision-Making Through Multi-Agent Conversations Using Large Language Models: Simulation Study %A Ke,Yuhe %A Yang,Rui %A Lie,Sui An %A Lim,Taylor Xin Yi %A Ning,Yilin %A Li,Irene %A Abdullah,Hairil Rizal %A Ting,Daniel Shu Wei %A Liu,Nan %+ Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore, 65 66016503, liu.nan@duke-nus.edu.sg %K clinical decision-making %K cognitive bias %K generative artificial intelligence %K large language model %K multi-agent %D 2024 %7 19.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive biases in clinical decision-making significantly contribute to errors in diagnosis and suboptimal patient outcomes. Addressing these biases presents a formidable challenge in the medical field. Objective: This study aimed to explore the role of large language models (LLMs) in mitigating these biases through the use of the multi-agent framework. We simulate the clinical decision-making processes through multi-agent conversation and evaluate its efficacy in improving diagnostic accuracy compared with humans. Methods: A total of 16 published and unpublished case reports where cognitive biases have resulted in misdiagnoses were identified from the literature. In the multi-agent framework, we leveraged GPT-4 (OpenAI) to facilitate interactions among different simulated agents to replicate clinical team dynamics. Each agent was assigned a distinct role: (1) making the final diagnosis after considering the discussions, (2) acting as a devil’s advocate to correct confirmation and anchoring biases, (3) serving as a field expert in the required medical subspecialty, (4) facilitating discussions to mitigate premature closure bias, and (5) recording and summarizing findings. We tested varying combinations of these agents within the framework to determine which configuration yielded the highest rate of correct final diagnoses. Each scenario was repeated 5 times for consistency. The accuracy of the initial diagnoses and the final differential diagnoses were evaluated, and comparisons with human-generated answers were made using the Fisher exact test. Results: A total of 240 responses were evaluated (3 different multi-agent frameworks). The initial diagnosis had an accuracy of 0% (0/80). However, following multi-agent discussions, the accuracy for the top 2 differential diagnoses increased to 76% (61/80) for the best-performing multi-agent framework (Framework 4-C). This was significantly higher compared with the accuracy achieved by human evaluators (odds ratio 3.49; P=.002). Conclusions: The multi-agent framework demonstrated an ability to re-evaluate and correct misconceptions, even in scenarios with misleading initial investigations. In addition, the LLM-driven, multi-agent conversation framework shows promise in enhancing diagnostic accuracy in diagnostically challenging medical scenarios. %M 39561363 %R 10.2196/59439 %U https://www.jmir.org/2024/1/e59439 %U https://doi.org/10.2196/59439 %U http://www.ncbi.nlm.nih.gov/pubmed/39561363 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e57754 %T Data Ownership in the AI-Powered Integrative Health Care Landscape %A Liu,Shuimei %A Guo,L Raymond %+ School of Juris Master, China University of Political Science and Law, 25 Xitucheng Rd, Hai Dian Qu, Beijing, 100088, China, 1 (734) 358 3970, shuiliu0802@alumni.iu.edu %K data ownership %K integrative healthcare %K artificial intelligence %K AI %K ownership %K data science %K governance %K consent %K privacy %K security %K access %K model %K framework %K transparency %D 2024 %7 19.11.2024 %9 Viewpoint %J JMIR Med Inform %G English %X In the rapidly advancing landscape of artificial intelligence (AI) within integrative health care (IHC), the issue of data ownership has become pivotal. This study explores the intricate dynamics of data ownership in the context of IHC and the AI era, presenting the novel Collaborative Healthcare Data Ownership (CHDO) framework. The analysis delves into the multifaceted nature of data ownership, involving patients, providers, researchers, and AI developers, and addresses challenges such as ambiguous consent, attribution of insights, and international inconsistencies. Examining various ownership models, including privatization and communization postulates, as well as distributed access control, data trusts, and blockchain technology, the study assesses their potential and limitations. The proposed CHDO framework emphasizes shared ownership, defined access and control, and transparent governance, providing a promising avenue for responsible and collaborative AI integration in IHC. This comprehensive analysis offers valuable insights into the complex landscape of data ownership in IHC and the AI era, potentially paving the way for ethical and sustainable advancements in data-driven health care. %M 39560980 %R 10.2196/57754 %U https://medinform.jmir.org/2024/1/e57754 %U https://doi.org/10.2196/57754 %U http://www.ncbi.nlm.nih.gov/pubmed/39560980 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e63356 %T EDAI Framework for Integrating Equity, Diversity, and Inclusion Throughout the Lifecycle of AI to Improve Health and Oral Health Care: Qualitative Study %A Abbasgholizadeh Rahimi,Samira %A Shrivastava,Richa %A Brown-Johnson,Anita %A Caidor,Pascale %A Davies,Claire %A Idrissi Janati,Amal %A Kengne Talla,Pascaline %A Madathil,Sreenath %A Willie,Bettina M %A Emami,Elham %+ Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada, 1 514 399 9218, samira.rahimi@mcgill.ca %K equity, diversity, and inclusion %K EDI %K health care %K oral health care %K machine learning %K artificial intelligence %K AI %D 2024 %7 15.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Recent studies have identified significant gaps in equity, diversity, and inclusion (EDI) considerations within the lifecycle of artificial intelligence (AI), spanning from data collection and problem definition to implementation stages. Despite the recognized need for integrating EDI principles, there is currently no existing guideline or framework to support this integration in the AI lifecycle. Objective: This study aimed to address this gap by identifying EDI principles and indicators to be integrated into the AI lifecycle. The goal was to develop a comprehensive guiding framework to guide the development and implementation of future AI systems. Methods: This study was conducted in 3 phases. In phase 1, a comprehensive systematic scoping review explored how EDI principles have been integrated into AI in health and oral health care settings. In phase 2, a multidisciplinary team was established, and two 2-day, in-person international workshops with over 60 representatives from diverse backgrounds, expertise, and communities were conducted. The workshops included plenary presentations, round table discussions, and focused group discussions. In phase 3, based on the workshops’ insights, the EDAI framework was developed and refined through iterative feedback from participants. The results of the initial systematic scoping review have been published separately, and this paper focuses on subsequent phases of the project, which is related to framework development. Results: In this study, we developed the EDAI framework, a comprehensive guideline that integrates EDI principles and indicators throughout the entire AI lifecycle. This framework addresses existing gaps at various stages, from data collection to implementation, and focuses on individual, organizational, and systemic levels. Additionally, we identified both the facilitators and barriers to integrating EDI within the AI lifecycle in health and oral health care. Conclusions: The developed EDAI framework provides a comprehensive, actionable guideline for integrating EDI principles into AI development and deployment. By facilitating the systematic incorporation of these principles, the framework supports the creation and implementation of AI systems that are not only technologically advanced but also sensitive to EDI principles. %M 39546793 %R 10.2196/63356 %U https://www.jmir.org/2024/1/e63356 %U https://doi.org/10.2196/63356 %U http://www.ncbi.nlm.nih.gov/pubmed/39546793 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50497 %T Clarifying the Concepts of Personalization and Tailoring of eHealth Technologies: Multimethod Qualitative Study %A ten Klooster,Iris %A Kip,Hanneke %A Beyer,Sina L %A van Gemert-Pijnen,Lisette J E W C %A Kelders,Saskia M %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 620730557, i.tenklooster@utwente.nl %K eHealth %K personalization %K tailoring %K segmentation %K adaptation %K interviews %K definition %D 2024 %7 13.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Although personalization and tailoring have been identified as alternatives to a “one-size-fits-all” approach for eHealth technologies, there is no common understanding of these two concepts and how they should be applied. Objective: This study aims to describe (1) how tailoring and personalization are defined in the literature and by eHealth experts, and what the differences and similarities are; (2) what type of variables can be used to segment eHealth users into more homogeneous groups or at the individual level; (3) what elements of eHealth technologies are adapted to these segments; and (4) how the segments are matched with eHealth adaptations. Methods: We used a multimethod qualitative study design. To gain insights into the definitions of personalization and tailoring, definitions were collected from the literature and through interviews with eHealth experts. In addition, the interviews included questions about how users can be segmented and how eHealth can be adapted accordingly, and responses to 3 vignettes of examples of eHealth technologies, varying in personalization and tailoring strategies to elicit responses about views from stakeholders on how the two components were applied and matched in different contexts. Results: A total of 28 unique definitions of tailoring and 16 unique definitions of personalization were collected from the literature and interviews. The definitions of tailoring and personalization varied in their components, namely adaptation, individuals, user groups, preferences, symptoms, characteristics, context, behavior, content, identification, feedback, channel, design, computerization, and outcomes. During the interviews, participants mentioned 9 types of variables that can be used to segment eHealth users, namely demographics, preferences, health variables, psychological variables, behavioral variables, individual determinants, environmental information, intervention interaction, and technology variables. In total, 5 elements were mentioned that can be adapted to those segments, namely channeling, content, graphical, functionalities, and behavior change strategy. Participants mentioned substantiation methods and variable levels as two components for matching the segmentations with adaptations. Conclusions: Tailoring and personalization are multidimensional concepts, and variability and technology affordances seem to determine whether and how personalization and tailoring should be applied to eHealth technologies. On the basis of our findings, tailoring and personalization can be differentiated by the way that segmentations and adaptations are matched. Tailoring matches segmentations and adaptations based on general group characteristics using if-then algorithms, whereas personalization involves the direct insertion of user information (such as name) or adaptations based on individual-level inferences. We argue that future research should focus on how inferences can be made at the individual level to further develop the field of personalized eHealth. %M 39536317 %R 10.2196/50497 %U https://www.jmir.org/2024/1/e50497 %U https://doi.org/10.2196/50497 %U http://www.ncbi.nlm.nih.gov/pubmed/39536317 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59158 %T A Web-Based Intervention to Support a Growth Mindset and Well-Being in Unemployed Young Adults: Development Study %A Straand,Ingjerd J %A Følstad,Asbjørn %A Wünsche,Burkhard C %+ Department of Social Work, University of Stavanger, Kjell Arholms hus, Kjell Arholms gate 41, Stavanger, 4021, Norway, 47 93222289, ingjerd.j.straand@uis.no %K web-based intervention %K positive psychology %K mental health %K user experience %K persuasive design %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Engaging young adults in the labor market is vital for economic growth and well-being. However, the path to employment often presents setbacks that impact motivation and psychological functioning. Research suggests exploring positive psychology interventions in job-seeking and scaling the delivery of these using technology. However, dropout rates are high for self-administered psychological interventions on digital platforms. This challenge needs to be addressed for such platforms to be effective conveyors of psychological interventions. This study addresses this challenge by exploring user-oriented methods and proposes persuasive features for the design and development of a new web-based intervention targeting young unemployed adults. Objective: This study aims to provide an overview of a new positive psychology wise intervention, including its theoretical underpinnings and human-centered design methodology, targeting young, unemployed adults. Methods: Researchers collaborated with designers, developers, and stakeholders to design a web-based positive psychology intervention that leverages evidence-based wise interventions. Key improvements and adaptations were explored through formative usability testing with 13 unemployed young adults aged between 18 and 25 years (the target population). Qualitative usability testing data were collected, analyzed, and integrated into the ongoing design process as iterative improvements. Results: The result of this study is a modular intervention web application named RØST, designed to align with the user needs and the preferences of the specific end-user group of unemployed young adults. During the project, this application evolved from early concept sketches and prototypes into a developed solution ready for further testing and use. Insights from both end-user feedback and rich user observation gained in the study were used to refine the content and the design. To increase targeted end users’ motivation, persuasive design features including praise, rewards, and reminders were added. The web application was designed primarily to be used on mobile phones using text messaging for reminders. The development process included technical and data protection considerations. Conclusions: This study offers valuable insights into developing psychological or behavioral interventions to support unemployed young adults by documenting the design process and the adaptation and combination of diverse theoretical and empirical foundations. Involving stakeholders and end users in the development enabled relatable content development and resolved potential usability problems. An essential implication is the finding that end-user feedback and insights are crucial in shaping interventions. However, we experienced tensions between the evidence-based interventions and the human-centered design approaches. These tensions were not resolved and highlighted a need for ongoing user motivation support through monetary rewards, which were incorporated into the final web app design. %M 39514255 %R 10.2196/59158 %U https://formative.jmir.org/2024/1/e59158 %U https://doi.org/10.2196/59158 %U http://www.ncbi.nlm.nih.gov/pubmed/39514255 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e62691 %T Transitioning Perspectives in Digital Health Through Phenomenology Integration %A Fiordelli,Maddalena %+ Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, Lugano, 6900, Switzerland, 41 586664139, maddalena.fiordelli@usi.ch %K eHealth %K digital health %K phenomenology %K phenomenological %K participatory %K health communication %K health information %K active listening %K lived experience %D 2024 %7 23.10.2024 %9 Viewpoint %J J Med Internet Res %G English %X The evolution of digital health, from its early days as eHealth to its current expansive scope, reflects a significant transformation in health care delivery and management. This transition underscores the integration of digital technologies across the health continuum from prevention and diagnosis to treatment and rehabilitation. The emergence of digital health has introduced innovative solutions but also posed challenges, particularly in aligning technological advancements with health needs, human experiences, and ethical considerations. This position paper aims to explore the integration of phenomenology in digital health, advocating for a paradigm that emphasizes the centrality of human experience in the design and implementation of digital health solutions. It specifically seeks to address challenges related to relevance for individuals who “speak” different languages, ensuring long-term use, addressing digital and health literacy, coordinating various sources, and navigating ethical issues in the rapidly evolving digital health landscape. Drawing upon years of research and practical experience in communication technologies and health, this paper uses a reflective approach to examine the intersection of digital health and phenomenology. It reviews the historical development of digital health, identifies the challenges faced during its evolution, and discusses the potential of phenomenological methods to enhance user-centered design and ethical practices in digital health. The integration of phenomenology into digital health facilitates a deeper understanding of user experiences, enabling the development of more responsive and ethical digital health solutions. Participatory design models, informed by phenomenological perspectives, offer a pathway to bridge the gap between technological innovation and human-centric health care. The paper highlights successful practices in digital health development, including mobile apps for vaccination decision-making and platforms for managing chronic conditions, illustrating the benefits of a phenomenological approach. Transitioning perspectives in digital health through phenomenology integration represents a critical step toward realizing the full potential of digital technologies in health care. %M 39442170 %R 10.2196/62691 %U https://www.jmir.org/2024/1/e62691 %U https://doi.org/10.2196/62691 %U http://www.ncbi.nlm.nih.gov/pubmed/39442170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58616 %T Quality Assessment of Digital Health Apps: Umbrella Review %A Zych,Maciej Marek %A Bond,Raymond %A Mulvenna,Maurice %A Martinez Carracedo,Jorge %A Bai,Lu %A Leigh,Simon %+ School of Computing, Ulster University, 2-24 York St, Belfast, BT15 1AP, United Kingdom, 44 7526852505, maciejmarekzych@gmail.com %K mHealth assessment %K digital health %K quality assessment %K health apps quality %K assessment criteria %K evaluation criteria %K health apps criteria %K assessment %K digital health app %K app %K umbrella review %K risk %K mobile phone %K frameworks %D 2024 %7 10.10.2024 %9 Review %J J Med Internet Res %G English %X Background: With an increasing number of digital health apps available in app stores, it is important to assess these technologies reliably regarding their quality. This is done to mitigate the risks associated with their use. There are many different guidelines, methods, and metrics available to assess digital health apps with regard to their quality. Objective: This study aimed to give a holistic summary of the current methods and “condition agnostic” frameworks that are broadly applicable for the quality assessment of all digital health apps. Methods: A systematic search of literature was conducted on 4 databases: Scopus, PubMed, ACM Digital Library, and IEEE Xplore. We followed the PICOS (Population, Patient, or Problem; Intervention; Comparison; Outcomes; and Study Design) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodologies when conducting this umbrella review. The search was conducted on January 26, 2024, for review articles published between 2018 and 2023. We identified 4781 candidate papers for inclusion; after title and abstract screening, 39 remained. After full-text analysis, we included 15 review articles in the full review. Results: Of the 15 review articles, scoping reviews were the most common (n=6, 40%), followed by systematic reviews (n=4, 27%), narrative reviews (n=4, 27%), and a rapid review (n=1, 7%). A total of 4 (27%) review articles proposed assessment criteria for digital health apps. “Data privacy and/or security” was the most mentioned criterion (n=13, 87%) and “Cost” was the least mentioned criterion (n=1, 7%) for the assessment of digital health apps. The Mobile App Rating Scale was the most frequently used framework for quality assessment of digital health apps. Conclusions: There is a lack of unity or consolidation across identified frameworks, as most do not meet all the identified criteria from the reviewed articles. Safety concerns associated with the use of digital health apps may be mitigated with the use of quality frameworks. %R 10.2196/58616 %U https://www.jmir.org/2024/1/e58616 %U https://doi.org/10.2196/58616 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57148 %T Exploring the Need for Medical Futures Studies: Insights From a Scoping Review of Health Care Foresight %A Meskó,Bertalan %A Kristóf,Tamás %A Dhunnoo,Pranavsingh %A Árvai,Nóra %A Katonai,Gellért %+ The Medical Futurist Institute, Povl Bang-Jensen u. 2/B1. 4/1, Budapest, 1118, Hungary, 36 703807260, berci@medicalfuturist.com %K foresight %K futures studies %K health care future %K medical futures %K technology foresight %D 2024 %7 9.10.2024 %9 Review %J J Med Internet Res %G English %X Background: The historical development and contemporary instances of futures studies, an interdisciplinary field that focuses on exploring and formulating alternative futures, exemplify the increasing significance of using futures methods in shaping the health care domain. Despite the wide array of these methodologies, there have been limited endeavors to employ them within the medical community thus far. Objective: We undertook the first scoping review to date about the application of futures methodologies and published foresight projects in health care. Methods: Through the use of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) method, we identified 59 studies that were subsequently categorized into the following 5 distinct themes: national strategies (n=19), strategic health care foresight (n=15), health care policy and workforce dynamics (n=6), pandemic preparedness and response (n=7), and specialized medical domains (n=12). Results: Our scoping review revealed that the application of futures methods and foresight has been successfully demonstrated in a wide range of fields, including national strategies, policy formulation, global threat preparedness, and technological advancements. The results of our review indicate that a total of 8 futures methods have already been used in medicine and health care, while there are more than 50 futures methods available. It may underscore the notion that the field is unexploited. Furthermore, the absence of structured methodologies and principles for employing foresight and futures techniques in the health care domain warrants the creation of medical futures studies as a separate scientific subfield within the broad domains of health care, medicine, and life sciences. This subfield would focus on the analysis of emerging technological trends, the evaluation of policy implications, and the proactive anticipation and mitigation of potential challenges. Conclusions: Futures studies can significantly enhance medical science by addressing a crucial deficiency in the promotion of democratic participation, facilitating interdisciplinary dialogue, and shaping alternative futures. To further contribute to the development of a new research community in medical futures studies, it is recommended to establish a specialized scientific journal. Additionally, appointing dedicated futurists in decision-making and national strategy, and incorporating futures methods into the medical curriculum could be beneficial. %R 10.2196/57148 %U https://www.jmir.org/2024/1/e57148 %U https://doi.org/10.2196/57148 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55472 %T Applying Implementation Science to Advance Electronic Health Record–Driven Learning Health Systems: Case Studies, Challenges, and Recommendations %A Trinkley,Katy E %A Maw,Anna M %A Torres,Cristina Huebner %A Huebschmann,Amy G %A Glasgow,Russell E %+ Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, Mail Stop F496, Aurora, CO, 80045, United States, 1 303 724 3103, katy.trinkley@cuanschutz.edu %K learning health systems %K implementation science %K chronic care %K electronic health record %K evidence-based medicine %K information technology %K research and technology %D 2024 %7 7.10.2024 %9 Viewpoint %J J Med Internet Res %G English %X With the widespread implementation of electronic health records (EHRs), there has been significant progress in developing learning health systems (LHSs) aimed at improving health and health care delivery through rapid and continuous knowledge generation and translation. To support LHSs in achieving these goals, implementation science (IS) and its frameworks are increasingly being leveraged to ensure that LHSs are feasible, rapid, iterative, reliable, reproducible, equitable, and sustainable. However, 6 key challenges limit the application of IS to EHR-driven LHSs: barriers to team science, limited IS experience, data and technology limitations, time and resource constraints, the appropriateness of certain IS approaches, and equity considerations. Using 3 case studies from diverse health settings and 1 IS framework, we illustrate these challenges faced by LHSs and offer solutions to overcome the bottlenecks in applying IS and utilizing EHRs, which often stymie LHS progress. We discuss the lessons learned and provide recommendations for future research and practice, including the need for more guidance on the practical application of IS methods and a renewed emphasis on generating and accessing inclusive data. %M 39374069 %R 10.2196/55472 %U https://www.jmir.org/2024/1/e55472 %U https://doi.org/10.2196/55472 %U http://www.ncbi.nlm.nih.gov/pubmed/39374069 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e62790 %T Evolutionary Trends in the Adoption, Adaptation, and Abandonment of Mobile Health Technologies: Viewpoint Based on 25 Years of Research %A Portz,Jennifer %A Moore,Susan %A Bull,Sheana %+ Division of General Internal Medicine, School of Medicine, University of Colorado, Mailstop B119, Aurora, CO, 80045, United States, 1 303 724 8856, jennifer.portz@CUAnschutz.edu %K technology adoption %K mobile health %K SMS text messaging %K mobile apps %K wearables %K social media %D 2024 %7 27.9.2024 %9 Viewpoint %J J Med Internet Res %G English %X Over the past quarter-century, mobile health (mHealth) technologies have experienced significant changes in adoption rates, adaptation strategies, and instances of abandonment. Understanding the underlying factors driving these trends is essential for optimizing the design, implementation, and sustainability of interventions using these technologies. The evolution of mHealth adoption has followed a progressive trajectory, starting with cautious exploration and later accelerating due to technological advancements, increased smartphone penetration, and growing acceptance of digital health solutions by both health care providers and patients. However, alongside widespread adoption, challenges related to usability, interoperability, privacy concerns, and socioeconomic disparities have emerged, necessitating ongoing adaptation efforts. While many mHealth initiatives have successfully adapted to address these challenges, technology abandonment remains common, often due to unsustainable business models, inadequate user engagement, and insufficient evidence of effectiveness. This paper utilizes the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework to examine the interplay between the academic and industry sectors in patterns of adoption, adaptation, and abandonment, using 3 major mHealth innovations as examples: health-related SMS text messaging, mobile apps and wearables, and social media for health communication. Health SMS text messaging has demonstrated significant potential as a tool for health promotion, disease management, and patient engagement. The proliferation of mobile apps and devices has facilitated a shift from in-person and in-clinic practices to mobile- and wearable-centric solutions, encompassing everything from simple activity trackers to advanced health monitoring devices. Social media, initially characterized by basic text-based interactions in chat rooms and online forums, underwent a paradigm shift with the emergence of platforms such as MySpace and Facebook. This transition ushered in an era of mass communication through social media. The rise of microblogging and visually focused platforms such as Twitter(now X), Instagram, Snapchat, and TikTok, along with the integration of live streaming and augmented reality features, exemplifies the ongoing innovation within the social media landscape. Over the past 25 years, there have been remarkable strides in the adoption and adaptation of mHealth technologies, driven by technological innovation and a growing recognition of their potential to revolutionize health care delivery. Each mobile technology uniquely enhances public health and health care by catering to different user needs. SMS text messaging offers wide accessibility and proven effectiveness, while mobile apps and wearables provide comprehensive functionalities for more in-depth health management. Social media platforms amplify these efforts with their vast reach and community-building potential, making it essential to select the right tool for specific health interventions to maximize impact and engagement. Nevertheless, continued efforts are needed to address persistent challenges and mitigate instances of abandonment, ensuring that mHealth interventions reach their full potential in improving health outcomes and advancing equitable access to care. %M 39331463 %R 10.2196/62790 %U https://www.jmir.org/2024/1/e62790 %U https://doi.org/10.2196/62790 %U http://www.ncbi.nlm.nih.gov/pubmed/39331463 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e57304 %T The Mediating Role of Problematic Use of Loot Boxes Between Internet Gaming Disorder and Online Gambling Disorder: Cross-Sectional Analytical Study %A González-Cabrera,Joaquín %A Caba-Machado,Vanessa %A Díaz-López,Adoración %A Jiménez-Murcia,Susana %A Mestre-Bach,Gemma %A Machimbarrena,Juan M %K loot boxes %K loot box %K gaming %K gambling %K problematic %K video games %K game %K games %K addict %K addiction %K addictions %K addictive %K internet %K virtual object %K virtual objects %K gamification %K IGD %K OGD %K monetize %K monetization %K reward %K rewards %K incentive %K incentives %K internet gaming disorder %K online gambling disorder %D 2024 %7 20.9.2024 %9 %J JMIR Serious Games %G English %X Background: The video game industry has introduced a new form of monetization through microtransactions. A controversial example has been the so-called “loot boxes” (LBs) as virtual objects, which are randomized and bought with legal money. In recent years, LBs have come to connect 2 distinct problem behaviors, namely internet gaming disorder (IGD) and online gambling disorder (OGD). Many association studies have been conducted on the 3 constructs, but few have delved into the relationship of problematic use of LBs (PU-LB) with IGD and OGD. Objective: This study aims to explore the mediating role of the PU-LB between IGD and OGD. Methods: This cross-sectional and analytical study used incidental sampling in 24 Spanish schools. The final sample consisted of 542 participants (male: n=523, 96.5%; age: range 11‐30 y) who played video games, bought LBs, and had gambled online in the last 12 months. Participants then completed the Spanish versions of the Internet Gaming Disorder Scale–Short Form, Online Gambling Disorder Questionnaire, and PU-LB scale. Results: IGD scores were found to be significantly associated with both PU-LB (r=0.473, P<.001) and OGD (r=0.209, P<.001). Moreover, PU-LB was significantly associated with OGD (r=0.351, P<.001). The structural equation model results indicated that IGD had no significant direct effect on OGD (P=.903). However, the indirect effect of IGD on OGD through PU-LB was significant (P<.001). Therefore, PU-LB fully mediated the relationship between IGD and OGD. Furthermore, these results were found in the subsamples of both minors (<18 y) and young adults (≥18 y). Conclusions: It is suggested that there is a mediation effect of problematic LB use between internet gambling and online gambling problems in both minors and young adults. This has potential practical implications by providing more evidence on how LBs have become a hinge feature between 2 clinically relevant and independent issues. In this regard, adequate industry self-regulation is needed, and effective legislation for the protection of minors is necessary. %R 10.2196/57304 %U https://games.jmir.org/2024/1/e57304 %U https://doi.org/10.2196/57304 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54269 %T Developing and Evaluating Digital Public Health Interventions Using the Digital Public Health Framework DigiPHrame: A Framework Development Study %A Jahnel,Tina %A Pan,Chen-Chia %A Pedros Barnils,Núria %A Muellmann,Saskia %A Freye,Merle %A Dassow,Hans-Henrik %A Lange,Oliver %A Reinschluessel,Anke V %A Rogowski,Wolf %A Gerhardus,Ansgar %+ Department of Health Services Research, Institute for Public Health and Nursing Research, University of Bremen, Grazer Str 4, Bremen, 28359, Germany, 49 042121868808, jahnel@uni-bremen.de %K digital public health %K DiPH %K digital health %K public health %K framework %K development %K evaluation %K guidance %K program evaluation %K telemedicine %K intervention %K technological advancement %K opportunity %K technology %K implementation %K digital public health framework %K DigiPHrame %K scoping review %K COVID-19 %K contact-tracing app %K contact tracing %D 2024 %7 12.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital public health (DiPH) interventions may help us tackle substantial public health challenges and reach historically underserved populations, in addition to presenting valuable opportunities to improve and complement existing services. However, DiPH interventions are often triggered through technological advancements and opportunities rather than public health needs. To develop and evaluate interventions designed to serve public health needs, a comprehensive framework is needed that systematically covers all aspects with relevance for public health. This includes considering the complexity of the technology, the context in which the technology is supposed to operate, its implementation, and its effects on public health, including ethical, legal, and social aspects. Objective: We aimed to develop such a DiPH framework with a comprehensive list of core principles to be considered throughout the development and evaluation process of any DiPH intervention. Methods: The resulting digital public health framework (DigiPHrame) was based on a scoping review of existing digital health and public health frameworks. After extracting all assessment criteria from these frameworks, we clustered the criteria. During a series of multidisciplinary meetings with experts from the Leibniz ScienceCampus Digital Public Health, we restructured each domain to represent the complexity of DiPH. In this paper, we used a COVID-19 contact–tracing app as a use case to illustrate how DigiPHrame may be applied to assess DiPH interventions. Results: The current version of DigiPHrame consists of 182 questions nested under 12 domains. Domain 1 describes the current status of health needs and existing interventions; domains 2 and 3, the DiPH technology under assessment and aspects related to human-computer interaction, respectively; domains 4 and 5, structural and process aspects, respectively; and domains 6-12, contextual conditions and the outcomes of the DiPH intervention from broad perspectives. In the CWA use case, a number of questions relevant during its development but also important for assessors once the CWA was available were highlighted. Conclusions: DigiPHrame is a comprehensive framework for the development and assessment of digital technologies designed for public health purposes. It is a living framework and will, therefore, be updated regularly and as new public health needs and technological advancements emerge. %M 39264696 %R 10.2196/54269 %U https://www.jmir.org/2024/1/e54269 %U https://doi.org/10.2196/54269 %U http://www.ncbi.nlm.nih.gov/pubmed/39264696 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52798 %T Digital Competencies and Training Approaches to Enhance the Capacity of Practitioners to Support the Digital Transformation of Public Health: Rapid Review of Current Recommendations %A Ramachandran,Swathi %A Chang,Hsiu-Ju %A Worthington,Catherine %A Kushniruk,Andre %A Ibáñez-Carrasco,Francisco %A Davies,Hugh %A McKee,Geoffrey %A Brown,Adalsteinn %A Gilbert,Mark %A Iyamu,Ihoghosa %K digital public health %K digital transformation %K digital transformations %K rapid review %K rapid reviews %K synthesis %K review methods %K review methodology %K competencies %K competency %K training and practice recommendations %K public health workforce %K workforce %K worker %K workers %K practitioner %K practitioners %K public health %K digital health %K training %K continuing education %K skills %K skill %K recommendation %K recommendations %K best practice %K guideline %K guidelines %D 2024 %7 9.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic highlighted gaps in the public health workforce’s capacity to deploy digital technologies while upholding ethical, social justice, and health equity principles. Existing public health competency frameworks have not been updated to reflect the prominent role digital technologies play in contemporary public health, and public health training institutions are seeking to integrate digital technologies in their curricula. Objective: As a first step in a multiphase study exploring recommendations for updates to public health competency frameworks within the Canadian public health context, we conducted a rapid review of literature aiming to identify recommendations for digital competencies, training approaches, and inter- or transdisciplinary partnerships that can enhance public health practitioners’ capacity to support the digital transformation of public health. Methods: Following the World Health Organization’s (2017) guidelines for rapid reviews, a systematic search was conducted on Ovid MEDLINE, Ovid Embase, ERIC (Education Resources Information Center), and Web of Science for peer-reviewed articles. We also searched Google Scholar and various public health agency and public health association websites for gray literature using search terms related to public health, digital health, practice competencies, and training approaches. We included articles with explicit practice competencies and training recommendations related to digital technologies among public health practitioners published between January 2010 and December 2022. We excluded articles describing these concepts in passing or from a solely clinical perspective. Results: Our search returned 2023 titles and abstracts, of which only 12 studies met the inclusion criteria. We found recommendations for new competencies to enable public health practitioners to appropriately use digital technologies that cut across all existing categories of the core competencies for public health framework of the Public Health Agency of Canada. We also identified a new competency category related to data, data systems management, and governance. Training approaches identified include adapted degree-awarding programs like combined public health and informatics or data science degree programs and ongoing professional certifications with integration of practice-based learning in multi- and interdisciplinary training. Disciplines suggested as important to facilitate practice competency and training recommendations included public health, public health informatics, data, information and computer sciences, biostatistics, health communication, and business. Conclusions: Despite the growth of digital technologies in public health, recommendations about practice competencies and training approaches necessary to effectively support the digital transformation of public health remain limited in the literature. Where available, evidence suggests the workforce requires new competencies that cut across and extend existing public health competencies, including new competencies related to the use and protection of new digital data sources, alongside facilitating health communication and promotion functions using digital media. Recommendations also emphasize the need for training approaches that focus on interdisciplinarity through adapted degree-awarding public health training programs and ongoing professional development. %R 10.2196/52798 %U https://publichealth.jmir.org/2024/1/e52798 %U https://doi.org/10.2196/52798 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e54173 %T The Digital Determinants of Health: A Guide for Competency Development in Digital Care Delivery for Health Professions Trainees %A Lawrence,Katharine %A Levine,Defne L %K digital health %K digital determinants of health %K digital health competencies %K medical education curriculum %K competency development %K digital health education %K training competencies %K digital health skills %K digital care delivery %K health professions training %D 2024 %7 29.8.2024 %9 %J JMIR Med Educ %G English %X Health care delivery is undergoing an accelerated period of digital transformation, spurred in part by the COVID-19 pandemic and the use of “virtual-first” care delivery models such as telemedicine. Medical education has responded to this shift with calls for improved digital health training, but there is as yet no universal understanding of the needed competencies, domains, and best practices for teaching these skills. In this paper, we argue that a “digital determinants of health” (DDoH) framework for understanding the intersections of health outcomes, technology, and training is critical to the development of comprehensive digital health competencies in medical education. Much like current social determinants of health models, the DDoH framework can be integrated into undergraduate, graduate, and professional education to guide training interventions as well as competency development and evaluation. We provide possible approaches to integrating this framework into training programs and explore priorities for future research in digitally-competent medical education. %R 10.2196/54173 %U https://mededu.jmir.org/2024/1/e54173 %U https://doi.org/10.2196/54173 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49692 %T Digital Serious Games to Promote Behavior Change in Children With Chronic Diseases: Scoping Review and Development of a Self-Management Learning Framework %A Sarasmita,Made Ary %A Lee,Ya-Han %A Chan,Fan-Ying %A Chen,Hsiang-Yin %+ Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Health and Science Building, 7th Fl., 250 Wuxing Street, Taipei, 110, Taiwan, 886 02 2736 1661 ext 6175, shawn@tmu.edu.tw %K children %K chronic disease %K digital game %K patient education %K serious game %D 2024 %7 19.8.2024 %9 Review %J J Med Internet Res %G English %X Background: Digital serious games (SGs) have rapidly become a promising strategy for entertainment-based health education; however, developing SGs for children with chronic diseases remains a challenge. Objective: In this study, we attempted to provide an updated scope of understanding of the development and evaluation of SG educational tools and develop a framework for SG education development to promote self-management activities and behavior change in children with chronic diseases. Methods: This study consists of a knowledge base and an analytical base. This study followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. To build the knowledge base, 5 stages of research were developed, including refining the review question (stage 1), searching for studies (stage 2), selecting relevant studies (stage 3), charting the information (stage 4), and collating the results (stage 5). Eligible studies that developed SG prototypes and evaluated SG education for children with chronic diseases were searched for in PubMed, Embase, Google Scholar, and peer-reviewed journals. In the analytical base, the context-mechanism-output approach and game taxonomy were used to analyze relevant behavioral theories and essential game elements. Game taxonomy included social features, presentation, narrative and identity, rewards and punishment, and manipulation and control. A total of 2 researchers selected the domains for the included behavioral theories and game elements. The intended SG framework was finalized by assembling SG fragments. Those SG fragments were appropriately reintegrated to visualize a new SG framework. Results: This scoping review summarized data from 16 randomized controlled trials that evaluated SG education for children with chronic diseases and 14 studies on SG frameworks. It showed that self-determination theory was the most commonly used behavioral theory (9/30, 30%). Game elements included feedback, visual and audio designs, characters, narratives, rewards, challenges, competitions, goals, levels, rules, and tasks. In total, 3 phases of a digital SG framework are proposed in this review: requirements (phase 1), design and development (phase 2), and evaluation (phase 3). A total of 6 steps are described: exploring SG requirements (step 1), identifying target users (step 2), designing an SG prototype (step 3), building the SG prototype (step 4), evaluating the SG prototype (step 5), and marketing and monitoring the use of the SG prototype (step 6). Safety recommendations to use digital SG-based education for children in the post–COVID-19 era were also made. Conclusions: This review summarizes the fundamental behavioral theories and game elements of the available literature to establish a new theory-driven step-by-step framework. It can support game designers, clinicians, and educators in designing, developing, and evaluating digital, SG-based educational tools to increase self-management activities and promote behavior change in children with chronic diseases. %M 39158952 %R 10.2196/49692 %U https://www.jmir.org/2024/1/e49692 %U https://doi.org/10.2196/49692 %U http://www.ncbi.nlm.nih.gov/pubmed/39158952 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57082 %T Application of an Adapted Health Action Process Approach Model to Predict Engagement With a Digital Mental Health Website: Cross-Sectional Study %A Rouvere,Julien %A Blanchard,Brittany E %A Johnson,Morgan %A Griffith Fillipo,Isabell %A Mosser,Brittany %A Romanelli,Meghan %A Nguyen,Theresa %A Rushton,Kevin %A Marion,John %A Althoff,Tim %A Areán,Patricia A %A Pullmann,Michael D %+ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560, United States, 1 206 221 5498, rouvere@uw.edu %K Health Action Process Approach (HAPA) %K digital health %K health behavior %K Mental Health America (MHA) %K digital mental health engagement %K mental health website %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital Mental Health (DMH) tools are an effective, readily accessible, and affordable form of mental health support. However, sustained engagement with DMH is suboptimal, with limited research on DMH engagement. The Health Action Process Approach (HAPA) is an empirically supported theory of health behavior adoption and maintenance. Whether this model also explains DMH tool engagement remains unknown. Objective: This study examined whether an adapted HAPA model predicted engagement with DMH via a self-guided website. Methods: Visitors to the Mental Health America (MHA) website were invited to complete a brief survey measuring HAPA constructs. This cross-sectional study tested the adapted HAPA model with data collected using voluntary response sampling from 16,078 sessions (15,619 unique IP addresses from United States residents) on the MHA website from October 2021 through February 2022. Model fit was examined via structural equation modeling in predicting two engagement outcomes: (1) choice to engage with DMH (ie, spending 3 or more seconds on an MHA page, excluding screening pages) and (2) level of engagement (ie, time spent on MHA pages and number of pages visited, both excluding screening pages). Results: Participants chose to engage with the MHA website in 94.3% (15,161/16,078) of the sessions. Perceived need (β=.66; P<.001), outcome expectancies (β=.49; P<.001), self-efficacy (β=.44; P<.001), and perceived risk (β=.17-.18; P<.001) significantly predicted intention, and intention (β=.77; P<.001) significantly predicted planning. Planning was not significantly associated with choice to engage (β=.03; P=.18). Within participants who chose to engage, the association between planning with level of engagement was statistically significant (β=.12; P<.001). Model fit indices for both engagement outcomes were poor, with the adapted HAPA model accounting for only 0.1% and 1.4% of the variance in choice to engage and level of engagement, respectively. Conclusions: Our data suggest that the HAPA model did not predict engagement with DMH via a self-guided website. More research is needed to identify appropriate theoretical frameworks and practical strategies (eg, digital design) to optimize DMH tool engagement. %M 39110965 %R 10.2196/57082 %U https://humanfactors.jmir.org/2024/1/e57082 %U https://doi.org/10.2196/57082 %U http://www.ncbi.nlm.nih.gov/pubmed/39110965 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46407 %T Evaluating Artificial Intelligence in Clinical Settings—Let Us Not Reinvent the Wheel %A Cresswell,Kathrin %A de Keizer,Nicolette %A Magrabi,Farah %A Williams,Robin %A Rigby,Michael %A Prgomet,Mirela %A Kukhareva,Polina %A Wong,Zoie Shui-Yee %A Scott,Philip %A Craven,Catherine K %A Georgiou,Andrew %A Medlock,Stephanie %A Brender McNair,Jytte %A Ammenwerth,Elske %+ Usher Institute, The University of Edinburgh, Usher Building, 5-7 Little France Road, Edinburgh, EH16 4UX, United Kingdom, 44 131 650 6984, kathrin.cresswell@ed.ac.uk %K artificial intelligence %K evaluation %K theory %K patient safety %K optimisation %K health care %K optimization %D 2024 %7 7.8.2024 %9 Viewpoint %J J Med Internet Res %G English %X Given the requirement to minimize the risks and maximize the benefits of technology applications in health care provision, there is an urgent need to incorporate theory-informed health IT (HIT) evaluation frameworks into existing and emerging guidelines for the evaluation of artificial intelligence (AI). Such frameworks can help developers, implementers, and strategic decision makers to build on experience and the existing empirical evidence base. We provide a pragmatic conceptual overview of selected concrete examples of how existing theory-informed HIT evaluation frameworks may be used to inform the safe development and implementation of AI in health care settings. The list is not exhaustive and is intended to illustrate applications in line with various stakeholder requirements. Existing HIT evaluation frameworks can help to inform AI-based development and implementation by supporting developers and strategic decision makers in considering relevant technology, user, and organizational dimensions. This can facilitate the design of technologies, their implementation in user and organizational settings, and the sustainability and scalability of technologies. %M 39110494 %R 10.2196/46407 %U https://www.jmir.org/2024/1/e46407 %U https://doi.org/10.2196/46407 %U http://www.ncbi.nlm.nih.gov/pubmed/39110494 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e55090 %T Research on Traditional Chinese Medicine: Domain Knowledge Graph Completion and Quality Evaluation %A Liu,Chang %A Li,Zhan %A Li,Jianmin %A Qu,Yiqian %A Chang,Ying %A Han,Qing %A Cao,Lingyong %A Lin,Shuyuan %+ School of Basic Medical Sciences, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, China, 86 057186633015, lin_shuyuan@foxmail.com %K graph completion %K traditional Chinese medicine %K graph quality evaluation %K graph representation %K knowledge graph %D 2024 %7 2.8.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: Knowledge graphs (KGs) can integrate domain knowledge into a traditional Chinese medicine (TCM) intelligent syndrome differentiation model. However, the quality of current KGs in the TCM domain varies greatly, related to the lack of knowledge graph completion (KGC) and evaluation methods. Objective: This study aims to investigate KGC and evaluation methods tailored for TCM domain knowledge. Methods: In the KGC phase, according to the characteristics of TCM domain knowledge, we proposed a 3-step “entity-ontology-path” completion approach. This approach uses path reasoning, ontology rule reasoning, and association rules. In the KGC quality evaluation phase, we proposed a 3-dimensional evaluation framework that encompasses completeness, accuracy, and usability, using quantitative metrics such as complex network analysis, ontology reasoning, and graph representation. Furthermore, we compared the impact of different graph representation models on KG usability. Results: In the KGC phase, 52, 107, 27, and 479 triples were added by outlier analysis, rule-based reasoning, association rules, and path-based reasoning, respectively. In addition, rule-based reasoning identified 14 contradictory triples. In the KGC quality evaluation phase, in terms of completeness, KG had higher density and lower sparsity after completion, and there were no contradictory rules within the KG. In terms of accuracy, KG after completion was more consistent with prior knowledge. In terms of usability, the mean reciprocal ranking, mean rank, and hit rate of the first N tail entities predicted by the model (Hits@N) of the TransE, RotatE, DistMult, and ComplEx graph representation models all showed improvement after KGC. Among them, the RotatE model achieved the best representation. Conclusions: The 3-step completion approach can effectively improve the completeness, accuracy, and availability of KGs, and the 3-dimensional evaluation framework can be used for comprehensive KGC evaluation. In the TCM field, the RotatE model performed better at KG representation. %M 39094109 %R 10.2196/55090 %U https://medinform.jmir.org/2024/1/e55090 %U https://doi.org/10.2196/55090 %U http://www.ncbi.nlm.nih.gov/pubmed/39094109 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51355 %T Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity %A Kepper,Maura M %A Fowler,Lauren A %A Kusters,Isabelle S %A Davis,Jean W %A Baqer,Manal %A Sagui-Henson,Sara %A Xiao,Yunyu %A Tarfa,Adati %A Yi,Jean C %A Gibson,Bryan %A Heron,Kristin E %A Alberts,Nicole M %A Burgermaster,Marissa %A Njie-Carr,Veronica PS %A Klesges,Lisa M %+ Prevention Research Center, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, United States, 1 3149350142, kepperm@wustl.edu %K digital health %K health equity %K mobile health %K mHealth %K health care access %K digital divide %K behavioral medicine %K implementation %K mobile phone %D 2024 %7 1.8.2024 %9 Viewpoint %J J Med Internet Res %G English %X The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science–based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity. %M 39088246 %R 10.2196/51355 %U https://www.jmir.org/2024/1/e51355 %U https://doi.org/10.2196/51355 %U http://www.ncbi.nlm.nih.gov/pubmed/39088246 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e56237 %T Making Metadata Machine-Readable as the First Step to Providing Findable, Accessible, Interoperable, and Reusable Population Health Data: Framework Development and Implementation Study %A Amadi,David %A Kiwuwa-Muyingo,Sylvia %A Bhattacharjee,Tathagata %A Taylor,Amelia %A Kiragga,Agnes %A Ochola,Michael %A Kanjala,Chifundo %A Gregory,Arofan %A Tomlin,Keith %A Todd,Jim %A Greenfield,Jay %+ Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom, 44 20 7636 8636, david.amadi@lshtm.ac.uk %K FAIR data principles %K metadata %K machine-readable metadata %K DDI %K Data Documentation Initiative %K standardization %K JSON-LD %K JavaScript Object Notation for Linked Data %K OMOP CDM %K Observational Medical Outcomes Partnership Common Data Model %K data science %K data models %D 2024 %7 1.8.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Metadata describe and provide context for other data, playing a pivotal role in enabling findability, accessibility, interoperability, and reusability (FAIR) data principles. By providing comprehensive and machine-readable descriptions of digital resources, metadata empower both machines and human users to seamlessly discover, access, integrate, and reuse data or content across diverse platforms and applications. However, the limited accessibility and machine-interpretability of existing metadata for population health data hinder effective data discovery and reuse. Objective: To address these challenges, we propose a comprehensive framework using standardized formats, vocabularies, and protocols to render population health data machine-readable, significantly enhancing their FAIRness and enabling seamless discovery, access, and integration across diverse platforms and research applications. Methods: The framework implements a 3-stage approach. The first stage is Data Documentation Initiative (DDI) integration, which involves leveraging the DDI Codebook metadata and documentation of detailed information for data and associated assets, while ensuring transparency and comprehensiveness. The second stage is Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) standardization. In this stage, the data are harmonized and standardized into the OMOP CDM, facilitating unified analysis across heterogeneous data sets. The third stage involves the integration of Schema.org and JavaScript Object Notation for Linked Data (JSON-LD), in which machine-readable metadata are generated using Schema.org entities and embedded within the data using JSON-LD, boosting discoverability and comprehension for both machines and human users. We demonstrated the implementation of these 3 stages using the Integrated Disease Surveillance and Response (IDSR) data from Malawi and Kenya. Results: The implementation of our framework significantly enhanced the FAIRness of population health data, resulting in improved discoverability through seamless integration with platforms such as Google Dataset Search. The adoption of standardized formats and protocols streamlined data accessibility and integration across various research environments, fostering collaboration and knowledge sharing. Additionally, the use of machine-interpretable metadata empowered researchers to efficiently reuse data for targeted analyses and insights, thereby maximizing the overall value of population health resources. The JSON-LD codes are accessible via a GitHub repository and the HTML code integrated with JSON-LD is available on the Implementation Network for Sharing Population Information from Research Entities website. Conclusions: The adoption of machine-readable metadata standards is essential for ensuring the FAIRness of population health data. By embracing these standards, organizations can enhance diverse resource visibility, accessibility, and utility, leading to a broader impact, particularly in low- and middle-income countries. Machine-readable metadata can accelerate research, improve health care decision-making, and ultimately promote better health outcomes for populations worldwide. %M 39088253 %R 10.2196/56237 %U https://ojphi.jmir.org/2024/1/e56237 %U https://doi.org/10.2196/56237 %U http://www.ncbi.nlm.nih.gov/pubmed/39088253 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55130 %T Cultural and Contextual Adaptation of Digital Health Interventions: Narrative Review %A Naderbagi,Aila %A Loblay,Victoria %A Zahed,Iqthyer Uddin Md %A Ekambareshwar,Mahalakshmi %A Poulsen,Adam %A Song,Yun J C %A Ospina-Pinillos,Laura %A Krausz,Michael %A Mamdouh Kamel,Mostafa %A Hickie,Ian B %A LaMonica,Haley M %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Sydney NSW, 2050, Australia, 61 0426955658, haley.lamonica@sydney.edu.au %K cultural adaptation %K digital health %K context %K translation %K participatory research %K mobile phone %D 2024 %7 9.7.2024 %9 Review %J J Med Internet Res %G English %X Background: Emerging evidence suggests that positive impacts can be generated when digital health interventions are designed to be responsive to the cultural and socioeconomic context of their intended audiences. Objective: This narrative review aims to synthesize the literature about the cultural adaptation of digital health interventions. It examines how concepts of culture and context feature in design and development processes, including the methods, models, and content of these interventions, with the aim of helping researchers to make informed decisions about how to approach cultural adaptation in digital health. Methods: Literature searches for this narrative review were conducted across 4 databases. Following full-text article screening by 2 authors, 16 studies of interventions predominantly focused on the self-management of health were selected based on their detailed focus on the process of cultural adaptation. Key considerations for cultural adaptation were identified and synthesized through a qualitative narrative approach, enabling an integrative and in-depth understanding of cultural adaptation. Results: The literature demonstrates varying approaches and levels of cultural adaptation across stages of intervention development, involving considerations such as the research ethos orienting researchers, the methodologies and models used, and the resultant content adaptations. In relation to the latter, culturally appropriate and accessible user interface design and translation can be seen as particularly important in shaping the level of adaptation. Conclusions: Optimizing cultural adaptation involves linking culture with other contextual factors such as economic conditions and social systems to ensure accessibility and the sustained use of digital health interventions. Culturally humble approaches that use the involvement of a broad range of participants, experts, and other stakeholders are demonstrated to spark vital insights for content development, implementation, and evaluation. %M 38980719 %R 10.2196/55130 %U https://www.jmir.org/2024/1/e55130 %U https://doi.org/10.2196/55130 %U http://www.ncbi.nlm.nih.gov/pubmed/38980719 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e51987 %T Technology Usability for People Living With Dementia: Concept Analysis %A Chien,Shao-Yun %A Zaslavsky,Oleg %A Berridge,Clara %+ School of Nursing, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 2068493301, ozasl@uw.edu %K usability %K dementia %K older adults %K technology %K concept analysis %K mobile phone %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Usability is a key indicator of the quality of technology products. In tandem with technological advancements, potential use by individuals with dementia is increasing. However, defining the usability of technology for individuals with dementia remains an ongoing challenge. The diverse and progressive nature of dementia adds complexity to the creation of universal usability criteria, highlighting the need for focused deliberations. Technological interventions offer potential benefits for people living with dementia and caregivers. Amid COVID-19, technology’s role in health care access is growing, especially among older adults. Enabling the diverse population of people living with dementia to enjoy the benefits of technologies requires particular attention to their needs, desires, capabilities, and vulnerabilities to potential harm from technologies. Successful technological interventions for dementia require meticulous consideration of technology usability. Objective: This concept analysis aims to examine the usability of technology in the context of individuals living with dementia to establish a clear definition for usability within this specific demographic. Methods: The framework by Walker and Avant was used to guide this concept analysis. We conducted a literature review spanning 1984 to 2024, exploring technology usability for people with dementia through the PubMed, Web of Science, and Google Scholar databases using the keywords “technology usability” and “dementia.” We also incorporated clinical definitions and integrated interview data from 29 dyads comprising individuals with mild Alzheimer dementia and their respective care partners, resulting in a total of 58 older adults. This approach aimed to offer a more comprehensive portrayal of the usability needs of individuals living with dementia, emphasizing practical application. Results: The evidence from the literature review unveiled that usability encompasses attributes such as acceptable learnability, efficiency, and satisfaction. The clinical perspective on dementia stages, subtypes, and symptoms underscores the importance of tailored technology usability assessment. Feedback from 29 dyads also emphasized the value of simplicity, clear navigation, age-sensitive design, personalized features, and audio support. Thus, design should prioritize personalized assistance for individuals living with dementia, moving away from standardized technological approaches. Synthesized from various sources, the defined usability attributes for individuals living with dementia not only encompass the general usability properties of effectiveness, efficiency, and satisfaction but also include other key factors: adaptability, personalization, intuitiveness, and simplicity, to ensure that technology is supportive and yields tangible benefits for this demographic. Conclusions: Usability is crucial for people living with dementia when designing technological interventions. It necessitates an understanding of user characteristics, dementia stages, symptoms, needs, and tasks, as well as consideration of varied physical requirements, potential sensory loss, and age-related changes. Disease progression requires adapting to evolving symptoms. Recommendations include versatile, multifunctional technology designs; accommodating diverse needs; and adjusting software functionalities for personalization. Product feature classification can be flexible based on user conditions. %M 38959053 %R 10.2196/51987 %U https://aging.jmir.org/2024/1/e51987 %U https://doi.org/10.2196/51987 %U http://www.ncbi.nlm.nih.gov/pubmed/38959053 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50182 %T Developing a Chatbot to Support Individuals With Neurodevelopmental Disorders: Tutorial %A Singla,Ashwani %A Khanna,Ritvik %A Kaur,Manpreet %A Kelm,Karen %A Zaiane,Osmar %A Rosenfelt,Cory Scott %A Bui,Truong An %A Rezaei,Navid %A Nicholas,David %A Reformat,Marek Z %A Majnemer,Annette %A Ogourtsova,Tatiana %A Bolduc,Francois %+ Department of Pediatrics, University of Alberta, 11315 87th Avenue, Edmonton, AB, T6G 2E1, Canada, 1 780 492 9713, fbolduc@ualberta.ca %K chatbot %K user interface %K knowledge graph %K neurodevelopmental disability %K autism %K intellectual disability %K attention-deficit/hyperactivity disorder %D 2024 %7 18.6.2024 %9 Tutorial %J J Med Internet Res %G English %X Families of individuals with neurodevelopmental disabilities or differences (NDDs) often struggle to find reliable health information on the web. NDDs encompass various conditions affecting up to 14% of children in high-income countries, and most individuals present with complex phenotypes and related conditions. It is challenging for their families to develop literacy solely by searching information on the internet. While in-person coaching can enhance care, it is only available to a minority of those with NDDs. Chatbots, or computer programs that simulate conversation, have emerged in the commercial sector as useful tools for answering questions, but their use in health care remains limited. To address this challenge, the researchers developed a chatbot named CAMI (Coaching Assistant for Medical/Health Information) that can provide information about trusted resources covering core knowledge and services relevant to families of individuals with NDDs. The chatbot was developed, in collaboration with individuals with lived experience, to provide information about trusted resources covering core knowledge and services that may be of interest. The developers used the Django framework (Django Software Foundation) for the development and used a knowledge graph to depict the key entities in NDDs and their relationships to allow the chatbot to suggest web resources that may be related to the user queries. To identify NDD domain–specific entities from user input, a combination of standard sources (the Unified Medical Language System) and other entities were used which were identified by health professionals as well as collaborators. Although most entities were identified in the text, some were not captured in the system and therefore went undetected. Nonetheless, the chatbot was able to provide resources addressing most user queries related to NDDs. The researchers found that enriching the vocabulary with synonyms and lay language terms for specific subdomains enhanced entity detection. By using a data set of numerous individuals with NDDs, the researchers developed a knowledge graph that established meaningful connections between entities, allowing the chatbot to present related symptoms, diagnoses, and resources. To the researchers’ knowledge, CAMI is the first chatbot to provide resources related to NDDs. Our work highlighted the importance of engaging end users to supplement standard generic ontologies to named entities for language recognition. It also demonstrates that complex medical and health-related information can be integrated using knowledge graphs and leveraging existing large datasets. This has multiple implications: generalizability to other health domains as well as reducing the need for experts and optimizing their input while keeping health care professionals in the loop. The researchers' work also shows how health and computer science domains need to collaborate to achieve the granularity needed to make chatbots truly useful and impactful. %M 38888947 %R 10.2196/50182 %U https://www.jmir.org/2024/1/e50182 %U https://doi.org/10.2196/50182 %U http://www.ncbi.nlm.nih.gov/pubmed/38888947 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54518 %T Key Considerations for Designing Clinical Studies to Evaluate Digital Health Solutions %A Bolinger,Elaina %A Tyl,Benoit %+ Integrated Evidence Generation & Business Innovation, Bayer HealthCare SAS, 10 Place de Belgique, La Garenne Colombes, F-92254, France, 33 6 80 29 07 79, benoit.tyl@bayer.com %K evidence generation %K clinical robustness %K clinical trials %K digital health %K solutions %K digital health solutions %K DHS %K health care system %K patients %K patient %K individuals %K individual %K healthcare system %K control arm adaptations %K randomization methods %K real-world data %K platform research %D 2024 %7 17.6.2024 %9 Viewpoint %J J Med Internet Res %G English %X Evidence of clinical impact is critical to unlock the potential of digital health solutions (DHSs), yet many solutions are failing to deliver positive clinical results. We argue in this viewpoint that this failure is linked to current approaches to DHS evaluation design, which neglect numerous key characteristics (KCs) requiring specific scientific and design considerations. We first delineate the KCs of DHSs: (1) they are implemented at health care system and patient levels; (2) they are “complex” interventions; (3) they can drive multiple clinical outcomes indirectly through a multitude of smaller clinical benefits; (4) their mechanism of action can vary between individuals and change over time based on patient needs; and (5) they develop through short, iterative cycles—optimally within a real-world use context. Following our objective to drive better alignment between clinical evaluation design and the unique traits of DHSs, we then provide methodological suggestions that better address these KCs, including tips on mechanism-of-action mapping, alternative randomization methods, control-arm adaptations, and novel end-point selection, as well as innovative methods utilizing real-world data and platform research. %M 38885020 %R 10.2196/54518 %U https://www.jmir.org/2024/1/e54518 %U https://doi.org/10.2196/54518 %U http://www.ncbi.nlm.nih.gov/pubmed/38885020 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e48099 %T Enhancing Serious Game Design: Expert-Reviewed, Stakeholder-Centered Framework %A Bunt,Lance %A Greeff,Japie %A Taylor,Estelle %+ Unit for Data Science and Computing, North-West University, 1174 Hendrick Van Eck Boulevard, Vanderbijlpark, 1900, South Africa, 27 720880188, Lance.Bunt@nwu.ac.za %K serious games %K stakeholder theory %K enterprise architecture %K serious game development %K design framework %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Traditional serious game design methods often overlook stakeholder needs. This study integrates stakeholder theory and enterprise architecture (EA), along with the Architecture Development Method, to propose a novel framework for serious game design. Crafted to aid practitioners, researchers, and specialists in leveraging resources more effectively, the framework is validated through a design science research methodology. Expert reviews have further refined its features, making it a robust tool for enhancing serious game design and implementation. Objective: This paper introduces a framework for designing serious games, covering stakeholder analysis, requirements gathering, and design implementation planning. It highlights the importance of expert review in validating and refining the framework, ensuring its effectiveness and reliability for use in serious game design. Through critical assessment by experts, the framework is optimized for practical application by practitioners, researchers, and specialists in the field, ensuring its utility in enhancing serious game development. The next step will be to validate the framework empirically by applying it to a serious game development project. Methods: We developed and validated a conceptual framework for serious game design by synthesizing stakeholder theory and EA through literature review, concept mapping, and theory development by way of a design science research approach. The framework is iteratively refined and validated via expert review, drawing on insights from professionals experienced in serious games, stakeholder theory, and EA. This method ensures the framework’s practical relevance and effectiveness in addressing real-world design challenges. Results: An expert review by 29 serious game practitioners validated the framework’s success in stakeholder management, confirming its stakeholder-centered effectiveness. Although the experts praised its structured approach, they suggested clearer guidance for game design elements. In addition, the experts, while acknowledging the framework’s complexity, saw its depth as valuable for efficient management. The consensus calls for a refined balance between detailed functionality and user-friendly design, with the framework’s impact on stakeholder capabilities revealing a spectrum of professional needs. Conclusions: This paper presents a framework for creating effective and organizationally aligned serious games. Evaluated across execution, practical, and EA levels, it is logical but varies in ease of understanding, with experts calling for more accessibility at the EA level. It enhances stakeholder efficiency and management but is criticized for rigidity and a need for flexibility. Recommendations include streamlining the framework, enhancing clarity, reducing administrative tasks, and incorporating clear guidelines on technology use, motivational elements, and operational tools. This aims to help stakeholders produce more targeted and adaptable game designs. The next iteration will be developed after application to a project and team feedback. %M 38820585 %R 10.2196/48099 %U https://games.jmir.org/2024/1/e48099 %U https://doi.org/10.2196/48099 %U http://www.ncbi.nlm.nih.gov/pubmed/38820585 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52027 %T Enabling Health Information Recommendation Using Crowdsourced Refinement in Web-Based Health Information Applications: User-Centered Design Approach and EndoZone Informatics Case Study %A Li,Wenhao %A O'Hara,Rebecca %A Hull,M Louise %A Slater,Helen %A Sirohi,Diksha %A Parker,Melissa A %A Bidargaddi,Niranjan %+ College of Medicine and Public Health, Flinders University, 1284 South Road, Clovelly Park, 5042, Australia, 61 423416543, niranjan.bidargaddi@flinders.edu.au %K information recommendation %K crowdsourcing %K health informatics %K digital health %K endometriosis %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In the digital age, search engines and social media platforms are primary sources for health information, yet their commercial interests–focused algorithms often prioritize irrelevant content. Web-based health applications by reputable sources offer a solution to circumvent these biased algorithms. Despite this advantage, there remains a significant gap in research on the effective integration of content-ranking algorithms within these specialized health applications to ensure the delivery of personalized and relevant health information. Objective: This study introduces a generic methodology designed to facilitate the development and implementation of health information recommendation features within web-based health applications. Methods: We detail our proposed methodology, covering conceptual foundation and practical considerations through the stages of design, development, operation, review, and optimization in the software development life cycle. Using a case study, we demonstrate the practical application of the proposed methodology through the implementation of recommendation functionalities in the EndoZone platform, a platform dedicated to providing targeted health information on endometriosis. Results: Application of the proposed methodology in the EndoZone platform led to the creation of a tailored health information recommendation system known as EndoZone Informatics. Feedback from EndoZone stakeholders as well as insights from the implementation process validate the methodology’s utility in enabling advanced recommendation features in health information applications. Preliminary assessments indicate that the system successfully delivers personalized content, adeptly incorporates user feedback, and exhibits considerable flexibility in adjusting its recommendation logic. While certain project-specific design flaws were not caught in the initial stages, these issues were subsequently identified and rectified in the review and optimization stages. Conclusions: We propose a generic methodology to guide the design and implementation of health information recommendation functionality within web-based health information applications. By harnessing user characteristics and feedback for content ranking, this methodology enables the creation of personalized recommendations that align with individual user needs within trusted health applications. The successful application of our methodology in the development of EndoZone Informatics marks a significant progress toward personalized health information delivery at scale, tailored to the specific needs of users. %M 38809588 %R 10.2196/52027 %U https://humanfactors.jmir.org/2024/1/e52027 %U https://doi.org/10.2196/52027 %U http://www.ncbi.nlm.nih.gov/pubmed/38809588 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54375 %T Digital Behavior Change Intervention Designs for Habit Formation: Systematic Review %A Zhu,Yujie %A Long,Yonghao %A Wang,Hailiang %A Lee,Kun Pyo %A Zhang,Lie %A Wang,Stephen Jia %+ School of Design, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong, China (Hong Kong), 852 2766 5478, stephen.j.wang@polyu.edu.hk %K habit formation %K digital health %K digital behavior change interventions design %K behavior change techniques %K physical activity %K mobile phone %D 2024 %7 24.5.2024 %9 Review %J J Med Internet Res %G English %X Background: With the development of emerging technologies, digital behavior change interventions (DBCIs) help to maintain regular physical activity in daily life. Objective: To comprehensively understand the design implementations of habit formation techniques in current DBCIs, a systematic review was conducted to investigate the implementations of behavior change techniques, types of habit formation techniques, and design strategies in current DBCIs. Methods: The process of this review followed the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. A total of 4 databases were systematically searched from 2012 to 2022, which included Web of Science, Scopus, ACM Digital Library, and PubMed. The inclusion criteria encompassed studies that used digital tools for physical activity, examined behavior change intervention techniques, and were written in English. Results: A total of 41 identified research articles were included in this review. The results show that the most applied behavior change techniques were the self-monitoring of behavior, goal setting, and prompts and cues. Moreover, habit formation techniques were identified and developed based on intentions, cues, and positive reinforcement. Commonly used methods included automatic monitoring, descriptive feedback, general guidelines, self-set goals, time-based cues, and virtual rewards. Conclusions: A total of 32 commonly design strategies of habit formation techniques were summarized and mapped to the proposed conceptual framework, which was categorized into target-mediated (generalization and personalization) and technology-mediated interactions (explicitness and implicitness). Most of the existing studies use the explicit interaction, aligning with the personalized habit formation techniques in the design strategies of DBCIs. However, implicit interaction design strategies are lacking in the reviewed studies. The proposed conceptual framework and potential solutions can serve as guidelines for designing strategies aimed at habit formation within DBCIs. %M 38787601 %R 10.2196/54375 %U https://www.jmir.org/2024/1/e54375 %U https://doi.org/10.2196/54375 %U http://www.ncbi.nlm.nih.gov/pubmed/38787601 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52572 %T Identifying Existing Guidelines, Frameworks, Checklists, and Recommendations for Implementing Patient-Reported Outcome Measures: Protocol for a Scoping Review %A Jayasinghe,Randi Thisakya %A Ahern,Susannah %A Maharaj,Ashika D %A Romero,Lorena %A Ruseckaite,Rasa %+ School of Public Health and Preventive Medicine, Monash University, 335 St Kilda Road, Melbourne, 3004, Australia, 61 399030437, Rasa.Ruseckaite@monash.edu %K patient-reported outcome measures %K patient-reported outcomes %K quality of life %K clinical quality registry %K guidelines %K frameworks %K recommendations %K scoping review %K patient perspectives %K patient perspective %K patient-reported outcome %K patient-reported %K clinical setting %K clinical registry %K registry %K systematic review %D 2024 %7 21.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Implementing patient-reported outcome measures (PROMs) to measure and evaluate health outcomes is increasing worldwide. Along with this emerging trend, it is important to identify which guidelines, frameworks, checklists, and recommendations exist, and if and how they have been used in implementing PROMs, especially in clinical quality registries (CQRs). Objective: This review aims to identify existing publications, as well as publications that discuss the application of actual guidelines, frameworks, checklists, and recommendations on PROMs’ implementation for various purposes such as clinical trials, clinical practice, and CQRs. In addition, the identified publications will be used to guide the development of a new guideline for PROMs’ implementation in CQRs, which is the aim of the broader project. Methods: A literature search of the databases MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials will be conducted since the inception of the databases, in addition to using Google Scholar and gray literature to identify literature for the scoping review. Predefined inclusion and exclusion criteria will be used for all phases of screening. Existing publications of guidelines, frameworks, checklists, recommendations, and publications discussing the application of those methodologies for implementing PROMs in clinical trials, clinical practice, and CQRs will be included in the final review. Data relating to bibliographic information, aim, the purpose of PROMs use (clinical trial, practice, or registries), name of guideline, framework, checklist and recommendations, the rationale for development, and their purpose and implications will be extracted. Additionally, for publications of actual methodologies, aspects or domains of PROMs’ implementation will be extracted. A narrative synthesis of included publications will be conducted. Results: The electronic database searches were completed in March 2024. Title and abstract screening, full-text screening, and data extraction will be completed in May 2024. The review is expected to be completed by the end of August 2024. Conclusions: The findings of this scoping review will provide evidence on any existing methodologies and tools for PROMs’ implementation in clinical trials, clinical practice, and CQRs. It is anticipated that the publications will help us guide the development of a new guideline for PROMs’ implementation in CQRs. Trial Registration: PROSPERO CRD42022366085; https://tinyurl.com/bdesk98x International Registered Report Identifier (IRRID): DERR1-10.2196/52572 %M 38771621 %R 10.2196/52572 %U https://www.researchprotocols.org/2024/1/e52572 %U https://doi.org/10.2196/52572 %U http://www.ncbi.nlm.nih.gov/pubmed/38771621 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51952 %T User-Centered Framework for Implementation of Technology (UFIT): Development of an Integrated Framework for Designing Clinical Decision Support Tools Packaged With Tailored Implementation Strategies %A Ray,Jessica %A Finn,Emily Benjamin %A Tyrrell,Hollyce %A Aloe,Carlin F %A Perrin,Eliana M %A Wood,Charles T %A Miner,Dean S %A Grout,Randall %A Michel,Jeremy J %A Damschroder,Laura J %A Sharifi,Mona %+ Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 1889 Museum Road, Gainesville, FL, 32611, United States, 1 321 356 4346, jessica.ray@ufl.edu %K user-centered design %K implementation science %K clinical decision support %K human factors %K implementation %K decision support %K develop %K development %K framework %K frameworks %K design %K user-centered %K digital health %K health technology %K health technologies %K need %K needs %K tailor %K tailoring %K guidance %K guideline %K guidelines %K pediatric %K pediatrics %K child %K children %K obese %K obesity %K weight %K overweight %K primary care %D 2024 %7 21.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health record–based clinical decision support (CDS) tools can facilitate the adoption of evidence into practice. Yet, the impact of CDS beyond single-site implementation is often limited by dissemination and implementation barriers related to site- and user-specific variation in workflows and behaviors. The translation of evidence-based CDS from initial development to implementation in heterogeneous environments requires a framework that assures careful balancing of fidelity to core functional elements with adaptations to ensure compatibility with new contexts. Objective: This study aims to develop and apply a framework to guide tailoring and implementing CDS across diverse clinical settings. Methods: In preparation for a multisite trial implementing CDS for pediatric overweight or obesity in primary care, we developed the User-Centered Framework for Implementation of Technology (UFIT), a framework that integrates principles from user-centered design (UCD), human factors/ergonomics theories, and implementation science to guide both CDS adaptation and tailoring of related implementation strategies. Our transdisciplinary study team conducted semistructured interviews with pediatric primary care clinicians and a diverse group of stakeholders from 3 health systems in the northeastern, midwestern, and southeastern United States to inform and apply the framework for our formative evaluation. Results: We conducted 41 qualitative interviews with primary care clinicians (n=21) and other stakeholders (n=20). Our workflow analysis found 3 primary ways in which clinicians interact with the electronic health record during primary care well-child visits identifying opportunities for decision support. Additionally, we identified differences in practice patterns across contexts necessitating a multiprong design approach to support a variety of workflows, user needs, preferences, and implementation strategies. Conclusions: UFIT integrates theories and guidance from UCD, human factors/ergonomics, and implementation science to promote fit with local contexts for optimal outcomes. The components of UFIT were used to guide the development of Improving Pediatric Obesity Practice Using Prompts, an integrated package comprising CDS for obesity or overweight treatment with tailored implementation strategies. Trial Registration: ClinicalTrials.gov NCT05627011; https://clinicaltrials.gov/study/NCT05627011 %M 38771622 %R 10.2196/51952 %U https://www.jmir.org/2024/1/e51952 %U https://doi.org/10.2196/51952 %U http://www.ncbi.nlm.nih.gov/pubmed/38771622 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e47280 %T Theoretical Perspectives Underpinning Research on the Physician-Patient Relationship in a Digital Health Practice: Scoping Review %A Nassehi,Damoun %A Gripsrud,Birgitta Haga %A Ramvi,Ellen %+ Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, Stavanger, 4036, Norway, 47 45426096, damoun.nassehi@uis.no %K digital health %K mobile health %K telemedicine %K physician-patient relations %K relational ethics %K primary care %K patient-provider %K physician-patient %K telehealth %K relationship %K eHealth %K scoping review %K review method %K mobile phone %D 2024 %7 15.5.2024 %9 Review %J Interact J Med Res %G English %X Background: The advent of digital health technologies has transformed the landscape of health care, influencing the dynamics of the physician-patient relationship. Although these technologies offer potential benefits, they also introduce challenges and complexities that require ethical consideration. Objective: This scoping review aims to investigate the effects of digital health technologies, such as digital messaging, telemedicine, and electronic health records, on the physician-patient relationship. To understand the complex consequences of these tools within health care, it contrasts the findings of studies that use various theoretical frameworks and concepts with studies grounded in relational ethics. Methods: Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review. Data were retrieved through keyword searches on MEDLINE/PubMed, Embase, IEEE Xplore, and Cochrane. We screened 427 original peer-reviewed research papers published in English-language journals between 2010 and 2021. A total of 73 papers were assessed for eligibility, and 10 of these were included in the review. The data were summarized through a narrative synthesis of the findings. Results: Digital health technologies enhance communication, improve health care delivery efficiency, and empower patients, leading to shifts in power dynamics in the physician-patient relationship. They also potentially reinforce inequities in health care access due to variations in technology literacy among patients and lead to decreases in patient satisfaction due to the impersonal nature of digital interactions. Studies applying a relational ethics framework have revealed the nuanced impacts of digital health technologies on the physician-patient relationship, highlighting shifts toward more collaborative and reciprocal care. These studies have also explored transitions from traditional hierarchical relationships to mutual engagement, capturing the complexities of power dynamics and vulnerabilities. Other theoretical frameworks, such as patient-centered care, and concepts, such as patient empowerment, were also valuable for understanding these interactions in the context of digital health. Conclusions: The shift from hierarchical to collaborative models in the physician-patient relationship not only underscores the empowering potential of digital tools but also presents new challenges and reinforces existing ones. Along with applications for various theoretical frameworks and concepts, this review highlights the unique comprehensiveness of a relational ethics perspective, which could provide a more nuanced understanding of trust, empathy, and power dynamics in the context of digital health. The adoption of relational ethics in empirical research may offer richer insights into the real-life complexities of the physician-patient relationship, as mediated by digital technologies. %M 38748465 %R 10.2196/47280 %U https://www.i-jmr.org/2024/1/e47280 %U https://doi.org/10.2196/47280 %U http://www.ncbi.nlm.nih.gov/pubmed/38748465 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50204 %T Envisioning the Future of Personalized Medicine: Role and Realities of Digital Twins %A Vallée,Alexandre %+ Department of Epidemiology and Public Health, Foch Hospital, 40 rue Worth, Suresnes, 92150, France, 33 0146257352, al.vallee@hopital-foch.com %K digital health %K digital twin %K personalized medicine %K prevention %K prediction %K health care system %D 2024 %7 13.5.2024 %9 Viewpoint %J J Med Internet Res %G English %X Digital twins have emerged as a groundbreaking concept in personalized medicine, offering immense potential to transform health care delivery and improve patient outcomes. It is important to highlight the impact of digital twins on personalized medicine across the understanding of patient health, risk assessment, clinical trials and drug development, and patient monitoring. By mirroring individual health profiles, digital twins offer unparalleled insights into patient-specific conditions, enabling more accurate risk assessments and tailored interventions. However, their application extends beyond clinical benefits, prompting significant ethical debates over data privacy, consent, and potential biases in health care. The rapid evolution of this technology necessitates a careful balancing act between innovation and ethical responsibility. As the field of personalized medicine continues to evolve, digital twins hold tremendous promise in transforming health care delivery and revolutionizing patient care. While challenges exist, the continued development and integration of digital twins hold the potential to revolutionize personalized medicine, ushering in an era of tailored treatments and improved patient well-being. Digital twins can assist in recognizing trends and indicators that might signal the presence of diseases or forecast the likelihood of developing specific medical conditions, along with the progression of such diseases. Nevertheless, the use of human digital twins gives rise to ethical dilemmas related to informed consent, data ownership, and the potential for discrimination based on health profiles. There is a critical need for robust guidelines and regulations to navigate these challenges, ensuring that the pursuit of advanced health care solutions does not compromise patient rights and well-being. This viewpoint aims to ignite a comprehensive dialogue on the responsible integration of digital twins in medicine, advocating for a future where technology serves as a cornerstone for personalized, ethical, and effective patient care. %M 38739913 %R 10.2196/50204 %U https://www.jmir.org/2024/1/e50204 %U https://doi.org/10.2196/50204 %U http://www.ncbi.nlm.nih.gov/pubmed/38739913 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53255 %T Family Involvement in the Care of Hospitalized Older Adults: Protocol for a Qualitative Evidence Synthesis %A Vick,Judith B %A Golden,Blair P %A Cantrell,Sarah %A Harris-Gersten,Melissa Louise %A Selmanoff,Mollie R %A Hastings,Susan Nicole %A Oyesanya,Tolu O %A Goldstein,Karen M %A Van Houtven,Courtney %+ Durham VA Health Care System, 701 W. Main Street, Durham, NC, 27701, United States, 1 410 236 0650, judith.vick@duke.edu %K systematic review %K family %K patient participation %K hospital medicine %K aged %K geriatrics %K qualitative research %D 2024 %7 10.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults are frequently hospitalized. Family involvement during these hospitalizations is incompletely characterized in the literature. Objective: This study aimed to better understand how families are involved in the care of hospitalized older adults and develop a conceptual model describing the phenomenon of family involvement in the care of hospitalized older adults. Methods: We describe the protocol of a qualitative evidence synthesis (QES), a systematic review of qualitative studies. We chose to focus on qualitative studies given the complexity and multifaceted nature of family involvement in care, a type of topic best understood through qualitative inquiry. The protocol describes our process of developing a research question and eligibility criteria for inclusion in our QES based on the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) tool. It describes the development of our search strategy, which was used to search MEDLINE (via Ovid), Embase (via Elsevier), PsycINFO (via Ovid), and CINAHL Complete (via EBSCO). Title and abstract screening and full-text screening will occur sequentially. Purposive sampling may be used depending on the volume of studies identified as eligible for inclusion during our screening process. Descriptive data regarding included individual studies will be extracted and summarized in tables. The results from included studies will be synthesized using qualitative methods and used to develop a conceptual model. The conceptual model will be presented to community members via engagement panels for further refinement. Results: As of September 2023, we have assembled a multidisciplinary team including physicians, nurses, health services researchers, a librarian, a social worker, and a health economist. We have finalized our search strategy and executed the search, yielding 8862 total citations. We are currently screening titles and abstracts and anticipate that full-text screening, data extraction, quality appraisal, and synthesis will be completed by summer of 2024. Conceptual model development will then take place with community engagement panels. We anticipate submitting our manuscript for publication in the fall of 2024. Conclusions: This paper describes the protocol for a QES of family involvement in the care of hospitalized older adults. We will use identified themes to create a conceptual model to inform further intervention development and policy change. Trial Registration: PROSPERO 465617; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023465617 International Registered Report Identifier (IRRID): PRR1-10.2196/53255 %M 38457771 %R 10.2196/53255 %U https://www.researchprotocols.org/2024/1/e53255 %U https://doi.org/10.2196/53255 %U http://www.ncbi.nlm.nih.gov/pubmed/38457771 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51698 %T A Typology of Social Media Use by Human Service Nonprofits: Mixed Methods Study %A Xue,Jia %A Shier,Micheal L %A Chen,Junxiang %A Wang,Yirun %A Zheng,Chengda %A Chen,Chen %+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada, 1 4169465429, jia.xue@utoronto.ca %K human service nonprofits %K sexual assault support centers %K Canada %K typology %K theory %K Twitter %K machine learning %K social media %K tweet %K tweets %K nonprofit %K nonprofits %K crisis %K sexual assault %K sexual violence %K sexual abuse %K support center %K support centers %K communication %K communications %K organization %K organizations %K organizational %K sentiment analysis %K business %K marketing %D 2024 %7 8.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Nonprofit organizations are increasingly using social media to improve their communication strategies with the broader population. However, within the domain of human service nonprofits, there is hesitancy to fully use social media tools, and there is limited scope among organizational personnel in applying their potential beyond self-promotion and service advertisement. There is a pressing need for greater conceptual clarity to support education and training on the varied reasons for using social media to increase organizational outcomes. Objective: This study leverages the potential of Twitter (subsequently rebranded as X [X Corp]) to examine the online communication content within a sample (n=133) of nonprofit sexual assault (SA) centers in Canada. To achieve this, we developed a typology using a qualitative and supervised machine learning model for the automatic classification of tweets posted by these centers. Methods: Using a mixed methods approach that combines machine learning and qualitative analysis, we manually coded 10,809 tweets from 133 SA centers in Canada, spanning the period from March 2009 to March 2023. These manually labeled tweets were used as the training data set for the supervised machine learning process, which allowed us to classify 286,551 organizational tweets. The classification model based on supervised machine learning yielded satisfactory results, prompting the use of unsupervised machine learning to classify the topics within each thematic category and identify latent topics. The qualitative thematic analysis, in combination with topic modeling, provided a contextual understanding of each theme. Sentiment analysis was conducted to reveal the emotions conveyed in the tweets. We conducted validation of the model with 2 independent data sets. Results: Manual annotation of 10,809 tweets identified seven thematic categories: (1) community engagement, (2) organization administration, (3) public awareness, (4) political advocacy, (5) support for others, (6) partnerships, and (7) appreciation. Organization administration was the most frequent segment, and political advocacy and partnerships were the smallest segments. The supervised machine learning model achieved an accuracy of 63.4% in classifying tweets. The sentiment analysis revealed a prevalence of neutral sentiment across all categories. The emotion analysis indicated that fear was predominant, whereas joy was associated with the partnership and appreciation tweets. Topic modeling identified distinct themes within each category, providing valuable insights into the prevalent discussions surrounding SA and related issues. Conclusions: This research contributes an original theoretical model that sheds light on how human service nonprofits use social media to achieve their online organizational communication objectives across 7 thematic categories. The study advances our comprehension of social media use by nonprofits, presenting a comprehensive typology that captures the diverse communication objectives and contents of these organizations, which provide content to expand training and education for nonprofit leaders to connect and engage with the public, policy experts, other organizations, and potential service users. %M 38718390 %R 10.2196/51698 %U https://www.jmir.org/2024/1/e51698 %U https://doi.org/10.2196/51698 %U http://www.ncbi.nlm.nih.gov/pubmed/38718390 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53311 %T Using Routine Data to Improve Lesbian, Gay, Bisexual, and Transgender Health %A Saunders,Catherine L %+ Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, United Kingdom, 44 1223337106, cs834@medschl.cam.ac.uk %K lesbian %K gay %K bisexual %K trans %K LGBTQ+ %K routine data %K England %K United Kingdom %K health %K viewpoint %K sexual orientation %K health services %K infrastructure data %K policy %K gender %K health outcome %K epidemiology %K risk prediction %K risk %D 2024 %7 1.5.2024 %9 Viewpoint %J Interact J Med Res %G English %X The collection of sexual orientation in routine data, generated either from contacts with health services or in infrastructure data resources designed and collected for policy and research, has improved substantially in the United Kingdom in the last decade. Inclusive measures of gender and transgender status are now also beginning to be collected. This viewpoint considers current data collections, and their strengths and limitations, including accessing data, sample size, measures of sexual orientation and gender, measures of health outcomes, and longitudinal follow-up. The available data are considered within both sociopolitical and biomedical models of health for individuals who are lesbian, gay, bisexual, transgender, queer, or of other identities including nonbinary (LGBTQ+). Although most individual data sets have some methodological limitations, when put together, there is now a real depth of routine data for LGBTQ+ health research. This paper aims to provide a framework for how these data can be used to improve health and health care outcomes. Four practical analysis approaches are introduced—descriptive epidemiology, risk prediction, intervention development, and impact evaluation—and are discussed as frameworks for translating data into research with the potential to improve health. %M 38691398 %R 10.2196/53311 %U https://www.i-jmr.org/2024/1/e53311 %U https://doi.org/10.2196/53311 %U http://www.ncbi.nlm.nih.gov/pubmed/38691398 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45702 %T Patients’ Representations of Perceived Distance and Proximity to Telehealth in France: Qualitative Study %A Loriot,Amélie %A Larceneux,Fabrice %A Guillard,Valérie %A Bertocchio,Jean-Philippe %+ Paris Dauphine–PSL (Paris Sciences & Lettres) University, Place du Maréchal de Lattre de Tassigny, Paris, 75116, France, 33 144054405, amelie.loriot@dauphine.psl.eu %K telehealth %K teleconsultation %K social representations %K perceived proximity %K semiotic square %D 2024 %7 26.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In the last 2 decades, new technologies have emerged in health care. The COVID-19 pandemic further accelerated the adoption of technology by both health care professionals and patients. These technologies create remote care practices that bring several benefits to the health care system: easier access to care, improved communication with physicians, and greater continuity of care. However, disparities in the acceptance and use of telehealth tools still exist among patients. These tools also disrupt conventional medical practices and prompt a new reassessment of the perceptions of distance and proximity as physical (ie, time and space dimensions) and nonphysical (ie, behavioral dimensions) concepts. The reasons why patients do or do not adopt telehealth tools for their care and therefore their perspectives on telehealth remain unanswered questions. Objective: We explored the barriers as well as the motivations for patients to adopt telehealth tools. We specifically focused on the social representations of telehealth to establish a comprehensive conceptual framework to get a better understanding of how telehealth is perceived by patients. Methods: This study uses a qualitative design through in-depth individual interviews. Participants were recruited using a convenience sampling method with balanced consideration of gender, age, location (urban/rural), and socioeconomic background. After collecting informed consent, interviews were transcribed and analyzed using the thematic analysis methodology. Results: We conducted 14 interviews, with which data saturation was reached. The 2 main opposed dimensions, perceived proximity and distance, emerged as an essential structure for understanding the social representations of telehealth. A logic of engagement versus hostility emerged as the main tension in adopting telehealth, almost ideological. Interestingly, practical issues emerged regarding the adoption of telehealth: A logic of integration was opposed to a logic of constraints. Altogether, those dimensions enabled us to conceptualize a semiotic square, providing 4 categories with a coherent body of social representations. Due to the dynamic nature of these representations, we proposed 2 “paths” through which adherence to telehealth may improve. Conclusions: Our semiotic square illustrating patients’ adherence to telehealth differentiates socially beneficial versus socially dangerous considerations and pragmatic from ideological postures. It shows how crucial it is to consider perceived distance and proximity to better understand barriers and motivations to adopting telehealth. These representations can also be considered as leverage that could be modified to encourage the step-by-step adhesion process. Even if reducing the perceived temporal distance to in-person meeting and enhancing the perceived proximity of access to care may be seen as efficient ways to adopt telehealth tools, telehealth can also be perceived as a care practice that threatens the patient-physician relationship. The patient-oriented perceived value turns out to be critical in the future development of and adherence to telehealth tools. %M 38669676 %R 10.2196/45702 %U https://www.jmir.org/2024/1/e45702 %U https://doi.org/10.2196/45702 %U http://www.ncbi.nlm.nih.gov/pubmed/38669676 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50889 %T Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations: Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool %A Hellstrand Tang,Ulla %A Smith,Frida %A Karilampi,Ulla Leyla %A Gremyr,Andreas %+ Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Falkenbergsgatan 3, Gothenburg, SE-412 85, Sweden, 46 706397913, ulla.tang@vgregion.se %K digital %K bottom-up innovation %K complexity %K eHealth %K health care %K nonadoption, abandonment, scale-up, spread, and sustainability complexity assessment tool %K NASSS-CAT %K mobile phone %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations. Objective: This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up. Methods: A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges. Results: The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization’s readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization’s system and its setting. Conclusions: Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations. %M 38669076 %R 10.2196/50889 %U https://humanfactors.jmir.org/2024/1/e50889 %U https://doi.org/10.2196/50889 %U http://www.ncbi.nlm.nih.gov/pubmed/38669076 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48694 %T Methodological Frameworks and Dimensions to Be Considered in Digital Health Technology Assessment: Scoping Review and Thematic Analysis %A Segur-Ferrer,Joan %A Moltó-Puigmartí,Carolina %A Pastells-Peiró,Roland %A Vivanco-Hidalgo,Rosa Maria %+ Agency for Health Quality and Assessment of Catalonia, Roc Boronat Street, 81-95, 2nd Fl, Barcelona, 08005, Spain, 34 935 513 900, joan.segur@gencat.cat %K digital health %K eHealth %K mHealth %K mobile health %K AI %K artificial intelligence %K framework %K health technology assessment %K scoping review %K technology %K health care system %K methodological framework %K thematic analysis %D 2024 %7 10.4.2024 %9 Review %J J Med Internet Res %G English %X Background: Digital health technologies (dHTs) offer a unique opportunity to address some of the major challenges facing health care systems worldwide. However, the implementation of dHTs raises some concerns, such as the limited understanding of their real impact on health systems and people’s well-being or the potential risks derived from their use. In this context, health technology assessment (HTA) is 1 of the main tools that health systems can use to appraise evidence and determine the value of a given dHT. Nevertheless, due to the nature of dHTs, experts highlight the need to reconsider the frameworks used in traditional HTA. Objective: This scoping review (ScR) aimed to identify the methodological frameworks used worldwide for digital health technology assessment (dHTA); determine what domains are being considered; and generate, through a thematic analysis, a proposal for a methodological framework based on the most frequently described domains in the literature. Methods: The ScR was performed in accordance with the guidelines established in the PRISMA-ScR guidelines. We searched 7 databases for peer reviews and gray literature published between January 2011 and December 2021. The retrieved studies were screened using Rayyan in a single-blind manner by 2 independent authors, and data were extracted using ATLAS.ti software. The same software was used for thematic analysis. Results: The systematic search retrieved 3061 studies (n=2238, 73.1%, unique), of which 26 (0.8%) studies were included. From these, we identified 102 methodological frameworks designed for dHTA. These frameworks revealed great heterogeneity between them due to their different structures, approaches, and items to be considered in dHTA. In addition, we identified different wording used to refer to similar concepts. Through thematic analysis, we reduced this heterogeneity. In the first phase of the analysis, 176 provisional codes related to different assessment items emerged. In the second phase, these codes were clustered into 86 descriptive themes, which, in turn, were grouped in the third phase into 61 analytical themes and organized through a vertical hierarchy of 3 levels: level 1 formed by 13 domains, level 2 formed by 38 dimensions, and level 3 formed by 11 subdimensions. From these 61 analytical themes, we developed a proposal for a methodological framework for dHTA. Conclusions: There is a need to adapt the existing frameworks used for dHTA or create new ones to more comprehensively assess different kinds of dHTs. Through this ScR, we identified 26 studies including 102 methodological frameworks and tools for dHTA. The thematic analysis of those 26 studies led to the definition of 12 domains, 38 dimensions, and 11 subdimensions that should be considered in dHTA. %M 38598288 %R 10.2196/48694 %U https://www.jmir.org/2024/1/e48694 %U https://doi.org/10.2196/48694 %U http://www.ncbi.nlm.nih.gov/pubmed/38598288 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55779 %T Converge or Collide? Making Sense of a Plethora of Open Data Standards in Health Care %A Tsafnat,Guy %A Dunscombe,Rachel %A Gabriel,Davera %A Grieve,Grahame %A Reich,Christian %+ Evidentli Pty Ltd, 50 Holt St, Suite 516, Surry Hills, 2010, Australia, 61 415481043, guyt@evidentli.com %K interoperability %K clinical data %K open data standards %K health care %K digital health %K health care data %D 2024 %7 9.4.2024 %9 Editorial %J J Med Internet Res %G English %X Practitioners of digital health are familiar with disjointed data environments that often inhibit effective communication among different elements of the ecosystem. This fragmentation leads in turn to issues such as inconsistencies in services versus payments, wastage, and notably, care delivered being less than best-practice. Despite the long-standing recognition of interoperable data as a potential solution, efforts in achieving interoperability have been disjointed and inconsistent, resulting in numerous incompatible standards, despite the widespread agreement that fewer standards would enhance interoperability. This paper introduces a framework for understanding health care data needs, discussing the challenges and opportunities of open data standards in the field. It emphasizes the necessity of acknowledging diverse data standards, each catering to specific viewpoints and needs, while proposing a categorization of health care data into three domains, each with its distinct characteristics and challenges, along with outlining overarching design requirements applicable to all domains and specific requirements unique to each domain. %M 38593431 %R 10.2196/55779 %U https://www.jmir.org/2024/1/e55779 %U https://doi.org/10.2196/55779 %U http://www.ncbi.nlm.nih.gov/pubmed/38593431 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55209 %T Telehealth Evaluation in the United States: Protocol for a Scoping Review %A Zhang,Yunxi %A Lin,Yueh-Yun %A Lal,Lincy S %A Reneker,Jennifer C %A Hinton,Elizabeth G %A Chandra,Saurabh %A Swint,J Michael %+ Department of Data Science, John D Bower School of Population Health, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216-4505, United States, 1 6018153477, yzhang4@umc.edu %K cost %K effectiveness %K evaluation %K framework %K healthcare delivery %K measurement %K quality %K scoping review %K telehealth %K United States %D 2024 %7 28.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The rapid expansion of telehealth services, driven by the COVID-19 pandemic, necessitates systematic evaluation to guarantee the quality, effectiveness, and cost-effectiveness of telehealth services and programs in the United States. While numerous evaluation frameworks have emerged, crafted by various stakeholders, their comprehensiveness is limited, and the overall state of telehealth evaluation remains unclear. Objective: The overarching goal of this scoping review is to create a comprehensive overview of telehealth evaluation, incorporating perspectives from multiple stakeholder categories. Specifically, we aim to (1) map the existing landscape of telehealth evaluation, (2) identify key concepts for evaluation, (3) synthesize existing evaluation frameworks, and (4) identify measurements and assessments considered in the United States. Methods: We will conduct this scoping review in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). This scoping review will consider documents, including reviews, reports, and white papers, published since January 1, 2019. It will focus on evaluation frameworks and associated measurements of telehealth services and programs in the US health care system, developed by telehealth stakeholders, professional organizations, and authoritative sources, excluding those developed by individual researchers, to collect data that reflect the collective expertise and consensus of experts within the respective professional group. Results: The data extracted from selected documents will be synthesized using tools such as tables and figures. Visual aids like Venn diagrams will be used to illustrate the relationships between the evaluation frameworks from various sources. A narrative summary will be crafted to further describe how the results align with the review objectives, facilitating a comprehensive overview of the findings. This scoping review is expected to conclude by August 2024. Conclusions: By addressing critical gaps in telehealth evaluation, this scoping review protocol lays the foundation for a comprehensive and multistakeholder assessment of telehealth services and programs. Its findings will inform policy makers, health care providers, researchers, and other stakeholders in advancing the quality, effectiveness, and cost-effectiveness of telehealth in the US health care system. Trial Registration: OSF Registries osf.io/aytus; https://osf.io/aytus International Registered Report Identifier (IRRID): DERR1-10.2196/55209 %M 38546709 %R 10.2196/55209 %U https://www.researchprotocols.org/2024/1/e55209 %U https://doi.org/10.2196/55209 %U http://www.ncbi.nlm.nih.gov/pubmed/38546709 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46971 %T The Political Economy of Digital Health Equity: Structural Analysis %A Shaw,James %A Glover,Wiljeana %+ Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G1V7, Canada, 1 4169780315, jay.shaw@wchospital.ca %K digital health equity %K health equity %K health policy %K telemedicine %K digital care %K political economy %K race %K ethnicity %K socioeconomic %K policy %D 2024 %7 26.3.2024 %9 Viewpoint %J J Med Internet Res %G English %X Digital technologies have produced many innovations in care delivery and enabled continuity of care for many people when in-person care was impossible. However, a growing body of research suggests that digital health can also exacerbate health inequities for those excluded from its benefits for reasons of cost, digital literacy, and structural discrimination related to characteristics such as age, race, ethnicity, and socioeconomic status. In this paper, we draw on a political economy perspective to examine structural barriers to progress in advancing digital health equity at the policy level. Considering the incentive structures and investments of powerful actors in the field, we outline how characteristics of neoliberal capitalism in Western contexts produce and sustain digital health inequities by describing 6 structural challenges to the effort to promote health equity through digital health, as follows: (1) the revenue-first incentives of technology corporations, (2) the influence of venture capital, (3) inequitable access to the internet and digital devices, (4) underinvestment in digital health literacy, (5) uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital health. Building on these important challenges, we propose future immediate and long-term directions for work to support meaningful change for digital health equity. %M 38530341 %R 10.2196/46971 %U https://www.jmir.org/2024/1/e46971 %U https://doi.org/10.2196/46971 %U http://www.ncbi.nlm.nih.gov/pubmed/38530341 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e43078 %T Gamification of Behavior Change: Mathematical Principle and Proof-of-Concept Study %A Lieder,Falk %A Chen,Pin-Zhen %A Prentice,Mike %A Amo,Victoria %A Tošić,Mateo %+ Department of Psychology, University of California, Los Angeles, 502 Portola Plaza, Los Angeles, Los Angeles, CA, 90095, United States, 1 424 259 5300, falk.lieder@psych.ucla.edu %K gamification %K points %K feedback %K behavior change %K habit formation %K chatbot %K digital interventions %K mobile phone %K artificial intelligence %D 2024 %7 22.3.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Many people want to build good habits to become healthier, live longer, or become happier but struggle to change their behavior. Gamification can make behavior change easier by awarding points for the desired behavior and deducting points for its omission. Objective: In this study, we introduced a principled mathematical method for determining how many points should be awarded or deducted for the enactment or omission of the desired behavior, depending on when and how often the person has succeeded versus failed to enact it in the past. We called this approach optimized gamification of behavior change. Methods: As a proof of concept, we designed a chatbot that applies our optimized gamification method to help people build healthy water-drinking habits. We evaluated the effectiveness of this gamified intervention in a 40-day field experiment with 1 experimental group (n=43) that used the chatbot with optimized gamification and 2 active control groups for which the chatbot’s optimized gamification feature was disabled. For the first control group (n=48), all other features were available, including verbal feedback. The second control group (n=51) received no feedback or reminders. We measured the strength of all participants’ water-drinking habits before, during, and after the intervention using the Self-Report Habit Index and by asking participants on how many days of the previous week they enacted the desired habit. In addition, all participants provided daily reports on whether they enacted their water-drinking intention that day. Results: A Poisson regression analysis revealed that, during the intervention, users who received feedback based on optimized gamification enacted the desired behavior more often (mean 14.71, SD 6.57 times) than the active (mean 11.64, SD 6.38 times; P<.001; incidence rate ratio=0.80, 95% CI 0.71-0.91) or passive (mean 11.64, SD 5.43 times; P=.001; incidence rate ratio=0.78, 95% CI 0.69-0.89) control groups. The Self-Report Habit Index score significantly increased in all conditions (P<.001 in all cases) but did not differ between the experimental and control conditions (P>.11 in all cases). After the intervention, the experimental group performed the desired behavior as often as the 2 control groups (P≥.17 in all cases). Conclusions: Our findings suggest that optimized gamification can be used to make digital behavior change interventions more effective. Trial Registration: Open Science Framework (OSF) H7JN8; https://osf.io/h7jn8 %M 38517466 %R 10.2196/43078 %U https://games.jmir.org/2024/1/e43078 %U https://doi.org/10.2196/43078 %U http://www.ncbi.nlm.nih.gov/pubmed/38517466 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52150 %T Tanzania’s and Germany’s Digital Health Strategies and Their Consistency With the World Health Organization’s Global Strategy on Digital Health 2020-2025: Comparative Policy Analysis %A Holl,Felix %A Kircher,Jennifer %A Hertelendy,Attila J %A Sukums,Felix %A Swoboda,Walter %+ DigiHealth Institute, Neu-Ulm University of Applied Sciences, Wileystraße 1, Neu-Ulm, 89231, Germany, 49 7319762 ext 1613, felix.holl@hnu.de %K digital health strategies %K comparative policy analysis %K DHS %K eHealth %K digital health %K strategy %K strategies %K policy %K policies %K document analysis %K document analyses %K GSDH %K Germany %K Europe %K Africa %K Tanzania %D 2024 %7 18.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, the fast-paced adoption of digital health (DH) technologies has transformed health care delivery. However, this rapid evolution has also led to challenges such as uncoordinated development and information silos, impeding effective health care integration. Recognizing these challenges, nations have developed digital health strategies (DHSs), aligning with their national health priorities and guidance from global frameworks. The World Health Organization (WHO)’s Global Strategy on Digital Health 2020-2025 (GSDH) guides national DHSs. Objective: This study analyzes the DHSs of Tanzania and Germany as case studies and assesses their alignment with the GSDH and identifies strengths, shortcomings, and areas for improvement. Methods: A comparative policy analysis was conducted, focusing on the DHSs of Tanzania and Germany as case studies, selected for their contrasting health care systems and cooperative history. The analysis involved a three-step process: (1) assessing consistency with the GSDH, (2) comparing similarities and differences, and (3) evaluating the incorporation of emergent technologies. Primary data sources included national eHealth policy documents and related legislation. Results: Both Germany’s and Tanzania’s DHSs align significantly with the WHO’s GSDH, incorporating most of its 35 elements, but each missing 5 distinct elements. Specifically, Tanzania’s DHS lacks in areas such as knowledge management and capacity building for leaders, while Germany’s strategy falls short in engaging health care service providers and beneficiaries in development phases and promoting health equity. Both countries, however, excel in other aspects like collaboration, knowledge transfer, and advancing national DHSs, reflecting their commitment to enhancing DH infrastructures. The high ratings of both countries on the Global Digital Health Monitor underscore their substantial progress in DH, although challenges persist in adopting the rapidly advancing technologies and in the need for more inclusive and comprehensive strategies. Conclusions: This study reveals that both Tanzania and Germany have made significant strides in aligning their DHSs with the WHO’s GSDH. However, the rapid evolution of technologies like artificial intelligence and machine learning presents challenges in keeping strategies up-to-date. This study recommends the development of more comprehensive, inclusive strategies and regular revisions to align with emerging technologies and needs. The research underscores the importance of context-specific adaptations in DHSs and highlights the need for broader, strategic guidelines to direct the future development of the DH ecosystem. The WHO’s GSDH serves as a crucial blueprint for national DHSs. This comparative analysis demonstrates the value and challenges of aligning national strategies with global guidelines. Both Tanzania and Germany offer valuable insights into developing and implementing effective DHSs, highlighting the importance of continuous adaptation and context-specific considerations. Future policy assessments require in-depth knowledge of the country’s health care needs and structure, supplemented by stakeholder input for a comprehensive evaluation. %M 38498021 %R 10.2196/52150 %U https://www.jmir.org/2024/1/e52150 %U https://doi.org/10.2196/52150 %U http://www.ncbi.nlm.nih.gov/pubmed/38498021 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53008 %T Generative AI in Medical Practice: In-Depth Exploration of Privacy and Security Challenges %A Chen,Yan %A Esmaeilzadeh,Pouyan %+ Department of Information Systems and Business Analytics, College of Business, Florida International University, Modesto A Maidique Campus, 11200 SW 8th St, RB 261 B, Miami, FL, 33199, United States, 1 3053483302, pesmaeil@fiu.edu %K artificial intelligence %K AI %K generative artificial intelligence %K generative AI %K medical practices %K potential benefits %K security and privacy threats %D 2024 %7 8.3.2024 %9 Viewpoint %J J Med Internet Res %G English %X As advances in artificial intelligence (AI) continue to transform and revolutionize the field of medicine, understanding the potential uses of generative AI in health care becomes increasingly important. Generative AI, including models such as generative adversarial networks and large language models, shows promise in transforming medical diagnostics, research, treatment planning, and patient care. However, these data-intensive systems pose new threats to protected health information. This Viewpoint paper aims to explore various categories of generative AI in health care, including medical diagnostics, drug discovery, virtual health assistants, medical research, and clinical decision support, while identifying security and privacy threats within each phase of the life cycle of such systems (ie, data collection, model development, and implementation phases). The objectives of this study were to analyze the current state of generative AI in health care, identify opportunities and privacy and security challenges posed by integrating these technologies into existing health care infrastructure, and propose strategies for mitigating security and privacy risks. This study highlights the importance of addressing the security and privacy threats associated with generative AI in health care to ensure the safe and effective use of these systems. The findings of this study can inform the development of future generative AI systems in health care and help health care organizations better understand the potential benefits and risks associated with these systems. By examining the use cases and benefits of generative AI across diverse domains within health care, this paper contributes to theoretical discussions surrounding AI ethics, security vulnerabilities, and data privacy regulations. In addition, this study provides practical insights for stakeholders looking to adopt generative AI solutions within their organizations. %M 38457208 %R 10.2196/53008 %U https://www.jmir.org/2024/1/e53008 %U https://doi.org/10.2196/53008 %U http://www.ncbi.nlm.nih.gov/pubmed/38457208 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49208 %T The Digital Therapeutics Real-World Evidence Framework: An Approach for Guiding Evidence-Based Digital Therapeutics Design, Development, Testing, and Monitoring %A Kim,Meelim %A Patrick,Kevin %A Nebeker,Camille %A Godino,Job %A Stein,Spencer %A Klasnja,Predrag %A Perski,Olga %A Viglione,Clare %A Coleman,Aaron %A Hekler,Eric %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr, MC0811, La Jolla, CA, 92093, United States, 1 858 429 9370, ehekler@ucsd.edu %K accessible %K decision making %K decision %K decision-based evidence-making %K development %K digital therapeutics %K medication adherence %K monitoring %K pharmaceuticals %K public health %K real-world data %K real-world evidence %K safe %K testing %K therapeutics %D 2024 %7 5.3.2024 %9 Viewpoint %J J Med Internet Res %G English %X Digital therapeutics (DTx) are a promising way to provide safe, effective, accessible, sustainable, scalable, and equitable approaches to advance individual and population health. However, developing and deploying DTx is inherently complex in that DTx includes multiple interacting components, such as tools to support activities like medication adherence, health behavior goal-setting or self-monitoring, and algorithms that adapt the provision of these according to individual needs that may change over time. While myriad frameworks exist for different phases of DTx development, no single framework exists to guide evidence production for DTx across its full life cycle, from initial DTx development to long-term use. To fill this gap, we propose the DTx real-world evidence (RWE) framework as a pragmatic, iterative, milestone-driven approach for developing DTx. The DTx RWE framework is derived from the 4-phase development model used for behavioral interventions, but it includes key adaptations that are specific to the unique characteristics of DTx. To ensure the highest level of fidelity to the needs of users, the framework also incorporates real-world data (RWD) across the entire life cycle of DTx development and use. The DTx RWE framework is intended for any group interested in developing and deploying DTx in real-world contexts, including those in industry, health care, public health, and academia. Moreover, entities that fund research that supports the development of DTx and agencies that regulate DTx might find the DTx RWE framework useful as they endeavor to improve how DTxcan advance individual and population health. %M 38441954 %R 10.2196/49208 %U https://www.jmir.org/2024/1/e49208 %U https://doi.org/10.2196/49208 %U http://www.ncbi.nlm.nih.gov/pubmed/38441954 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45209 %T Electronic Health Record and Semantic Issues Using Fast Healthcare Interoperability Resources: Systematic Mapping Review %A Amar,Fouzia %A April,Alain %A Abran,Alain %+ École de technologie supérieure - ETS, 1100 Notre Dame Ouest, Montreal, QC, H3C 1K3, Canada, 1 514 396 8800, famar2022@gmail.com %K electronic health record %K EHR %K Health Level Seven International Fast Healthcare Interoperability Resources %K HL7 FHIR %K interoperability, web ontology language %K OWL %K ontology %K semantic %K terminology %K resource description framework %K RDF %K machine learning %K ML %K natural language processing %K NLP %D 2024 %7 30.1.2024 %9 Review %J J Med Internet Res %G English %X Background: The increasing use of electronic health records and the Internet of Things has led to interoperability issues at different levels (structural and semantic). Standards are important not only for successfully exchanging data but also for appropriately interpreting them (semantic interoperability). Thus, to facilitate the semantic interoperability of data exchanged in health care, considerable resources have been deployed to improve the quality of shared clinical data by structuring and mapping them to the Fast Healthcare Interoperability Resources (FHIR) standard. Objective: The aims of this study are 2-fold: to inventory the studies on FHIR semantic interoperability resources and terminologies and to identify and classify the approaches and contributions proposed in these studies. Methods: A systematic mapping review (SMR) was conducted using 10 electronic databases as sources of information for inventory and review studies published during 2012 to 2022 on the development and improvement of semantic interoperability using the FHIR standard. Results: A total of 70 FHIR studies were selected and analyzed to identify FHIR resource types and terminologies from a semantic perspective. The proposed semantic approaches were classified into 6 categories, namely mapping (31/126, 24.6%), terminology services (18/126, 14.3%), resource description framework or web ontology language–based proposals (24/126, 19%), annotation proposals (18/126, 14.3%), machine learning (ML) and natural language processing (NLP) proposals (20/126, 15.9%), and ontology-based proposals (15/126, 11.9%). From 2012 to 2022, there has been continued research in 6 categories of approaches as well as in new and emerging annotations and ML and NLP proposals. This SMR also classifies the contributions of the selected studies into 5 categories: framework or architecture proposals, model proposals, technique proposals, comparison services, and tool proposals. The most frequent type of contribution is the proposal of a framework or architecture to enable semantic interoperability. Conclusions: This SMR provides a classification of the different solutions proposed to address semantic interoperability using FHIR at different levels: collecting, extracting and annotating data, modeling electronic health record data from legacy systems, and applying transformation and mapping to FHIR models and terminologies. The use of ML and NLP for unstructured data is promising and has been applied to specific use case scenarios. In addition, terminology services are needed to accelerate their use and adoption; furthermore, techniques and tools to automate annotation and ontology comparison should help reduce human interaction. %M 38289660 %R 10.2196/45209 %U https://www.jmir.org/2024/1/e45209 %U https://doi.org/10.2196/45209 %U http://www.ncbi.nlm.nih.gov/pubmed/38289660 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47197 %T Understanding the Integrated Health Management System Policy in China From Multiple Perspectives: Systematic Review and Content Analysis %A Yu,Yang %A Wang,Sufen %A You,Lijue %+ Glorious Sun School of Business and Management, Donghua University, 1882 West Yan-an Road, Shanghai, 200051, China, 86 18116350361, sf_wang@dhu.edu.cn %K integrated health management system %K medical association %K medical consortium %K policy tools %K content analysis %K PRISMA %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses %D 2024 %7 24.1.2024 %9 Review %J J Med Internet Res %G English %X Background: The integrated health management system (IHMS), which unites all health care–related institutions under a health-centered organizational framework, is of great significance to China in promoting the hierarchical treatment system and improving the new health care reform. China’s IHMS policy consists of multiple policies at different levels and at different times; however, there is a lack of comprehensive interpretation and analysis of these policies, which is not conducive to the further development of the IHMS in China. Objective: This study aims to comprehensively analyze and understand the characteristics, development, and evolution of China’s IHMS policy to inform the design and improvement of the system. Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to collect 152 policy documents. With the perspective of policy tools and policy orientation as the core, a comprehensive 6D framework including policy level, policy nature, release time, policy tools, stakeholders, and policy orientation was established by combining the content of policy texts. These dimensions were then analyzed using content analysis. Results: First, we found that, regarding the coordination of policy tools and stakeholders, China’s IHMS policy was more inclined to use environment-based policy tools (1089/1929, 56.45%), which suggests a need for further balance in the internal structure of policy tools. Attention to different actors varied, and the participation of physicians and residents needs further improvement (65/2019, 3.22% and 11/2019, 0.54%, respectively). Second, in terms of level differences, Shanghai’s IHMS policy used fewer demand-based policy tools (43/483, 8.9%), whereas the national IHMS policy and those of other provinces and cities used fewer supply-based tools (61/357, 17.1% and 248/357, 69.5%, respectively). The national IHMS strategy placed more emphasis on the construction of smart health care (including digital health; 10/275, 3.6%), whereas Shanghai was a leader in the development of healthy community and healthy China (9/158, 5.7% and 4/158, 2.5%, respectively). Third, in terms of time evolution, the various policy tools showed an increasing and then decreasing trend from 2014 to 2021, with relatively more use of environment-based policy tools and less use of demand-based policy tools in the last 3 years. The growth of China’s IHMS policy can be divided into 3 stages: the disease-centered period (2014-2017), the e-health technology development period (2017-2019), and the health-centered period (2018-2021). Conclusions: Policy makers should make several adjustments, such as coordinating policy tools and the uneven relationships among stakeholders; grasping key policy priorities in the context of local characteristics; and focusing on horizontal, multidimensional integration of health resources starting from the community. This study expands the objects of policy research and improves the framework for policy analysis. The findings provide some possible lessons for future policy formulation and optimization. %M 38265862 %R 10.2196/47197 %U https://www.jmir.org/2024/1/e47197 %U https://doi.org/10.2196/47197 %U http://www.ncbi.nlm.nih.gov/pubmed/38265862 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 9 %N %P e58911 %T Enhancing Ultrasound Image Quality Across Disease Domains: Application of Cycle-Consistent Generative Adversarial Network and Perceptual Loss %A Athreya,Shreeram %A Radhachandran,Ashwath %A Ivezić,Vedrana %A Sant,Vivek R %A Arnold,Corey W %A Speier,William %+ Department of Electrical and Computer Engineering, University of California Los Angeles, 924 Westwood Boulevard, Suite 600, Los Angeles, CA, 90024, United States, 1 4244206158, shreeram@ucla.edu %K generative networks %K cycle generative adversarial network %K image enhancement %K perceptual loss %K ultrasound scans %K ultrasound images %K imaging %K machine learning %K portable handheld devices %D 2024 %7 17.12.2024 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Numerous studies have explored image processing techniques aimed at enhancing ultrasound images to narrow the performance gap between low-quality portable devices and high-end ultrasound equipment. These investigations often use registered image pairs created by modifying the same image through methods like down sampling or adding noise, rather than using separate images from different machines. Additionally, they rely on organ-specific features, limiting the models’ generalizability across various imaging conditions and devices. The challenge remains to develop a universal framework capable of improving image quality across different devices and conditions, independent of registration or specific organ characteristics. Objective: This study aims to develop a robust framework that enhances the quality of ultrasound images, particularly those captured with compact, portable devices, which are often constrained by low quality due to hardware limitations. The framework is designed to effectively process nonregistered ultrasound image pairs, a common challenge in medical imaging, across various clinical settings and device types. By addressing these challenges, the research seeks to provide a more generalized and adaptable solution that can be widely applied across diverse medical scenarios, improving the accessibility and quality of diagnostic imaging. Methods: A retrospective analysis was conducted by using a cycle-consistent generative adversarial network (CycleGAN) framework enhanced with perceptual loss to improve the quality of ultrasound images, focusing on nonregistered image pairs from various organ systems. The perceptual loss was integrated to preserve anatomical integrity by comparing deep features extracted from pretrained neural networks. The model’s performance was evaluated against corresponding high-resolution images, ensuring that the enhanced outputs closely mimic those from high-end ultrasound devices. The model was trained and validated using a publicly available, diverse dataset to ensure robustness and generalizability across different imaging scenarios. Results: The advanced CycleGAN framework, enhanced with perceptual loss, significantly outperformed the previous state-of-the-art, stable CycleGAN, in multiple evaluation metrics. Specifically, our method achieved a structural similarity index of 0.2889 versus 0.2502 (P<.001), a peak signal-to-noise ratio of 15.8935 versus 14.9430 (P<.001), and a learned perceptual image patch similarity score of 0.4490 versus 0.5005 (P<.001). These results demonstrate the model’s superior ability to enhance image quality while preserving critical anatomical details, thereby improving diagnostic usefulness. Conclusions: This study presents a significant advancement in ultrasound imaging by leveraging a CycleGAN model enhanced with perceptual loss to bridge the quality gap between images from different devices. By processing nonregistered image pairs, the model not only enhances visual quality but also ensures the preservation of essential anatomical structures, crucial for accurate diagnosis. This approach holds the potential to democratize high-quality ultrasound imaging, making it accessible through low-cost portable devices, thereby improving health care outcomes, particularly in resource-limited settings. Future research will focus on further validation and optimization for clinical use. %M 39689310 %R 10.2196/58911 %U https://biomedeng.jmir.org/2024/1/e58911 %U https://doi.org/10.2196/58911 %U http://www.ncbi.nlm.nih.gov/pubmed/39689310 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48702 %T Can OpenEHR, ISO 13606, and HL7 FHIR Work Together? An Agnostic Approach for the Selection and Application of Electronic Health Record Standards to the Next-Generation Health Data Spaces %A Pedrera-Jiménez,Miguel %A García-Barrio,Noelia %A Frid,Santiago %A Moner,David %A Boscá-Tomás,Diego %A Lozano-Rubí,Raimundo %A Kalra,Dipak %A Beale,Thomas %A Muñoz-Carrero,Adolfo %A Serrano-Balazote,Pablo %+ Data Science Unit, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, Madrid, 28041, Spain, 34 634209791, mpedrerajimenez@gmail.com %K electronic health records %K FAIR principles %K health information standards %K HL7 FHIR %K ISO 13606 %K OpenEHR %K semantics %D 2023 %7 28.12.2023 %9 Viewpoint %J J Med Internet Res %G English %X In order to maximize the value of electronic health records (EHRs) for both health care and secondary use, it is necessary for the data to be interoperable and reusable without loss of the original meaning and context, in accordance with the findable, accessible, interoperable, and reusable (FAIR) principles. To achieve this, it is essential for health data platforms to incorporate standards that facilitate addressing needs such as formal modeling of clinical knowledge (health domain concepts) as well as the harmonized persistence, query, and exchange of data across different information systems and organizations. However, the selection of these specifications has not been consistent across the different health data initiatives, often applying standards to address needs for which they were not originally designed. This issue is essential in the current scenario of implementing the European Health Data Space, which advocates harmonization, interoperability, and reuse of data without regulating the specific standards to be applied for this purpose. Therefore, this viewpoint aims to establish a coherent, agnostic, and homogeneous framework for the use of the most impactful EHR standards in the new-generation health data spaces: OpenEHR, International Organization for Standardization (ISO) 13606, and Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR). Thus, a panel of EHR standards experts has discussed several critical points to reach a consensus that will serve decision-making teams in health data platform projects who may not be experts in these EHR standards. It was concluded that these specifications possess different capabilities related to modeling, flexibility, and implementation resources. Because of this, in the design of future data platforms, these standards must be applied based on the specific needs they were designed for, being likewise fully compatible with their combined functional and technical implementation. %M 38153779 %R 10.2196/48702 %U https://www.jmir.org/2023/1/e48702 %U https://doi.org/10.2196/48702 %U http://www.ncbi.nlm.nih.gov/pubmed/38153779 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50573 %T Building on Existing Classifications of Behavior Change Techniques to Classify Planned Coping Strategies: Physical Activity Diary Study %A Braun,Maya %A Schroé,Helene %A De Paepe,Annick L %A Crombez,Geert %+ Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Gent, 9000, Belgium, 32 0456159365, maya.braun@ugent.be %K behavior change %K problem-solving %K classification %K personalization %K physically active %K digital intervention %K solution %K techniques %K plan %K physical activity %D 2023 %7 18.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: When trying to be more physically active, preparing for possible barriers by considering potential coping strategies increases the likelihood of plan enactment. Digital interventions can support this process by providing personalized recommendations for coping strategies, but this requires that possible coping strategies are identified and classified. Existing classification systems of behavior change, such as the compendium of self-enactable techniques, may be reused to classify coping strategies in the context of physical activity (PA) coping planning. Objective: This study investigated whether coping strategies created by a student population to overcome barriers to be physically active can be mapped onto the compendium of self-enactable techniques and which adaptations or additions to the frameworks are needed. Methods: In total, 359 Flemish university students created action and coping plans for PA for 8 consecutive days in 2020, resulting in 5252 coping plans. A codebook was developed iteratively using the compendium of self-enactable techniques as a starting point to code coping strategies. Additional codes were added to the codebook iteratively. Interrater reliability was calculated, and descriptive statistics were provided for the coping strategies. Results: Interrater reliability was moderate (Cohen κ=0.72) for the coded coping strategies. Existing self-enactable techniques covered 64.6% (3393/5252) of the coded coping strategies, and added coping strategies covered 28.52% (n=1498). The remaining coping strategies could not be coded as entries were too vague or contained no coping strategy. The added classes covered multiple ways of adapting the original action plan, managing one’s time, ensuring the availability of required material, and doing the activity with someone else. When exploring the data further, we found that almost half (n=2371, 45.1%) of the coping strategies coded focused on contextual factors. Conclusions: The study’s objective was to categorize PA coping strategies. The compendium of self-enactable techniques addressed almost two-thirds (3393/5252, 64.6%) of these strategies, serving as valuable starting points for classification. In total, 9 additional strategies were integrated into the self-enactable techniques, which are largely absent in other existing classification systems. These new techniques can be seen as further refinements of “problem-solving” or “coping planning.” Due to data constraints stemming from the COVID-19 pandemic and the study’s focus on a healthy Flemish student population, it is anticipated that more coping strategies would apply under normal conditions, in the general population, and among clinical groups. Future research should expand to diverse populations and establish connections between coping strategies and PA barriers, with ontologies recommended for this purpose. This study is a first step in classifying the content of coping strategies for PA. We believe this is an important and necessary step toward digital health interventions that incorporate personalized suggestions for PA coping plans. %M 38109171 %R 10.2196/50573 %U https://formative.jmir.org/2023/1/e50573 %U https://doi.org/10.2196/50573 %U http://www.ncbi.nlm.nih.gov/pubmed/38109171 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47505 %T Innovation Process and Industrial System of US Food and Drug Administration–Approved Software as a Medical Device: Review and Content Analysis %A Yu,Jiakan %A Zhang,Jiajie %A Sengoku,Shintaro %+ Department of Innovation Science, School of Environment and Society, Tokyo Institute of Technology, Tokyo Campus Innovation Center 9th Floor Room 908N, 3-3-6 Shibaura, Minato-ku, Tokyo, 108-0023, Japan, 81 03 3454 8907, sengoku.s.aa@m.titech.ac.jp %K digital health %K digital therapeutics %K software as a medical device %K innovation process %K artificial intelligence %D 2023 %7 24.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been a surge in academic and business interest in software as a medical device (SaMD). SaMD enables medical professionals to streamline existing medical practices and make innovative medical processes such as digital therapeutics a reality. Furthermore, SaMD is a billion-dollar market. However, SaMD is not clearly understood as a technological change and emerging industry. Objective: This study aims to review the landscape of SaMD in response to increasing interest in SaMD within health systems and regulation. The objectives of the study are to (1) clarify the innovation process of SaMD, (2) identify the prevailing typology of such innovation, and (3) elucidate the underlying mechanisms driving the SaMD innovation process. Methods: We collected product information on 581 US Food and Drug Administration–approved SaMDs from the OpenFDA website and 268 company profiles of the corresponding manufacturers from Crunchbase, Bloomberg, PichBook.com, and other company websites. In addition to assessing the metadata of SaMD, we used correspondence and business process analysis to assess the distribution of intended use and how SaMDs interact with other devices in the medical process. Results: The current SaMD industry is highly concentrated in medical image processing and radiological analysis. Incumbents in the medical device industry currently lead the market and focus on incremental innovation, whereas new entrants, particularly startups, produce more disruptive innovation. We found that hardware medical device functions as a complementary asset for SaMD, whereas how SaMD interacts with the complementary asset differs according to its intended use. Based on these findings, we propose a regime map that illustrates the SaMD innovation process. Conclusions: SaMD, as an industry, is nascent and dominated by incremental innovation. The innovation process of the present SaMD industry is shaped by data accessibility, which is key to building disruptive innovation. %M 37999948 %R 10.2196/47505 %U https://www.jmir.org/2023/1/e47505 %U https://doi.org/10.2196/47505 %U http://www.ncbi.nlm.nih.gov/pubmed/37999948 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45821 %T Medical Extended Reality Trials: Building Robust Comparators, Controls, and Sham %A Persky,Susan %A Colloca,Luana %+ Social and Behavioral Research Branch, National Human Genome Research Institute, 31 Center Drive, B1B36, Bethesda, MD, 20892, United States, 1 3014430098, perskys@mail.nih.gov %K augmented reality %K clinical trial design %K control conditions %K medical extended reality %K sham VR %K virtual reality %D 2023 %7 22.11.2023 %9 Viewpoint %J J Med Internet Res %G English %X The explosive pace of development and research in medical extended reality (MXR) is a testament to its promise for health care and medicine. In comparison with this growth, there is a relative sparsity of rigorous clinical trials that establish the efficacy and effectiveness of these interventions. Explicating mechanisms of action across clinical areas and MXR applications is another major area of need. A primary impediment to these goals is a lack of frameworks for trial design, more specifically, the selection of appropriate controls that effectively address unique elements of MXR. This paper delineates a framework for designing controls, sham conditions, and comparators, as well as proposed considerations for MXR trial designs. Special consideration is given to the design of sham conditions. Improved designs would enable more robust findings and the development of generalizable knowledge that could be adopted across MXR interventions. %M 37991836 %R 10.2196/45821 %U https://www.jmir.org/2023/1/e45821 %U https://doi.org/10.2196/45821 %U http://www.ncbi.nlm.nih.gov/pubmed/37991836 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e47103 %T Empowerment Enabled by Information and Communications Technology and Intention to Sustain a Healthy Behavior: Survey of General Users %A Alluhaidan,Ala Saleh %A Chatterjee,Samir %A Drew,David E %A Ractham,Peter %A Kaewkitipong,Laddawan %+ Center of Excellence in Operations and Information Management, Thammasat Business School, Thammasat University, 2 Prachan Rd., Pranakorn, Bangkok, 10200, Thailand, 66 26132200, laddawan@tbs.tu.ac.th %K empowerment %K behavior change %K information and communications technology %K ICT %K sustaining health behavior %K long-term health behavior %K mobile phone %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Most people with chronic conditions fail to adhere to self-management behavioral guidelines. In the last 2 decades, several mobile health apps and IT-based systems have been designed and developed to help patients change and sustain their healthy behaviors. However, these systems often lead to short-term behavior change or adherence while the goal is to engage the population toward long-term behavior change. Objective: This study aims to contribute to the development of long-term health behavior changes or to help people sustain their healthy behavior. For this purpose, we built and tested a theoretical model that includes enablers of empowerment and an intention to sustain a healthy behavior when patients are assisted by information and communications technology. Methods: Structural equation modeling was used to analyze 427 survey returns collected from a diverse population of participants and patients. Notably, the model testing was performed for physical activity as a generally desirable healthy goal. Results: Message aligned with personal goals, familiarity with technology tools, high self-efficacy, social connection, and community support played a significant role (P<.001) in empowering individuals to maintain a healthy behavior. The feeling of being empowered exhibited a strong influence, with a path coefficient of 0.681 on an intention to sustain healthy behavior. Conclusions: The uniqueness of this model is its recognition of needs (ie, social connection, community support, and self-efficacy) to sustain a healthy behavior. Individuals are empowered when they are assisted by family and community, specifically when they possess the knowledge, skills, and self-awareness to ascertain and achieve their goals. This nascent theory explains what might lead to more sustainable behavior change and is meant to help designers build better apps that enable people to conduct self-care routines and sustain their behavior. %M 37991814 %R 10.2196/47103 %U https://humanfactors.jmir.org/2023/1/e47103 %U https://doi.org/10.2196/47103 %U http://www.ncbi.nlm.nih.gov/pubmed/37991814 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50216 %T A Framework to Guide Implementation of AI in Health Care: Protocol for a Cocreation Research Project %A Nilsen,Per %A Svedberg,Petra %A Neher,Margit %A Nair,Monika %A Larsson,Ingrid %A Petersson,Lena %A Nygren,Jens %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 706341151, per.nilsen@liu.se %K artificial intelligence %K AI %K health care %K implementation %K process models %K frameworks %K framework %K process model %D 2023 %7 8.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Artificial intelligence (AI) has the potential in health care to transform patient care and administrative processes, yet health care has been slow to adopt AI due to many types of barriers. Implementation science has shown the importance of structured implementation processes to overcome implementation barriers. However, there is a lack of knowledge and tools to guide such processes when implementing AI-based applications in health care. Objective: The aim of this protocol is to describe the development, testing, and evaluation of a framework, “Artificial Intelligence-Quality Implementation Framework” (AI-QIF), intended to guide decisions and activities related to the implementation of various AI-based applications in health care. Methods: The paper outlines the development of an AI implementation framework for broad use in health care based on the Quality Implementation Framework (QIF). QIF is a process model developed in implementation science. The model guides the user to consider implementation-related issues in a step-by-step design and plan and perform activities that support implementation. This framework was chosen for its adaptability, usability, broad scope, and detailed guidance concerning important activities and considerations for successful implementation. The development will proceed in 5 phases with primarily qualitative methods being used. The process starts with phase I, in which an AI-adapted version of QIF is created (AI-QIF). Phase II will produce a digital mockup of the AI-QIF. Phase III will involve the development of a prototype of the AI-QIF with an intuitive user interface. Phase IV is dedicated to usability testing of the prototype in health care environments. Phase V will focus on evaluating the usability and effectiveness of the AI-QIF. Cocreation is a guiding principle for the project and is an important aspect in 4 of the 5 development phases. The cocreation process will enable the use of both on research-based and practice-based knowledge. Results: The project is being conducted within the frame of a larger research program, with the overall objective of developing theoretically and empirically informed frameworks to support AI implementation in routine health care. The program was launched in 2021 and has carried out numerous research activities. The development of AI-QIF as a tool to guide the implementation of AI-based applications in health care will draw on knowledge and experience acquired from these activities. The framework is being developed over 2 years, from January 2023 to December 2024. It is under continuous development and refinement. Conclusions: The development of the AI implementation framework, AI-QIF, described in this study protocol aims to facilitate the implementation of AI-based applications in health care based on the premise that implementation processes benefit from being well-prepared and structured. The framework will be coproduced to enhance its relevance, validity, usefulness, and potential value for application in practice. International Registered Report Identifier (IRRID): DERR1-10.2196/50216 %M 37938896 %R 10.2196/50216 %U https://www.researchprotocols.org/2023/1/e50216 %U https://doi.org/10.2196/50216 %U http://www.ncbi.nlm.nih.gov/pubmed/37938896 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49846 %T Developing a Theory of Change for a Digital Youth Mental Health Service (Moderated Online Social Therapy): Mixed Methods Knowledge Synthesis Study %A Cross,Shane %A Nicholas,Jennifer %A Mangelsdorf,Shaminka %A Valentine,Lee %A Baker,Simon %A McGorry,Patrick %A Gleeson,John %A Alvarez-Jimenez,Mario %+ Orygen, 35 Poplar Rd, Parkville, Melbourne, 3052, Australia, 61 3 9966 9383, shane.cross@orygen.org.au %K adolescence %K adolescent %K blended care %K blended %K co-design %K development %K digital health %K digital intervention %K digital mental health %K framework %K hybrid %K mental health %K model %K platform %K self-determination theory %K service %K services %K theory of change %K therapy %K youth mental health %K youth %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Common challenges in the youth mental health system include low access, poor uptake, poor adherence, and limited overall effectiveness. Digital technologies offer promise, yet challenges in real-world integration and uptake persist. Moderated Online Social Therapy (MOST) aims to overcome these problems by integrating a comprehensive digital platform into existing youth mental health services. Theory of change (ToC) frameworks can help articulate how and why complex interventions work and what conditions are required for success. Objective: The objective of this study is to create a ToC for MOST to explain how it works, why it works, who benefits and how, and what conditions are required for its success. Methods: We used a multimethod approach to construct a ToC for MOST. The synthesis aimed to assess the real-world impact of MOST, a digital platform designed to enhance face-to-face youth mental health services, and to guide its iterative refinement. Data were gathered from 2 completed and 4 ongoing randomized controlled trials, 11 pilot studies, and over 1000 co-design sessions using MOST. Additionally, published qualitative findings from diverse clinical contexts and a review of related digital mental health literature were included. The study culminated in an updated ToC framework informed by expert feedback. The final ToC was produced in both narrative and table form and captured components common in program logic and ToC frameworks. Results: The MOST ToC captured several assumptions about digital mental health adoption, including factors such as the readiness of young people and service providers to embrace digital platforms. External considerations included high service demand and a potential lack of infrastructure to support integration. Young people and service providers face several challenges and pain points MOST seeks to address, such as limited accessibility, high demand, poor engagement, and a lack of personalized support. Self-determination theory, transdiagnostic psychological treatment approaches, and evidence-based implementation theories and their associated mechanisms are drawn upon to frame the intervention components that make up the platform. Platform usage data are captured and linked to short-, medium-, and long-term intended outcomes, such as reductions in mental health symptoms, improvements in functioning and quality of life, reductions in hospital visits, and reduced overall mental health care costs. Conclusions: The MOST ToC serves as a strategic framework for refining MOST over time. The creation of the ToC helped guide the development of therapeutic content personalization, user engagement enhancement, and clinician adoption through specialized implementation frameworks. While powerful, the ToC approach has its limitations, such as a lack of standardized methodology and the amount of resourcing required for its development. Nonetheless, it provides an invaluable roadmap for iterative development, evaluation, and scaling of MOST and offers a replicable model for other digital health interventions aiming for targeted, evidence-based impact. %M 37921858 %R 10.2196/49846 %U https://formative.jmir.org/2023/1/e49846 %U https://doi.org/10.2196/49846 %U http://www.ncbi.nlm.nih.gov/pubmed/37921858 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50767 %T Conversational Agents in Health Care: Expert Interviews to Inform the Definition, Classification, and Conceptual Framework %A Martinengo,Laura %A Lin,Xiaowen %A Jabir,Ahmad Ishqi %A Kowatsch,Tobias %A Atun,Rifat %A Car,Josip %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Level 18, Singapore, 308232, Singapore, 65 69047155, lorainne.tudor.car@ntu.edu.sg %K conceptual framework %K conversational agent %K chatbot %K mobile health %K mHealth %K digital health %K expert interview %K mobile phone %D 2023 %7 1.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Conversational agents (CAs), or chatbots, are computer programs that simulate conversations with humans. The use of CAs in health care settings is recent and rapidly increasing, which often translates to poor reporting of the CA development and evaluation processes and unreliable research findings. We developed and published a conceptual framework, designing, developing, evaluating, and implementing a smartphone-delivered, rule-based conversational agent (DISCOVER), consisting of 3 iterative stages of CA design, development, and evaluation and implementation, complemented by 2 cross-cutting themes (user-centered design and data privacy and security). Objective: This study aims to perform in-depth, semistructured interviews with multidisciplinary experts in health care CAs to share their views on the definition and classification of health care CAs and evaluate and validate the DISCOVER conceptual framework. Methods: We conducted one-on-one semistructured interviews via Zoom (Zoom Video Communications) with 12 multidisciplinary CA experts using an interview guide based on our framework. The interviews were audio recorded, transcribed by the research team, and analyzed using thematic analysis. Results: Following participants’ input, we defined CAs as digital interfaces that use natural language to engage in a synchronous dialogue using ≥1 communication modality, such as text, voice, images, or video. CAs were classified by 13 categories: response generation method, input and output modalities, CA purpose, deployment platform, CA development modality, appearance, length of interaction, type of CA-user interaction, dialogue initiation, communication style, CA personality, human support, and type of health care intervention. Experts considered that the conceptual framework could be adapted for artificial intelligence–based CAs. However, despite recent advances in artificial intelligence, including large language models, the technology is not able to ensure safety and reliability in health care settings. Finally, aligned with participants’ feedback, we present an updated iteration of the conceptual framework for health care conversational agents (CHAT) with key considerations for CA design, development, and evaluation and implementation, complemented by 3 cross-cutting themes: ethics, user involvement, and data privacy and security. Conclusions: We present an expanded, validated CHAT and aim at guiding researchers from a variety of backgrounds and with different levels of expertise in the design, development, and evaluation and implementation of rule-based CAs in health care settings. %M 37910153 %R 10.2196/50767 %U https://www.jmir.org/2023/1/e50767 %U https://doi.org/10.2196/50767 %U http://www.ncbi.nlm.nih.gov/pubmed/37910153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46639 %T Scenario-Based e-Simulation Design for Global Health Education: Theoretical Foundation and Practical Recommendations %A Bahattab,Awsan %A Caviglia,Marta %A Martini,Daniela %A Hubloue,Ives %A Della Corte,Francesco %A Ragazzoni,Luca %+ Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health (CRIMEDIM), Università del Piemonte Orientale, Via Lanino, 1, Novara, 28100, Italy, 39 333 9252944, awsan.bahattab@uniupo.it %K global health %K education %K medical %K computer simulation %K scenario-based learning %K scenario-based e-simulation %K simulation %K design %K education %K training %K development %K medical educator %D 2023 %7 30.10.2023 %9 Viewpoint %J J Med Internet Res %G English %X Electronic simulation (e-simulation)—particularly scenario-based e-simulation (SBES)—is an increasingly used, promising educational strategy for global health education that can address gaps in training access, effectiveness, and cost. However, there is little guidance for educators on how to develop an SBES, and guidance is lacking outside the clinical context. Moreover, literature on medical education rarely uses the theoretical basis for e-simulation design and development, including for SBES. Hence, we aim to differentiate and describe the concept, design elements, and theoretical basis of SBES with examples from different topics in global health. In addition to enhancing the understanding of the potential of SBES for global health education, this manuscript also provides practical recommendations for global health educators in designing and developing SBESs based on the existing literature and authors’ experiences. Overall, this manuscript will be useful for global health educators as well as other medical educators seeking to develop an SBES for similar skill sets. %M 37902810 %R 10.2196/46639 %U https://www.jmir.org/2023/1/e46639 %U https://doi.org/10.2196/46639 %U http://www.ncbi.nlm.nih.gov/pubmed/37902810 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46547 %T Architectural Design of a Blockchain-Enabled, Federated Learning Platform for Algorithmic Fairness in Predictive Health Care: Design Science Study %A Liang,Xueping %A Zhao,Juan %A Chen,Yan %A Bandara,Eranga %A Shetty,Sachin %+ Department of Information Systems and Business Analytics, Florida International University, 11200 SW 8th St, Miami, FL, 33199, United States, 1 305 348 2830, xuliang@fiu.edu %K fairness %K federated learning %K bias %K health care %K blockchain %K software %K proof of concept %K implementation %K privacy %D 2023 %7 30.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Developing effective and generalizable predictive models is critical for disease prediction and clinical decision-making, often requiring diverse samples to mitigate population bias and address algorithmic fairness. However, a major challenge is to retrieve learning models across multiple institutions without bringing in local biases and inequity, while preserving individual patients’ privacy at each site. Objective: This study aims to understand the issues of bias and fairness in the machine learning process used in the predictive health care domain. We proposed a software architecture that integrates federated learning and blockchain to improve fairness, while maintaining acceptable prediction accuracy and minimizing overhead costs. Methods: We improved existing federated learning platforms by integrating blockchain through an iterative design approach. We used the design science research method, which involves 2 design cycles (federated learning for bias mitigation and decentralized architecture). The design involves a bias-mitigation process within the blockchain-empowered federated learning framework based on a novel architecture. Under this architecture, multiple medical institutions can jointly train predictive models using their privacy-protected data effectively and efficiently and ultimately achieve fairness in decision-making in the health care domain. Results: We designed and implemented our solution using the Aplos smart contract, microservices, Rahasak blockchain, and Apache Cassandra–based distributed storage. By conducting 20,000 local model training iterations and 1000 federated model training iterations across 5 simulated medical centers as peers in the Rahasak blockchain network, we demonstrated how our solution with an improved fairness mechanism can enhance the accuracy of predictive diagnosis. Conclusions: Our study identified the technical challenges of prediction biases faced by existing predictive models in the health care domain. To overcome these challenges, we presented an innovative design solution using federated learning and blockchain, along with the adoption of a unique distributed architecture for a fairness-aware system. We have illustrated how this design can address privacy, security, prediction accuracy, and scalability challenges, ultimately improving fairness and equity in the predictive health care domain. %M 37902833 %R 10.2196/46547 %U https://www.jmir.org/2023/1/e46547 %U https://doi.org/10.2196/46547 %U http://www.ncbi.nlm.nih.gov/pubmed/37902833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45163 %T Using Theories, Models, and Frameworks to Inform Implementation Cycles of Computerized Clinical Decision Support Systems in Tertiary Health Care Settings: Scoping Review %A Fernando,Manasha %A Abell,Bridget %A Tyack,Zephanie %A Donovan,Thomasina %A McPhail,Steven M %A Naicker,Sundresan %+ Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Q Block, 60 Musk Avenue, Kelvin Grove QLD, Brisbane, 4059, Australia, 61 3138 6454, sundresan.naicker@qut.edu.au %K computerized clinical decision support systems %K CDSS %K implementation science %K hospital %K theories %K models %K frameworks %K mobile phone %D 2023 %7 18.10.2023 %9 Review %J J Med Internet Res %G English %X Background: Computerized clinical decision support systems (CDSSs) are essential components of modern health system service delivery, particularly within acute care settings such as hospitals. Theories, models, and frameworks may assist in facilitating the implementation processes associated with CDSS innovation and its use within these care settings. These processes include context assessments to identify key determinants, implementation plans for adoption, promoting ongoing uptake, adherence, and long-term evaluation. However, there has been no prior review synthesizing the literature regarding the theories, models, and frameworks that have informed the implementation and adoption of CDSSs within hospitals. Objective: This scoping review aims to identify the theory, model, and framework approaches that have been used to facilitate the implementation and adoption of CDSSs in tertiary health care settings, including hospitals. The rationales reported for selecting these approaches, including the limitations and strengths, are described. Methods: A total of 5 electronic databases were searched (CINAHL via EBSCOhost, PubMed, Scopus, PsycINFO, and Embase) to identify studies that implemented or adopted a CDSS in a tertiary health care setting using an implementation theory, model, or framework. No date or language limits were applied. A narrative synthesis was conducted using full-text publications and abstracts. Implementation phases were classified according to the “Active Implementation Framework stages”: exploration (feasibility and organizational readiness), installation (organizational preparation), initial implementation (initiating implementation, ie, training), full implementation (sustainment), and nontranslational effectiveness studies. Results: A total of 81 records (42 full text and 39 abstracts) were included. Full-text studies and abstracts are reported separately. For full-text studies, models (18/42, 43%), followed by determinants frameworks (14/42,33%), were most frequently used to guide adoption and evaluation strategies. Most studies (36/42, 86%) did not list the limitations associated with applying a specific theory, model, or framework. Conclusions: Models and related quality improvement methods were most frequently used to inform CDSS adoption. Models were not typically combined with each other or with theory to inform full-cycle implementation strategies. The findings highlight a gap in the application of implementation methods including theories, models, and frameworks to facilitate full-cycle implementation strategies for hospital CDSSs. %M 37851492 %R 10.2196/45163 %U https://www.jmir.org/2023/1/e45163 %U https://doi.org/10.2196/45163 %U http://www.ncbi.nlm.nih.gov/pubmed/37851492 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47903 %T Enhancing Mental Health and Medication Adherence Among Men Who Have Sex With Men Recently Diagnosed With HIV With a Dialectical Behavior Therapy–Informed Intervention Incorporating mHealth, Online Skills Training, and Phone Coaching: Development Study Using Human-Centered Design Approach %A Wang,Liying %A Yuwen,Weichao %A Hua,Wenzhe %A Chen,Lingxiao %A Forsythe Cox,Vibh %A Zheng,Huang %A Ning,Zhen %A Zhao,Zhuojun %A Liu,Zhaoyu %A Jiang,Yunzhang %A Li,Xinran %A Guo,Yawen %A Simoni,Jane M %+ Department of Psychology, University of Washington, 3921 W Stevens Way NE, Seattle, WA, 98195, United States, 1 (206) 543 2640, liyingw@uw.edu %K intervention mapping %K participatory approach %K cultural adaptation %K dialectical behavior therapy %K DBT %K men who have sex with men %K MSM %K coping skill training %D 2023 %7 13.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health problems are common among men who have sex with men (MSM) living with HIV and may negatively affect medication adherence. Psychosocial interventions designed to address these urgent needs are scarce in China. Incorporating behavioral health theories into intervention development strengthens the effectiveness of these interventions. The absence of a robust theoretical basis for interventions may also present challenges to identify active intervention ingredients. Objective: This study aims to systematically describe the development of a mobile health–based intervention for MSM recently diagnosed with HIV in China, including the theoretical basis for the content and the considerations for its technological delivery. Methods: We used intervention mapping (IM) to guide overall intervention development, a behavioral intervention technology model for technological delivery design, and a human-centered design and cultural adaptation model for intervention tailoring throughout all steps of IM. Results: The dialectical behavior therapy (DBT)–informed intervention, Turning to Sunshine, comprised 3 components: app-based individual skills learning, group-based skills training, and on-demand phone coaching. The theoretical basis for the intervention content is based on the DBT model of emotions, which fits our conceptualization of the intervention user’s mental health needs. The intervention aims to help MSM recently diagnosed with HIV (1) survive moments of high emotional intensity and strong action urges, (2) change emotional expression to regulate emotions, and (3) reduce emotional vulnerability, as well as (4) augment community resources for mental health services. Technological delivery considerations included rationale of the medium, complexity, and esthetics of information delivery; data logs; data visualization; notifications; and passive data collection. Conclusions: This study laid out the steps for the development of a DBT-informed mobile health intervention that integrated app-based individual learning, group-based skills training, and phone coaching. This intervention, Turning to Sunshine, aims to improve mental health outcomes for MSM newly diagnosed with HIV in China. The IM framework informed by human-centered design principles and cultural adaptation considerations offered a systematic approach to develop the current intervention and tailor it to the target intervention users. The behavioral intervention technology model facilitated the translation of behavioral intervention strategies into technological delivery components. The systematic development and reporting of the current intervention can serve as a guide for similar intervention studies. The content of the current intervention could be adapted for a broader population with similar emotional struggles to improve their mental health outcomes. %M 37831497 %R 10.2196/47903 %U https://formative.jmir.org/2023/1/e47903 %U https://doi.org/10.2196/47903 %U http://www.ncbi.nlm.nih.gov/pubmed/37831497 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45409 %T Cultural Responsivity in Technology-Enabled Services: Integrating Culture Into Technology and Service Components %A Eustis,Elizabeth H %A LoPresti,Jessica %A Aguilera,Adrian %A Schueller,Stephen M %+ Center for Anxiety and Related Disorders, Boston University, 900 Commonwealth Ave 2nd Floor, Boston, MA, 02215, United States, 1 617 353 9610, liz.eustis@gmail.com %K technology %K mobile health %K mHealth %K mental health %K cultural responsivity %K human support %K mobile phone %D 2023 %7 3.10.2023 %9 Viewpoint %J J Med Internet Res %G English %X Technology-enabled services (TESs) are clinical interventions that combine technological and human components to provide health services. TESs for mental health are efficacious in the treatment of anxiety and depression and are currently being offered as frontline treatments around the world. It is hoped that these interventions will be able to reach diverse populations across a range of identities and ultimately decrease disparities in mental health treatment. However, this hope is largely unrealized. TESs include both technology and human service components, and we argue that cultural responsivity must be considered in each of these components to help address existing treatment disparities. To date, there is limited guidance on how to consider cultural responsivity within these interventions, including specific targets for the development, tailoring, or design of the technologies and services within TESs. In response, we propose a framework that provides specific recommendations for targets based on existing models, both at the technological component level (informed by the Behavioral Intervention Technology Model) and the human support level (informed by the Efficiency Model of Support). We hope that integrating culturally responsive considerations into these existing models will facilitate increased attention to cultural responsivity within TESs to ensure they are ethical and responsive for everyone. %M 37788050 %R 10.2196/45409 %U https://www.jmir.org/2023/1/e45409 %U https://doi.org/10.2196/45409 %U http://www.ncbi.nlm.nih.gov/pubmed/37788050 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41715 %T A Narrow Definition of Clinical Robustness %A Marshall,Jaclyn %A Yurkovic,Alexandra %A Thames,Todd %A Parekh,Ami %+ Included Health, 1 California Street, Ste 2300, San Francisco, CA, 94111, United States, 1 855 431 5533, jaclyn.marshall@includedhealth.com %K digital health %K research %K virtual care %D 2023 %7 21.9.2023 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 37733417 %R 10.2196/41715 %U https://www.jmir.org/2023/1/e41715 %U https://doi.org/10.2196/41715 %U http://www.ncbi.nlm.nih.gov/pubmed/37733417 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48496 %T A Comprehensive, Valid, and Reliable Tool to Assess the Degree of Responsibility of Digital Health Solutions That Operate With or Without Artificial Intelligence: 3-Phase Mixed Methods Study %A Lehoux,Pascale %A Rocha de Oliveira,Robson %A Rivard,Lysanne %A Silva,Hudson Pacifico %A Alami,Hassane %A Mörch,Carl Maria %A Malas,Kathy %+ Department of Health Management, Evaluation and Policy, Université de Montréal; Center for Public Health Research, 7101, Avenue du Parc, Montréal, QC, H3N 1X9, Canada, 1 5143437978, pascale.lehoux@umontreal.ca %K Responsible Innovation in Health %K digital health policy %K artificial intelligence ethics %K responsible research and innovation %K mixed methods %K e-Delphi %K interrater agreement %K mobile phone %D 2023 %7 28.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinicians’ scope of responsibilities is being steadily transformed by digital health solutions that operate with or without artificial intelligence (DAI solutions). Most tools developed to foster ethical practices lack rigor and do not concurrently capture the health, social, economic, and environmental issues that such solutions raise. Objective: To support clinical leadership in this field, we aimed to develop a comprehensive, valid, and reliable tool that measures the responsibility of DAI solutions by adapting the multidimensional and already validated Responsible Innovation in Health Tool. Methods: We conducted a 3-phase mixed methods study. Relying on a scoping review of available tools, phase 1 (concept mapping) led to a preliminary version of the Responsible DAI solutions Assessment Tool. In phase 2, an international 2-round e-Delphi expert panel rated on a 5-level scale the importance, clarity, and appropriateness of the tool’s components. In phase 3, a total of 2 raters independently applied the revised tool to a sample of DAI solutions (n=25), interrater reliability was measured, and final minor changes were made to the tool. Results: The mapping process identified a comprehensive set of responsibility premises, screening criteria, and assessment attributes specific to DAI solutions. e-Delphi experts critically assessed these new components and provided comments to increase content validity (n=293), and after round 2, consensus was reached on 85% (22/26) of the items surveyed. Interrater agreement was substantial for a subcriterion and almost perfect for all other criteria and assessment attributes. Conclusions: The Responsible DAI solutions Assessment Tool offers a comprehensive, valid, and reliable means of assessing the degree of responsibility of DAI solutions in health. As regulation remains limited, this forward-looking tool has the potential to change practice toward more equitable as well as economically and environmentally sustainable digital health care. %M 37639297 %R 10.2196/48496 %U https://www.jmir.org/2023/1/e48496 %U https://doi.org/10.2196/48496 %U http://www.ncbi.nlm.nih.gov/pubmed/37639297 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e44842 %T Designing Interoperable Health Care Services Based on Fast Healthcare Interoperability Resources: Literature Review %A Nan,Jingwen %A Xu,Li-Qun %+ Health IT Research, China Mobile (Chengdu) Industrial Research Institute, Unit 2, Block C1, AI Innovation Center, Hele Second Street, Gaoxin District, Chengdu, 610213, China, 86 (28) 60103585, xuliqun@chinamobile.com %K Health level 7 Fast Healthcare Interoperability Resources %K HL7 FHIR %K interoperability %K literature review %K practice guideline %K mobile phone %D 2023 %7 21.8.2023 %9 Review %J JMIR Med Inform %G English %X Background: With the advent of the digital economy and the aging population, the demand for diversified health care services and innovative care delivery models has been overwhelming. This trend has accelerated the urgency to implement effective and efficient data exchange and service interoperability, which underpins coordinated care services among tiered health care institutions, improves the quality of oversight of regulators, and provides vast and comprehensive data collection to support clinical medicine and health economics research, thus improving the overall service quality and patient satisfaction. To meet this demand and facilitate the interoperability of IT systems of stakeholders, after years of preparation, Health Level 7 formally introduced, in 2014, the Fast Healthcare Interoperability Resources (FHIR) standard. It has since continued to evolve. FHIR depends on the Implementation Guide (IG) to ensure feasibility and consistency while developing an interoperable health care service. The IG defines rules with associated documentation on how FHIR resources are used to tackle a particular problem. However, a gap remains between IGs and the process of building actual services because IGs are rules without specifying concrete methods, procedures, or tools. Thus, stakeholders may feel it nontrivial to participate in the ecosystem, giving rise to the need for a more actionable practice guideline (PG) for promoting FHIR’s fast adoption. Objective: This study aimed to propose a general FHIR PG to facilitate stakeholders in the health care ecosystem to understand FHIR and quickly develop interoperable health care services. Methods: We selected a collection of FHIR-related papers about the latest studies or use cases on designing and building FHIR-based interoperable health care services and tagged each use case as belonging to 1 of the 3 dominant innovation feature groups that are also associated with practice stages, that is, data standardization, data management, and data integration. Next, we reviewed each group’s detailed process and key techniques to build respective care services and collate a complete FHIR PG. Finally, as an example, we arbitrarily selected a use case outside the scope of the reviewed papers and mapped it back to the FHIR PG to demonstrate the effectiveness and generalizability of the PG. Results: The FHIR PG includes 2 core elements: one is a practice design that defines the responsibilities of stakeholders and outlines the complete procedure from data to services, and the other is a development architecture for practice design, which lists the available tools for each practice step and provides direct and actionable recommendations. Conclusions: The FHIR PG can bridge the gap between IGs and the process of building actual services by proposing actionable methods, procedures, and tools. It assists stakeholders in identifying participants’ roles, managing the scope of responsibilities, and developing relevant modules, thus helping promote FHIR-based interoperable health care services. %M 37603388 %R 10.2196/44842 %U https://medinform.jmir.org/2023/1/e44842 %U https://doi.org/10.2196/44842 %U http://www.ncbi.nlm.nih.gov/pubmed/37603388 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44578 %T Fortifying Health Care Intellectual Property Transactions With Blockchain %A Liang,Huan-Wei %A Chu,Yuan-Chia %A Han,Tsung-Hsien %+ Technology Transfer Office, Department of Medical Research, Taipei Veterans General Hospital, Technology Transfer Office, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan, 886 2 2871 2121 ext 1265, hrcreator@gmail.com %K intellectual property %K open innovation %K blockchain %K appropriability regime %K health care %K mobile phone %D 2023 %7 18.8.2023 %9 Viewpoint %J J Med Internet Res %G English %X Background: Intellectual property (IP) is a substantial competitive advantage in the health care industry. However, the COVID-19 pandemic highlighted the need for open innovation and collaboration for the greater good. Despite this, the industry faces challenges with innovation owing to organizational and departmental barriers. A secure platform is necessary to facilitate IP sharing without compromising the rights of IP owners. Objective: This study proposes a blockchain-based framework to secure IP transactions in health care and bring social impact. Methods: This study reviews existing researches, publications, practical cases, firm and organization websites, and conferences related to blockchain technology, blockchain in health care, blockchain in IP management, IP pledge research, and practice of IP management blockchain. The platform architecture has 7 components: pledgers, advanced research technology (ART), IP pledge platforms, IP databases, health care research, seeking ART, and transaction condition setting. These components work together seamlessly to support the sharing and pledging of ART and knowledge, while ensuring the platform’s transparency, security, and trust. Results: The open IP pledge framework can promote technology dissemination and use, reduce research and development costs, foster collaboration, and serve the public interest. Medical organizations’ leadership and support and active participation from stakeholders are necessary for success. By leveraging blockchain technology, the platform ensures tamper-proof and transparent transactions and protects the rights of IP owners. In addition, the platform offers incentive mechanisms through pledge tokens that encourage stakeholders to share their ART and contribute to the platform. Conclusions: Overall, the proposed framework can facilitate technological innovation, tackle various challenges, and secure IP transactions. It provides a secure platform for stakeholders to share their IP without compromising their rights, promoting collaboration and progress in the health care industry. The implementation of the framework has the potential to revolutionize the industry’s approach to innovation, allowing a more open and collaborative environment driven by the greater good. %M 37594787 %R 10.2196/44578 %U https://www.jmir.org/2023/1/e44578 %U https://doi.org/10.2196/44578 %U http://www.ncbi.nlm.nih.gov/pubmed/37594787 %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 %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48000 %T Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review %A van Kessel,Robin %A Roman-Urrestarazu,Andres %A Anderson,Michael %A Kyriopoulos,Ilias %A Field,Samantha %A Monti,Giovanni %A Reed,Shelby D %A Pavlova,Milena %A Wharton,George %A Mossialos,Elias %+ LSE Health, Department of Health Policy, London School of Economics and Political Science, London, WC2A 2AE, United Kingdom, 44 7772 707841, e.a.mossialos@lse.ac.uk %K digital health %K uptake %K implementation %K adoption %K framework %K digital therapeutics %K scoping review %K thematic analysis %K digital medicine %K policy %D 2023 %7 25.7.2023 %9 Review %J J Med Internet Res %G English %X Background: Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products. Objective: In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals. Methods: A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis. Results: We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure. Conclusions: The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system’s readiness for digital therapeutics. %M 37490322 %R 10.2196/48000 %U https://www.jmir.org/2023/1/e48000 %U https://doi.org/10.2196/48000 %U http://www.ncbi.nlm.nih.gov/pubmed/37490322 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44900 %T Factors Influencing Clinicians’ Use of Hospital Information Systems for Infection Prevention and Control: Cross-Sectional Study Based on the Extended DeLone and McLean Model %A Zheng,Feiyang %A Wang,Kang %A Wang,Qianning %A Yu,Tiantian %A Wang,Lu %A Zhang,Xinping %A Wu,Xiang %A Zhou,Qian %A Tan,Li %+ School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China, 86 15927562116, xpzhang602@hust.edu.cn %K hospital infection prevention and control %K information system %K information systems success model %D 2023 %7 22.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Healthcare-associated infections have become a serious public health problem. Various types of information systems have begun to be applied in hospital infection prevention and control (IPC) practice. Clinicians are the key users of these systems, but few studies have assessed the use of infection prevention and control information systems (IPCISs) from their perspective. Objective: This study aimed to (1) apply the extended DeLone and McLean Information Systems Success model (D&M model) that incorporates IPC culture to examine how technical factors like information quality, system quality, and service quality, as well as organizational culture factors affect clinicians’ use intention, satisfaction, and perceived net benefits, and (2) identify which factors are the most important for clinicians’ use intention. Methods: A total of 12,317 clinicians from secondary and tertiary hospitals were surveyed online. Data were analyzed using partial least squares-structural equation modeling and the importance-performance matrix analysis. Results: Among the technical factors, system quality (β=.089-.252; P<.001), information quality (β=.294-.102; P<.001), and service quality (β=.126-.411; P<.001) were significantly related to user satisfaction (R2=0.833), use intention (R2=0.821), and perceived net benefits (communication benefits [R2=0.676], decision-making benefits [R2=0.624], and organizational benefits [R2=0.656]). IPC culture had an effect on use intention (β=.059; P<.001), and it also indirectly affected perceived net benefits (β=.461-.474; P<.001). In the importance-performance matrix analysis, the attributes of service quality (providing user training) and information quality (readability) were present in the fourth quadrant, indicating their high importance and low performance. Conclusions: This study provides valuable insights into IPCIS usage among clinicians from the perspectives of technology and organization culture factors. It found that technical factors (system quality, information quality, and service quality) and hospital IPC culture have an impact on the successful use of IPCISs after evaluating the application of IPCISs based on the extended D&M model. Furthermore, service quality and information quality showed higher importance and lower performance for use intention. These findings provide empirical evidence and specific practical directions for further improving the construction of IPCISs. %M 37347523 %R 10.2196/44900 %U https://www.jmir.org/2023/1/e44900 %U https://doi.org/10.2196/44900 %U http://www.ncbi.nlm.nih.gov/pubmed/37347523 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43303 %T Therapeutic Relational Connection in Telehealth: Concept Analysis %A Duffy,Lisa V %A Evans,Rebecka %A Bennett,Veronica %A Hady,Joan Marie %A Palaniappan,Priya %+ School of Nursing, Bouvé College of Health Sciences, Northeastern University, Robinson Hall 106H, 336 Huntington Ave, Boston, MA, 02115, United States, 1 617 373 5448, l.duffy@northeastern.edu %K therapeutic relational connection %K telehealth %K telemedicine %K eHealth %K telemedicine %K concept analysis %K provider-patient relationship %K therapeutic relationship %K relationship %K connection %K patient-provider %K patient-physician %D 2023 %7 22.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background:  Therapeutic relational connection (TRC) in telehealth is a new concept that refers to the intentional use of relationship connection between health care providers and their patients as both parties work toward a therapeutic aim. It has been demonstrated that TRC positively affects patient-centered outcomes including adherence, self-management, and satisfaction with care. What is not known are best practices for establishing TRC during telehealth visits. The rapid emergence of telehealth during the COVID-19 pandemic has identified a number of challenges. These challenges include lack of human contact, distance creating mistrust, the inability to rely on nonverbal communication, and a sense of depersonalization. Training for health care providers in these interpersonal communication skills needed to establish TRC during telehealth visits is needed. Objective:  This paper aims to explore the evolutionary concept of TRC in telehealth. The purpose of this paper is to provide a concept analysis of TRC during telehealth interactions between providers and patients through a comprehensive review of the existing published literature. Methods:  Rodgers’ evolutionary concept analysis method was used to guide this study. PubMed, Embase, PsycINFO, and CINAHL were used to search for relevant publications. An integrative review strategy aided by Rayyan software was used to identify a final sample of 13 papers for analysis. Results:  The proposed definition of TRC in telehealth is the experience of a mutually responsive patient-provider relationship that is built on mutual respect and understanding and informed by cultural humility, presence, empathy, and the ability to effectively evaluate patient concerns to work toward a therapeutic aim. The key attributes of TRC in telehealth are the provider’s ability to evaluate patient concerns, interpersonal communication, cultural humility, mutual trust and respect, presence, empathy, and building relationships. Clinical presence, proper environment, knowledge about the use of technology (both patient and provider), use of verbal and nonverbal communication, and knowledge about community and culture are important antecedents of TRC. Consequences of TRC include improved communication resulting in mutual respect and caring, adherence to follow-up recommendations, increased coping, collaborative decision-making, and satisfaction with care. Conclusions:  Telehealth visits necessitate alternative approaches to establishing TRC as compared to in-person clinic visits. With the rapid expansion of telehealth platforms and a heightened acceptance of the technology, there is a need to integrate knowledge and provide a clear conceptualization of TRC in telehealth as TRC has been demonstrated to result in positive patient-centered outcomes. Identifying the attributes and antecedents of TRC in telehealth allows us the opportunity to develop guidelines and educational interventions aimed at training health care providers in the skills needed to establish TRC during telehealth visits. %M 37347526 %R 10.2196/43303 %U https://www.jmir.org/2023/1/e43303 %U https://doi.org/10.2196/43303 %U http://www.ncbi.nlm.nih.gov/pubmed/37347526 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41512 %T Development of an Evidence-Based Conceptual Model of the Health Care Sector Under Digital Transformation: Integrative Review %A Konopik,Jens %A Blunck,Dominik %+ Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Lange Gasse 20, Nuremberg, 90403, Germany, 49 911 5302 95 383, jens.konopik@fau.de %K digital transformation %K health care %K Healthcare 4.0 %K digital health %K eHealth %K conceptual model %K literature review %K grounded theory %K integrative review %D 2023 %7 8.6.2023 %9 Review %J J Med Internet Res %G English %X Background: Digital transformation is currently one of the most influential developments. It is fundamentally changing consumers’ expectations and behaviors, challenging traditional firms, and disrupting numerous markets. Recent discussions in the health care sector tend to assess the influence of technological implications but neglect other factors needed for a holistic view on the digital transformation. This calls for a reevaluation of the current state of digital transformation in health care. Consequently, there is a need for a holistic view on the complex interdependencies of digital transformation in the health care sector. Objective: This study aimed to examine the effects of digital transformation on the health care sector. This is accomplished by providing a conceptual model of the health care sector under digital transformation. Methods: First, the most essential stakeholders in the health care sector were identified by a scoping review and grounded theory approach. Second, the effects on these stakeholders were assessed. PubMed, Web of Science, and Dimensions were searched for relevant studies. On the basis of an integrative review and grounded theory methodology, the relevant academic literature was systematized and quantitatively and qualitatively analyzed to evaluate the impact on the value creation of, and the relationships among, the stakeholders. Third, the findings were synthesized into a conceptual model of the health care sector under digital transformation. Results: A total of 2505 records were identified from the database search; of these, 140 (5.59%) were included and analyzed. The results revealed that providers of medical treatments, patients, governing institutions, and payers are the most essential stakeholders in the health care sector. As for the individual stakeholders, patients are experiencing a technology-enabled growth of influence in the sector. Providers are becoming increasingly dependent on intermediaries for essential parts of the value creation and patient interaction. Payers are expected to try to increase their influence on intermediaries to exploit the enormous amounts of data while seeing their business models be challenged by emerging technologies. Governing institutions regulating the health care sector are increasingly facing challenges from new entrants in the sector. Intermediaries increasingly interconnect all these stakeholders, which in turn drives new ways of value creation. These collaborative efforts have led to the establishment of a virtually integrated health care ecosystem. Conclusions: The conceptual model provides a novel and evidence-based perspective on the interrelations among actors in the health care sector, indicating that individual stakeholders need to recognize their role in the system. The model can be the basis of further evaluations of strategic actions of actors and their effects on other actors or the health care ecosystem itself. %M 37289482 %R 10.2196/41512 %U https://www.jmir.org/2023/1/e41512 %U https://doi.org/10.2196/41512 %U http://www.ncbi.nlm.nih.gov/pubmed/37289482 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46694 %T iCHECK-DH: Guidelines and Checklist for the Reporting on Digital Health Implementations %A Perrin Franck,Caroline %A Babington-Ashaye,Awa %A Dietrich,Damien %A Bediang,Georges %A Veltsos,Philippe %A Gupta,Pramendra Prasad %A Juech,Claudia %A Kadam,Rigveda %A Collin,Maxime %A Setian,Lucy %A Serrano Pons,Jordi %A Kwankam,S Yunkap %A Garrette,Béatrice %A Barbe,Solenne %A Bagayoko,Cheick Oumar %A Mehl,Garrett %A Lovis,Christian %A Geissbuhler,Antoine %+ Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Chemin des Mines 9, Geneva, CH-1202, Switzerland, 41 0787997725, caroline.perrin@gmx.de %K implementation science %K knowledge management %K reporting standards %K publishing standards %K guideline %K Digital Health Hub %K reporting guideline %K digital health implementation %K health outcome %D 2023 %7 10.5.2023 %9 Implementation Report %J J Med Internet Res %G English %X Background: Implementation of digital health technologies has grown rapidly, but many remain limited to pilot studies due to challenges, such as a lack of evidence or barriers to implementation. Overcoming these challenges requires learning from previous implementations and systematically documenting implementation processes to better understand the real-world impact of a technology and identify effective strategies for future implementation. Objective: A group of global experts, facilitated by the Geneva Digital Health Hub, developed the Guidelines and Checklist for the Reporting on Digital Health Implementations (iCHECK-DH, pronounced “I checked”) to improve the completeness of reporting on digital health implementations. Methods: A guideline development group was convened to define key considerations and criteria for reporting on digital health implementations. To ensure the practicality and effectiveness of the checklist, it was pilot-tested by applying it to several real-world digital health implementations, and adjustments were made based on the feedback received. The guiding principle for the development of iCHECK-DH was to identify the minimum set of information needed to comprehensively define a digital health implementation, to support the identification of key factors for success and failure, and to enable others to replicate it in different settings. Results: The result was a 20-item checklist with detailed explanations and examples in this paper. The authors anticipate that widespread adoption will standardize the quality of reporting and, indirectly, improve implementation standards and best practices. Conclusions: Guidelines for reporting on digital health implementations are important to ensure the accuracy, completeness, and consistency of reported information. This allows for meaningful comparison and evaluation of results, transparency, and accountability and informs stakeholder decision-making. i-CHECK-DH facilitates standardization of the way information is collected and reported, improving systematic documentation and knowledge transfer that can lead to the development of more effective digital health interventions and better health outcomes. %M 37163336 %R 10.2196/46694 %U https://www.jmir.org/2023/1/e46694 %U https://doi.org/10.2196/46694 %U http://www.ncbi.nlm.nih.gov/pubmed/37163336 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43085 %T A Design-Led Theory of Change for a Mobile Game App (Go Nisha Go) for Adolescent Girls in India: Multimix Methodology Study %A Shankar,Lalita %A Dixit,Anvita %A Howard,Susan %+ Howard Delafield International LLP, 1101 30th St NW, Suite 500, Washington, DC, 20007, United States, 1 202 625 4364, lalita@howard-delafield.com %K Theory of Change %K social behavior change %K mobile game app %K digital innovation %K adolescent girls %K sexual and reproductive health %K India %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: India has one of the largest adolescent populations in the world. Yet adolescents, particularly adolescent girls, have limited access to correct sexual and reproductive health information and services. The context in which adolescent girls live is one of gender inequity where they contend with early marriage and early pregnancy and have few opportunities for quality education and labor force participation. The digital revolution has expanded the penetration of mobile phones across India, increasingly being used by adolescent girls. Health interventions are also moving onto digital platforms. Evidence has shown that applications of game elements and game-based learning can be powerful tools in behavior change and health interventions. This provides a unique opportunity, particularly for the private sector, to reach and empower adolescent girls directly with information, products, and services in a private and fun manner. Objective: The objective of this paper is to describe how a design-led Theory of Change (ToC) was formulated for a mobile game app that is not only underpinned by theories of various behavior change models but also identifies variables and triggers for in-game behavioral intentions that can be tracked and measured within the game and validated through a rigorous post-gameplay outcome evaluation. Methods: We describe the use of a multimix methodology to formulate a ToC informing behavioral frameworks and co-design approaches in our proof-of-concept product development journey. This process created a statement of hypothesis and “pathways to impact” with a continuous, cumulative, and iterative design process that included key stakeholders in the production of a smartphone app. With theoretical underpinnings of social behavior and modeling frameworks, systematic research, and other creative methods, we developed a design-led ToC pathway that can delineate complex and multidisciplinary outputs for measuring impact. Results: The statement of hypothesis that emerged posits that “If girls virtually experience the outcomes of choices that they make for their avatar in the mobile game, then they can make informed decisions that direct the course of their own life.” Four learning pathways (DISCOVER, PLAY, DECIDE, and ACT) are scaffolded on 3 pillars of evidence, engagement, and evaluation to support the ToC-led framework. It informs decision-making and life outcomes through game-based objectives and in-game triggers that offer direct access to information, products, and services. Conclusions: This approach of using a multimix methodology for identifying varied and multidisciplinary pathways to change is of particular interest to measuring the impact of innovations, especially digital products, that do not necessarily conform with traditional behavioral change models or standard co-design approaches. We also explain the benefits of using iterative and cumulative inputs to integrate ongoing user feedback, while identifying pathways to various impacts, and not limiting it to only the design and development phase. %M 37071463 %R 10.2196/43085 %U https://formative.jmir.org/2023/1/e43085 %U https://doi.org/10.2196/43085 %U http://www.ncbi.nlm.nih.gov/pubmed/37071463 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43682 %T Learning From Experience and Finding the Right Balance in the Governance of Artificial Intelligence and Digital Health Technologies %A Gilbert,Stephen %A Anderson,Stuart %A Daumer,Martin %A Li,Phoebe %A Melvin,Tom %A Williams,Robin %+ Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden, 74 Fetscherstraße, Dresden, 01307, Germany, 49 35145819630, stephen.gilbert@tu-dresden.de %K artificial intelligence %K machine learning %K regulation %K algorithm change protocol %K health care %K regulatory framework %K medical tool %K tool %K patient %K intervention %K safety %K performance %K technology %K implementation %D 2023 %7 14.4.2023 %9 Viewpoint %J J Med Internet Res %G English %X Artificial intelligence (AI) and machine learning medical tools have the potential to be transformative in care delivery; however, this change will only be realized if accompanied by effective governance that ensures patient safety and public trust. Recent digital health initiatives have called for tighter governance of digital health. A correct balance must be found between ensuring product safety and performance while also enabling the innovation needed to deliver better approaches for patients and affordable efficient health care for society. This requires innovative, fit-for-purpose approaches to regulation. Digital health technologies, particularly AI-based tools, pose specific challenges to the development and implementation of functional regulation. The approaches of regulatory science and “better regulation” have a critical role in developing and evaluating solutions to these problems and ensuring effective implementation. We describe the divergent approaches of the European Union and the United States in the implementation of new regulatory approaches in digital health, and we consider the United Kingdom as a third example, which is in a unique position of developing a new post-Brexit regulatory framework. %M 37058329 %R 10.2196/43682 %U https://www.jmir.org/2023/1/e43682 %U https://doi.org/10.2196/43682 %U http://www.ncbi.nlm.nih.gov/pubmed/37058329 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43009 %T Digital Health at Enterprise Scale: Evaluation Framework for Selecting Patient-Facing Software in a Digital-First Health System %A Shapiro,Martin %A Renly,Sondra %A Maiorano,Ali %A Young,Jerry %A Medina,Eli %A Neinstein,Aaron %A Odisho,Anobel Y %+ Center for Digital Health Innovation, University of California, San Francisco, 550 16th Street Box 1695, San Francisco, CA, 94143, United States, 1 4155022018, anobel.odisho@ucsf.edu %K artificial intelligence %K digital health pathway %K eHealth %K enterprise digital health %K evaluation framework %K framework %K healthcare delivery %K healthcare system %K intelligent care %K intelligent system %K privacy %K security %K service delivery %K systems design %K telehealth %K telemedicine %D 2023 %7 7.4.2023 %9 Viewpoint %J JMIR Form Res %G English %X The digital transformation of our health care system will require not only digitization of existing tools but also a redesign of our care delivery system and collaboration with digital partners. Traditional patient journeys are reactive to symptom presentation and delayed by health care system–centric scheduling, leading to poor experience and avoidable adverse outcomes. Patient journeys will be reimagined to a digital health pathway that seamlessly integrates various care experiences from telemedicine, remote monitoring, to in-person clinic visits. Through centering the care delivery around the patients, they can have more delightful experiences and enjoy the quality of standardized condition pathways and outcomes. To design and implement digital health pathways at scale, enterprise health care systems need to develop capabilities and partnerships in human-centered design, operational workflow, clinical content management, communication channels and mechanisms, reporting and analytics, standards-based integration, security and data management, and scalability. Using a human-centered design methodology, care pathways will be built upon an understanding of the unmet needs of the patients to have a more enjoyable experience of care with improved clinical outcomes. To power this digital care pathway, enterprises will choose to build or partner for clinical content management to operationalize up-to-date, best-in-class pathways. With this clinical engine, this digital solution will engage with patients through multimodal communication modalities, including written, audio, photo, or video, throughout the patient journey. Leadership teams will review reporting and analytics functions to track that the digital care pathways will be iterated to improve patient experience, clinical metrics, and operational efficiency. On the backend, standards-based integration will allow this system to be built in conjunction with the electronic medical record and other data systems to provide safe and efficient use of the digital care solution. For protecting patient information and compliance, a security and data management strategy is critical to derisking breeches and preserving privacy. Finally, a framework of technical scalability will allow digital care pathways to proliferate throughout the enterprise and support the entire patient population. This framework empowers enterprise health care systems to avoid collecting a fragmented series of one-off solutions but develop a sustainable concerted roadmap to the future of proactive intelligent patient care. %M 37027184 %R 10.2196/43009 %U https://formative.jmir.org/2023/1/e43009 %U https://doi.org/10.2196/43009 %U http://www.ncbi.nlm.nih.gov/pubmed/37027184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43386 %T A “Do No Harm” Novel Safety Checklist and Research Approach to Determine Whether to Launch an Artificial Intelligence–Based Medical Technology: Introducing the Biological-Psychological, Economic, and Social (BPES) Framework %A Khan,Waqas Ullah %A Seto,Emily %+ Health Informatics, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M6H 1E1, Canada, 1 6474031872, waqas.khan@alum.utoronto.ca %K artificial intelligence %K AI %K safety checklist %K Do No Harm %K biological-psychological factors %K economic factors %K social factors %K AI medical hardware devices %K AI medical mobile apps %K AI medical software programs %D 2023 %7 5.4.2023 %9 Viewpoint %J J Med Internet Res %G English %X Given the impact artificial intelligence (AI)–based medical technologies (hardware devices, software programs, and mobile apps) can have on society, debates regarding the principles behind their development and deployment are emerging. Using the biopsychosocial model applied in psychiatry and other fields of medicine as our foundation, we propose a novel 3-step framework to guide industry developers of AI-based medical tools as well as health care regulatory agencies on how to decide if a product should be launched—a “Go or No-Go” approach. More specifically, our novel framework places stakeholders’ (patients, health care professionals, industry, and government institutions) safety at its core by asking developers to demonstrate the biological-psychological (impact on physical and mental health), economic, and social value of their AI tool before it is launched. We also introduce a novel cost-effective, time-sensitive, and safety-oriented mixed quantitative and qualitative clinical phased trial approach to help industry and government health care regulatory agencies test and deliberate on whether to launch these AI-based medical technologies. To our knowledge, our biological-psychological, economic, and social (BPES) framework and mixed method phased trial approach are the first to place the Hippocratic Oath of “Do No Harm” at the center of developers’, implementers’, regulators’, and users’ mindsets when determining whether an AI-based medical technology is safe to launch. Moreover, as the welfare of AI users and developers becomes a greater concern, our framework’s novel safety feature will allow it to complement existing and future AI reporting guidelines. %M 37018019 %R 10.2196/43386 %U https://www.jmir.org/2023/1/e43386 %U https://doi.org/10.2196/43386 %U http://www.ncbi.nlm.nih.gov/pubmed/37018019 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42615 %T Digital Health Data Quality Issues: Systematic Review %A Syed,Rehan %A Eden,Rebekah %A Makasi,Tendai %A Chukwudi,Ignatius %A Mamudu,Azumah %A Kamalpour,Mostafa %A Kapugama Geeganage,Dakshi %A Sadeghianasl,Sareh %A Leemans,Sander J J %A Goel,Kanika %A Andrews,Robert %A Wynn,Moe Thandar %A ter Hofstede,Arthur %A Myers,Trina %+ School of Information Systems, Faculty of Science, Queensland University of Technology, 2 George Street, Brisbane, 4000, Australia, 61 7 3138 9360, r.syed@qut.edu.au %K data quality %K digital health %K electronic health record %K eHealth %K systematic reviews %D 2023 %7 31.3.2023 %9 Review %J J Med Internet Res %G English %X Background: The promise of digital health is principally dependent on the ability to electronically capture data that can be analyzed to improve decision-making. However, the ability to effectively harness data has proven elusive, largely because of the quality of the data captured. Despite the importance of data quality (DQ), an agreed-upon DQ taxonomy evades literature. When consolidated frameworks are developed, the dimensions are often fragmented, without consideration of the interrelationships among the dimensions or their resultant impact. Objective: The aim of this study was to develop a consolidated digital health DQ dimension and outcome (DQ-DO) framework to provide insights into 3 research questions: What are the dimensions of digital health DQ? How are the dimensions of digital health DQ related? and What are the impacts of digital health DQ? Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a developmental systematic literature review was conducted of peer-reviewed literature focusing on digital health DQ in predominately hospital settings. A total of 227 relevant articles were retrieved and inductively analyzed to identify digital health DQ dimensions and outcomes. The inductive analysis was performed through open coding, constant comparison, and card sorting with subject matter experts to identify digital health DQ dimensions and digital health DQ outcomes. Subsequently, a computer-assisted analysis was performed and verified by DQ experts to identify the interrelationships among the DQ dimensions and relationships between DQ dimensions and outcomes. The analysis resulted in the development of the DQ-DO framework. Results: The digital health DQ-DO framework consists of 6 dimensions of DQ, namely accessibility, accuracy, completeness, consistency, contextual validity, and currency; interrelationships among the dimensions of digital health DQ, with consistency being the most influential dimension impacting all other digital health DQ dimensions; 5 digital health DQ outcomes, namely clinical, clinician, research-related, business process, and organizational outcomes; and relationships between the digital health DQ dimensions and DQ outcomes, with the consistency and accessibility dimensions impacting all DQ outcomes. Conclusions: The DQ-DO framework developed in this study demonstrates the complexity of digital health DQ and the necessity for reducing digital health DQ issues. The framework further provides health care executives with holistic insights into DQ issues and resultant outcomes, which can help them prioritize which DQ-related problems to tackle first. %M 37000497 %R 10.2196/42615 %U https://www.jmir.org/2023/1/e42615 %U https://doi.org/10.2196/42615 %U http://www.ncbi.nlm.nih.gov/pubmed/37000497 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e45143 %T Assessing the Quality and Impact of eHealth Tools: Systematic Literature Review and Narrative Synthesis %A Jacob,Christine %A Lindeque,Johan %A Klein,Alexander %A Ivory,Chris %A Heuss,Sabina %A Peter,Marc K %+ FHNW - University of Applied Sciences Northwestern Switzerland, Bahnhofstrasse 6, Windisch, 5210, Switzerland, 41 798769376, christine.k.jacob@gmail.com %K eHealth %K mobile health %K mHealth %K digital health %K technology assessment %K technology adoption %K technology implementation %D 2023 %7 23.3.2023 %9 Review %J JMIR Hum Factors %G English %X Background: Technological advancements have opened the path for many technology providers to easily develop and introduce eHealth tools to the public. The use of these tools is increasingly recognized as a critical quality driver in health care; however, choosing a quality tool from the myriad of tools available for a specific health need does not come without challenges. Objective: This review aimed to systematically investigate the literature to understand the different approaches and criteria used to assess the quality and impact of eHealth tools by considering sociotechnical factors (from technical, social, and organizational perspectives). Methods: A structured search was completed following the participants, intervention, comparators, and outcomes framework. We searched the PubMed, Cochrane, Web of Science, Scopus, and ProQuest databases for studies published between January 2012 and January 2022 in English, which yielded 675 results, of which 40 (5.9%) studies met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were followed to ensure a systematic process. Extracted data were analyzed using NVivo (QSR International), with a thematic analysis and narrative synthesis of emergent themes. Results: Similar measures from the different papers, frameworks, and initiatives were aggregated into 36 unique criteria grouped into 13 clusters. Using the sociotechnical approach, we classified the relevant criteria into technical, social, and organizational assessment criteria. Technical assessment criteria were grouped into 5 clusters: technical aspects, functionality, content, data management, and design. Social assessment criteria were grouped into 4 clusters: human centricity, health outcomes, visible popularity metrics, and social aspects. Organizational assessment criteria were grouped into 4 clusters: sustainability and scalability, health care organization, health care context, and developer. Conclusions: This review builds on the growing body of research that investigates the criteria used to assess the quality and impact of eHealth tools and highlights the complexity and challenges facing these initiatives. It demonstrates that there is no single framework that is used uniformly to assess the quality and impact of eHealth tools. It also highlights the need for a more comprehensive approach that balances the social, organizational, and technical assessment criteria in a way that reflects the complexity and interdependence of the health care ecosystem and is aligned with the factors affecting users’ adoption to ensure uptake and adherence in the long term. %M 36843321 %R 10.2196/45143 %U https://humanfactors.jmir.org/2023/1/e45143 %U https://doi.org/10.2196/45143 %U http://www.ncbi.nlm.nih.gov/pubmed/36843321 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45095 %T Making Sense of Theories, Models, and Frameworks in Digital Health Behavior Change Design: Qualitative Descriptive Study %A Voorheis,Paula %A Bhuiya,Aunima R %A Kuluski,Kerry %A Pham,Quynh %A Petch,Jeremy %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 7058163180, paula.voorheis@mail.utoronto.ca %K behavioral science %K behavior change %K health behavior %K digital health %K mobile health %K theories %K models %K frameworks %D 2023 %7 15.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions are increasingly being designed to support health behaviors. Although digital health interventions informed by behavioral science theories, models, and frameworks (TMFs) are more likely to be effective than those designed without them, design teams often struggle to use these evidence-informed tools. Until now, little work has been done to clarify the ways in which behavioral science TMFs can add value to digital health design. Objective: The aim of this study was to better understand how digital health design leaders select and use TMFs in design practice. The questions that were addressed included how do design leaders perceive the value of TMFs in digital health design, what considerations do design leaders make when selecting and applying TMFs, and what do design leaders think is needed in the future to advance the utility of TMFs in digital health design? Methods: This study used a qualitative description design to understand the experiences and perspectives of digital health design leaders. The participants were identified through purposive and snowball sampling. Semistructured interviews were conducted via Zoom software. Interviews were audio-recorded and transcribed using Otter.ai software. Furthermore, 3 researchers coded a sample of interview transcripts and confirmed the coding strategy. One researcher completed the qualitative analysis using a codebook thematic analysis approach. Results: Design leaders had mixed opinions on the value of behavioral science TMFs in digital health design. Leaders suggested that TMFs added the most value when viewed as a starting point rather than the final destination for evidence-informed design. Specifically, these tools added value when they acted as a gateway drug to behavioral science, supported health behavior conceptualization, were balanced with expert knowledge and user-centered design principles, were complementary to existing design methods, and supported both individual- and systems-level thinking. Design leaders also felt that there was a considerable nuance in selecting the most value-adding TMFs. Considerations should be made regarding their source, appropriateness, complexity, accessibility, adaptability, evidence base, purpose, influence, audience, fit with team expertise, fit with team culture, and fit with external pressures. Design leaders suggested multiple opportunities to advance the use of TMFs. These included improving TMF reporting, design, and accessibility, as well as improving design teams' capacity to use TMFs appropriately in practice. Conclusions: When designing a digital health behavior change intervention, using TMFs can help design teams to systematically integrate behavioral insights. The future of digital health behavior change design demands an easier way for designers to integrate evidence-based TMFs into practice. %M 36920442 %R 10.2196/45095 %U https://www.jmir.org/2023/1/e45095 %U https://doi.org/10.2196/45095 %U http://www.ncbi.nlm.nih.gov/pubmed/36920442 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e40054 %T A Software Engineering Framework for Reusable Design of Personalized Serious Games for Health: Development Study %A Carlier,Stéphanie %A Naessens,Vince %A De Backere,Femke %A De Turck,Filip %+ Internet Technology and Data Science Lab, Faculty of Engineering and Architecture, Ghent University, Technologiepark-Zwijnaarde 126, Ghent, 9052, Belgium, 32 9 331 49 38, stephanie.carlier@ugent.be %K serious game %K health care %K personalization %K domain knowledge %K framework %K eHealth %K cocreation %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: The use of serious games in health care is on the rise, as these games motivate treatment adherence, reduce treatment costs, and educate patients and families. However, current serious games fail to offer personalized interventions, ignoring the need to abandon the one-size-fits-all approach. Moreover, these games, with a primary objective other than pure entertainment, are costly and complex to develop and require the constant involvement of a multidisciplinary team. No standardized approach exists on how serious games can be personalized, as existing literature focuses on specific use cases and scenarios. The serious game development domain fails to consider any transfer of domain knowledge, which means this labor-intensive process must be repeated for each serious game. Objective: We proposed a software engineering framework that aims to streamline the multidisciplinary design process of personalized serious games in health care and facilitates the reuse of domain knowledge and personalization algorithms. By focusing on the transfer of knowledge to new serious games by reusing components and personalization algorithms, the comparison and evaluation of different personalization strategies can be simplified and expedited. In doing so, the first steps are taken in advancing the state of the art of knowledge regarding personalized serious games in health care. Methods: The proposed framework aimed to answer 3 questions that need to be asked when designing personalized serious games: Why is the game personalized? What parameters can be used for personalization? and How is the personalization achieved? The 3 involved stakeholders, namely, the domain expert, the (game) developer, and the software engineer, were each assigned a question and then assigned responsibilities regarding the design of the personalized serious game. The (game) developer was responsible for all the game-related components; the domain expert was in charge of the modeling of the domain knowledge using simple or complex concepts (eg, ontologies); and the software engineer managed the personalization algorithms or models integrated into the system. The framework acted as an intermediate step between game conceptualization and implementation; it was illustrated by developing and evaluating a proof of concept. Results: The proof of concept, a serious game for shoulder rehabilitation, was evaluated using simulations of heart rate and game scores to assess how personalization was achieved and whether the framework responded as expected. The simulations indicated the value of both real-time and offline personalization. The proof of concept illustrated how the interaction between different components worked and how the framework was used to simplify the design process. Conclusions: The proposed framework for personalized serious games in health care identifies the responsibilities of the involved stakeholders in the design process, using 3 key questions for personalization. The framework focuses on the transferability of knowledge and reusability of personalization algorithms to simplify the design process of personalized serious games. %M 36877554 %R 10.2196/40054 %U https://games.jmir.org/2023/1/e40054 %U https://doi.org/10.2196/40054 %U http://www.ncbi.nlm.nih.gov/pubmed/36877554 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37784 %T Off-World Mental Health: Considerations for the Design of Well-being–Supportive Technologies for Deep Space Exploration %A Smith,Nathan %A Peters,Dorian %A Jay,Caroline %A Sandal,Gro M %A Barrett,Emma C %A Wuebker,Robert %+ Protective Security and Resilience Centre, Coventry University, Cheetah Road, Coventry, CV1 2TL, United Kingdom, 44 7807045630, nathan.j.smithphd@gmail.com %K long duration space exploration %K astronaut mental health %K countermeasures %K digital design %K human factors %K technology %D 2023 %7 14.2.2023 %9 Viewpoint %J JMIR Form Res %G English %X During future long-duration space exploration missions, humans will be exposed to combinations of extreme physical, psychological, and interpersonal demands. These demands create risks for the safety, performance, health, and well-being of both individuals and crew. The communication latency in deep space means that explorers will increasingly have to operate independently and take responsibility for their own self-care and self-management. At present, several research programs are focused on developing and testing digital technologies and countermeasures that support the effective functioning of deep space crews. Although promising, these initiatives have been stimulated mostly by technological opportunity rather than cogent theory. In this perspective, we argue that digital technologies developed for spaceflight should be informed by well-being–supportive design principles and be cognizant of broader conversations around the development and use of digital health applications, especially pertaining to issues of autonomy, privacy, and trust. These issues are important for designing potentially mission-critical health technologies and may be determining factors in the safe and successful completion of future off-world endeavors. %M 36787162 %R 10.2196/37784 %U https://formative.jmir.org/2023/1/e37784 %U https://doi.org/10.2196/37784 %U http://www.ncbi.nlm.nih.gov/pubmed/36787162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43486 %T Optimizing the Implementation of Clinical Predictive Models to Minimize National Costs: Sepsis Case Study %A Rogers,Parker %A Boussina,Aaron E %A Shashikumar,Supreeth P %A Wardi,Gabriel %A Longhurst,Christopher A %A Nemati,Shamim %+ Department of Economics, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 405 850 4751, parogers@ucsd.edu %K sepsis %K machine learning %K evaluation %K utility assessment %K workflow simulation %K simulation %K model %K implementation %K data %K acute kidney injury %K injury %K technology %K care %K diagnosis %K clinical %K cost %D 2023 %7 13.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sepsis costs and incidence vary dramatically across diagnostic categories, warranting a customized approach for implementing predictive models. Objective: The aim of this study was to optimize the parameters of a sepsis prediction model within distinct patient groups to minimize the excess cost of sepsis care and analyze the potential effect of factors contributing to end-user response to sepsis alerts on overall model utility. Methods: We calculated the excess costs of sepsis to the Centers for Medicare and Medicaid Services (CMS) by comparing patients with and without a secondary sepsis diagnosis but with the same primary diagnosis and baseline comorbidities. We optimized the parameters of a sepsis prediction algorithm across different diagnostic categories to minimize these excess costs. At the optima, we evaluated diagnostic odds ratios and analyzed the impact of compliance factors such as noncompliance, treatment efficacy, and tolerance for false alarms on the net benefit of triggering sepsis alerts. Results: Compliance factors significantly contributed to the net benefit of triggering a sepsis alert. However, a customized deployment policy can achieve a significantly higher diagnostic odds ratio and reduced costs of sepsis care. Implementing our optimization routine with powerful predictive models could result in US $4.6 billion in excess cost savings for CMS. Conclusions: We designed a framework for customizing sepsis alert protocols within different diagnostic categories to minimize excess costs and analyzed model performance as a function of false alarm tolerance and compliance with model recommendations. We provide a framework that CMS policymakers could use to recommend minimum adherence rates to the early recognition and appropriate care of sepsis that is sensitive to hospital department-level incidence rates and national excess costs. Customizing the implementation of clinical predictive models by accounting for various behavioral and economic factors may improve the practical benefit of predictive models. %M 36780203 %R 10.2196/43486 %U https://www.jmir.org/2023/1/e43486 %U https://doi.org/10.2196/43486 %U http://www.ncbi.nlm.nih.gov/pubmed/36780203 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e38921 %T Designing an App for Parents and Caregivers to Promote Cognitive and Socioemotional Development and Well-being Among Children Aged 0 to 5 Years in Diverse Cultural Settings: Scientific Framework %A Crouse,Jacob J %A LaMonica,Haley M %A Song,Yun Ju Christine %A Boulton,Kelsie A %A Rohleder,Cathrin %A DeMayo,Marilena M %A Wilson,Chloe E %A Loblay,Victoria %A Hindmarsh,Gabrielle %A Stratigos,Tina %A Krausz,Michael %A Foo,Nathanael %A Teo,Melissa %A Hunter,Andrew %A Guastella,Adam J %A Banati,Richard B %A Troy,Jakelin %A Hickie,Ian B %+ Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94-100 Mallett St, Camperdown, 2050, Australia, 61 291144000, jacob.crouse@sydney.edu.au %K early childhood development %K digital technology %K health information technology %K mHealth %K smartphone %K neuroscience %K pediatrics %K mobile app %D 2023 %7 13.2.2023 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Recent years have seen remarkable progress in our scientific understanding of early childhood social, emotional, and cognitive development, as well as our capacity to widely disseminate health information by using digital technologies. Together, these scientific and technological advances offer exciting opportunities to deliver high-quality information about early childhood development (ECD) to parents and families globally, which may ultimately lead to greater knowledge and confidence among parents and better outcomes among children (particularly in lower- and middle-income countries). With these potential benefits in mind, we set out to design, develop, implement, and evaluate a new parenting app—Thrive by Five—that will be available in 30 countries. The app will provide caregivers and families with evidence-based and culturally appropriate information about ECD, accompanied by sets of collective actions that go beyond mere tips for parenting practices. Herein, we describe this ongoing global project and discuss the components of our scientific framework for developing and prototyping the app’s content. Specifically, we describe (1) 5 domains that are used to organize the content and goals of the app’s information and associated practices; (2) 5 neurobiological systems that are relevant to ECD and can be behaviorally targeted to potentially influence social, emotional, and cognitive development; (3) our anthropological and cultural framework for learning about local contexts and appreciating decolonization perspectives; and (4) our approach to tailoring the app’s content to local contexts, which involves collaboration with in-country partner organizations and local and international subject matter experts in ECD, education, medicine, psychology, and anthropology, among others. Finally, we provide examples of the content that was incorporated in Thrive by Five when it launched globally. %M 36780220 %R 10.2196/38921 %U https://pediatrics.jmir.org/2023/1/e38921 %U https://doi.org/10.2196/38921 %U http://www.ncbi.nlm.nih.gov/pubmed/36780220 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43404 %T Advancing Digital Health Innovation in Oncology: Priorities for High-Value Digital Transformation in Cancer Care %A Patel,Smit %A Goldsack,Jennifer C %A Cordovano,Grace %A Downing,Andrea %A Fields,Karen K %A Geoghegan,Cindy %A Grewal,Upinder %A Nieva,Jorge %A Patel,Nikunj %A Rollison,Dana E %A Sah,Archana %A Said,Maya %A Van De Keere,Isabel %A Way,Amanda %A Wolff-Hughes,Dana L %A Wood,William A %A Robinson,Edmondo J %+ Digital Medicine Society, 90 Canal St, 4th Floor, Boston, MA, 02114, United States, 1 765 234 3463, jennifer@dimesociety.org %K digital health %K innovation %K oncology %K cancer care %K cancer %K patient journey %K digital transformation %K digital divide %K health care delivery %K service delivery %K equity %K patient-reported outcome %K PROM %K biomarker %K digital innovation %D 2023 %7 4.1.2023 %9 Viewpoint %J J Med Internet Res %G English %X Although health care delivery is becoming increasingly digitized, driven by the pursuit of improved access, equity, efficiency, and effectiveness, progress does not appear to be equally distributed across therapeutic areas. Oncology is renowned for leading innovation in research and in care; digital pathology, digital radiology, real-world data, next-generation sequencing, patient-reported outcomes, and precision approaches driven by complex data and biomarkers are hallmarks of the field. However, remote patient monitoring, decentralized approaches to care and research, “hospital at home,” and machine learning techniques have yet to be broadly deployed to improve cancer care. In response, the Digital Medicine Society and Moffitt Cancer Center convened a multistakeholder roundtable discussion to bring together leading experts in cancer care and digital innovation. This viewpoint highlights the findings from these discussions, in which experts agreed that digital innovation is lagging in oncology relative to other therapeutic areas. It reports that this lag is most likely attributed to poor articulation of the challenges in cancer care and research best suited to digital solutions, lack of incentives and support, and missing standardized infrastructure to implement digital innovations. It concludes with suggestions for actions needed to bring the promise of digitization to cancer care to improve lives. %M 36598811 %R 10.2196/43404 %U https://www.jmir.org/2023/1/e43404 %U https://doi.org/10.2196/43404 %U http://www.ncbi.nlm.nih.gov/pubmed/36598811 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e36265 %T Navigating the Systemic Conditions of a Digital Health Ecosystem in Alberta, Canada: Embedded Case Study %A Saunders,Chad %A Currie,Devon %A Virani,Shane %A De Grood,Jill %+ Entrepreneurship & Innovation, Haskayne School of Business, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada, 1 403 220 6075, wsaunder@ucalgary.ca %K digital health %K entrepreneurial ecosystem %K systemic conditions %K policy %D 2022 %7 21.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health promises numerous value-creating outcomes. These include improved health, reduced costs, and the creation of lucrative markets, which, in turn, provide high-quality employment, productivity growth, and a climate that attracts investment. For this value creation and capture, the activities of a diverse set of stakeholders within a digital health ecosystem require coordination. However, the antecedents of the coordination needed for an effective digital health ecosystem are not well understood. Objective: The purpose of this study was to investigate the systemic conditions of the digital health ecosystem in Alberta, Canada, as critical antecedents to ecosystem coordination from the perspective of the authors as applicants to an innovative digital health funding program embedded within the larger digital health ecosystem of innovators or entrepreneurs, health system leaders, support partners, and funders. Methods: We employed a qualitative embedded case study of the systemic conditions within the digital health ecosystem in Alberta, Canada (main case) using semistructured interviews with 36 stakeholders representing innovators or entrepreneurs, health system leaders, support partners, and funders (subcases). The interviews were conducted over a 2-month period between May 26 and July 22, 2021. Data were coded for key themes and synthesized around 5 propositions developed from academic publications and policy reports. Results: The findings indicated varying levels of support for each proposition, with moderate support for accessing real problems, data, training, and space for evaluations. However, the most fundamental gap appears to be in ecosystem navigation, in particular, the absence of intermediaries (eg, individuals, organizations, and technology) to provide guidance on the available support services and dependencies among the various ecosystem actors and programs. Conclusions: Navigating the systemic conditions of the digital health ecosystem is extremely challenging for entrepreneurs, especially those without prior health care experience, and this remains an issue even for those with such experience. Policy interventions aimed at increasing collaboration among ecosystem support providers, along with tools and incentives to ensure coordination, are essential as the ecosystem and those dependent on it grow. %M 36542428 %R 10.2196/36265 %U https://formative.jmir.org/2022/12/e36265 %U https://doi.org/10.2196/36265 %U http://www.ncbi.nlm.nih.gov/pubmed/36542428 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e41463 %T Omnichannel Communication to Boost Patient Engagement and Behavioral Change With Digital Health Interventions %A Blasiak,Agata %A Sapanel,Yoann %A Leitman,Dana %A Ng,Wei Ying %A De Nicola,Raffaele %A Lee,V Vien %A Todorov,Atanas %A Ho,Dean %+ The Institute for Digital Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 28 Medical Drive, #05-COR Centre for Life Sciences, Singapore, 117456, Singapore, 65 6601 7766, agata.blasiak@nus.edu.sg %K digital health intervention %K omnichannel engagement %K behavioral change %K communication channels %K personalized engagement %K health care %K patient care %K health care outcome %K patient engagement %K digital twin %K DHI %K digital health %K eHealth %K framework %K development %D 2022 %7 16.11.2022 %9 Viewpoint %J J Med Internet Res %G English %X Digital health interventions are being increasingly incorporated into health care workflows to improve the efficiency of patient care. In turn, sustained patient engagement with digital health interventions can maximize their benefits toward health care outcomes. In this viewpoint, we outline a dynamic patient engagement by using various communication channels and the potential use of omnichannel engagement to integrate these channels. We conceptualize a novel patient care journey where multiple web-based and offline communication channels are integrated through a “digital twin.” The principles of implementing omnichannel engagement for digital health interventions and digital twins are also broadly covered. Omnichannel engagement in digital health interventions implies a flexibility for personalization, which can enhance and sustain patient engagement with digital health interventions, and ultimately, patient quality of care and outcomes. We believe that the novel concept of omnichannel engagement in health care can be greatly beneficial to patients and the system once it is successfully realized to its full potential. %M 36383427 %R 10.2196/41463 %U https://www.jmir.org/2022/11/e41463 %U https://doi.org/10.2196/41463 %U http://www.ncbi.nlm.nih.gov/pubmed/36383427 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e39323 %T How Digital Therapeutics Are Urging the Need for a Paradigm Shift: From Evidence-Based Health Care to Evidence-Based Well-being %A Smits,Merlijn %A Ludden,Geke D S %A Verbeek,Peter-Paul %A van Goor,Harry %+ Department of Surgery, Radboud university medical center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, Netherlands, 31 634165922, merlijnsmits@hotmail.com %K digital therapeutics %K digital health %K paradigm shift %K paradigm %K health policy %K health care %K evidence %K evidence-based %K decision-making %K challenges %K implementation %K well-being %K digital %K technology %D 2022 %7 20.10.2022 %9 Viewpoint %J Interact J Med Res %G English %X A scientific paradigm consists of a set of shared rules, beliefs, values, methods, and instruments for addressing scientific problems. Currently, health care embraces the paradigm of evidence-based health care (EBH). This paradigm prompts health care institutions to base decisions on the best available evidence, which is commonly generated in large-scale randomized controlled trials. We illustrate the application of EBH via the evaluation of drugs. We show how EBH is challenged when it is applied to the evaluation of digital therapeutics, which refers to technology and data to prevent, manage, or treat a medical disorder or disease. We conclude that amid the growing application of digital therapeutics, the paradigm of EBH is challenged in four domains: population, intervention, comparison, outcome. In the second part of this viewpoint, we argue for a paradigm shift in health care so we can optimally evaluate and implement digital therapeutics, and we sketch out the contours of this novel paradigm. We address the need for considering design in health care and evaluation processes, studying user values so that health care can move from a focus on health to well-being, focusing on individual experiences rather than the average, addressing the need for evaluation in authentic use contexts, and stressing the need for continuous evaluation of the dynamic relations between users, context, and digital therapeutics. We conclude that the transition from EBH toward evidence-based well-being would improve the successful implementation of digital technologies in health care. %M 36264624 %R 10.2196/39323 %U https://www.i-jmr.org/2022/2/e39323 %U https://doi.org/10.2196/39323 %U http://www.ncbi.nlm.nih.gov/pubmed/36264624 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e39905 %T Methodological Frameworks and Dimensions to Be Taken Into Consideration in Digital Health Technology Assessment: Protocol for a Scoping Review %A Segur-Ferrer,Joan %A Moltó-Puigmartí,Carolina %A Pastells-Peiró,Roland %A Vivanco-Hidalgo,Rosa Maria %+ Health Technology Assessment and Quality of Care Area, Agency for Health Quality and Assessment of Catalonia, Carrer de Roc Boronat, 81-95 (segona planta), Barcelona, 08005, Spain, 34 935 513 900, joan.segur@gencat.cat %K digital health %K eHealth %K mobile health %K artificial intelligence %K framework %K health technology assessment %D 2022 %7 11.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health technology assessment (HTA) is one of the main tools that health systems have to appraise evidence and determine the value of a given health technology. Although the existing HTA frameworks are useful tools for the evaluation of a wide range of health technologies, more and more experts, organizations across the world, and HTA agencies are highlighting the need to update or develop specific methodological frameworks for the evaluation of digital health technologies in order to take into account additional domains that cover these technologies’ intrinsic characteristics. Objective: The purpose of our scoping review is to identify the methodological frameworks that are used worldwide for the assessment of digital health technologies; determine what dimensions and aspects are being considered; and generate, through a thematic analysis, a proposal for a methodological framework that is based on the most frequently described dimensions in the literature. Methods: The scoping review will be performed in accordance with the guidelines established in the updated statement of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). We will search for peer-reviewed and grey literature published between 2011 and the date of the search execution. The retrieved references will be reviewed in a single-blind manner by 2 independent authors, and their quality will be assessed by using the Critical Appraisal Skills Program tool. The ATLAS.ti software (Scientific Software Development GmbH) will be used for data extraction and to perform the thematic analysis. Results: The scoping review is currently (May 2022) in progress. It is expected to be completed in October 2022, and the final results of the research will be presented and published by November 2022. Conclusions: To our knowledge, no studies have been published to date that identify the existing methodological frameworks for digital HTA, determine which dimensions must be evaluated for correct decision-making, and serve as a basis for the development of a methodological framework of reference that health care systems can use to carry out this kind of assessment. This work is intended to address this knowledge gap of key relevance for the field of HTA. International Registered Report Identifier (IRRID): DERR1-10.2196/39905 %M 36222788 %R 10.2196/39905 %U https://www.researchprotocols.org/2022/10/e39905 %U https://doi.org/10.2196/39905 %U http://www.ncbi.nlm.nih.gov/pubmed/36222788 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e38740 %T Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER): Development of a Conceptual Framework %A Dhinagaran,Dhakshenya Ardhithy %A Martinengo,Laura %A Ho,Moon-Ho Ringo %A Joty,Shafiq %A Kowatsch,Tobias %A Atun,Rifat %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Rd69047142, Clinical Sciences Building Level 18, Singapore, 308232, Singapore, 65 69047142, lorainne.tudor.car@ntu.edu.sg %K conceptual framework %K conversational agent %K chatbot %K mobile health %K mHealth %K digital health %K mobile phone %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Conversational agents (CAs), also known as chatbots, are computer programs that simulate human conversations by using predetermined rule-based responses or artificial intelligence algorithms. They are increasingly used in health care, particularly via smartphones. There is, at present, no conceptual framework guiding the development of smartphone-based, rule-based CAs in health care. To fill this gap, we propose structured and tailored guidance for their design, development, evaluation, and implementation. Objective: The aim of this study was to develop a conceptual framework for the design, evaluation, and implementation of smartphone-delivered, rule-based, goal-oriented, and text-based CAs for health care. Methods: We followed the approach by Jabareen, which was based on the grounded theory method, to develop this conceptual framework. We performed 2 literature reviews focusing on health care CAs and conceptual frameworks for the development of mobile health interventions. We identified, named, categorized, integrated, and synthesized the information retrieved from the literature reviews to develop the conceptual framework. We then applied this framework by developing a CA and testing it in a feasibility study. Results: The Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER) conceptual framework includes 8 iterative steps grouped into 3 stages, as follows: design, comprising defining the goal, creating an identity, assembling the team, and selecting the delivery interface; development, including developing the content and building the conversation flow; and the evaluation and implementation of the CA. They were complemented by 2 cross-cutting considerations—user-centered design and privacy and security—that were relevant at all stages. This conceptual framework was successfully applied in the development of a CA to support lifestyle changes and prevent type 2 diabetes. Conclusions: Drawing on published evidence, the DISCOVER conceptual framework provides a step-by-step guide for developing rule-based, smartphone-delivered CAs. Further evaluation of this framework in diverse health care areas and settings and for a variety of users is needed to demonstrate its validity. Future research should aim to explore the use of CAs to deliver health care interventions, including behavior change and potential privacy and safety concerns. %M 36194462 %R 10.2196/38740 %U https://mhealth.jmir.org/2022/10/e38740 %U https://doi.org/10.2196/38740 %U http://www.ncbi.nlm.nih.gov/pubmed/36194462 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e35907 %T Points and the Delivery of Gameful Experiences in a Gamified Environment: Framework Development and Case Analysis %A Park,Sungjin %A Kim,Sangkyun %+ Graduate School of Business, Kyung Hee University, 506, Orbis Hall, 24, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 02 961 0448, saviour@khu.ac.kr %K point %K design framework %K gamification %K gameful experience %K pointsification %K overjustification effect %D 2022 %7 29.9.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Points represent one of the most widely used game mechanics in gamification. They have been used as a means to provide feedback to users. They visually show user performance and are used along with other game mechanics to produce synergy effects. However, using points without analyzing the application environment and targets adversely affects users. Objective: This study aims to identify the problems that users encounter when points are applied improperly, to solve problems based on an analysis of previous studies and actual point use cases, and to develop a point design framework to deliver gameful experiences. Methods: Three problems were identified by analyzing previous studies. The first problem is points that only accumulate. The second is points that emphasize a user’s difference from other people. The third pertains to the reward distribution problem that occurs when points are used as rewards. Results: We developed a framework by deriving 3 criteria for applying points. The first criterion is based on the passive acquisition approach and the active use approach. The second criterion is used to classify points as “high/low” and “many/few” types. The third criterion is the classification of personal reward points and group reward points based on segmentation of the reward criteria. We developed 8 types of points based on the derived point design framework. Conclusions: We expect that some of the problems that users experience when using points can be solved. Furthermore, we expect that some of the problems that arise when points are used as rewards, such as pointsification and the overjustification effect, can be solved. By solving such problems, we suggest a direction that enables a gameful experience for point users and improves the core value delivery through gameful experiences. We also suggest a gameful experience delivery method in the context of the ongoing COVID-19 pandemic. %M 36173674 %R 10.2196/35907 %U https://games.jmir.org/2022/3/e35907 %U https://doi.org/10.2196/35907 %U http://www.ncbi.nlm.nih.gov/pubmed/36173674 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 9 %P e40611 %T The Influence of Context on Implementation and Improvement: Protocol for a Mixed Methods, Secondary Analyses Study %A Estabrooks,Carole %A Song,Yuting %A Anderson,Ruth %A Beeber,Anna %A Berta,Whitney %A Chamberlain,Stephanie %A Cummings,Greta %A Duan,Yinfei %A Hayduk,Leslie %A Hoben,Matthias %A Iaconi,Alba %A Lanham,Holly %A Perez,Janelle %A Wang,Jing %A Norton,Peter %+ Faculty of Nursing, University of Alberta, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada, 1 780 492 3451, carole.estabrooks@ualberta.ca %K organizational context %K facilitation %K PARIHS framework %K Promoting Action on Research Implementation in Health Services %K implementation science %D 2022 %7 15.9.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Caring for the well-being of older adults is one of the greatest challenges in modern societies. Improving the quality of care and life for older adults and the work lives of their care providers calls for effective knowledge translation of evidence-based best practices. Objective: This study’s purpose is to contribute to knowledge translation by better understanding the roles of organizational context (workplace environment) and facilitation (process or role) in implementation and improvement success. Our study has 2 goals: (1) to advance knowledge translation science by further developing and testing the Promoting Action on Research Implementation in Health Services framework (which outlines how implementation relies on the interplay of context, facilitation, and evidence) and (2) to advance research by optimizing implementation success via tailoring of modifiable elements of organizational context and facilitation. Methods: This is secondary analyses of 15 years of longitudinal data from the Translating Research in Elder Care (TREC) program’s multiple data sources. This research is ongoing in long-term care (LTC) homes in western Canada. TREC data include the following: 5 waves of survey collection, 2 clinical trials, and regular ongoing outcome data for LTC residents. We will use a sequential exploratory and confirmatory mixed methods design. We will analyze qualitative and quantitative data holdings in an iterative process: (1) comprehensive reanalysis of qualitative data to derive hypotheses, (2) quantitative modeling to test hypotheses, and (3) action cycles to further refine and integrate qualitative and quantitative analyses. The research team includes 4 stakeholder panels: (1) system decision- and policy makers, (2) care home managers, (3) direct care staff, and (4) a citizen engagement group of people living with dementia and family members of LTC residents. A fifth group is our panel of external scientific advisors. Each panel will engage periodically, providing their perspectives on project direction and findings. Results: This study is funded by the Canadian Institutes of Health Research. Ethics approval was obtained from the University of Alberta (Pro00096541). The results of the secondary analyses are expected by the end of 2023. Conclusions: The project will advance knowledge translation science by deepening our understanding of the roles of context, the interactions between context and facilitation, and their influence on resident and staff quality outcomes. Importantly, findings will inform understanding of the mechanisms by which context and facilitation affect the success of implementation and offer insights into factors that influence the implementation success of interventions in nursing homes. International Registered Report Identifier (IRRID): DERR1-10.2196/40611 %M 36107475 %R 10.2196/40611 %U https://www.researchprotocols.org/2022/9/e40611 %U https://doi.org/10.2196/40611 %U http://www.ncbi.nlm.nih.gov/pubmed/36107475 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e39910 %T Enrollment and Retention of Participants in Remote Digital Health Studies: Scoping Review and Framework Proposal %A Daniore,Paola %A Nittas,Vasileios %A von Wyl,Viktor %+ Institute for Implementation Science in Healthcare, University of Zurich, Universitatstrasse 84, Zurich, 8006, Switzerland, 41 0446343762, viktor.vonwyl@uzh.ch %K remote digital health studies %K remote clinical trials %K remote cohorts %K digital epidemiology %K digital health %K health outcome %K conceptual framework %K user-centered design %K population-based digital health %K participant recruitment %K interventional study %D 2022 %7 9.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies are increasingly used in health research to collect real-world data from wider populations. A new wave of digital health studies relies primarily on digital technologies to conduct research entirely remotely. Remote digital health studies hold promise to significant cost and time advantages over traditional, in-person studies. However, such studies have been reported to typically suffer from participant attrition, the sources for which are still largely understudied. Objective: To contribute to future remote digital health study planning, we present a conceptual framework and hypotheses for study enrollment and completion. The framework introduces 3 participation criteria that impact remote digital health study outcomes: (1) participant motivation profile and incentives or nudges, (2) participant task complexity, and (3) scientific requirements. The goal of this study is to inform the planning and implementation of remote digital health studies from a person-centered perspective. Methods: We conducted a scoping review to collect information on participation in remote digital health studies, focusing on methodological aspects that impact participant enrollment and retention. Comprehensive searches were conducted on the PubMed, CINAHL, and Web of Science databases, and additional sources were included in our study from citation searching. We included digital health studies that were fully conducted remotely, included information on at least one of the framework criteria during recruitment, onboarding or retention phases of the studies, and included study enrollment or completion outcomes. Qualitative analyses were performed to synthesize the findings from the included studies. Results: We report qualitative findings from 37 included studies that reveal high values of achieved median participant enrollment based on target sample size calculations, 128% (IQR 100%-234%), and median study completion, 48% (IQR 35%-76%). Increased median study completion is observed for studies that provided incentives or nudges to extrinsically motivated participants (62%, IQR 43%-78%). Reducing task complexity for participants in the absence of incentives or nudges did not improve median study enrollment (103%, IQR 102%-370%) or completion (43%, IQR 22%-60%) in observational studies, in comparison to interventional studies that provided more incentives or nudges (median study completion rate of 55%, IQR 38%-79%). Furthermore, there were inconsistencies in measures of completion across the assessed remote digital health studies, where only around half of the studies with completion measures (14/27, 52%) were based on participant retention throughout the study period. Conclusions: Few studies reported on participatory factors and study outcomes in a consistent manner, which may have limited the evidence base for our study. Our assessment may also have suffered from publication bias or unrepresentative study samples due to an observed preference for participants with digital literacy skills in digital health studies. Nevertheless, we find that future remote digital health study planning can benefit from targeting specific participant profiles, providing incentives and nudges, and reducing study complexity to improve study outcomes. %M 36083626 %R 10.2196/39910 %U https://www.jmir.org/2022/9/e39910 %U https://doi.org/10.2196/39910 %U http://www.ncbi.nlm.nih.gov/pubmed/36083626 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e35693 %T The Challenges Toward Real-world Implementation of Digital Health Design Approaches: Narrative Review %A Duffy,Anthony %A Christie,Gregory J %A Moreno,Sylvain %+ School of Interactive Arts & Technology, Simon Fraser University, 13450 102 Ave #250, Surrey, BC, V3T 0A3, Canada, 1 7787829742, sylvain_moreno@sfu.ca %K digital health %K end users %K user experience %K health behavior %K intervention %K co-design %K mobile health %K mobile phone %D 2022 %7 9.9.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Digital health represents an important strategy in the future of health care delivery. Over the past decade, mobile health has accelerated the agency of health care users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability, and patient outcome. This challenge is confounded by 2 industries, digital and health, which have vastly different approaches to research, design, testing, and implementation. In this regard, there is a need to examine prevailing design approaches, weigh their benefits and challenges toward implementation, and recommend a path forward that synthesizes the needs of this complex stakeholder group. Objective: In this review, we aimed to study prominent digital health intervention design approaches that mediate the digital health space. In doing so, we sought to examine the origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios of each methodology. Methods: A narrative review of digital health design approaches was performed between September 2020 and April 2021 by referencing keywords such as “digital health design,” “mHealth design,” “e-Health design,” “agile health,” and “agile healthcare.” The studies selected after screening were those that discussed the design and implementation of digital health design approaches. A total of 120 studies were selected for full-text review, of which 62 (51.6%) were selected for inclusion in this review. Results: A review identifying the 5 overarching digital health design approaches was compiled: user-centered design, person-based design, human-centered design, patient-centered design, and patient-led design. The findings were synthesized in a narrative structure discussing the origins, advantages, disadvantages, challenges, and potential use-case scenarios. Conclusions: Digital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented to harmonize the needs of a complex stakeholder group. Whether the end user is positioned as a person, patient, or user, the challenge to synthesize the constraints and affordances of both digital design and health care, built equally around user satisfaction and clinical efficacy, remains paramount. Further research that works toward a transdisciplinarity in digital health may help break down friction in this field. Until digital health is viewed as a hybridized industry with unique requirements rather than one with competing interests, the nuances that each design approach posits will be difficult to realize in a real-world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, to create a better digital health culture and design ethos. %M 36083628 %R 10.2196/35693 %U https://humanfactors.jmir.org/2022/3/e35693 %U https://doi.org/10.2196/35693 %U http://www.ncbi.nlm.nih.gov/pubmed/36083628 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e35577 %T User Experience of the Co-design Research Approach in eHealth: Activity Analysis With the Course-of-Action Framework %A Tremblay,Melanie %A Hamel,Christine %A Viau-Guay,Anabelle %A Giroux,Dominique %+ Department of Teaching and Learning Studies, Laval University, 2325 Rue de l'Université, Québec, QC, G1V 0A6, Canada, 1 (418) 656 2131, melanie.tremblay.50@ulaval.ca %K co-design %K caregivers %K activity analysis %K course-of-action framework %K participant experience %K intrinsic description %K guidelines %K affordances %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The cocreation of eHealth solutions with potential users, or co-design, can help make the solution more acceptable. However, the co-design research approach requires substantial investment, and projects are not always fruitful. Researchers have provided guidelines for the co-design approach, but these are either applicable only in specific situations or not supported by empirical data. Ways to optimize the experience of the co-design process from the point of view of the participants are also missing. Scientific literature in the co-design field generally provides an extrinsic description of the experience of participants in co-design projects. Objective: We addressed this issue by describing a co-design project and focusing on the participants’ experiences looking at what was significant from their point of view. Methods: We used a qualitative situated cognitive anthropology approach for this study. Data were collected on a co-design research project that aimed to support the help-seeking process of caregivers of functionally dependent older adults. The methodology was based on the perspective of experience by Dewey and used the course-of-action theoretical and methodological framework. Data collection was conducted in 2 phases: observation of participants and recording of sessions and participant self-confrontation interviews using the session recordings. We interviewed 27% (20/74) of the participants. We analyzed the data through nonexclusive emerging categorization of themes using the constant comparative method. Results: In total, 5 emerging themes were identified. The perception of extrinsic constraints and the effects of the situation was central and the most important theme, affecting other themes (frustrating interactions with others, learning together, destabilization, and getting personal benefits). Co-occurrences between codes allowed for a visual and narrative understanding of what was significant for the participants during this project. The results highlighted the importance of the role of the research team in preparing and moderating the sessions. They also provided a detailed description of the interactions between participants during the sessions, which is a core aspect of the co-design approach. There were positive and negative aspects of the participants’ experiences during this co-design project. Reflecting on our results, we provided potential affordances to shape the experience of participants in co-design. Conclusions: Potential users are an essential component of the co-design research approach. Researchers and designers should seek to offer these users a positive and contributory experience to encourage participation in further co-design initiatives. Future research should explore how the proposed affordances influence the success of the intervention. %M 35943783 %R 10.2196/35577 %U https://humanfactors.jmir.org/2022/3/e35577 %U https://doi.org/10.2196/35577 %U http://www.ncbi.nlm.nih.gov/pubmed/35943783 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 8 %P e35726 %T Harnessing the Electronic Health Care Record to Optimize Patient Safety in Primary Care: Framework for Evaluating e–Safety-Netting Tools %A Black,Georgia Bell %A Bhuiya,Afsana %A Friedemann Smith,Claire %A Hirst,Yasemin %A Nicholson,Brian David %+ Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 2031083157, g.black@ucl.ac.uk %K primary care %K patient safety %K electronic health record %K safety %K optimize %K framework %K evaluation %K tool %K diagnostic %K uncertainty %K management %K netting %K software %K criteria %D 2022 %7 1.8.2022 %9 Viewpoint %J JMIR Med Inform %G English %X The management of diagnostic uncertainty is part of every primary care physician’s role. e–Safety-netting tools help health care professionals to manage diagnostic uncertainty. Using software in addition to verbal or paper based safety-netting methods could make diagnostic delays and errors less likely. There are an increasing number of software products that have been identified as e–safety-netting tools, particularly since the start of the COVID-19 pandemic. e–Safety-netting tools can have a variety of functions, such as sending clinician alerts, facilitating administrative tasking, providing decision support, and sending reminder text messages to patients. However, these tools have not been evaluated by using robust research designs for patient safety interventions. We present an emergent framework of criteria for effective e–safety-netting tools that can be used to support the development of software. The framework is based on validated frameworks for electronic health record development and patient safety. There are currently no tools available that meet all of the criteria in the framework. We hope that the framework will stimulate clinical and public conversations about e–safety-netting tools. In the future, a validated framework would drive audits and improvements. We outline key areas for future research both in primary care and within integrated care systems. %M 35916722 %R 10.2196/35726 %U https://medinform.jmir.org/2022/8/e35726 %U https://doi.org/10.2196/35726 %U http://www.ncbi.nlm.nih.gov/pubmed/35916722 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e37338 %T Using an Integrated Framework to Investigate the Facilitators and Barriers of Health Information Technology Implementation in Noncommunicable Disease Management: Systematic Review %A Sung,Meekang %A He,Jinyu %A Zhou,Qi %A Chen,Yaolong %A Ji,John S %A Chen,Haotian %A Li,Zhihui %+ Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 10084, China, 86 13718264652, zhihuili@mail.tsinghua.edu.cn %K health information technology %K noncommunicable disease management %K chronic disease management %K systematic review %K implementation science %D 2022 %7 20.7.2022 %9 Review %J J Med Internet Res %G English %X Background: Noncommunicable disease (NCD) management is critical for reducing attributable health burdens. Although health information technology (HIT) is a crucial strategy to improve chronic disease management, many health care systems have failed in implementing HIT. There has been a lack of research on the implementation process of HIT for chronic disease management. Objective: We aimed to identify the barriers and facilitators of HIT implementation, analyze how these factors influence the implementation process, and identify key areas for future action. We will develop a framework for understanding implementation determinants to synthesize available evidence. Methods: We conducted a systematic review to understand the barriers and facilitators of the implementation process. We searched MEDLINE, Cochrane, Embase, Scopus, and CINAHL for studies published between database inception and May 5, 2022. Original studies involving HIT-related interventions for NCD management published in peer-reviewed journals were included. Studies that did not discuss relevant outcome measures or did not have direct contact with or observation of stakeholders were excluded. The analysis was conducted in 2 parts. In part 1, we analyzed how the intrinsic attributes of HIT interventions affect the successfulness of implementation by using the intervention domain of the Consolidated Framework for Implementation Research (CFIR). In part 2, we focused on the extrinsic factors of HIT using an integrated framework, which was developed based on the CFIR and the levels of change framework by Ferlie and Shortell. Results: We identified 51 papers with qualitative, mixed-method, and cross-sectional methodologies. Included studies were heterogeneous regarding disease populations and HIT interventions. In part 1, having a relative advantage over existing health care systems was the most prominent intrinsic facilitator (eg, convenience, improvement in quality of care, and increase in access). Poor usability was the most noted intrinsic barrier of HIT. In part 2, we mapped the various factors of implementation to the integrated framework (the coordinates are shown as level of change-CFIR). The key barriers to the extrinsic factors of HIT included health literacy and lack of digital skills (individual-characteristics of individuals). The key facilitators included physicians’ suggestions, cooperation (interpersonal-process), integration into a workflow, and adequate management of data (organizational-inner setting). The importance of health data security was identified. Self-efficacy issues of patients and organizational readiness for implementation were highlighted. Conclusions: Internal factors of HIT and external human factors of implementation interplay in HIT implementation for chronic disease management. Strategies for improvement include ensuring HIT has a relative advantage over existing health care; tackling usability issues; and addressing underlying socioeconomic, interpersonal, and organizational conditions. Further research should focus on studying various stakeholders, such as service providers and administrative workforces; various disease populations, such as those with obesity and mental diseases; and various countries, including low- and middle-income countries. %M 35857364 %R 10.2196/37338 %U https://www.jmir.org/2022/7/e37338 %U https://doi.org/10.2196/37338 %U http://www.ncbi.nlm.nih.gov/pubmed/35857364 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e31921 %T What are Digital Public Health Interventions? First Steps Toward a Definition and an Intervention Classification Framework %A Wienert,Julian %A Jahnel,Tina %A Maaß,Laura %+ Health Psychology, Social Sciences, IU International University for Applied Sciences, Kaiserplatz 1, Bad Reichenhall, 83435, Germany, 49 1725858645, julian.wienert@iu.org %K digital health %K digital Public Health %K digital public health interventions %K digital health technologies %K mHealth %K eHealth %K participatory approach %K framework %K mobile phone %D 2022 %7 28.6.2022 %9 Viewpoint %J J Med Internet Res %G English %X Digital public health is an emerging field in population-based research and practice. The fast development of digital technologies provides a fundamentally new understanding of improving public health by using digitalization, especially in prevention and health promotion. The first step toward a better understanding of digital public health is to conceptualize the subject of the assessment by defining what digital public health interventions are. This is important, as one cannot evaluate tools if one does not know what precisely an intervention in this field can be. Therefore, this study aims to provide the first definition of digital public health interventions. We will merge leading models for public health functions by the World Health Organization, a framework for digital health technologies by the National Institute for Health and Care Excellence, and a user-centered approach to intervention development. Together, they provide an overview of the functions and areas of use for digital public health interventions. Nevertheless, one must keep in mind that public health functions can differ among different health care systems, limiting our new framework’s universal validity. We conclude that a digital public health intervention should address essential public health functions through digital means. Furthermore, it should include members of the target group in the development process to improve social acceptance and achieve a population health impact. %M 35763320 %R 10.2196/31921 %U https://www.jmir.org/2022/6/e31921 %U https://doi.org/10.2196/31921 %U http://www.ncbi.nlm.nih.gov/pubmed/35763320 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32577 %T Using the Consolidated Framework for Implementation Research to Inform the Design of the Mobile Inspección Visual con Ácido Acético System: Mixed Methods Case Study %A Reid,Hadley Woodruff %A Proeschold-Bell,Rae Jean %A Makarushka,Christina %A Melgar Vega,Katherine Dayllan %A Huchko,Megan %A Jeronimo,Jose %A Vasudevan,Lavanya %+ Department of Family Medicine and Community Health, Duke University, Suite 600, 2200 West Main Street, Durham, NC, 27705, United States, 1 919 613 1423, lavanya.vasudevan@duke.edu %K cervical cancer %K mobile health %K Peru %K colposcopy %K implementation science %K Consolidated Framework for Implementation Research %K CFIR %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing evidence supporting the use of mobile health (mHealth) interventions in low- and middle-income countries to address resource limitations in the delivery of health information and services to vulnerable populations. In parallel, there is an increasing emphasis on the use of implementation science tools and frameworks for the early identification of implementation barriers and to improve the acceptability, appropriateness, and adoption of mHealth interventions in resource-limited settings. However, there are limited examples of the application of implementation science tools and frameworks to the formative phase of mHealth design for resource-limited settings despite the potential benefits of this work for enhancing subsequent implementation, scale-up, and sustainability. Objective: We presented a case study on the use of an implementation science framework in mHealth design. In particular, we illustrated the usability of the Consolidated Framework for Implementation Research (CFIR) for organizing and interpreting formative research findings during the design of the mobile Inspección Visual con Ácido Acético (mIVAA) system in Lima, Peru. Methods: We collected formative data from prospective users of the mIVAA intervention using multiple research methodologies, including structured observations, surveys, group and individual interviews, and discussions with local stakeholders at the partnering organization in Peru. These activities enabled the documentation of clinical workflows, perceived barriers to and facilitators of mIVAA, overarching barriers to cervical cancer screening in community-based settings, and related local policies and guidelines in health care. Using a convergent mixed methods analytic approach and the CFIR as an organizing framework, we mapped formative research findings to identify key implementation barriers and inform iterations of the mIVAA system design. Results: In the setting of our case study, most implementation barriers were identified in the CFIR domains of intervention characteristics and inner setting. All but one barrier were addressed before mIVAA deployment by modifying the system design and adding supportive resources. Solutions involved improvements to infrastructure, including cellular data plans to avoid disruption from internet failure; improved process and flow, including an updated software interface; and better user role definition for image capture to be consistent with local health care laws. Conclusions: The CFIR can serve as a comprehensive framework for organizing formative research data and identifying key implementation barriers during mHealth intervention design. In our case study of the mIVAA system in Peru, formative research contributing to the CFIR domains of intervention characteristics and inner setting elicited the most key barriers to implementation. The early identification of barriers enabled design iterations before system deployment. Future efforts to develop mHealth interventions for low- and middle-income countries may benefit from using the approach presented in this case study as well as prioritizing the CFIR domains of intervention characteristics and inner setting. %M 35737455 %R 10.2196/32577 %U https://formative.jmir.org/2022/6/e32577 %U https://doi.org/10.2196/32577 %U http://www.ncbi.nlm.nih.gov/pubmed/35737455 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35421 %T Toward an Ecologically Valid Conceptual Framework for the Use of Artificial Intelligence in Clinical Settings: Need for Systems Thinking, Accountability, Decision-making, Trust, and Patient Safety Considerations in Safeguarding the Technology and Clinicians %A Choudhury,Avishek %+ Industrial and Management Systems Engineering, Benjamin M Statler College of Engineering and Mineral Resources, West Virginia University, 1306 Evansdale Drive, PO Box 6107, Morgantown, WV, 26506-6107, United States, 1 5156080777, avishek.choudhury@mail.wvu.edu %K health care %K artificial intelligence %K ecological validity %K trust in AI %K clinical workload %K patient safety %K AI accountability %K reliability %D 2022 %7 21.6.2022 %9 Viewpoint %J JMIR Hum Factors %G English %X The health care management and the medical practitioner literature lack a descriptive conceptual framework for understanding the dynamic and complex interactions between clinicians and artificial intelligence (AI) systems. As most of the existing literature has been investigating AI’s performance and effectiveness from a statistical (analytical) standpoint, there is a lack of studies ensuring AI’s ecological validity. In this study, we derived a framework that focuses explicitly on the interaction between AI and clinicians. The proposed framework builds upon well-established human factors models such as the technology acceptance model and expectancy theory. The framework can be used to perform quantitative and qualitative analyses (mixed methods) to capture how clinician-AI interactions may vary based on human factors such as expectancy, workload, trust, cognitive variables related to absorptive capacity and bounded rationality, and concerns for patient safety. If leveraged, the proposed framework can help to identify factors influencing clinicians’ intention to use AI and, consequently, improve AI acceptance and address the lack of AI accountability while safeguarding the patients, clinicians, and AI technology. Overall, this paper discusses the concepts, propositions, and assumptions of the multidisciplinary decision-making literature, constituting a sociocognitive approach that extends the theories of distributed cognition and, thus, will account for the ecological validity of AI. %M 35727615 %R 10.2196/35421 %U https://humanfactors.jmir.org/2022/2/e35421 %U https://doi.org/10.2196/35421 %U http://www.ncbi.nlm.nih.gov/pubmed/35727615 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e37677 %T Assessing the Clinical Robustness of Digital Health Startups: Cross-sectional Observational Analysis %A Day,Sean %A Shah,Veeraj %A Kaganoff,Sari %A Powelson,Shannon %A Mathews,Simon C %+ Division of Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, United States, 1 410 955 5000, smathe14@jhmi.edu %K digital health %K health tech %K software as a medical device (SaaMD) %K real-world evidence %K venture capital %D 2022 %7 20.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The digital health sector has experienced rapid growth over the past decade. However, health care technology stakeholders lack a comprehensive understanding of clinical robustness and claims across the industry. Objective: This analysis aimed to examine the clinical robustness and public claims made by digital health companies. Methods: A cross-sectional observational analysis was conducted using company data from the Rock Health Digital Health Venture Funding Database, the US Food and Drug Administration, and the US National Library of Medicine. Companies were included if they sell products targeting the prevention, diagnosis, or treatment phases of the care continuum. Clinical robustness was defined using regulatory filings and clinical trials completed by each company. Public claims data included clinical, economic, and engagement claims regarding product outcomes made by each company on its website. Results: A total of 224 digital health companies with an average age of 7.7 years were included in our cohort. Average clinical robustness was 2.5 (1.8 clinical trials and 0.8 regulatory filings) with a median score of 1. Ninety-eight (44%) companies had a clinical robustness score of 0, while 45 (20%) companies had a clinical robustness score of 5 or more. The average number of public claims was 1.3 (0.5 clinical, 0.4 economic, and 0.4 engagement); the median number of claims was 1. No correlation was observed between clinical robustness and number of clinical claims (r2=0.02), clinical robustness and total funding (r2=0.08), or clinical robustness and company age (r2=0.18). Conclusions: Many digital health companies have a low level of clinical robustness and do not make many claims as measured by regulatory filings, clinical trials, and public data shared online. Companies and customers may benefit from investing in greater clinical validation efforts. %M 35723914 %R 10.2196/37677 %U https://www.jmir.org/2022/6/e37677 %U https://doi.org/10.2196/37677 %U http://www.ncbi.nlm.nih.gov/pubmed/35723914 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e35337 %T User Requirements for Comanaged Digital Health and Care: Review %A Chute,Chaloner %A French,Tara %A Raman,Sneha %A Bradley,Jay %+ The Digital Health & Care Innovation Centre, University of Strathclyde, 1st Floor, Suite B, Inovo Building, 121 George Street, Glasgow, G1 1RD, United Kingdom, 44 01414447074, chalonerchute@dhi-scotland.com %K delivery of health care %K integrated %K patient-centered care %K digital technology %K decision-making %K health services accessibility %K trust %K mHealth %K eHealth %K telehealth %D 2022 %7 10.6.2022 %9 Review %J J Med Internet Res %G English %X Background: The sustainability of health and social care has led to an imperative to shift the balance of care to communities and support person-centered, integrated, preventive, comanaged, and sustainable care. The digital tool set can support this shift; however, it must extend beyond a clinical focus to include broader personal, social, and environmental needs, experiences, and outcomes. The existing digital health and care design and user requirements literature focuses mainly on specific digital products or design methods. There is little whole-system or whole-of-life consideration, which is crucial to enacting more significant transformations that span different groups and domains. Objective: This study aimed to present a set of recurring user requirements and themes for comanaged digital health and care services derived from the body of co-design projects within a digital health and care program. This study aimed to enable people and organizations looking to reorient their approach to health and care research and delivery from a system-led and condition-specific approach to a more person-centric, whole-of-life model. Methods: Participatory design formed the core methodological approach in underlying the design research, from which user requirements were derived. The process of surfacing requirements involved a selection framework for the identification of eligible projects and a structured review process to consolidate user requirements. Results: This paper presents a set of 14 common user requirements that resulted from a review of co-design projects. The findings demonstrate overlapping and reinforcing sets of needs from citizens and care professionals related to how data are comanaged to improve care and outcomes. This paper discusses the alignment, contrasts, and gaps with broader, comparable literature. It highlights consensus around requirements for personal health storytelling, sharing data on care experiences and how this can support personalized guidance, visualize trends to support decision-making, and generally improve dialog between a citizen and care professionals. These findings identify gaps around how groups and networks of people engage, posing difficult questions for people designing support services as some of the user requirements are not easily met by organizations operating in silos. Conclusions: This study proposes future recommendations for citizens as active, informed, and consenting partners using new forms of privacy-preserving digital infrastructure that puts the citizen in firm control. It is also recommended that these findings be used by people developing new digital services to ensure that they can start with knowledge of the broader user requirement context. This should inform domain-specific research and development questions and processes. Further work is needed to extend these common requirements to more explicitly consider the trust framework required when citizens comanage their data and care across a broad range of formal and informal actors. Consideration of how authority, delegation, and trust function between members of the public will be critical. %M 35687379 %R 10.2196/35337 %U https://www.jmir.org/2022/6/e35337 %U https://doi.org/10.2196/35337 %U http://www.ncbi.nlm.nih.gov/pubmed/35687379 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 7 %N 1 %P e36734 %T A Novel Framework for Mixed Reality–Based Control of Collaborative Robot: Development Study %A Shahria,Md Tanzil %A Sunny,Md Samiul Haque %A Zarif,Md Ishrak Islam %A Khan,Md Mahafuzur Rahaman %A Modi,Preet Parag %A Ahamed,Sheikh Iqbal %A Rahman,Mohammad H %+ Department of Computer Science, University of Wisconsin-Milwaukee, 3200 N Cramer Street, Milwaukee, WI, 53211, United States, 1 4147376701, mshahria@uwm.edu %K robot framework %K mixed reality %K collaborative robot %K Unity %K Windows Mixed Reality %K Azure mixed reality services %K HoloLens 2 %D 2022 %7 17.5.2022 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Applications of robotics in daily life are becoming essential by creating new possibilities in different fields, especially in the collaborative environment. The potentials of collaborative robots are tremendous as they can work in the same workspace as humans. A framework employing a top-notch technology for collaborative robots will surely be worthwhile for further research. Objective: This study aims to present the development of a novel framework for the collaborative robot using mixed reality. Methods: The framework uses Unity and Unity Hub as a cross-platform gaming engine and project management tool to design the mixed reality interface and digital twin. It also uses the Windows Mixed Reality platform to show digital materials on holographic display and the Azure mixed reality services to capture and expose digital information. Eventually, it uses a holographic device (HoloLens 2) to execute the mixed reality–based collaborative system. Results: A thorough experiment was conducted to validate the novel framework for mixed reality–based control of a collaborative robot. This framework was successfully applied to implement a collaborative system using a 5–degree of freedom robot (xArm-5) in a mixed reality environment. The framework was stable and worked smoothly throughout the collaborative session. Due to the distributed nature of cloud applications, there is a negligible latency between giving a command and the execution of the physical collaborative robot. Conclusions: Opportunities for collaborative robots in telerehabilitation and teleoperation are vital as in any other field. The proposed framework was successfully applied in a collaborative session, and it can also be applied in other similar potential applications for robust and more promising performance. %M 38875679 %R 10.2196/36734 %U https://biomedeng.jmir.org/2022/1/e36734 %U https://doi.org/10.2196/36734 %U http://www.ncbi.nlm.nih.gov/pubmed/38875679 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e27707 %T The Role of Emotion Regulation and Loss-Related Coping Self-efficacy in an Internet Intervention for Grief: Mediation Analysis %A Brodbeck,Jeannette %A Berger,Thomas %A Biesold,Nicola %A Rockstroh,Franziska %A Schmidt,Stefanie J %A Znoj,Hansjoerg %+ Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland, 41 316843805, jeannette.brodbeck@unibe.ch %K grief %K divorce %K separation %K bereavement %K internet intervention %K emotion regulation %K coping self-efficacy %K mediation %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet interventions for mental disorders and psychological problems such as prolonged grief have established their efficacy. However, little is known about how internet interventions work and the mechanisms through which they are linked to the outcomes. Objective: As a first step in identifying mechanisms of change, this study aimed to examine emotion regulation and loss-related coping self-efficacy as putative mediators in a randomized controlled trial of a guided internet intervention for prolonged grief symptoms after spousal bereavement or separation or divorce. Methods: The sample comprised older adults who reported prolonged grief or adaptation problems after bereavement, separation, or divorce and sought help from a guided internet intervention. They were recruited mainly via newspaper articles. The outcome variables were grief symptoms assessed using the Texas Revised Inventory of Grief and psychopathology symptoms assessed using the Brief Symptom Inventory. A total of 6 module-related items assessed loss-focused emotion regulation and loss-related coping self-efficacy. In the first step, path models were used to examine emotion regulation and loss-related coping self-efficacy as single mediators for improvements in grief and psychopathology symptoms. Subsequently, exploratory path models with the simultaneous inclusion of emotion regulation and self-efficacy were used to investigate the specificity and relative strength of these variables as parallel mediators. Results: A total of 100 participants took part in the guided internet intervention. The average age was 51.11 (SD 13.60) years; 80% (80/100) were separated or divorced, 69% (69/100) were female, and 76% (76/100) were of Swiss origin. The internet intervention increased emotion regulation skills (β=.33; P=.001) and loss-related coping self-efficacy (β=.30; P=.002), both of which correlated with improvements in grief and psychopathology symptoms. Path models suggested that emotion regulation and loss-related coping self-efficacy were mediators for improvement in grief. Emotion regulation showed a significant indirect effect (β=.13; P=.009), whereas coping self-efficacy showed a trend (β=.07; P=.06). Both were confirmed as mediators for psychopathology (β=.12, P=.02; β=.10; P=.02, respectively). The path from the intervention to the improvement in grief remained significant when including the mediators (β=.26, P=.004; β=.32, P≤.001, respectively) in contrast to the path from the intervention to improvements in psychopathology (β=.15, P=.13; β=.16, P=.10, respectively). Conclusions: Emotion regulation and loss-related coping self-efficacy are promising therapeutic targets for optimizing internet interventions for grief. Both should be further examined as transdiagnostic or disorder-specific putative mediators in internet interventions for other disorders. Trial Registration: ClinicalTrials.gov NCT02900534; https://clinicaltrials.gov/ct2/show/NCT02900534 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-016-1759-5 %M 35522459 %R 10.2196/27707 %U https://mental.jmir.org/2022/5/e27707 %U https://doi.org/10.2196/27707 %U http://www.ncbi.nlm.nih.gov/pubmed/35522459 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e36775 %T Therapeutic Alliance in Online and Face-to-face Psychological Treatment: Comparative Study %A Mercadal Rotger,Josep %A Cabré,Victor %+ Institut Universitari de Salut Mental Vidal i Barraquer, Universitat Ramon Llull, C/ Sant Gervasi de Cassoles 88-90, Barcelona, 08022, Spain, 34 660221557, jmercadal@fvb.cat %K online psychological intervention %K therapeutic alliance %K digital health %K mental health %K mental health education %K mental health treatment %K health interventions %K health professional %K online health %K web-based health %K intervention modality %D 2022 %7 2.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Since the COVID-19 pandemic, the number of online mental health treatments have grown exponentially. Additionally, it seems inevitable that this technical resource is here to stay at health centers. However, there is still very little scholarly literature published on this topic, and therefore, the impact of the changes that have had to be dealt with in this regard has not been studied. Objective: This study aims to evaluate the differences in the establishment of the therapeutic alliance (TA) based on the intervention modality (online or face-to-face), the type of attachment, and diagnosis. Methods: A total of 291 subjects participated in the study, 149 (51.2%) of whom were men and 142 were (48.8%) women between the ages of 18 and 30 years. The instruments used were sociodemographic data, SOFTA-o (System for Observing Family Therapeutic Alliances—observational), and Relationship Questionnaire. Results: The results show that the treatments conducted face-to-face obtain significantly better scores in the creation of the TA than those conducted online (t=–42.045, df=289, P<.001). The same holds true with attachment, in that users with secure attachment show a better TA than those with insecure attachment (t=6.068, P<.001,), although there were no significant differences with the diagnosis (F=4.566, P=.44), age (r=0.02, P=.70), and sex (t=0.217, P=.33). Conclusions: We believe that professionals are not yet prepared to conduct remote treatment with a degree of efficacy similar to that of face-to-face. It is essential for professionals to receive training in this new technical resource and to understand and incorporate the variants it entails into their daily practice. %M 35499910 %R 10.2196/36775 %U https://mental.jmir.org/2022/5/e36775 %U https://doi.org/10.2196/36775 %U http://www.ncbi.nlm.nih.gov/pubmed/35499910 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e30898 %T Social Networking Service, Patient-Generated Health Data, and Population Health Informatics: National Cross-sectional Study of Patterns and Implications of Leveraging Digital Technologies to Support Mental Health and Well-being %A Ye,Jiancheng %A Wang,Zidan %A Hai,Jiarui %+ Feinberg School of Medicine, Northwestern University, 633 N. Saint Clair St, Chicago, IL, 60611, United States, 1 312 503 3690, jiancheng.ye@u.northwestern.edu %K patient-generated health data %K social network %K population health informatics %K mental health %K social determinants of health %K health data sharing %K technology acceptability %K mobile phone %K mobile health %D 2022 %7 29.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The emerging health technologies and digital services provide effective ways of collecting health information and gathering patient-generated health data (PGHD), which provide a more holistic view of a patient’s health and quality of life over time, increase visibility into a patient’s adherence to a treatment plan or study protocol, and enable timely intervention before a costly care episode. Objective: Through a national cross-sectional survey in the United States, we aimed to describe and compare the characteristics of populations with and without mental health issues (depression or anxiety disorders), including physical health, sleep, and alcohol use. We also examined the patterns of social networking service use, PGHD, and attitudes toward health information sharing and activities among the participants, which provided nationally representative estimates. Methods: We drew data from the 2019 Health Information National Trends Survey of the National Cancer Institute. The participants were divided into 2 groups according to mental health status. Then, we described and compared the characteristics of the social determinants of health, health status, sleeping and drinking behaviors, and patterns of social networking service use and health information data sharing between the 2 groups. Multivariable logistic regression models were applied to assess the predictors of mental health. All the analyses were weighted to provide nationally representative estimates. Results: Participants with mental health issues were significantly more likely to be younger, White, female, and lower-income; have a history of chronic diseases; and be less capable of taking care of their own health. Regarding behavioral health, they slept <6 hours on average, had worse sleep quality, and consumed more alcohol. In addition, they were more likely to visit and share health information on social networking sites, write online diary blogs, participate in online forums or support groups, and watch health-related videos. Conclusions: This study illustrates that individuals with mental health issues have inequitable social determinants of health, poor physical health, and poor behavioral health. However, they are more likely to use social networking platforms and services, share their health information, and actively engage with PGHD. Leveraging these digital technologies and services could be beneficial for developing tailored and effective strategies for self-monitoring and self-management. %M 35486428 %R 10.2196/30898 %U https://www.jmir.org/2022/4/e30898 %U https://doi.org/10.2196/30898 %U http://www.ncbi.nlm.nih.gov/pubmed/35486428 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e36338 %T A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States %A Krishnamurti,Tamar %A Birru Talabi,Mehret %A Callegari,Lisa S %A Kazmerski,Traci M %A Borrero,Sonya %+ Division of General Internal Medicine, University of Pittsburgh, 200 Meyran Avenue, Suite 200, Pittsburgh, PA, 15213, United States, 1 4126924855, tamark@pitt.edu %K United States %K North America %K femtech %K mHealth %K health equity %K pregnancy %K women's health %K preterm birth %K contraception %K family planning %K reproductive care %K sterilization %K cystic fibrosis %K rheumatic disease %K eHealth %K mobile health %K reproductive health %K digital health %K health technology %K health outcomes %D 2022 %7 28.4.2022 %9 Viewpoint %J J Med Internet Res %G English %X The United States has abysmal reproductive health indices that, in part, reflect stark inequities experienced by people of color and those with preexisting medical conditions. The growth of “femtech,” or technology-based solutions to women’s health issues, in the public and private sectors is promising, yet these solutions are often geared toward health-literate, socioeconomically privileged, and/or relatively healthy white cis-women. In this viewpoint, we propose a set of guiding principles for building technologies that proactively identify and address these critical gaps in health care for people from socially and economically marginalized populations that are capable of pregnancy, as well as people with serious chronic medical conditions. These guiding principles require that such technologies: (1) include community stakeholders in the design, development, and deployment of the technology; (2) are grounded in person-centered frameworks; and (3) address health disparities as a strategy to advance health equity and improve health outcomes. %M 35482371 %R 10.2196/36338 %U https://www.jmir.org/2022/4/e36338 %U https://doi.org/10.2196/36338 %U http://www.ncbi.nlm.nih.gov/pubmed/35482371 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e33502 %T Toward Human Digital Twins for Cybersecurity Simulations on the Metaverse: Ontological and Network Science Approach %A Nguyen,Tam N %+ Department of Management Information Systems, University of Arizona, 1130 E Helen St, PO Box 210108, Tucson, AZ, 85721-0108, United States, 1 970 404 1232, tamn@email.arizona.edu %K human behavior modeling %K cognitive twins %K human digital twins %K cybersecurity %K cognitive systems %K digital twins %K Metaverse %K artificial intelligence %D 2022 %7 20.4.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Cyber defense is reactive and slow. On average, the time-to-remedy is hundreds of times larger than the time-to-compromise. In response, Human Digital Twins (HDTs) offer the capability of running massive simulations across multiple domains on the Metaverse. Simulated results may predict adversaries' behaviors and tactics, leading to more proactive cyber defense strategies. However, current HDTs’ cognitive architectures are underdeveloped for such use. Objective: This paper aims to make a case for extending the current digital cognitive architectures as the first step toward more robust HDTs that are suitable for realistic Metaverse cybersecurity simulations. Methods: This study formally documented 108 psychology constructs and thousands of related paths based on 20 time-tested psychology theories, all of which were packaged as Cybonto—a novel ontology. Then, this study applied 20 network science centrality algorithms in ranking the Cybonto psychology constructs by their influences. Results: Out of 108 psychology constructs, the top 10 are Behavior, Arousal, Goals, Perception, Self-efficacy, Circumstances, Evaluating, Behavior-Controllability, Knowledge, and Intentional Modality. In this list, only Behaviors, Goals, Perception, Evaluating, and Knowledge are parts of existing digital cognitive architectures. Notably, some of the constructs are not explicitly implemented. Early usability tests demonstrate that Cybonto can also be useful for immediate uses such as manual analysis of hackers’ behaviors and automatic analysis of behavioral cybersecurity knowledge texts. Conclusions: The results call for specific extensions of current digital cognitive architectures such as explicitly implementing more refined structures of Long-term Memory and Perception, placing a stronger focus on noncognitive yet influential constructs such as Arousal, and creating new capabilities for simulating, reasoning about, and selecting circumstances. %M 27666280 %R 10.2196/33502 %U https://med.jmirx.org/2022/2/e33502 %U https://doi.org/10.2196/33502 %U http://www.ncbi.nlm.nih.gov/pubmed/27666280 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e29492 %T Designing a Framework for Remote Cancer Care Through Community Co-design: Participatory Development Study %A Aronoff-Spencer,Eliah %A McComsey,Melanie %A Chih,Ming-Yuan %A Hubenko,Alexandra %A Baker,Corey %A Kim,John %A Ahern,David K %A Gibbons,Michael Christopher %A Cafazzo,Joseph A %A Nyakairu,Pia %A Vanderpool,Robin C %A Mullett,Timothy W %A Hesse,Bradford W %+ Department of Health & Clinical Sciences, College of Health Sciences, University of Kentuck, Lexington, CA, United States, 1 8592297665, timothy.mullett@uky.edu %K cancer care %K distress screening %K human-centered design %K participatory design %K Appalachia %K mobile phone %D 2022 %7 12.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Recent shifts to telemedicine and remote patient monitoring demonstrate the potential for new technology to transform health systems; yet, methods to design for inclusion and resilience are lacking. Objective: The aim of this study is to design and implement a participatory framework to produce effective health care solutions through co-design with diverse stakeholders. Methods: We developed a design framework to cocreate solutions to locally prioritized health and communication problems focused on cancer care. The framework is premised on the framing and discovery of problems through community engagement and lead-user innovation with the hypothesis that diversity and inclusion in the co-design process generate more innovative and resilient solutions. Discovery, design, and development were implemented through structured phases with design studios at various locations in urban and rural Kentucky, including Appalachia, each building from prior work. In the final design studio, working prototypes were developed and tested. Outputs were assessed using the System Usability Scale as well as semistructured user feedback. Results: We co-designed, developed, and tested a mobile app (myPath) and service model for distress surveillance and cancer care coordination following the LAUNCH (Linking and Amplifying User-Centered Networks through Connected Health) framework. The problem of awareness, navigation, and communication through cancer care was selected by the community after framing areas for opportunity based on significant geographic disparities in cancer and health burden resource and broadband access. The codeveloped digital myPath app showed the highest perceived combined usability (mean 81.9, SD 15.2) compared with the current gold standard of distress management for patients with cancer, the paper-based National Comprehensive Cancer Network Distress Thermometer (mean 74.2, SD 15.8). Testing of the System Usability Scale subscales showed that the myPath app had significantly better usability than the paper Distress Thermometer (t63=2.611; P=.01), whereas learnability did not differ between the instruments (t63=–0.311; P=.76). Notable differences by patient and provider scoring and feedback were found. Conclusions: Participatory problem definition and community-based co-design, design-with methods, may produce more acceptable and effective solutions than traditional design-for approaches. %M 35412457 %R 10.2196/29492 %U https://www.jmir.org/2022/4/e29492 %U https://doi.org/10.2196/29492 %U http://www.ncbi.nlm.nih.gov/pubmed/35412457 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e22866 %T Creation of an Evidence-Based Implementation Framework for Digital Health Technology in the Intensive Care Unit: Qualitative Study %A Mosch,Lina Katharina %A Poncette,Akira-Sebastian %A Spies,Claudia %A Weber-Carstens,Steffen %A Schieler,Monique %A Krampe,Henning %A Balzer,Felix %+ Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30450651 ext 767, lina.mosch@charite.de %K digital health %K patient monitoring %K intensive care medicine %K intensive care unit %K technological innovation %K user-centered %K usability %K implementation %K implementation science %K qualitative research %K interview %D 2022 %7 8.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health technologies such as continuous remote monitoring and artificial intelligence–driven clinical decision support systems could improve clinical outcomes in intensive care medicine. However, comprehensive evidence and guidelines for the successful implementation of digital health technologies into specific clinical settings such as the intensive care unit (ICU) are scarce. We evaluated the implementation of a remote patient monitoring platform and derived a framework proposal for the implementation of digital health technology in an ICU. Objective: This study aims to investigate barriers and facilitators to the implementation of a remote patient monitoring technology and to develop a proposal for an implementation framework for digital health technology in the ICU. Methods: This study was conducted from May 2018 to March 2020 during the implementation of a tablet computer–based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of 7 semistructured interviews with clinical ICU stakeholders and descriptive questionnaire data. The results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework. Results: This study revealed an insufficient implementation process due to lack of staff engagement and few perceived benefits from the novel solution. Further implementation barriers were the high staff presence and monitoring coverage in the ICU. The implementation framework includes strategies to be applied before and during implementation, targeting the implementation setting by involving all ICU stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, considering the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects in the ICU. Conclusions: Implementation of digital health in the ICU should involve a thorough preimplementation assessment of the ICU’s need for innovation and its readiness to change, as well as an ongoing evaluation of the implementation conditions. Involvement of all stakeholders, transparent communication, and continuous feedback in an equal atmosphere are essential, but leadership roles must be clearly defined and competently filled. Our proposed framework may guide health care providers with concrete, evidence-based, and step-by-step recommendations for implementation practice, facilitating the introduction of digital health in intensive care. Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 %M 35394445 %R 10.2196/22866 %U https://formative.jmir.org/2022/4/e22866 %U https://doi.org/10.2196/22866 %U http://www.ncbi.nlm.nih.gov/pubmed/35394445 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32619 %T The Rapid Development of Virtual Care Tools in Response to COVID-19: Case Studies in Three Australian Health Services %A Gray,Kathleen %A Chapman,Wendy %A Khan,Urooj R %A Borda,Ann %A Budge,Marc %A Dutch,Martin %A Hart,Graeme K %A Gilbert,Cecily %A Wani,Tafheem Ahmad %+ Centre for Digital Transformation of Health, University of Melbourne, Level 13, 305 Grattan Street, Melbourne, 3000, Australia, 61 3 8344 8936, kgray@unimelb.edu.au %K COVID-19 %K health system innovation %K rapid development and deployment methods %K remote patient monitoring %K software development %D 2022 %7 6.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: News of the impact of COVID-19 around the world delivered a brief opportunity for Australian health services to plan new ways of delivering care to large numbers of people while maintaining staff safety through greater physical separation. The rapid pivot to telemedicine and virtual care provided immediate and longer term benefits; however, such rapid-cycle development also created risks. Objective: The aim of this study was to understand the sociotechnical aspects of the rapid-cycle development of seven different COVID-19 virtual care tools, and to identify enablers, barriers, and risks at three health services in Victoria, Australia. Methods: A qualitative, embedded, multiple case study design was adopted. Researchers from three health services collaborated with university researchers who were independent from those health services to gather and analyze structured interview data from key people involved in either clinical or technical aspects of designing and deploying seven different virtual care tools. Results: The overall objectives of each health service reflected the international requirements for managing large numbers of patients safely but remotely and for protecting staff. However, the governance, digital maturity, and specific use cases at each institution shaped the methodology and specific outcomes required. Dependence on key individuals and their domain knowledge within an existing governance framework generally enabled rapid deployment, but sometimes posed barriers. Existing relationships with technical service developers enabled strong solutions, which in some cases were highly scalable. Conventional project methodologies such as steering committees, scope, budget control, tight functional specification, consumer engagement and codesign, universal accessibility, and postimplementation evaluation were ignored almost universally in this environment. Conclusions: These three health services took a variety of approaches to the rapid-cycle development of virtual care tools to meet their urgent needs for triaging and remote monitoring during the first year of the COVID-19 pandemic. Their experiences provided insights into many social and technical barriers and enablers to the development of virtual care tools. If these are addressed proactively, they will improve clinical governance and technical management of future virtual care. Some changes can be made within individual health services, while others entail health system policy reforms. Enhancing the environment for virtual care tool design and implementation now will yield returns not only during future health emergencies but also in many more routine care settings. %M 35297765 %R 10.2196/32619 %U https://formative.jmir.org/2022/4/e32619 %U https://doi.org/10.2196/32619 %U http://www.ncbi.nlm.nih.gov/pubmed/35297765 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33787 %T From Digital Health to Digital Well-being: Systematic Scoping Review %A Smits,Merlijn %A Kim,Chan Mi %A van Goor,Harry %A Ludden,Geke D S %+ Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, Netherlands, 31 634165922, merlijnsmits@hotmail.com %K well-being %K design %K evaluation %K technology assessment %K digital health %K eHealth %K mHealth %K telehealth %K mobile phone %D 2022 %7 4.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Digital health refers to the proper use of technology for improving the health and well-being of people and enhancing the care of patients through the intelligent processing of clinical and genetic data. Despite increasing interest in well-being in both health care and technology, there is no clear understanding of what constitutes well-being, which leads to uncertainty in how to create well-being through digital health. In an effort to clarify this uncertainty, Brey developed a framework to define problems in technology for well-being using the following four categories: epistemological problem, scope problem, specification problem, and aggregation problem. Objective: This systematic scoping review aims to gain insights into how to define and address well-being in digital health. Methods: We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Papers were identified from 6 databases and included if they addressed the design or evaluation of digital health and reported the enhancement of patient well-being as their purpose. These papers were divided into design and evaluation papers. We studied how the 4 problems in technology for well-being are considered per paper. Results: A total of 117 studies were eligible for analysis (n=46, 39.3% design papers and n=71, 60.7% evaluation papers). For the epistemological problem, the thematic analysis resulted in various definitions of well-being, which were grouped into the following seven values: healthy body, functional me, healthy mind, happy me, social me, self-managing me, and external conditions. Design papers mostly considered well-being as healthy body and self-managing me, whereas evaluation papers considered the values of healthy mind and happy me. Users were rarely involved in defining well-being. For the scope problem, patients with chronic care needs were commonly considered as the main users. Design papers also regularly involved other users, such as caregivers and relatives. These users were often not involved in evaluation papers. For the specification problem, most design and evaluation papers focused on the provision of care support through a digital platform. Design papers used numerous design methods, whereas evaluation papers mostly considered pre-post measurements and randomized controlled trials. For the aggregation problem, value conflicts were rarely described. Conclusions: Current practice has found pragmatic ways of circumventing or dealing with the problems of digital health for well-being. Major differences exist between the design and evaluation of digital health, particularly regarding their conceptualization of well-being and the types of users studied. In addition, we found that current methodologies for designing and evaluating digital health can be improved. For optimal digital health for well-being, multidisciplinary collaborations that move beyond the common dichotomy of design and evaluation are needed. %M 35377328 %R 10.2196/33787 %U https://www.jmir.org/2022/4/e33787 %U https://doi.org/10.2196/33787 %U http://www.ncbi.nlm.nih.gov/pubmed/35377328 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e33145 %T Stakeholder Perspectives on Clinical Decision Support Tools to Inform Clinical Artificial Intelligence Implementation: Protocol for a Framework Synthesis for Qualitative Evidence %A Al-Zubaidy,Mohaimen %A Hogg,HD Jeffry %A Maniatopoulos,Gregory %A Talks,James %A Teare,Marion Dawn %A Keane,Pearse A %A R Beyer,Fiona %+ Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE1 7RU, United Kingdom, 44 2086000 ext 0191, Jeffry.Hogg@newcastle.ac.uk %K artificial intelligence %K clinical decision support tools %K digital health %K implementation %K qualitative evidence synthesis %K stakeholders %K clinical decision %K decision support %D 2022 %7 1.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Quantitative systematic reviews have identified clinical artificial intelligence (AI)-enabled tools with adequate performance for real-world implementation. To our knowledge, no published report or protocol synthesizes the full breadth of stakeholder perspectives. The absence of such a rigorous foundation perpetuates the “AI chasm,” which continues to delay patient benefit. Objective: The aim of this research is to synthesize stakeholder perspectives of computerized clinical decision support tools in any health care setting. Synthesized findings will inform future research and the implementation of AI into health care services. Methods: The search strategy will use MEDLINE (Ovid), Scopus, CINAHL (EBSCO), ACM Digital Library, and Science Citation Index (Web of Science). Following deduplication, title, abstract, and full text screening will be performed by 2 independent reviewers with a third topic expert arbitrating. The quality of included studies will be appraised to support interpretation. Best-fit framework synthesis will be performed, with line-by-line coding completed by 2 independent reviewers. Where appropriate, these findings will be assigned to 1 of 22 a priori themes defined by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability framework. New domains will be inductively generated for outlying findings. The placement of findings within themes will be reviewed iteratively by a study advisory group including patient and lay representatives. Results: Study registration was obtained from PROSPERO (CRD42021256005) in May 2021. Final searches were executed in April, and screening is ongoing at the time of writing. Full text data analysis is due to be completed in October 2021. We anticipate that the study will be submitted for open-access publication in late 2021. Conclusions: This paper describes the protocol for a qualitative evidence synthesis aiming to define barriers and facilitators to the implementation of computerized clinical decision support tools from all relevant stakeholders. The results of this study are intended to expedite the delivery of patient benefit from AI-enabled clinical tools. Trial Registration: PROSPERO CRD42021256005; https://tinyurl.com/r4x3thvp International Registered Report Identifier (IRRID): DERR1-10.2196/33145 %M 35363141 %R 10.2196/33145 %U https://www.researchprotocols.org/2022/4/e33145 %U https://doi.org/10.2196/33145 %U http://www.ncbi.nlm.nih.gov/pubmed/35363141 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e32994 %T Synthesizing Dimensions of Digital Maturity in Hospitals: Systematic Review %A Duncan,Rhona %A Eden,Rebekah %A Woods,Leanna %A Wong,Ides %A Sullivan,Clair %+ School of Information Systems, Queensland University of Technology, 2 George Street, Brisbane, 4000, Australia, 61 434237975, rg.eden@qut.edu.au %K digital maturity %K digital capability %K eHealth %K digital hospitals %K capability model %K maturity model %K literature review %K electronic medical records %D 2022 %7 30.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Digital health in hospital settings is viewed as a panacea for achieving the “quadruple aim” of health care, yet the outcomes have been largely inconclusive. To optimize digital health outcomes, a strategic approach is necessary, requiring digital maturity assessments. However, current approaches to assessing digital maturity have been largely insufficient, with uncertainty surrounding the dimensions to assess. Objective: The aim of this study was to identify the current dimensions used to assess the digital maturity of hospitals. Methods: A systematic literature review was conducted of peer-reviewed literature (published before December 2020) investigating maturity models used to assess the digital maturity of hospitals. A total of 29 relevant articles were retrieved, representing 27 distinct maturity models. The articles were inductively analyzed, and the maturity model dimensions were extracted and consolidated into a maturity model framework. Results: The consolidated maturity model framework consisted of 7 dimensions: strategy; information technology capability; interoperability; governance and management; patient-centered care; people, skills, and behavior; and data analytics. These 7 dimensions can be evaluated based on 24 respective indicators. Conclusions: The maturity model framework developed for this study can be used to assess digital maturity and identify areas for improvement. %M 35353050 %R 10.2196/32994 %U https://www.jmir.org/2022/3/e32994 %U https://doi.org/10.2196/32994 %U http://www.ncbi.nlm.nih.gov/pubmed/35353050 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e32162 %T Implementation of Teleophthalmology to Improve Diabetic Retinopathy Surveillance: Qualitative Interview Study of Clinical Staff Informed by Implementation Science Frameworks %A Ramchandran,Rajeev S %A Yousefi-Nooraie,Reza %A Dadgostar,Porooshat %A Yilmaz,Sule %A Basant,Jesica %A Dozier,Ann M %+ Flaum Eye Institute, University of Rochester Medical Center, 601 Elmwood Ave Box 659, Rochester, NY, 14642, United States, 1 5853760361, Rajeev_Ramchandran@URMC.Rochester.edu %K Consolidated Framework for Implementation Research %K teleophthalmology %K diabetic retinopathy %K implementation %K qualitative study %K Practical, Robust Implementation and Sustainability Model %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: The store-and-forward camera-based evaluation of the eye, or teleophthalmology, is an effective way to identify diabetic retinopathy, the leading cause of blindness in the United States, but uptake has been slow. Understanding the barriers to and facilitators of implementing teleophthalmology programs from those actively adopting, running, and sustaining such programs is important for widespread adoption. Objective: This study aims to understand the factors that are important in introducing teleophthalmology to improve access to diagnostic eye care for patients with diabetes in primary care clinics by using implementation science. Methods: This qualitative study in 3 urban, low-income, largely racial and ethnic minority–serving safety-net primary care clinics in Rochester, New York, interviewed nurses and physicians on implementing a teleophthalmology program by using questions informed by the Practical, Robust Implementation and Sustainability Model and the Consolidated Framework for Implementation Research. Results: Primary care nurses operationalizing the program in their clinics saw increased work burden and a lack of self-efficacy as barriers. Continuous training on the teleophthalmology process for nurses, physicians, and administrative staff through in-service and peer training by champions and superusers were identified by interviewees as needs. Facilitators included the perceived convenience for the patient and a perceived educational advantage to the program, as it gave an opportunity for providers to discuss the importance of eye care with patients. Concerns in making and tracking referrals to ophthalmology because of challenges related to care coordination were highlighted. The financial aspects of the program (eg, patient coverage and care provider reimbursement) were unclear to many staff members, influencing adoption and sustainability. Conclusions: Streamlining processes and workflows, training and assigning adequate staff, effectively coordinating care between primary care and eye care to improve follow-ups, and ensuring financial viability can all help streamline the adoption of teleophthalmology. %M 35353038 %R 10.2196/32162 %U https://diabetes.jmir.org/2022/1/e32162 %U https://doi.org/10.2196/32162 %U http://www.ncbi.nlm.nih.gov/pubmed/35353038 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e33128 %T Telehealth Business Models and Their Components: Systematic Review %A Velayati,Farnia %A Ayatollahi,Haleh %A Hemmat,Morteza %A Dehghan,Reza %+ Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, No. 4 Rashid Yasemi St, Vali-Asr St, Tehran, 1996713883, Iran, 98 21 88794302, ayatollahi.h@iums.ac.ir %K telehealth %K telemedicine %K mobile health %K business model %K value %K commerce %K revenue %K market %K systematic review %K health care %D 2022 %7 29.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Telehealth technology is an excellent solution to resolve the problems of health care delivery. However, this technology may fail during large-scale implementation. As a result, business models can be used to facilitate commercialization of telehealth products and services. Objective: The purpose of this study was to review different types of business models or frameworks and their components used in the telehealth industry. Methods: This was a systematic review conducted in 2020. The databases used for searching related articles included Ovid, PubMed, Scopus, Web of Science, Emerald, and ProQuest. Google Scholar was also searched. These databases and Google Scholar were searched until the end of January 2020 and duplicate references were removed. Finally, articles meeting the inclusion criteria were selected and the Critical Appraisal Skills Programme (CASP) checklist was used for appraising the strengths and limitations of each study. Data were extracted using a data extraction form, and the results were synthesized narratively. Results: Initially, 4998 articles were found and after screening, 23 were selected to be included in the study. The results showed that new telehealth business models were presented in 13 studies, and the applications of the existing business models were reported in 10 studies. These studies were related to different types of services, namely, telemonitoring (4 studies), telemedicine (3 studies), mobile health (3 studies), telerehabilitation (3 studies), telehealth (2 studies), assisted living technologies (2 studies), sensor-based systems (2 studies), and mobile teledermoscopy, teleradiology, telecardiology, and teletreatment (1 study related to each area). In most of the business models, value proposition, financial variables, and revenue streams were the main components. Conclusions: Applying business models in the commercialization of telehealth services will be useful to gain a better understanding of the required components, market challenges, and possible future changes. The results showed that different business models can be used for different telehealth technologies in various health systems and cultures. However, it is necessary to evaluate the effectiveness of these models in practice. Moreover, comparing the usefulness of these models in different domains of telehealth services will help identify the strengths and weaknesses of these models for future optimization. %M 35348471 %R 10.2196/33128 %U https://www.jmir.org/2022/3/e33128 %U https://doi.org/10.2196/33128 %U http://www.ncbi.nlm.nih.gov/pubmed/35348471 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e16430 %T Development of a Digital Health Intervention for Rheumatoid Arthritis Symptom Management in a Biotechnology Industry Context: Protocol for the Application of a Human-Centered Design Framework %A Nugent,Lisa %A Anthony Kouyate,Robin %A Jackson,Shawna %A Smith,Meredith Y %+ Amgen, 1224 Paseo Rancho Serrano, Thousand Oaks, CA, 91362, United States, 1 4102413997, rakouyate@gmail.com %K human-centered design %K patient-reported outcomes %K rheumatoid arthritis %K digital journal %K patient diaries %K data visualization %K mobile phone %D 2022 %7 22.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Involving chronically ill patients in the management of their health is widely recognized as a vital component of high-quality health care. However, to assume the role of informed participants, patients need both access to their health information and assistance in interpreting such data. Smartphone technology with SMS text messaging functionality offers a convenient and minimally demanding mechanism for providing such dual capabilities to patients. To date, a number of similar digital tools have been developed for use in various chronic and progressive disease conditions, including rheumatoid arthritis. Objective: This paper aims to describe the development of a research protocol that applies a human-centered design (HCD) approach to develop a mobile health (mHealth) intervention to support symptom management and treatment adherence for rheumatoid arthritis. Methods: To guide the development of the mHealth intervention for use within a commercial biotechnology context, we selected and applied an HCD framework consisting of three phases: understanding, ideation, and implementation. Results: Leveraging the framework, we mapped the key objectives and research questions to each phase and identified the HCD techniques and methods most suitable for addressing them. In addition, we identified the need to include a fourth phase, one that referred to postimplementation assessment, which would enable evaluation of patient engagement and intervention impact on symptom self-management. Conclusions: This paper presents a research protocol that applied an HCD framework to guide the development of an mHealth intervention within a commercial biotechnology context. This type of guidance is salient because commercial entities are becoming one of the leading producers of this type of intervention. However, the methodologies used and challenges faced from a research and development perspective are not well-represented in the published research literature to date. Our application of the HCD framework yielded important findings. Each phase of the HCD framework provided important guidance for increasing the likelihood that the final product would be understandable, acceptable, feasible, and engaging to use. Consistent with other researchers in the field of mHealth interventions, we identified the need to add a fourth phase to the HCD framework, one that focused on a postimplementation assessment to guide further improvements to support adoption in real-world settings. International Registered Report Identifier (IRRID): RR1-10.2196/16430 %M 35315784 %R 10.2196/16430 %U https://www.researchprotocols.org/2022/3/e16430 %U https://doi.org/10.2196/16430 %U http://www.ncbi.nlm.nih.gov/pubmed/35315784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31977 %T Digital Education for Health Professionals: An Evidence Map, Conceptual Framework, and Research Agenda %A Tudor Car,Lorainne %A Poon,Selina %A Kyaw,Bhone Myint %A Cook,David A %A Ward,Victoria %A Atun,Rifat %A Majeed,Azeem %A Johnston,Jamie %A van der Kleij,Rianne M J J %A Molokhia,Mariam %A V Wangenheim,Florian %A Lupton,Martin %A Chavannes,Niels %A Ajuebor,Onyema %A Prober,Charles G %A Car,Josip %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Clinical Science Building, Novena, Singapore, 308232, Singapore, 65 69041258, josip.car@ntu.edu.sg %K digital education %K health professions education %K evidence map %K systematic review %K research questions %K conceptual framework %K mobile phone %D 2022 %7 17.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Health professions education has undergone major changes with the advent and adoption of digital technologies worldwide. Objective: This study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education. Methods: We searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework. Results: We identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77, 13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants’ skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations). Conclusions: We identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low- and middle-income countries is needed. %M 35297767 %R 10.2196/31977 %U https://www.jmir.org/2022/3/e31977 %U https://doi.org/10.2196/31977 %U http://www.ncbi.nlm.nih.gov/pubmed/35297767 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e33046 %T Workarounds in Electronic Health Record Systems and the Revised Sociotechnical Electronic Health Record Workaround Analysis Framework: Scoping Review %A Blijleven,Vincent %A Hoxha,Florian %A Jaspers,Monique %+ Center for Marketing & Supply Chain Management, Nyenrode Business Universiteit, Straatweg 25, Breukelen, 3621 BG, Netherlands, 31 630023248, vincentblijleven@gmail.com %K electronic health records %K electronic medical records %K framework %K patient safety %K unintended consequences %K usability %K workarounds %K workflow %D 2022 %7 15.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Electronic health record (EHR) system users devise workarounds to cope with mismatches between workflows designed in the EHR and preferred workflows in practice. Although workarounds appear beneficial at first sight, they frequently jeopardize patient safety, the quality of care, and the efficiency of care. Objective: This review aims to aid in identifying, analyzing, and resolving EHR workarounds; the Sociotechnical EHR Workaround Analysis (SEWA) framework was published in 2019. Although the framework was based on a large case study, the framework still required theoretical validation, refinement, and enrichment. Methods: A scoping literature review was performed on studies related to EHR workarounds published between 2010 and 2021 in the MEDLINE, Embase, CINAHL, Cochrane, or IEEE databases. A total of 737 studies were retrieved, of which 62 (8.4%) were included in the final analysis. Using an analytic framework, the included studies were investigated to uncover the rationales that EHR users have for workarounds, attributes characterizing workarounds, possible scopes, and types of perceived impacts of workarounds. Results: The SEWA framework was theoretically validated and extended based on the scoping review. Extensive support for the pre-existing rationales, attributes, possible scopes, and types of impact was found in the included studies. Moreover, 7 new rationales, 4 new attributes, and 3 new types of impact were incorporated. Similarly, the descriptions of multiple pre-existing rationales for workarounds were refined to describe each rationale more accurately. Conclusions: SEWA is now grounded in the existing body of peer-reviewed empirical evidence on EHR workarounds and, as such, provides a theoretically validated and more complete synthesis of EHR workaround rationales, attributes, possible scopes, and types of impact. The revised SEWA framework can aid researchers and practitioners in a wider range of health care settings to identify, analyze, and resolve workarounds. This will improve user-centered EHR design and redesign, ultimately leading to improved patient safety, quality of care, and efficiency of care. %M 35289752 %R 10.2196/33046 %U https://www.jmir.org/2022/3/e33046 %U https://doi.org/10.2196/33046 %U http://www.ncbi.nlm.nih.gov/pubmed/35289752 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e30691 %T Digital Contact Tracing Apps for COVID-19: Development of a Citizen-Centered Evaluation Framework %A Tsvyatkova,Damyanka %A Buckley,Jim %A Beecham,Sarah %A Chochlov,Muslim %A O’Keeffe,Ian R %A Razzaq,Abdul %A Rekanar,Kaavya %A Richardson,Ita %A Welsh,Thomas %A Storni,Cristiano %A , %+ Department of Computer Science and Information Systems, University of Limerick, Computer Science Building, Plassey Park Rd, Limerick, V94 T9PX, Ireland, 353 61 202632, Cristiano.Storni@ul.ie %K COVID-19 %K mHealth %K digital contact tracing apps %K framework %K evaluation %K mobile health %K health apps %K digital health %K contact tracing %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The silent transmission of COVID-19 has led to an exponential growth of fatal infections. With over 4 million deaths worldwide, the need to control and stem transmission has never been more critical. New COVID-19 vaccines offer hope. However, administration timelines, long-term protection, and effectiveness against potential variants are still unknown. In this context, contact tracing and digital contact tracing apps (CTAs) continue to offer a mechanism to help contain transmission, keep people safe, and help kickstart economies. However, CTAs must address a wide range of often conflicting concerns, which make their development/evolution complex. For example, the app must preserve citizens’ privacy while gleaning their close contacts and as much epidemiological information as possible. Objective: In this study, we derived a compare-and-contrast evaluative framework for CTAs that integrates and expands upon existing works in this domain, with a particular focus on citizen adoption; we call this framework the Citizen-Focused Compare-and-Contrast Evaluation Framework (C3EF) for CTAs. Methods: The framework was derived using an iterative approach. First, we reviewed the literature on CTAs and mobile health app evaluations, from which we derived a preliminary set of attributes and organizing pillars. These attributes and the probing questions that we formulated were iteratively validated, augmented, and refined by applying the provisional framework against a selection of CTAs. Each framework pillar was then subjected to internal cross-team scrutiny, where domain experts cross-checked sufficiency, relevancy, specificity, and nonredundancy of the attributes, and their organization in pillars. The consolidated framework was further validated on the selected CTAs to create a finalized version of C3EF for CTAs, which we offer in this paper. Results: The final framework presents seven pillars exploring issues related to CTA design, adoption, and use: (General) Characteristics, Usability, Data Protection, Effectiveness, Transparency, Technical Performance, and Citizen Autonomy. The pillars encompass attributes, subattributes, and a set of illustrative questions (with associated example answers) to support app design, evaluation, and evolution. An online version of the framework has been made available to developers, health authorities, and others interested in assessing CTAs. Conclusions: Our CTA framework provides a holistic compare-and-contrast tool that supports the work of decision-makers in the development and evolution of CTAs for citizens. This framework supports reflection on design decisions to better understand and optimize the design compromises in play when evolving current CTAs for increased public adoption. We intend this framework to serve as a foundation for other researchers to build on and extend as the technology matures and new CTAs become available. %M 35084338 %R 10.2196/30691 %U https://mhealth.jmir.org/2022/3/e30691 %U https://doi.org/10.2196/30691 %U http://www.ncbi.nlm.nih.gov/pubmed/35084338 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e29891 %T Social Media for ImpLementing Evidence (SMILE): Conceptual Framework %A Zhao,Junqiang %A Harvey,Gillian %A Vandyk,Amanda %A Gifford,Wendy %+ School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada, 1 8192124678, jzhao126@uottawa.ca %K social media %K research use %K knowledge translation %K implementation science %K conceptual framework %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media has become widely used by individual researchers and professional organizations to translate research evidence into health care practice. Despite its increasing popularity, few social media initiatives consider the theoretical perspectives of how social media works as a knowledge translation strategy to affect research use. Objective: The purpose of this paper is to propose a conceptual framework to understand how social media works as a knowledge translation strategy for health care providers, policy makers, and patients to inform their health care decision-making. Methods: We developed this framework using an integrative approach that first involved reviewing 5 long-standing social media initiatives. We then drafted the initial framework using a deductive approach by referring to 5 theories on social media studies and knowledge translation. A total of 58 empirical studies on factors that influenced the use of social media and its messages and strategies for promoting the use of research evidence via social media were further integrated to substantiate and fine-tune our initial framework. Through an iterative process, we developed the Social Media for ImpLementing Evidence (SMILE) framework. Results: The SMILE framework has six key constructs: developers, messages and delivery strategies, recipients, context, triggers, and outcomes. For social media to effectively enable recipients to use research evidence in their decision-making, the framework proposes that social media content developers respond to target recipients’ needs and context and develop relevant messages and appropriate delivery strategies. The recipients’ use of social media messages is influenced by the virtual–technical, individual, organizational, and system contexts and can be activated by three types of triggers: sparks, facilitators, and signals. Conclusions: The SMILE framework maps the factors that are hypothesized to influence the use of social media messages by recipients and offers a heuristic device for social media content developers to create interventions for promoting the use of evidence in health care decision-making. Empirical studies are now needed to test the propositions of this framework. %M 35262488 %R 10.2196/29891 %U https://formative.jmir.org/2022/3/e29891 %U https://doi.org/10.2196/29891 %U http://www.ncbi.nlm.nih.gov/pubmed/35262488 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34920 %T Toward Successful Implementation of Artificial Intelligence in Health Care Practice: Protocol for a Research Program %A Svedberg,Petra %A Reed,Julie %A Nilsen,Per %A Barlow,James %A Macrae,Carl %A Nygren,Jens %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 035167100, jens.nygren@hh.se %K process evaluation %K complex intervention %K implementation %K knowledge exchange %K health policy %K organizational change %K capacity building %K qualitative methods %K framework analysis %D 2022 %7 9.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The uptake of artificial intelligence (AI) in health care is at an early stage. Recent studies have shown a lack of AI-specific implementation theories, models, or frameworks that could provide guidance for how to translate the potential of AI into daily health care practices. This protocol provides an outline for the first 5 years of a research program seeking to address this knowledge-practice gap through collaboration and co-design between researchers, health care professionals, patients, and industry stakeholders. Objective: The first part of the program focuses on two specific objectives. The first objective is to develop a theoretically informed framework for AI implementation in health care that can be applied to facilitate such implementation in routine health care practice. The second objective is to carry out empirical AI implementation studies, guided by the framework for AI implementation, and to generate learning for enhanced knowledge and operational insights to guide further refinement of the framework. The second part of the program addresses a third objective, which is to apply the developed framework in clinical practice in order to develop regional capacity to provide the practical resources, competencies, and organizational structure required for AI implementation; however, this objective is beyond the scope of this protocol. Methods: This research program will use a logic model to structure the development of a methodological framework for planning and evaluating implementation of AI systems in health care and to support capacity building for its use in practice. The logic model is divided into time-separated stages, with a focus on theory-driven and coproduced framework development. The activities are based on both knowledge development, using existing theory and literature reviews, and method development by means of co-design and empirical investigations. The activities will involve researchers, health care professionals, and other stakeholders to create a multi-perspective understanding. Results: The project started on July 1, 2021, with the Stage 1 activities, including model overview, literature reviews, stakeholder mapping, and impact cases; we will then proceed with Stage 2 activities. Stage 1 and 2 activities will continue until June 30, 2026. Conclusions: There is a need to advance theory and empirical evidence on the implementation requirements of AI systems in health care, as well as an opportunity to bring together insights from research on the development, introduction, and evaluation of AI systems and existing knowledge from implementation research literature. Therefore, with this research program, we intend to build an understanding, using both theoretical and empirical approaches, of how the implementation of AI systems should be approached in order to increase the likelihood of successful and widespread application in clinical practice. International Registered Report Identifier (IRRID): PRR1-10.2196/34920 %M 35262500 %R 10.2196/34920 %U https://www.researchprotocols.org/2022/3/e34920 %U https://doi.org/10.2196/34920 %U http://www.ncbi.nlm.nih.gov/pubmed/35262500 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e29415 %T mHealth Interventions for Self-management of Hypertension: Framework and Systematic Review on Engagement, Interactivity, and Tailoring %A Cao,Weidan %A Milks,M Wesley %A Liu,Xiaofu %A Gregory,Megan E %A Addison,Daniel %A Zhang,Ping %A Li,Lang %+ Department of Biomedical Informatics, The Ohio State University, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, United States, 1 614 292 4778, lang.li@osumc.edu %K mHealth %K mobile app %K digital behavior change %K interventions %K systematic review %K hypertension %K engagement %K interactivity %K tailoring %K mobile phone %D 2022 %7 2.3.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Engagement is essential for the effectiveness of digital behavior change interventions. Existing systematic reviews examining hypertension self-management interventions via mobile apps have primarily focused on intervention efficacy and app usability. Engagement in the prevention or management of hypertension is largely unknown. Objective: This systematic review explores the definition and role of engagement in hypertension-focused mobile health (mHealth) interventions, as well as how determinants of engagement (ie, tailoring and interactivity) have been implemented. Methods: A systematic review of mobile app interventions for hypertension self-management targeting adults, published from 2013 to 2020, was conducted. A total of 21 studies were included in this systematic review. Results: The engagement was defined or operationalized as a microlevel concept, operationalized as interaction with the interventions (ie, frequency of engagement, time or duration of engagement with the program, and intensity of engagement). For all 3 studies that tested the relationship, increased engagement was associated with better biomedical outcomes (eg, blood pressure change). Interactivity was limited in digital behavior change interventions, as only 7 studies provided 2-way communication between users and a health care professional, and 9 studies provided 1-way communication in possible critical conditions; that is, when abnormal blood pressure values were recorded, users or health care professionals were notified. The tailoring of interventions varied at different aspects, from the tailoring of intervention content (including goals, patient education, advice and feedback from health professionals, reminders, and motivational messages) to the tailoring of intervention dose and communication mode. Tailoring was carried out in a number of ways, considering patient characteristics such as goals, preferences, disease characteristics (eg, hypertension stage and medication list), disease self-management experience levels, medication adherence rate, and values and beliefs. Conclusions: Available studies support the importance of engagement in intervention effectiveness as well as the essential roles of patient factors in tailoring, interactivity, and engagement. A patient-centered engagement framework for hypertension self-management using mHealth technology is proposed here, with the intent of facilitating intervention design and disease self-management using mHealth technology. %M 35234655 %R 10.2196/29415 %U https://mhealth.jmir.org/2022/3/e29415 %U https://doi.org/10.2196/29415 %U http://www.ncbi.nlm.nih.gov/pubmed/35234655 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e32714 %T Understanding Decision-Making in the Adoption of Digital Health Technology: The Role of Behavioral Economics’ Prospect Theory %A Khan,Waqas Ullah %A Shachak,Aviv %A Seto,Emily %+ Department of Health Informatics, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T3M6, Canada, 1 9059037401, waqas.khan@alum.utoronto.ca %K decision-making %K digital health technology adoption %K prospect theory %D 2022 %7 7.2.2022 %9 Viewpoint %J J Med Internet Res %G English %X The decision to accept or reject new digital health technologies remains an ongoing challenge among health care patients, providers, technology companies, and policymakers. Over the past few decades, interest in understanding the choice to adopt technology has led to the development of numerous theories and models. In 1979, however, psychologists Kahneman and Tversky published their seminal research article that has pioneered the field of behavioral economics. They named their model the prospect theory and used it to explain decision-making behaviors under conditions of risk and uncertainty as well as to provide an understanding of why individuals may make irrational or inconsistent choices. Although the prospect theory has been used to explain decision-making in economics, law, political science, and clinically, at the individual level, its application to understanding choice in the adoption of digital health technology has not been explored. Herein, we discuss how the main components of the prospect theory’s editing phase (framing effect) and evaluation phase (value function and weighting function) can provide valuable insight on why health care patients, providers, technology companies, and policymakers may decide to accept or reject digital health technologies. %M 35129459 %R 10.2196/32714 %U https://www.jmir.org/2022/2/e32714 %U https://doi.org/10.2196/32714 %U http://www.ncbi.nlm.nih.gov/pubmed/35129459 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e31167 %T Boundary Objects as Dialogical Learning Accelerators for Social Change in Design for Health: Systematic Review %A Terlouw,Gijs %A Kuipers,Derek %A Veldmeijer,Lars %A van 't Veer,Job %A Prins,Jelle %A Pierie,Jean-Pierre %+ NHL Stenden University of Applied Sciences, Rengerslaan 10, Leeuwarden, 8919 DD, Netherlands, 31 628317457, gijs.terlouw@nhlstenden.com %K boundary objects %K health %K innovation %K design %K systematic review %D 2022 %7 3.2.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Boundary objects can add value for innovative design and implementation research in health care through their organizational focus and the dynamic structure between ill-structured and tailored use. However, when innovation is approached as a boundary object, more attention will need to be paid to the preimplementation phase. Research and design thinking pay attention to the preimplementation stage but do not have a social or organizational focus per se. The integration of boundary objects in design methodologies can provide a more social and organizational focus in innovative design projects by mapping out the mechanisms that occur at boundaries during design. Four dialogical learning mechanisms that can be triggered at boundaries have been described in the literature: identification, coordination, reflection, and transformation. These mechanisms seem suitable for integration in innovative design research on health. Objective: Focusing on innovation in health, this study aims to find out whether the different learning mechanisms can be linked to studies on health innovation that mention boundary objects as a concept and assess whether the related mechanisms provide insight into the stage of the design and implementation or change process. Methods: The following 6 databases were searched for relevant abstracts: PubMed, Scopus, Education Resources Information Center, PsycINFO, Information Science and Technology Abstracts, and Embase. These databases cover a wide range of published studies in the field of health. Results: Our initial search yielded 3102 records; after removing the duplicates, 2186 (70.47%) records were screened on the title and abstract, and 25 (0.81%) papers were included; of the 13 papers where we identified 1 mechanism, 5 (38%) described an innovation or innovative project, and of the 12 papers where we identified more mechanisms, 9 (75%) described the development or implementation of an innovation. The reflective mechanism was not identified solely but was present in papers describing a more successful development or implementation project of innovation. In these papers, the predetermined goals were achieved, and the process of integration was relatively smoother. Conclusions: The concept of boundary objects has found its way into health care. Although the idea of a boundary object was introduced to describe how specific artifacts can fulfill a bridging function between different sociocultural sites and thus have a social focus, the focus in the included papers was often on the boundary object itself rather than the social effect. The reflection and transformation mechanisms were underrepresented in the included studies but based on the findings in this review, pursuing to trigger the reflective mechanism in design, development, and implementation projects can lead to a more fluid and smooth integration of innovation into practice. %M 35113023 %R 10.2196/31167 %U https://humanfactors.jmir.org/2022/1/e31167 %U https://doi.org/10.2196/31167 %U http://www.ncbi.nlm.nih.gov/pubmed/35113023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31920 %T Design of an Integrated Acceptance Framework for Older Users and eHealth: Influential Factor Analysis %A Yu,Jiyeon %A de Antonio,Angelica %A Villalba-Mora,Elena %+ Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, 28223, Spain, 34 910679250, elena.villalba@upm.es %K eHealth %K older people %K older user %K health technology %K acceptance factors %K adoption %K acceptance framework %K systematic review %K thematic analysis %K influential factor analysis %K mobile phone %D 2022 %7 28.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth and telehealth play a crucial role in assisting older adults who visit hospitals frequently or who live in nursing homes and can benefit from staying at home while being cared for. Adapting to new technologies can be difficult for older people. Thus, to better apply these technologies to older adults’ lives, many studies have analyzed the acceptance factors for this particular population. However, there is not yet a consensual framework that can be used in further development and to search for solutions. Objective: This paper aims to present an integrated acceptance framework (IAF) for older users’ acceptance of eHealth based on 43 studies selected through a systematic review. Methods: We conducted a 4-step study. First, through a systematic review in the field of eHealth from 2010 to 2020, the acceptance factors and basic data for analysis were extracted. Second, we conducted a thematic analysis to group the factors into themes to propose an integrated framework for acceptance. Third, we defined a metric to evaluate the impact of the factors addressed in the studies. Finally, the differences among the important IAF factors were analyzed according to the participants’ health conditions, verification time, and year. Results: Through a systematic review, 731 studies were found in 5 major databases, resulting in 43 (5.9%) selected studies using the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) methodology. First, the research methods and acceptance factors for eHealth were compared and analyzed, extracting a total of 105 acceptance factors, which were grouped later, resulting in an IAF. A total of 5 dimensions (ie, personal, user–technology relational, technological, service-related, and environmental) emerged, with a total of 23 factors. In addition, we assessed the quality of evidence and then conducted a stratification analysis to reveal the more appropriate factors depending on the health condition and assessment time. Finally, we assessed the factors and dimensions that have recently become more important. Conclusions: The result of this investigation is a framework for conducting research on eHealth acceptance. To elaborately analyze the impact of the factors of the proposed framework, the criteria for evaluating the evidence from the studies that have the extracted factors are presented. Through this process, the impact of each factor in the IAF has been presented, in addition to the framework proposal. Moreover, a meta-analysis of the current status of research is presented, highlighting the areas where specific measures are needed to facilitate eHealth acceptance. %M 35089155 %R 10.2196/31920 %U https://www.jmir.org/2022/1/e31920 %U https://doi.org/10.2196/31920 %U http://www.ncbi.nlm.nih.gov/pubmed/35089155 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32855 %T Validity Testing and Cultural Adaptation of the eHealth Literacy Questionnaire (eHLQ) Among People With Chronic Diseases in Taiwan: Mixed Methods Study %A Chen,Yu-Chi %A Cheng,Christina %A Osborne,Richard H %A Kayser,Lars %A Liu,Chieh-Yu %A Chang,Li-Chun %+ Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, No.155, Section 2, Li-Nong Street, Beitou District, Taipei, 112, Taiwan, 886 228267093, ycchen2@nycu.edu.tw %K chronic illness %K eHealth literacy questionnaire %K eHLQ %K validation %K cultural adaptation %K eHealth %D 2022 %7 19.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Advancements in digital technologies seek to promote health and access to services. However, people lacking abilities and confidence to use technology are likely to be left behind, leading to health disparities. In providing digital health services, health care providers need to be aware of users’ diverse electronic health (eHealth) literacy to address their particular needs and ensure equitable uptake and use of digital services. To understand such needs, an instrument that captures users’ knowledge, skills, trust, motivation, and experiences in relation to technology is required. The eHealth Literacy Questionnaire (eHLQ) is a multidimensional tool with 7 scales covering diverse dimensions of eHealth literacy. The tool was simultaneously developed in English and Danish using a grounded and validity-driven approach and has been shown to have strong psychometric properties. Objective: This study aims to translate and culturally adapt the eHLQ for application among Mandarin-speaking people with chronic diseases in Taiwan and then undertake a rigorous set of validity-testing procedures. Methods: The cross-cultural adaptation of the eHLQ included translation and evaluation of the translations. The measurement properties were assessed using classical test theory and item response theory (IRT) approaches. Content validity, known-group validity, and internal consistency were explored, as well as item characteristic curves (ICCs), item discrimination, and item location/difficulty. Results: The adapted version was reviewed, and a recommended forward translation was confirmed through consensus. The tool exhibited good content validity. A total of 420 people with 1 or more chronic diseases participated in a validity-testing survey. The eHLQ showed good internal consistency (Cronbach α=.75-.95). For known-group validity, all 7 eHLQ scales showed strong associations with education. Unidimensionality and local independence assumptions were met except for scale 2. IRT analysis showed that all items demonstrated good discrimination (range 0.27-12.15) and a good range of difficulty (range 0.59-1.67) except for 2 items in scale 7. Conclusions: Using a rigorous process, the eHLQ was translated from English into a culturally appropriate tool for use in the Mandarin language. Validity testing provided evidence of satisfactory-to-strong psychometric properties of the eHLQ. The 7 scales are likely to be useful research tools for evaluating digital health interventions and for informing the development of health technology products and interventions that equitably suit diverse users’ needs. %M 35044310 %R 10.2196/32855 %U https://www.jmir.org/2022/1/e32855 %U https://doi.org/10.2196/32855 %U http://www.ncbi.nlm.nih.gov/pubmed/35044310 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e25419 %T Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment %A Lee,Edmund WJ %A McCloud,Rachel F %A Viswanath,Kasisomayajula %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Wee Kim Wee School of Communication and Information Building, Singapore, 637718, Singapore, 65 69083429, elwj88@gmail.com %K eHealth %K mobile health %K communication inequalities %K health disparities %K health informatics %K mobile phone %D 2022 %7 7.1.2022 %9 Viewpoint %J J Med Internet Res %G English %X Despite the proliferation of eHealth interventions, such as web portals, for health information dissemination or the use of mobile apps and wearables for health monitoring, research has shown that underserved groups do not benefit proportionately from these eHealth interventions. This is largely because of usability issues and the lack of attention to the broader structural, physical, and psychosocial barriers to technology adoption and use. The objective of this paper is to draw lessons from a decade of experience in designing different user-centered eHealth interventions (eg, web portals and health apps) to inform future work in leveraging technology to address health disparities. We draw these lessons from a series of interventions from the work we have done over 15 years in the Viswanath laboratory at the Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, focusing on three projects that used web portals and health apps targeted toward underserved groups. The projects were the following: Click to Connect, which was a community-based eHealth intervention that aimed to improve internet skills and health literacy among underserved groups by providing home access to high-speed internet, computer, and internet training classes, as well as a dedicated health web portal with ongoing technical support; PLANET MassCONECT, which was a knowledge translation project that built capacity among community-based organizations in Boston, Lawrence, and Worcester in Massachusetts to adopt evidence-based health promotion programs; and Smartphone App for Public Health, which was a mobile health research that facilitated both participatory (eg, surveys) and passive data (eg, geolocations and web-browsing behaviors) collection for the purpose of understanding tobacco message exposure in individuals’ built environment. Through our work, we distilled five key principles for researchers aiming to design eHealth interventions for underserved groups. They are as follows: develop a strategic road map to address communication inequalities (ie, a concrete action plan to identify the barriers faced by underserved groups and customize specific solutions to each of them), engage multiple stakeholders from the beginning for the long haul, design with usability—readability and navigability—in mind, build privacy safeguards into eHealth interventions and communicate privacy–utility tradeoffs in simplicity, and strive for an optimal balance between open science aspirations and protection of underserved groups. %M 34994700 %R 10.2196/25419 %U https://www.jmir.org/2022/1/e25419 %U https://doi.org/10.2196/25419 %U http://www.ncbi.nlm.nih.gov/pubmed/34994700 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30474 %T Using Health Concept Surveying to Elicit Usable Evidence: Case Studies of a Novel Evaluation Methodology %A Mariakakis,Alex %A Karkar,Ravi %A Patel,Shwetak N %A Kientz,Julie A %A Fogarty,James %A Munson,Sean A %+ Department of Computer Science, University of Toronto, Bahen Centre for Information Technology, Room 4283, 40 St. George Street, Toronto, ON, M5S 2E4, Canada, 1 416 978 5359, mariakakis@cs.toronto.edu %K mobile health %K survey instrument %K health screening %K health belief model %K path analysis %K user design %K health technology %K health intervention technology %K digital health %K mobile phone %D 2022 %7 3.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable evidence that can contribute to our broader understanding of HITs. Objective: In this research, we aim to develop and demonstrate a variation of vignette testing that supports developers and designers in evaluating early-stage HIT designs while generating usable evidence for the broader research community. Methods: We proposed a method called health concept surveying for untangling the causal relationships that people develop around conceptual HITs. In health concept surveying, investigators gather reactions to design concepts through a scenario-based survey instrument. As the investigator manipulates characteristics related to their HIT, the survey instrument also measures proximal cognitive factors according to a health behavior change model to project how HIT design decisions may affect the adoption and acceptability of an HIT. Responses to the survey instrument were analyzed using path analysis to untangle the causal effects of these factors on the outcome variables. Results: We demonstrated health concept surveying in 3 case studies of sensor-based health-screening apps. Our first study (N=54) showed that a wait time incentive could influence more people to go see a dermatologist after a positive test for skin cancer. Our second study (N=54), evaluating a similar application design, showed that although visual explanations of algorithmic decisions could increase participant trust in negative test results, the trust would not have been enough to affect people’s decision-making. Our third study (N=263) showed that people might prioritize test specificity or sensitivity depending on the nature of the medical condition. Conclusions: Beyond the findings from our 3 case studies, our research uses the framing of the Health Belief Model to elicit and understand the intrinsic and extrinsic factors that may affect the adoption and acceptability of an HIT without having to build a working prototype. We have made our survey instrument publicly available so that others can leverage it for their own investigations. %M 34982038 %R 10.2196/30474 %U https://humanfactors.jmir.org/2022/1/e30474 %U https://doi.org/10.2196/30474 %U http://www.ncbi.nlm.nih.gov/pubmed/34982038 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28086 %T The Mediating Influence of the Unified Theory of Acceptance and Use of Technology on the Relationship Between Internal Health Locus of Control and Mobile Health Adoption: Cross-sectional Study %A Ahadzadeh,Ashraf Sadat %A Wu,Shin Ling %A Ong,Fon Sim %A Deng,Ruolan %+ Department of Journalism, Xiamen University Malaysia, Bandar Sunsuria, Sepang, Selangor, 43900, Malaysia, 60 147393423, ahadzadeh1980@gmail.com %K mobile health %K mHealth %K internal health locus of control %K performance expectancy %K effort expectancy %K social influence %K mediation %D 2021 %7 29.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) as an innovative form of information and communications technology can efficiently deliver high-quality health care by enhancing communication and health management, reducing costs, and increasing access to health services. An individual’s internal health locus of control (HLOC) is found to be associated with the behavioral intent to adopt mHealth. However, little is known about the underlying mechanism of this association. Objective: The primary objective of this study was to test the mediation influence of the Unified Theory of Acceptance and Use of Technology (UTAUT) on the relationship between internal HLOC and the behavioral intention to use mHealth. Methods: A total of 374 responses were collected from Malaysian adult users of mHealth, using convenience and snowball sampling methods. Partial least squares structural equation modeling was used to analyze the data. Data were collected for variables, including demographics, internal HLOC, and modified UTAUT constructs (ie, performance expectancy, effort expectancy, and social influence). Results: The results showed that there was no direct relationship between internal HLOC and the behavioral intention to use mHealth (β=−0.039, P=.32). The indirect relationship between internal HLOC and the intent to adopt mHealth was supported, indicating that the UTAUT constructs performance expectancy (β=0.104, P<.001), effort expectancy (β=0.056, P=.02), and social influence (β=0.057, P=.002) mediated this relationship. The results showed full mediation, with total variance explained at 47.2%. Conclusions: This study developed an integrative model, where a health-related disposition (internal HLOC), mHealth-related beliefs (performance expectancy and effort expectancy), and normative pressure (social influence) were combined to explain the underlying mechanism of the behavioral intent to adopt mHealth. The results showed that the intention to adopt mHealth is mediated by the influence of UTAUT factors, while HLOC has no direct effect on adoption intention. The findings provide insights into augmenting mHealth adoption among the public by enhancing the perceived benefits of mHealth, helping design more effective and user-friendly mHealth tools, and capitalizing on social normative influence to adopt mHealth. This study utilized the constructs of the UTAUT model to determine the intention to use mHealth. Future research should focus on other health- and technology-related theories to ascertain other possible factors influencing the behavioral intent of mHealth adoption. %M 34964718 %R 10.2196/28086 %U https://www.jmir.org/2021/12/e28086 %U https://doi.org/10.2196/28086 %U http://www.ncbi.nlm.nih.gov/pubmed/34964718 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27033 %T Development of a Supportive Parenting App to Improve Parent and Infant Outcomes in the Perinatal Period: Development Study %A Shorey,Shefaly %A Tan,Thiam Chye %A , %A Mathews,Jancy %A Yu,Chun Yan %A Lim,Siew Hoon %A Shi,Luming %A Ng,Esperanza Debby %A Chan,Yiong Huak %A Law,Evelyn %A Chee,Cornelia %A Chong,Yap Seng %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66011294, nurssh@nus.edu.sg %K depression %K development %K education %K parent %K perinatal %K support %K telehealth %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child’s development. Given the rise in technology and parents’ preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants. Objective: The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned. Methods: The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles—the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development. Results: In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability. Conclusions: The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development. %M 36260376 %R 10.2196/27033 %U https://www.jmir.org/2021/12/e27033 %U https://doi.org/10.2196/27033 %U http://www.ncbi.nlm.nih.gov/pubmed/36260376 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e31633 %T Breaking the Data Value-Privacy Paradox in Mobile Mental Health Systems Through User-Centered Privacy Protection: A Web-Based Survey Study %A Zhang,Dongsong %A Lim,Jaewan %A Zhou,Lina %A Dahl,Alicia A %+ The University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223-0001, United States, 1 7046871893, dzhang15@uncc.edu %K mobile apps %K mental health %K privacy concerns %K privacy protection %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mobile mental health systems (MMHS) have been increasingly developed and deployed in support of monitoring, management, and intervention with regard to patients with mental disorders. However, many of these systems rely on patient data collected by smartphones or other wearable devices to infer patients’ mental status, which raises privacy concerns. Such a value-privacy paradox poses significant challenges to patients’ adoption and use of MMHS; yet, there has been limited understanding of it. Objective: To address the significant literature gap, this research aims to investigate both the antecedents of patients’ privacy concerns and the effects of privacy concerns on their continuous usage intention with regard to MMHS. Methods: Using a web-based survey, this research collected data from 170 participants with MMHS experience recruited from online mental health communities and a university community. The data analyses used both repeated analysis of variance and partial least squares regression. Results: The results showed that data type (P=.003), data stage (P<.001), privacy victimization experience (P=.01), and privacy awareness (P=.08) have positive effects on privacy concerns. Specifically, users report higher privacy concerns for social interaction data (P=.007) and self-reported data (P=.001) than for biometrics data; privacy concerns are higher for data transmission (P=.01) and data sharing (P<.001) than for data collection. Our results also reveal that privacy concerns have an effect on attitude toward privacy protection (P=.001), which in turn affects continuous usage intention with regard to MMHS. Conclusions: This study contributes to the literature by deepening our understanding of the data value-privacy paradox in MMHS research. The findings offer practical guidelines for breaking the paradox through the design of user-centered and privacy-preserving MMHS. %M 34951604 %R 10.2196/31633 %U https://mental.jmir.org/2021/12/e31633 %U https://doi.org/10.2196/31633 %U http://www.ncbi.nlm.nih.gov/pubmed/34951604 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28610 %T Using the Theoretical Domains Framework to Identify Barriers and Enablers to Implementing a Virtual Tertiary–Regional Telemedicine Rounding and Consultation for Kids (TRaC-K) Model: Qualitative Study %A Bele,Sumedh %A Cassidy,Christine %A Curran,Janet %A Johnson,David W %A Bailey,J A Michelle %+ Department of Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Dr NW, Calgary, AB, T3B 6A8, Canada, 1 403 955 3015, jamichelle.bailey@albertahealthservices.ca %K telemedicine %K eHealth %K pediatric care %K inpatient %K regional %K rural %K Canada %K Theoretical Domains Framework %K qualitative %D 2021 %7 22.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Inequities in access to health services are a global concern and a concern for Canadian populations living in rural areas. Rural children hospitalized at tertiary children’s hospitals have higher rates of medical complexity and experience more expensive hospitalizations and more frequent readmissions. The 2 tertiary pediatric hospitals in Alberta, Canada, have already been operating above capacity, but the pediatric beds at regional hospitals are underused. Such imbalance could lead to poor patient safety and increased readmission risk at tertiary pediatric hospitals and diminish the clinical exposure of regional pediatric health care providers, erode their confidence, and compel health systems to further reduce the capacity at regional sites. A Telemedicine Rounding and Consultation for Kids (TRaC-K) model was proposed to enable health care providers at Alberta Children’s Hospital to partner with their counterparts at Medicine Hat Regional Hospital to provide inpatient clinical care for pediatric patients who would otherwise have to travel or be transferred to the tertiary site. Objective: The aim of this study is to identify perceived barriers and enablers to implementing the TRaC-K model. Methods: This study was guided by the Theoretical Domains Framework (TDF) and used qualitative methods. We collected qualitative data from 42 participants from tertiary and regional hospitals through 31 semistructured interviews and 2 focus groups. These data were thematically analyzed to identify major subthemes within each TDF domain. These subthemes were further aggregated and categorized into barriers or enablers to implementing the TRaC-K model and were tabulated separately. Results: Our study identified 31 subthemes in 14 TDF domains, ranging from administrative issues to specific clinical conditions. We were able to merge these subthemes into larger themes and categorize them into 4 barriers and 4 enablers. Our findings showed that the barriers were lack of awareness of telemedicine, skills to provide virtual clinical care, unclear processes and resources to support TRaC-K, and concerns about clear roles and responsibilities. The enablers were health care providers’ motivation to provide care closer to home, supporting system resource stewardship, site and practice compatibility, and motivation to strengthen tertiary–regional relationships. Conclusions: This systematic inquiry into the perceived barriers and enablers to the implementation of TRaC-K helped us to gain insights from various health care providers’ and family members’ perspectives. We will use these findings to design interventions to overcome the identified barriers and harness the enablers to encourage successful implementation of TRaC-K. These findings will inform the implementation of telemedicine-based interventions in pediatric settings in other parts of Canada and beyond. International Registered Report Identifier (IRRID): RR2-10.1186/s12913-018-3859-2 %M 34941561 %R 10.2196/28610 %U https://www.jmir.org/2021/12/e28610 %U https://doi.org/10.2196/28610 %U http://www.ncbi.nlm.nih.gov/pubmed/34941561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25330 %T Active Usage of Mobile Health Applications: Cross-sectional Study %A Wang,Yang %A Wu,Tailai %A Chen,Zhuo %+ School of Medicine and Health Management, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 13477072665, lncle2012@yahoo.com %K active usage %K mobile health %K 3-factor theory %K consumer satisfaction %K consumer dissatisfaction %K medical informatics %D 2021 %7 22.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health applications are being increasingly used for people’s health management. The different uses of mobile health applications lead to different health outcomes. Although active usage of mobile health applications is shown to be linked to the effectiveness of mobile health services, the factors that influence people’s active usage of mobile health applications are not well studied. Objective: This paper aims to examine the antecedents of active usage of mobile health applications. Methods: Grounded on the 3-factor theory, we proposed 10 attributes of mobile health applications that influence the active usage of mobile health applications through consumers’ satisfaction and dissatisfaction. We classified these 10 attributes into 3 categories (ie, excitement attributes, performance attributes, and basic attributes). Using the survey method, 494 valid responses were collected and analyzed using structural equation modeling. Results: Our analysis results revealed that both consumer satisfaction (β=0.351, t=6.299, P<.001) and dissatisfaction (β=–0.251, t=5.119, P<.001) significantly influenced active usage. With regard to the effect of attributes, excitement attributes (β=0.525, t=12.861, P<.001) and performance attributes (β=0.297, t=6.508, P<.001) positively influenced consumer satisfaction, while performance attributes (β=–0.231, t=3.729, P<.001) and basic attributes (β=–0.412, t=7.132, P<.001) negatively influenced consumer dissatisfaction. The results of the analysis confirmed our proposed hypotheses. Conclusions: Our study provides a novel perspective to study the active usage of mobile health applications. By categorizing the attributes of mobile health applications into 3 categories, the differential effects of different attributes can be tested. Meanwhile, consumer satisfaction and dissatisfaction are confirmed to be independent from each other. %M 34941545 %R 10.2196/25330 %U https://www.jmir.org/2021/12/e25330 %U https://doi.org/10.2196/25330 %U http://www.ncbi.nlm.nih.gov/pubmed/34941545 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e29098 %T Perceptions of Factors Influencing Engagement With Health and Well-being Apps in the United Kingdom: Qualitative Interview Study %A Szinay,Dorothy %A Perski,Olga %A Jones,Andy %A Chadborn,Tim %A Brown,Jamie %A Naughton,Felix %+ School of Health Sciences, University of East Anglia, Norwich Research Park, Earlham Road, Norwich, NR4 7TJ, United Kingdom, 44 1603593064, d.szinay@uea.ac.uk %K behavior change %K health apps %K mHealth %K smartphone app %K framework analysis %K COM-B %K TDF %K user engagement %K motivation %K usability %K engagement %K mobile phone %D 2021 %7 16.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health devices, such as health and well-being smartphone apps, could offer an accessible and cost-effective way to deliver health and well-being interventions. A key component of the effectiveness of health and well-being apps is user engagement. However, engagement with health and well-being apps is typically poor. Previous studies have identified a list of factors that could influence engagement; however, most of these studies were conducted on a particular population or for an app targeting a particular behavior. An understanding of the factors that influence engagement with a wide range of health and well-being apps can inform the design and the development of more engaging apps in general. Objective: The aim of this study is to explore user experiences of and reasons for engaging and not engaging with a wide range of health and well-being apps. Methods: A sample of adults in the United Kingdom (N=17) interested in using a health or well-being app participated in a semistructured interview to explore experiences of engaging and not engaging with these apps. Participants were recruited via social media platforms. Data were analyzed with the framework approach, informed by the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework, which are 2 widely used frameworks that incorporate a comprehensive set of behavioral influences. Results: Factors that influence the capability of participants included available user guidance, statistical and health information, reduced cognitive load, well-designed reminders, self-monitoring features, features that help establish a routine, features that offer a safety net, and stepping-stone app characteristics. Tailoring, peer support, and embedded professional support were identified as important factors that enhance user opportunities for engagement with health and well-being apps. Feedback, rewards, encouragement, goal setting, action planning, self-confidence, and commitment were judged to be the motivation factors that affect engagement with health and well-being apps. Conclusions: Multiple factors were identified across all components of the COM-B model that may be valuable for the development of more engaging health and well-being apps. Engagement appears to be influenced primarily by features that provide user guidance, promote minimal cognitive load, support self-monitoring (capability), provide embedded social support (opportunity), and provide goal setting with action planning (motivation). This research provides recommendations for policy makers, industry, health care providers, and app developers for increasing effective engagement. %M 34927597 %R 10.2196/29098 %U https://mhealth.jmir.org/2021/12/e29098 %U https://doi.org/10.2196/29098 %U http://www.ncbi.nlm.nih.gov/pubmed/34927597 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e29956 %T Design of a Virtual Reality Interactive Training System for Public Health Emergency Preparedness for Major Emerging Infectious Diseases: Theory and Framework %A Luo,Yue %A Li,Mei %A Tang,Jian %A Ren,JianLan %A Zheng,Yu %A Yu,XingLi %A Jiang,LinRui %A Fan,DingLin %A Chen,YanHua %+ Department of Nursing, The Affiliated Hospital of Southwest Medical University, 25, Taiping Road, Luzhou City, 646000, China, 86 18982765016, Chen_yanhua25@163.com %K virtual reality %K major emerging infectious diseases %K emergency preparedness %K interactive narrative theory %K situated learning theory %K human-computer interaction theory %K emergency simulation %K public health %K training %K VR %K epidemic %K medical education %K education %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Sufficient public health emergency preparedness (PHEP) is the key factor in effectively responding to and recovering from major emerging infectious diseases (MEIDs). However, in the face of MEIDs, PHEP is insufficient, so it is necessary to improve PHEP. The rapid development of virtual reality and human-computer interaction provides unprecedented opportunities for innovative educational methods. Objective: This study designed a virtual reality interactive training system (VRITS) to provide an effective path for improving PHEP in the context of MEIDs so that the public can effectively respond to and recover from MEIDs. Methods: This study used interactive narrative, situated learning and human-computer interaction theories as a theoretical framework to guide the design of the system. We used the literature research method and the Delphi method; consulted multidisciplinary experts, such as infectious diseases, disease control, psychology, and public health personnel, to determine the educational content framework; and set up an interdisciplinary team to construct an operating system framework for the VRITS. Results: We named the VRITS “People’s War Against Pandemic.” The educational content framework includes 20 knowledge, emotion, and behavior skills in 5 aspects (cooperating with prevention and control work, improving emergency response ability, guaranteeing supplies and equipment, preparing economic resources, and maintaining physical and mental health). The operating system framework includes virtual interactive training, knowledge corner, intelligent evaluation, and community forum modules, and the core module is the virtual interactive training module. In this module, users control virtual characters to move in various scenes, and then identify and analyze the controllability and harmfulness of the evolving pandemic and select the correct prevention and control strategy to avoid infecting themselves and others. Conclusions: The development and sharing of the multidisciplinary theoretical framework adopted by People’s War Against Pandemic can help us clarify the design ideas and assumptions of the VRITS; predict training results; understand the ability of training to change emergency knowledge, emergency emotion, and behavioral responses to MEIDs; and promote the development of more effective training systems based on virtual reality. %M 34904951 %R 10.2196/29956 %U https://games.jmir.org/2021/4/e29956 %U https://doi.org/10.2196/29956 %U http://www.ncbi.nlm.nih.gov/pubmed/34904951 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e28896 %T Team Building Through Team Video Games: Randomized Controlled Trial %A Keith,Mark J %A Dean,Douglas L %A Gaskin,James %A Anderson,Greg %+ Information Systems Department, Marriott School of Business, Brigham Young University, Campus Dr, Provo, UT, 84602, United States, 1 801 674 5159, mark.keith@gmail.com %K team video gaming %K team building %K flow %K team cohesion %K video games %K gamification %K team %K teamwork %K cohesion %K theory %K framework %K performance %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Organizations of all types require the use of teams. Poor team member engagement costs billions of US dollars annually. Objective: This study aimed to explain how team building can be accomplished with team video gaming based on a team cohesion model enhanced by team flow theory. Methods: In this controlled experiment, teams were randomly assigned to a team video gaming treatment or a control treatment. Team productivity was measured during both pretreatment and posttreatment team tasks. After the pretest, teams who were involved in the team video gaming treatment competed against other teams by playing the Halo or Rock Band video game for 45 minutes. After the pretest, teams in the control treatment worked alone for 45 minutes. Then, all teams completed the posttest team activity. This same experimental protocol was conducted on 2 different team tasks. Results: For both tasks, teams in the team video gaming treatment increased their productivity significantly more (F1=8.760, P=.004) on the posttest task than teams in the control treatment. Our flow-based theoretical model explained team performance improvement more than twice as well (R2=40.6%) than prior related research (R2=18.5%). Conclusions: The focused immersion caused by team video gaming increased team performance while the enjoyment component of flow decreased team performance on the posttest. Both flow and team cohesion contributed to team performance, with flow contributing more than cohesion. Team video gaming did not increase team cohesion, so team video gaming effects are independent of cohesion. Team video gaming is a valid practical method for developing and improving newly formed teams. %M 34904954 %R 10.2196/28896 %U https://games.jmir.org/2021/4/e28896 %U https://doi.org/10.2196/28896 %U http://www.ncbi.nlm.nih.gov/pubmed/34904954 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25963 %T Explaining Online Information Seeking Behaviors in People With Different Health Statuses: German Representative Cross-sectional Survey %A Link,Elena %A Baumann,Eva %A Klimmt,Christoph %+ Department of Journalism and Communication Research, Hanover University of Music, Drama and Media, Expo Plaza 12, Hanover, 30539, Germany, 49 5113100474, Elena.Link@ijk.hmtm-hannover.de %K online health information seeking behavior %K Planned Risk Information Seeking Model %K health status %K theory building %K personal survey %D 2021 %7 10.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Worldwide, the internet is an increasingly important channel for health information. Many theories have been applied in research on online health information seeking behaviors (HISBs), with each model integrating a different set of predictors; thus, a common understanding of the predictors of (online) HISB is still missing. Another shortcoming of the theories explaining (online) HISB is that most existing models, so far, focus on very specific health contexts such as cancer. Therefore, the assumptions of the Planned Risk Information Seeking Model (PRISM) as the latest integrative model are applied to study online HISB, because this model identifies the general cognitive and sociopsychological factors that explain health information seeking intention. We shift away from single diseases and explore cross-thematic patterns of online HISB intention and compare predictors concerning different health statuses as it can be assumed that groups of people perceiving themselves as ill or healthy will differ concerning their drivers of online HISB. Considering the specifics of online HISB and variation in individual context factors is key for the development of generalizable theories. Objective: The objective of our study was to contribute to the development of the concept of online HISB in 2 areas. First, this study aimed to explore individual-level predictors of individuals’ online HISB intention by applying the postulates of PRISM. Second, we compared relevant predictors of online HISB in groups of people with different health statuses to identify cross-thematic central patterns of online HISB. Methods: Data from a representative sample of German internet users (n=822) served to explain online HISB intentions and influencing patterns in different groups of people. The applicability of the PRISM to online HISB intention was tested by structural equation modeling and multigroup comparison. Results: Our results revealed PRISM to be an effective framework for explaining online HISB intention. For online HISB, attitudes toward seeking health information online provided the most important explanatory power followed by risk perceptions and affective risk responses. The multigroup comparison revealed differences both regarding the explanatory power of the model and the relevance of predictors of online HISB. The online HISB intention could be better explained for people facing a health threat, suggesting that the predictors adopted from PRISM were more suitable to explain a problem-driven type of information-seeking behavior. Conclusions: Our findings indicate that attitudes toward seeking health information online and risk perceptions are of central importance for online HISB across different health-conditional contexts. Predictors such as self-efficacy and perceived knowledge insufficiency play a context-dependent role—they are more influential when individuals are facing health threats and the search for health information is of higher personal relevance and urgency. These findings can be understood as the first step to develop a generalized theory of online HISB. %M 34890348 %R 10.2196/25963 %U https://www.jmir.org/2021/12/e25963 %U https://doi.org/10.2196/25963 %U http://www.ncbi.nlm.nih.gov/pubmed/34890348 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e30092 %T Assessing Patient Engagement in Health Care: Proposal for a Modeling and Simulation Framework for Behavioral Analysis %A Alwasel,Athary %A Stergioulas,Lampros %A Fakhimi,Masoud %A Garn,Wolfgang %+ Surrey Business School, University of Surrey, Stag Hill, Guildford, GU2 7XH, United Kingdom, 44 1483 683048, a.alwasel@surrey.ac.uk %K modeling and simulation %K behavioral analysis %K patient engagement %K behavioral factors, health care %K human factors %K outcomes %K patient health %K health policy %K chronic diseases %K behavioral model %D 2021 %7 8.12.2021 %9 Proposal %J JMIR Res Protoc %G English %X Human behavior plays a vital role in health care effectiveness and system performance. Therefore, it is necessary to look carefully at the interactions within a system and how a system is affected by the behavioral responses and activities of its various components, particularly human components and actions. Modeling patients’ engagement behaviors can be valuable in many ways; for example, models can evaluate the effects of therapeutic interventions on health improvement, health care effectiveness, and desired outcomes of changing health lifestyles. Modeling and simulation (M&S) help us to understand the interactions within a whole system under defined conditions. M&S in patient behavior analysis involve models that attempt to identify certain human behaviors that most likely have an impact on health care operations and services. Our study’s overall aims are (1) to investigate the impacts of patients’ engagement and various human behavior patterns on health care effectiveness and the achievement of desired outcomes and (2) to construct and validate a framework for modeling patient engagement and implementing and supporting patient management best practices, health policy-making processes, and innovative interventions in health care. We intend to extract routinely collected data of different parameters from general patients diagnosed with chronic diseases, such as diabetes. Our plan is to design data sets and extract health data from a pool of >4 million patient records from different general practices in England. We will focus on the primary electronic medical records of patients with at least 1 chronic disease (>200,000 records). Simulation techniques will be used to study patient engagement and its impact on health care effectiveness and outcome measures. The study will integrate available approaches to develop a framework for modeling how patients’ behaviors affect health care activities and outcomes and to underline the characteristics and salient factors that operational management needs to be aware of when developing a behavioral model for assessing patient engagement. The M&S framework, which is under development, will consider patient behavior in context and the underlying factors of human behavior with the help of simulation techniques. The proposed framework will be validated and evaluated through a health care case study. We expect to identify leading factors that influence and affect patient engagement and associated behavioral activities and to illustrate the challenges and complexities of developing simulation models for conducting behavioral analyses within health care settings. Additionally, we will assess patients’ engagement behaviors in terms of achieving health care effectiveness and desired outcomes, and we will specifically evaluate the impacts of patient engagement activities on health care services, patient management styles, and the effectiveness of health interventions in terms of achieving the intended outcomes—improved health and patient satisfaction.International Registered Report Identifier (IRRID): PRR1-10.2196/30092 %M 34889774 %R 10.2196/30092 %U https://www.researchprotocols.org/2021/12/e30092 %U https://doi.org/10.2196/30092 %U http://www.ncbi.nlm.nih.gov/pubmed/34889774 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e27533 %T Selecting and Evaluating Mobile Health Apps for the Healthy Life Trajectories Initiative: Development of the eHealth Resource Checklist %A Vanderloo,Leigh M %A Carsley,Sarah %A Agarwal,Payal %A Marini,Flavia %A Dennis,Cindy-Lee %A Birken,Catherine %+ Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada, 1 5194956306, lvande32@uwo.ca %K eHealth resources %K applications %K quality assessment %K preconception health %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The ubiquity of smartphones and mobile devices in the general population presents an unprecedented opportunity for preventative health. Not surprisingly, the use of electronic health (eHealth) resources accessed through mobile devices in clinical trials is becoming more prevalent; the selection, screening, and collation of quality eHealth resources is necessary to clinical trials using these technologies. However, the constant creation and turnover of new eHealth resources can make this task difficult. Although syntheses of eHealth resources are becoming more common, their methodological and reporting quality require improvement so as to be more accessible to nonexperts. Further, there continues to be significant variation in quality criteria employed for assessment, with no clear method for developing the included criteria. There is currently no single existing framework that addresses all six dimensions of mobile health app quality identified in Agarwal et al’s recent scoping review (ie, basic descriptions of the design and usage of the resource; technical features and accessibility; health information quality; usability; evidence of impact; and user engagement and behavior change). In instances where highly systematic tactics are not possible (due to time constraints, cost, or lack of expertise), there may be value in adopting practical and pragmatic approaches to helping researchers and clinicians identify and disseminate e-resources. Objective: The study aimed to create a set of guidelines (ie, a checklist) to aid the members of the Healthy Life Trajectories Initiative (HeLTI) Canada trial—a preconception randomized controlled clinical trial to prevent child obesity—to assist their efforts in searching, identifying, screening, and including selected eHealth resources for participant use in the study intervention. Methods: A framework for searching, screening, and selecting eHealth resources was adapted from the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist for systematic and scoping reviews to optimize the rigor, clarity, and transparency of the process. Details regarding searching, selecting, extracting, and assessing quality of eHealth resources are described. Results: This study resulted in the systematic development of a checklist consisting of 12 guiding principles, organized in a chronological versus priority sequence to aid researchers in searching, screening, and assessing the quality of various eHealth resources. Conclusions: The eHealth Resource Checklist will assist researchers in navigating the eHealth resource space by providing a mechanism to detail their process of developing inclusion criteria, identifying search location, selecting and reviewing evidence, extracting information, evaluating the quality of the evidence, and synthesizing the extracted evidence. The overarching goal of this checklist is to provide researchers or generalists new to the eHealth field with a tool that balances pragmatism with rigor and that helps standardize the process of searching and critiquing digital material—a particularly important aspect given the recent explosion of and reliance on eHealth resources. Moreover, this checklist may be useful to other researchers and practitioners developing similar health interventions. %M 34860681 %R 10.2196/27533 %U https://mhealth.jmir.org/2021/12/e27533 %U https://doi.org/10.2196/27533 %U http://www.ncbi.nlm.nih.gov/pubmed/34860681 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31668 %T How to Implement Digital Services in a Way That They Integrate Into Routine Work: Qualitative Interview Study Among Health and Social Care Professionals %A Nadav,Janna %A Kaihlanen,Anu-Marja %A Kujala,Sari %A Laukka,Elina %A Hilama,Pirjo %A Koivisto,Juha %A Keskimäki,Ilmo %A Heponiemi,Tarja %+ Finnish Institution for Health and Welfare, PO Box 30, Mannerheimintie 166, Helsinki, FI-00271, Finland, 358 2952480, janna.nadav@thl.fi %K digital services %K implementation %K health and social care professionals %K integration %K normalization process theory %K interview %K social work %K health care %K focus groups %D 2021 %7 1.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although the COVID-19 pandemic has significantly boosted the implementation of digital services worldwide, it has become increasingly important to understand how these solutions are integrated into professionals’ routine work. Professionals who are using the services are key influencers in the success of implementations. To ensure successful implementations, it is important to understand the multiprofessional perspective, especially because implementations are likely to increase even more. Objective: The aim of this study is to examine health and social care professionals’ experiences of digital service implementations and to identify factors that support successful implementations and should be considered in the future to ensure that the services are integrated into professionals’ routine work. Methods: A qualitative approach was used, in which 8 focus group interviews were conducted with 30 health and social care professionals from 4 different health centers in Finland. Data were analyzed using qualitative content analysis. The resulting categories were organized under the components of normalization process theory. Results: Our results suggested 14 practices that should be considered when implementing new digital services into routine work. To get professionals to understand and make sense of the new service, (1) the communication related to the implementation should be comprehensive and continuous and (2) the implementation process should be consistent. (3) A justification for the service being implemented should also be given. The best way to engage the professionals with the service is (4) to give them opportunities to influence and (5) to make sure that they have a positive attitude toward the service. To enact the new service into professionals’ routine work, it is important that (6) the organization take a supportive approach by providing support from several easy and efficient sources. The professionals should also have (7) enough time to become familiar with the service, and they should have (8) enough know-how about the service. The training should be (9) targeted individually according to skills and work tasks, and (10) it should be diverse. The impact of the implementation on the professionals’ work should be evaluated. The service (11) should be easy to use, and (12) usage monitoring should happen. An opportunity (13) to give feedback on the service should also be offered. Moreover, (14) the service should support professionals’ work tasks. Conclusions: We introduce 14 practices for organizations and service providers on how to ensure sustainable implementation of new digital services and the smooth integration into routine work. It is important to pay more attention to comprehensive and continuing communication. Organizations should conduct a competence assessment before training in order to ensure proper alignment. Follow-ups to the implementation process should be performed to guarantee sustainability of the service. Our findings from a forerunner country of digitalization can be useful for countries that are beginning their service digitalization or further developing their digital services. %M 34855610 %R 10.2196/31668 %U https://www.jmir.org/2021/12/e31668 %U https://doi.org/10.2196/31668 %U http://www.ncbi.nlm.nih.gov/pubmed/34855610 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e27953 %T Game Design in Mental Health Care: Case Study–Based Framework for Integrating Game Design Into Therapeutic Content %A Siriaraya,Panote %A Visch,Valentijn %A Boffo,Marilisa %A Spijkerman,Renske %A Wiers,Reinout %A Korrelboom,Kees %A Hendriks,Vincent %A Salemink,Elske %A van Dooren,Marierose %A Bas,Michael %A Goossens,Richard %+ Faculty of Industrial Design Engineering, Delft University of Technology, Mekelweg 5, Delft, 2628 CD, Netherlands, 31 152789111, spanote@gmail.com %K design models %K gamification %K case studies %K mental health %K eHealth %D 2021 %7 1.12.2021 %9 Viewpoint %J JMIR Serious Games %G English %X While there has been increasing interest in the use of gamification in mental health care, there is a lack of design knowledge on how elements from games could be integrated into existing therapeutic treatment activities in a manner that is balanced and effective. To help address this issue, we propose a design process framework to support the development of mental health gamification. Based on the concept of experienced game versus therapy worlds, we highlight 4 different therapeutic components that could be gamified to increase user engagement. By means of a Dual-Loop model, designers can balance the therapeutic and game design components and design the core elements of a mental health care gamification. To support the proposed framework, 4 cases of game design in mental health care (eg, therapeutic protocols for addiction, anxiety, and low self-esteem) are presented. %M 34855611 %R 10.2196/27953 %U https://games.jmir.org/2021/4/e27953 %U https://doi.org/10.2196/27953 %U http://www.ncbi.nlm.nih.gov/pubmed/34855611 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e33144 %T Contribution of the co.LAB Framework to the Collaborative Design of Serious Games: Mixed Methods Validation Study %A Jaccard,Dominique %A Suppan,Laurent %A Bielser,Félicia %+ Media Engineering Institute, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. Sports 20, Yverdon, 1400, Switzerland, 41 245577556, dominique.jaccard@heig-vd.ch %K serious game %K educational game %K education %K simulation game %K gaming %K design %K framework %K methodology %K mixed method %K validation %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Multidisciplinary collaboration is essential to the successful development of serious games, albeit difficult to achieve. In a previous study, the co.LAB serious game design framework was created to support collaboration within serious game multidisciplinary design teams. Its use has not yet been validated in a real usage context. Objective: The objective of this study was to perform a first assessment of the impact of the co.LAB framework on collaboration within multidisciplinary teams during serious game design and development. Methods: A mixed methods study was conducted, based on 2 serious game design projects in which the co.LAB framework was used. The first phase was qualitative and carried out using a general inductive approach. To this end, all members of the first serious game project team who used the co.LAB framework were invited to take part in a focus group session (n=6). In a second phase, results inferred from qualitative data were used to define a quantitative instrument (questionnaire) that was designed according to the Checklist for Reporting Results of Internet E-Surveys. Members of both project teams (n=11) were then asked to answer the questionnaire. Quantitative results were reported as median (Q1, Q3), and appropriate nonparametric tests were used to assess between-group differences. Finally, results gathered through the qualitative and quantitative phases were integrated. Results: In both phases, the participation rate was 100% (6/6 and 11/11). Verbatim transcripts were classified into 4 high level themes: (1) influence on collaborative dimensions; (2) impact on project course, monitoring, and efficiency; (3) qualitative perceptions of the framework; and (4) influence of team composition on the use of the framework. The web-based questionnaire was then developed according to the 7 dimensions of collaboration by Burkhardt et al. In both projects, the co.LAB framework had a positive impact on most dimensions of collaboration during the multidisciplinary design and development of serious games. When all collaborative dimensions were aggregated, the overall impact of the framework was rated on a scale from –42 to 42 (very negative to very positive). The overall median score was 23 (Q1, Q3: 20, 27), with no significant difference between groups (P=.58). Most respondents also believed that all serious game design teams should include a member possessing significant expertise in serious game design to guide the development process. Conclusions: The co.LAB framework had a positive impact on collaboration within serious game design and development teams. However, expert guidance seems necessary to maximize development efficiency. Whether such guidance can be provided by means of a collaborative web platform remains to be determined. %M 34822336 %R 10.2196/33144 %U https://games.jmir.org/2021/4/e33144 %U https://doi.org/10.2196/33144 %U http://www.ncbi.nlm.nih.gov/pubmed/34822336 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e30420 %T Perception and Initial Adoption of Mobile Health Services of Older Adults in London: Mixed Methods Investigation %A Pan,Jing %A Dong,Hua %A Bryan-Kinns,Nick %+ Brunel Design School, Brunel University London, Kingston Lane, Uxbridge, Middlesex UB8 3PH, London, United Kingdom, 44 01895 257254, Hua.Dong@brunel.ac.uk %K older adults %K mHealth %K initial adoption %K technology acceptance %K design %K mobile phone %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Advances in mobile technology and public needs have resulted in the emergence of mobile health (mHealth) services. Despite the potential benefits of mHealth apps, older adults face challenges and barriers in adopting them. Objective: The aims of this study are to understand older adults’ perception of mHealth services and to discover the barriers that older adults face in the initial adoption of mHealth apps. Methods: This paper systematically analyzed main determinants related to mHealth services and investigated them through questionnaires, interviews, and a workshop. Two studies were carried out in London. In study 1, the questionnaires with follow-up interviews were conducted based on the literature review to uncover older adults’ perception (including perceived usefulness, perceived ease of use, and perceived behavioral control) of mHealth services. Study 2 was a workshop helping older adults to trial selected mHealth apps. The workshop was conducted by the first author (JP) with assistance from 5 research students. The barriers that older adults faced in the initial adoption period were observed. The interviews and workshop were audiotaped and transcribed. Descriptive statistics and the thematic analysis technique were used for data analysis. Results: In total, 30 older adults in London completed the questionnaires and interviews in study 1. The results of study 1 show that the lack of obvious advantage, low reliability, scary information, and the risk of privacy leakage would decrease older adults’ perceived usefulness of mHealth services; the design of app interface would directly affect the perceived ease of use; and aging factors, especially the generation gap, would create barriers for older users. In total, 12 participants took part in the workshop of study 2, including 8 who took part in study 1. The results of study 2 identified that access to technology, the way of interaction, the risk of money loss, heavy workload of using an mHealth app, and different lifestyle are influential factors to older adults’ adoption of mHealth services. Conclusions: The perceptions of mHealth services of older adults were investigated; the barriers that older adults may face in the initial adoption stage were identified. On the basis of the synthesis of these results, design suggestions were proposed, including technical improvement, free trial, information clarification, and participatory design. They will help inform the design of mHealth services to benefit older adults. %M 34807836 %R 10.2196/30420 %U https://aging.jmir.org/2021/4/e30420 %U https://doi.org/10.2196/30420 %U http://www.ncbi.nlm.nih.gov/pubmed/34807836 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e26931 %T Digital Interventions on Healthy Lifestyle Management: Systematic Review %A Chatterjee,Ayan %A Prinz,Andreas %A Gerdes,Martin %A Martinez,Santiago %+ Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Jon Lilletuns Vei 9, Grimstad, 4879, Norway, 47 94719372, ayan.chatterjee@uia.no %K eHealth %K digital intervention %K lifestyle %K obesity %K challenges %K mobile phone %D 2021 %7 17.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Digital interventions have tremendous potential to improve well-being and health care conveyance by improving adequacy, proficiency, availability, and personalization. They have gained acknowledgment in interventions for the management of a healthy lifestyle. Therefore, we are reviewing existing conceptual frameworks, digital intervention approaches, and associated methods to identify the impact of digital intervention on adopting a healthier lifestyle. Objective: This study aims to evaluate the impact of digital interventions on weight management in maintaining a healthy lifestyle (eg, regular physical activity, healthy habits, and proper dietary patterns). Methods: We conducted a systematic literature review to search the scientific databases (Nature, SpringerLink, Elsevier, IEEE Xplore, and PubMed) that included digital interventions on healthy lifestyle, focusing on preventing obesity and being overweight as a prime objective. Peer-reviewed articles published between 2015 and 2020 were included. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a framework for an evidence-based systematic review. Furthermore, we improved the review process by adopting the Rayyan tool and the Scale for the Assessment of Narrative Review Articles. Results: Our initial searches identified 780 potential studies through electronic and manual searches; however, 107 articles in the final stage were cited following the specified inclusion and exclusion criteria. The identified methods for a successful digital intervention to promote a healthy lifestyle are self-monitoring, self-motivation, goal setting, personalized feedback, participant engagement, psychological empowerment, persuasion, digital literacy, efficacy, and credibility. In this study, we identified existing conceptual frameworks for digital interventions, different approaches to provide digital interventions, associated methods, and execution challenges and their impact on the promotion of healthy lifestyle management. Conclusions: This systematic literature review selected intervention principles (rules), theories, design features, ways to determine efficient interventions, and weaknesses in healthy lifestyle management from established digital intervention approaches. The results help us understand how digital interventions influence lifestyle management and overcome the existing shortcomings. It serves as a basis for further research with a focus on designing, developing, testing, and evaluating the generation of personalized lifestyle recommendations as a part of digital health interventions. %M 34787575 %R 10.2196/26931 %U https://www.jmir.org/2021/11/e26931 %U https://doi.org/10.2196/26931 %U http://www.ncbi.nlm.nih.gov/pubmed/34787575 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30644 %T eHealth Literacy Instruments: Systematic Review of Measurement Properties %A Lee,Jiyeon %A Lee,Eun-Hyun %A Chae,Duckhee %+ Graduate School of Public Health, Ajou University, 164, Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea, 82 31 219 5296, ehlee@ajou.ac.kr %K eHealth literacy %K systematic review %K meta-analysis %K psychometrics %K reliability %K validity %K scale %K instrument %D 2021 %7 15.11.2021 %9 Review %J J Med Internet Res %G English %X Background: The internet is now a major source of health information. With the growth of internet users, eHealth literacy has emerged as a new concept for digital health care. Therefore, health professionals need to consider the eHealth literacy of consumers when providing care utilizing digital health technologies. Objective: This study aimed to identify currently available eHealth literacy instruments and evaluate their measurement properties to provide robust evidence to researchers and clinicians who are selecting an eHealth literacy instrument. Methods: We conducted a systematic review and meta-analysis of self-reported eHealth literacy instruments by applying the updated COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodology. Results: This study included 7 instruments from 41 articles describing 57 psychometric studies, as identified in 4 databases (PubMed, CINAHL, Embase, and PsycInfo). No eHealth literacy instrument provided evidence for all measurement properties. The eHealth literacy scale (eHEALS) was originally developed with a single-factor structure under the definition of eHealth literacy before the rise of social media and the mobile web. That instrument was evaluated in 18 different languages and 26 countries, involving diverse populations. However, various other factor structures were exhibited: 7 types of two-factor structures, 3 types of three-factor structures, and 1 bifactor structure. The transactional eHealth literacy instrument (TeHLI) was developed to reflect the broader concept of eHealth literacy and was demonstrated to have a sufficient low-quality and very low-quality evidence for content validity (relevance, comprehensiveness, and comprehensibility) and sufficient high-quality evidence for structural validity and internal consistency; however, that instrument has rarely been evaluated. Conclusions: The eHealth literacy scale was the most frequently investigated instrument. However, it is strongly recommended that the instrument's content be updated to reflect recent advancements in digital health technologies. In addition, the transactional eHealth literacy instrument needs improvements in content validity and further psychometric studies to increase the credibility of its synthesized evidence. %M 34779781 %R 10.2196/30644 %U https://www.jmir.org/2021/11/e30644 %U https://doi.org/10.2196/30644 %U http://www.ncbi.nlm.nih.gov/pubmed/34779781 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e31037 %T Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework %A Yakovchenko,Vera %A McInnes,D Keith %A Petrakis,Beth Ann %A Gillespie,Chris %A Lipschitz,Jessica M %A McCullough,Megan B %A Richardson,Lorilei %A Vetter,Brian %A Hogan,Timothy P %+ Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, 01730, United States, 1 781 687 3374, vera.yakovchenko@va.gov %K implementation science %K implementation facilitation %K texting %K veterans %K eHealth %K self-management %K digital health %K digital medicine %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. Objective: We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Methods: Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. Results: We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation. Conclusions: VHA’s new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management. Trial Registration: ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349 %M 34779779 %R 10.2196/31037 %U https://mhealth.jmir.org/2021/11/e31037 %U https://doi.org/10.2196/31037 %U http://www.ncbi.nlm.nih.gov/pubmed/34779779 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e25831 %T Software Engineering Frameworks Used for Serious Games Development in Physical Rehabilitation: Systematic Review %A Ambros-Antemate,Jorge Fernando %A Beristain-Colorado,María Del Pilar %A Vargas-Treviño,Marciano %A Gutiérrez-Gutiérrez,Jaime %A Hernández-Cruz,Pedro Antonio %A Gallegos-Velasco,Itandehui Belem %A Moreno-Rodríguez,Adriana %+ Doctorado en Biociencias, Facultad de Medicina y Cirugía, Universidad Autónoma “Benito Juárez” de Oaxaca, Ex Hacienda de Aguilera S/N, Calz. San Felipe del Agua, Oaxaca de Juárez, 68120, Mexico, 52 9511332346, jambros.cat@uabjo.mx %K serious game %K physical rehabilitation %K framework %K methodology %D 2021 %7 11.11.2021 %9 Review %J JMIR Serious Games %G English %X Background: Serious games are a support in the rehabilitation process for treating people with physical disabilities. However, many of these serious games are not adapted to the patient’s needs because they are not developed with a software engineering framework with a set of activities, actions, and tasks that must be executed when creating a software product. Better serious games for rehabilitation will be developed if the patient and therapist requirements are identified, the development is planned, and system improvements and feedback are involved. The goal is that the serious game must offer a more attractive environment, while maintaining patient interest in the rehabilitation process. Objective: This paper submits the results of a systematic review of serious games in physical rehabilitation identifying the benefits of using a software engineering framework. Methods: A systematic research was conducted using PubMed, PEDro (Physiotherapy Evidence Database), IEEE Xplore, ScienceDirect, ACM Digital Library, Mary Ann Liebert, Taylor & Francis Online, Wiley Online Library, and Springer databases. The initial search resulted in 701 papers. After assessing the results according to the inclusion criteria, 83 papers were selected for this study. Results: From the 83 papers reviewed, 8 used a software engineering framework for its development. Most of them focused their efforts on 1 or more aspects, such as data acquisition and processing, game levels, motivation, therapist supervision. Conclusions: This systematic review proves that most of the serious games do not use a software engineering framework for their development. As a result, development systems overlook several aspects and do not have a standardized process, eventually omitting important implementation aspects, which impact the patient’s recovery time. %M 34762052 %R 10.2196/25831 %U https://games.jmir.org/2021/4/e25831 %U https://doi.org/10.2196/25831 %U http://www.ncbi.nlm.nih.gov/pubmed/34762052 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e27896 %T Using Co-design in Mobile Health System Development: A Qualitative Study With Experts in Co-design and Mobile Health System Development %A Noorbergen,Tyler J %A Adam,Marc T P %A Teubner,Timm %A Collins,Clare E %+ School of Information and Physical Sciences, College of Engineering, Science and Environment, University of Newcastle, ES214, Es Building, Callaghan, 2308, Australia, 61 249215197, marc.adam@newcastle.edu.au %K co-design %K mHealth %K guidelines %K qualitative study %K mobile phone %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners emphasize that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and the lack of integration into existing system landscapes. Co-design is an approach used to address these pitfalls. By recognizing users as experts of their own experience, co-design directly involves users in the design process and provides them an active role in knowledge development, idea generation, and concept development. Objective: Despite the existence of a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mobile health (mHealth) systems. This study aims to contextualize an existing co-design framework for mHealth applications and construct guidelines to address common challenges of co-designing mHealth systems. Methods: Tapping into the knowledge and experience of experts in co-design and mHealth systems development, we conducted an exploratory qualitative study consisting of 16 semistructured interviews. Thereby, a constructivist ontological position was adopted while acknowledging the socially constructed nature of reality in mHealth system development. Purposive sampling across web-based platforms (eg, Google Scholar and ResearchGate) and publications by authors with co-design experience in mHealth were used to recruit co-design method experts (n=8) and mHealth system developers (n=8). Data were analyzed using thematic analysis along with our objectives of contextualizing the co-design framework and constructing guidelines for applying co-design to mHealth systems development. Results: The contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases, and an emphasis on immersion in real-world contexts. In addition, 7 guidelines were constructed that directly pertain to mHealth: understanding stakeholder vulnerabilities and diversity, health behavior change, co-design facilitators, immersion in the mHealth ecosystem, postdesign advocates, health-specific evaluation criteria, and usage data and contextual research to understand impact. Conclusions: System designers encounter unique challenges when engaging in mHealth systems development. The contextualized co-design framework and constructed guidelines have the potential to serve as a shared frame of reference to guide the co-design of mHealth systems and facilitate interdisciplinary collaboration at the nexus of information technology and health research. %M 34757323 %R 10.2196/27896 %U https://mhealth.jmir.org/2021/11/e27896 %U https://doi.org/10.2196/27896 %U http://www.ncbi.nlm.nih.gov/pubmed/34757323 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e25159 %T The Sociological Perspective of Users’ Invisible Work: A Qualitative Research Framework for Studying Digital Health Innovations Integration %A Trupia,Dilara Vanessa %A Mathieu-Fritz,Alexandre %A Duong,Tu Anh %+ LATTS, Univ Gustave Eiffel, CNRS, Ecole des Ponts, 5 boulevard Descartes, Cité Descartes, Bâtiment Bois de l’Etang, Marne-la-Vallée, F-77454, France, 33 618635423, dilaratrupia@gmail.com %K digital health innovations %K qualitative analysis %K sociological framework %K invisible work %K patient work %K user work %K participatory health care %K chronic illness %K self-quantification %D 2021 %7 4.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: When new technology is integrated into a care pathway, it faces resistance due to the changes it introduces into the existing context. To understand the success or failure of digital health innovations, it is necessary to pay attention to the adjustments that users must perform to make them work, by reshaping the context and sometimes by altering the ways in which they perform activities. This adaptation work, most of which remains invisible, constitutes an important factor in the success of innovations and the ways in which they transform care practices. Objective: This work aims to present a sociological framework for studying new health technology uses through a qualitative analysis of the different types of tasks and activities that users, both health professionals and patients, must perform to integrate these technologies and make them work in their daily routine. Methods: This paper uses a three-part method to structure a theoretical model to study users’ invisible work. The first part of the method includes a thematic literature review, previously published by one of the coauthors, of major sociological studies conducted on digital health innovations integration into existing care organizations and practices. The second part extends this review to introduce definitions and applications of the users’ invisible work concept. The third part consists of producing a theoretical framework to study the concept according to the different contexts and practices of the users. Results: The paper proposes four dimensions (organizational, interactional, practical, and experiential), each composed of a set of criteria that allow a comparative analysis of different users’ work according to different health technologies. Conclusions: This framework can be applied both as an analytical tool in a research protocol and as an agenda to identify less visible adoption criteria for digital health technologies. %M 34734832 %R 10.2196/25159 %U https://www.jmir.org/2021/11/e25159 %U https://doi.org/10.2196/25159 %U http://www.ncbi.nlm.nih.gov/pubmed/34734832 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e19846 %T Blockchain Integration With Digital Technology and the Future of Health Care Ecosystems: Systematic Review %A Fatoum,Hanaa %A Hanna,Sam %A Halamka,John D %A Sicker,Douglas C %A Spangenberg,Peter %A Hashmi,Shahrukh K %+ College of Medicine, Alfaisal University, Takhassusi, Riyadh, 11533, Saudi Arabia, 966 000000, Hanaa.Fatoum@outlook.com %K blockchain, Internet of Things %K digital %K artificial intelligence %K machine learning %K eHealth %K ledger %K distributed ledger technology %D 2021 %7 2.11.2021 %9 Review %J J Med Internet Res %G English %X Background: In the era of big data, artificial intelligence (AI), and the Internet of Things (IoT), digital data have become essential for our everyday functioning and in health care services. The sensitive nature of health care data presents several crucial issues such as privacy, security, interoperability, and reliability that must be addressed in any health care data management system. However, most of the current health care systems are still facing major obstacles and are lacking in some of these areas. This is where decentralized, secure, and scalable databases, most notably blockchains, play critical roles in addressing these requirements without compromising security, thereby attracting considerable interest within the health care community. A blockchain can be maintained and widely distributed using a large network of nodes, mostly computers, each of which stores a full replica of the data. A blockchain protocol is a set of predefined rules or procedures that govern how the nodes interact with the network, view, verify, and add data to the ledger. Objective: In this article, we aim to explore blockchain technology, its framework, current applications, and integration with other innovations, as well as opportunities in diverse areas of health care and clinical research, in addition to clarifying its future impact on the health care ecosystem. We also elucidate 2 case studies to instantiate the potential role of blockchains in health care. Methods: To identify related existing work, terms based on Medical Subject Headings were used. We included studies focusing mainly on health care and clinical research and developed a functional framework for implementation and testing with data. The literature sources for this systematic review were PubMed, Medline, and the Cochrane library, in addition to a preliminary search of IEEE Xplore. Results: The included studies demonstrated multiple framework designs and various implementations in health care including chronic disease diagnosis, management, monitoring, and evaluation. We found that blockchains exhibit many promising applications in clinical trial management such as smart-contract application, participant-controlled data access, trustless protocols, and data validity. Electronic health records (EHRs), patient-centered interoperability, remote patient monitoring, and clinical trial data management were found to be major areas for blockchain usage, which can become a key catalyst for health care innovations. Conclusions: The potential benefits of blockchains are limitless; however, concrete data on long-term clinical outcomes based on blockchains powered and supplemented by AI and IoT are yet to be obtained. Nonetheless, implementing blockchains as a novel way to integrate EHRs nationwide and manage common clinical problems in an algorithmic fashion has the potential for improving patient outcomes, health care experiences, as well as the overall health and well-being of individuals. %M 34726603 %R 10.2196/19846 %U https://www.jmir.org/2021/11/e19846 %U https://doi.org/10.2196/19846 %U http://www.ncbi.nlm.nih.gov/pubmed/34726603 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e29064 %T Development of a Theoretically Informed Web-Based Mind-Body Wellness Intervention for Patients With Primary Biliary Cholangitis: Formative Study %A Watt,Makayla %A Spence,John C %A Tandon,Puneeta %+ University of Alberta, 130-University Campus, Edmonton, AB, T6G2X8, Canada, 1 780 492 9844, ptandon@ualberta.ca %K liver disease %K meditation %K yoga %K breathwork %K behavior theory %K COM-B model %K behaviour change wheel %K behaviour change taxonomy %K internet %K digital %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mind-body interventions have the potential to positively impact the symptom burden associated with primary biliary cholangitis (PBC). Interventions are more likely to be effective if they are informed by a theoretical framework. The Behaviour Change Wheel (BCW) and the behaviour change technique taxonomy version 1 (BCTv1) provide frameworks for intervention development. Objective: This study describes how theory has guided the development of a 12-week multicomponent mind-body wellness intervention for PBC. Methods: The steps involved in developing the BCW intervention included specifying the target behavior; explaining barriers and facilitators using the Capability, Opportunity, Motivation, and Behaviour and the theoretical domains framework; identifying intervention functions to target explanatory domains; and selecting relevant behavior change techniques to address intervention functions. Qualitative data from patients with inflammatory bowel disease using an earlier version of the program and feedback from a PBC patient advisory team were used to guide intervention development. Results: Barriers and facilitators to intervention participation associated with capability, opportunity, and motivation were identified. Intervention functions and behavior change techniques were identified to target each barrier and facilitator. Conclusions: The Peace Power Pack PBC intervention was developed to help individuals with PBC manage their symptom burden. The theoretical frameworks employed in this intervention provide direction on targeting antecedents of behavior and allow standardized reporting of intervention components. Trial Registration: ClinicalTrials.gov NCT04791527; https://clinicaltrials.gov/ct2/show/NCT04791527 %M 34623317 %R 10.2196/29064 %U https://formative.jmir.org/2021/10/e29064 %U https://doi.org/10.2196/29064 %U http://www.ncbi.nlm.nih.gov/pubmed/34623317 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28766 %T A Road Map for Remote Digital Health Technology for Motor Neuron Disease %A van Eijk,Ruben P A %A Beelen,Anita %A Kruitwagen,Esther T %A Murray,Deirdre %A Radakovic,Ratko %A Hobson,Esther %A Knox,Liam %A Helleman,Jochem %A Burke,Tom %A Rubio Pérez,Miguel Ángel %A Reviers,Evy %A Genge,Angela %A Steyn,Frederik J %A Ngo,Shyuan %A Eaglesham,John %A Roes,Kit C B %A van den Berg,Leonard H %A Hardiman,Orla %A McDermott,Christopher J %+ UMC Utrecht Brain Centre, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands, 31 88 75 579 39, r.p.a.vaneijk-2@umcutrecht.nl %K amyotrophic lateral sclerosis %K digital health care technology %K e-health %D 2021 %7 22.9.2021 %9 Viewpoint %J J Med Internet Res %G English %X Despite recent and potent technological advances, the real-world implementation of remote digital health technology in the care and monitoring of patients with motor neuron disease has not yet been realized. Digital health technology may increase the accessibility to and personalization of care, whereas remote biosensors could optimize the collection of vital clinical parameters, irrespective of patients’ ability to visit the clinic. To facilitate the wide-scale adoption of digital health care technology and to align current initiatives, we outline a road map that will identify clinically relevant digital parameters; mediate the development of benefit-to-burden criteria for innovative technology; and direct the validation, harmonization, and adoption of digital health care technology in real-world settings. We define two key end products of the road map: (1) a set of reliable digital parameters to capture data collected under free-living conditions that reflect patient-centric measures and facilitate clinical decision making and (2) an integrated, open-source system that provides personalized feedback to patients, health care providers, clinical researchers, and caregivers and is linked to a flexible and adaptable platform that integrates patient data in real time. Given the ever-changing care needs of patients and the relentless progression rate of motor neuron disease, the adoption of digital health care technology will significantly benefit the delivery of care and accelerate the development of effective treatments. %M 34550089 %R 10.2196/28766 %U https://www.jmir.org/2021/9/e28766 %U https://doi.org/10.2196/28766 %U http://www.ncbi.nlm.nih.gov/pubmed/34550089 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28356 %T An Evaluation Service for Digital Public Health Interventions: User-Centered Design Approach %A Karpathakis,Kassandra %A Libow,Gene %A Potts,Henry W W %A Dixon,Simon %A Greaves,Felix %A Murray,Elizabeth %+ Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 20 3549 5303, h.potts@ucl.ac.uk %K digital health %K internet-based interventions %K mHealth %K evaluation studies %K public health %K human-centered design %K service design %K mobile phone %D 2021 %7 8.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) have the potential to improve public health by combining effective interventions and population reach. However, what biomedical researchers and digital developers consider an effective intervention differs, thereby creating an ongoing challenge to integrating their respective approaches when evaluating DHIs. Objective: This study aims to report on the Public Health England (PHE) initiative set out to operationalize an evaluation framework that combines biomedical and digital approaches and demonstrates the impact, cost-effectiveness, and benefit of DHIs on public health. Methods: We comprised a multidisciplinary project team including service designers, academics, and public health professionals and used user-centered design methods, such as qualitative research, engagement with end users and stakeholders, and iterative learning. The iterative approach enabled the team to sequentially define the problem, understand user needs, identify opportunity areas, develop concepts, test prototypes, and plan service implementation. Stakeholders, senior leaders from PHE, and a working group critiqued the outputs. Results: We identified 26 themes and 82 user needs from semistructured interviews (N=15), expressed as 46 Jobs To Be Done, which were then validated across the journey of evaluation design for a DHI. We identified seven essential concepts for evaluating DHIs: evaluation thinking, evaluation canvas, contract assistant, testing toolkit, development history, data hub, and publish health outcomes. Of these, three concepts were prioritized for further testing and development, and subsequently refined into the proposed PHE Evaluation Service for public health DHIs. Testing with PHE’s Couch-to-5K app digital team confirmed the viability, desirability, and feasibility of both the evaluation approach and the Evaluation Service. Conclusions: An iterative, user-centered design approach enabled PHE to combine the strengths of academic and biomedical disciplines with the expertise of nonacademic and digital developers for evaluating DHIs. Design-led methodologies can add value to public health settings. The subsequent service, now known as Evaluating Digital Health Products, is currently in use by health bodies in the United Kingdom and is available to others for tackling the problem of evaluating DHIs pragmatically and responsively. %M 34494965 %R 10.2196/28356 %U https://www.jmir.org/2021/9/e28356 %U https://doi.org/10.2196/28356 %U http://www.ncbi.nlm.nih.gov/pubmed/34494965 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e24546 %T The Impact of Gamification-Induced Users' Feelings on the Continued Use of mHealth Apps: A Structural Equation Model With the Self-Determination Theory Approach %A Wang,Tong %A Fan,Lingye %A Zheng,Xu %A Wang,Wei %A Liang,Jun %A An,Kai %A Ju,Mei %A Lei,Jianbo %+ Institute of Medical Technology, Health Science Center, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, China, 86 82805901, jblei@hsc.pku.edu.cn %K mHealth app %K continued use %K continuance intention %K gamification %K self-determination theory (SDT) %K expectation confirmation model of information system continuance (ECM-ISC) %K PLS-SEM %D 2021 %7 12.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Continued use of mHealth apps can achieve better effects in health management. Gamification is an important factor in promoting users’ intention to continue using mHealth apps. Past research has rarely explored the factors underlying the continued use of mobile health (mHealth) apps and gamification’s impact mechanism or path on continued use. Objective: This study aimed to explore the factors influencing mHealth app users’ intention to continue using mHealth apps and the impact mechanism and path of users’ feelings induced by gamification on continued mHealth app use. Methods: First, based on the expectation confirmation model of information system continuance, we built a theoretical model for continued use of mHealth apps based on users’ feelings toward gamification. We used self-determination theory to analyze gamification’s impact on user perceptions and set the resulting feelings (competence, autonomy, and relatedness) as constructs in the model. Second, we used the survey method to validate the research model, and we used partial least squares to analyze the data. Results: A total of 2988 responses were collected from mHealth app users, and 307 responses were included in the structural equation model after passing the acceptance criteria. The intrinsic motivation for using mHealth apps is significantly affected by autonomy (β=.312; P<.001), competence (β=.346; P<.001), and relatedness (β=.165; P=.004) induced by gamification. The intrinsic motivation for using mHealth apps has a significant impact on satisfaction (β=.311, P<.001) and continuance intention (β=.142; P=.045); furthermore, satisfaction impacts continuance intention significantly (β=.415; P<.001). Confirmation has a significant impact on perceived usefulness (β=.859; P<.001) and satisfaction (β=.391; P<.001), and perceived usefulness has a significant impact on satisfaction (β=.269; P<.001) and continuance intention (β=.273; P=.001). The mediating effect analysis showed that in the impact path of the intrinsic motivation for using the mHealth apps on continuance intention, satisfaction plays a partial mediating role (β=.129; P<.001), with a variance accounted for of 0.466. Conclusions: This study explored the impact path of users’ feelings induced by gamification on the intention of continued mHealth app use. We confirmed that perceived usefulness, confirmation, and satisfaction in the classical continued use theory for nonmedical information systems positively affect continuance intention. We also found that the path and mechanism of users' feelings regarding autonomy, competence, and relatedness generated during interactions with different gamification elements promote the continued use of mHealth apps. %M 34387550 %R 10.2196/24546 %U https://www.jmir.org/2021/8/e24546 %U https://doi.org/10.2196/24546 %U http://www.ncbi.nlm.nih.gov/pubmed/34387550 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e18198 %T Conceptualizing Usability for the eHealth Context: Content Analysis of Usability Problems of eHealth Applications %A Broekhuis,Marijke %A van Velsen,Lex %A Peute,Linda %A Halim,Meilani %A Hermens,Hermie %+ Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede, 7522 AH, Netherlands, 31 0880875728, m.broekhuis@rrd.nl %K usability benchmarking %K eHealth systems %K content analysis %K usability framework %K summative evaluation %K mobile phone %D 2021 %7 27.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Usability tests can be either formative (where the aim is to detect usability problems) or summative (where the aim is to benchmark usability). There are ample formative methods that consider user characteristics and contexts (ie, cognitive walkthroughs, interviews, and verbal protocols). This is especially valuable for eHealth applications, as health conditions can influence user-system interactions. However, most summative usability tests do not consider eHealth-specific factors that could potentially affect the usability of a system. One of the reasons for this is the lack of fine-grained frameworks or models of usability factors that are unique to the eHealth domain. Objective: In this study, we aim to develop an ontology of usability problems, specifically for eHealth applications, with patients as primary end users. Methods: We analyzed 8 data sets containing the results of 8 formative usability tests for eHealth applications. These data sets contained 400 usability problems that could be used for analysis. Both inductive and deductive coding were used to create an ontology from 6 data sets, and 2 data sets were used to validate the framework by assessing the intercoder agreement. Results: We identified 8 main categories of usability factors, including basic system performance, task-technology fit, accessibility, interface design, navigation and structure, information and terminology, guidance and support, and satisfaction. These 8 categories contained a total of 21 factors: 14 general usability factors and 7 eHealth-specific factors. Cohen κ was calculated for 2 data sets on both the category and factor levels, and all Cohen κ values were between 0.62 and 0.67, which is acceptable. Descriptive analysis revealed that approximately 69.5% (278/400) of the usability problems can be considered as general usability factors and 30.5% (122/400) as eHealth-specific usability factors. Conclusions: Our ontology provides a detailed overview of the usability factors for eHealth applications. Current usability benchmarking instruments include only a subset of the factors that emerged from our study and are therefore not fully suited for summative evaluations of eHealth applications. Our findings support the development of new usability benchmarking tools for the eHealth domain. %M 34313594 %R 10.2196/18198 %U https://formative.jmir.org/2021/7/e18198 %U https://doi.org/10.2196/18198 %U http://www.ncbi.nlm.nih.gov/pubmed/34313594 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e27758 %T The Sharing Economy in China’s Aging Industry: Applications, Challenges, and Recommendations %A Hu,Yaolin %A Wang,Jian %A Nicholas,Stephen %A Maitland,Elizabeth %+ Dong Fureng Institute of Economic and Social Development, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, 430072, China, 86 13864157135, wangjian993@whu.edu.cn %K sharing economy %K aging industry %K older adult population %K older adults %K aging %K health services %K sharing model %K sharing %K China %K East Asia %D 2021 %7 6.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: All aging societies face the challenge of allocating limited resources for the highest value of use. The sharing economy provides one method to address the imbalance between the demand and supply of health services to the older adult population. With a substantial aging population, China’s practices in the sharing aging industry may set examples for other “getting old before getting rich” countries. Objective: There is a gap in both the data and research on China’s aging industry sharing economy. This paper addresses these data and research lacunae by constructing a framework for the application of a sharing model in China’s aging industry, by assessing the current state of the aging industry sharing economy, by setting out the challenges to the sharing aging health care and service economy, and by making recommendations for the development of the aging industry sharing economy. Methods: This paper constructs a sharing economy framework in the aging industry covering four aspects (people, facilities, capital, and information) to test the current state and future prospects of China’s aging industry sharing economy. Results: In people sharing, we analyzed the sharing of emotional companionship, doctors, nurses, nursing attendants, and domestic helpers. We discussed facility sharing models from the point of land and housing, medical devices, and other items such as pensioner meals and shared medicine bins. We acknowledge that crowdfunding platforms have developed fast in China, but many older adult users faced problems in their operation. Information sharing is a developing field, which can optimize users’ experiences and should help older adults filter out misinformation, but China currently does not have adequate sharing information platforms for older adults. Conclusions: We identified four major challenges in China’s aging industry sharing economy: poor adaptability to technology for older adults, mediocre quality of shared services, one-size-fits-all and the concept of the useless elderly, and shortage of qualified practitioners. We make recommendations for specific measures by governments, communities, and enterprises to improve the sharing economy in the aging industry. %M 34255691 %R 10.2196/27758 %U https://www.jmir.org/2021/7/e27758 %U https://doi.org/10.2196/27758 %U http://www.ncbi.nlm.nih.gov/pubmed/34255691 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e25854 %T Standardizing the Development of Serious Games for Physical Rehabilitation: Conceptual Framework Proposal %A Beristain-Colorado,María Del Pilar %A Ambros-Antemate,Jorge Fernando %A Vargas-Treviño,Marciano %A Gutiérrez-Gutiérrez,Jaime %A Moreno-Rodriguez,Adriana %A Hernández-Cruz,Pedro Antonio %A Gallegos-Velasco,Itandehui Belem %A Torres-Rosas,Rafael %+ Doctorado en Biociencias, Facultad de Medicina y Cirugía, Universidad Autónoma “Benito Juárez” de Oaxaca, Ex Hacienda de Aguilera S/N, Calz. San Felipe del Agua., Oaxaca de Juárez, 68120, Mexico, 52 9511332346, pberistain.cat@uabjo.mx %K serious game %K physical rehabilitation %K framework %K software engineering %K gamification %D 2021 %7 24.6.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Serious games have been used as supportive therapy for traditional rehabilitation. However, most are designed without a systematic process to guide their development from the phases of requirement identification, planning, design, construction, and evaluation, which reflect the lack of adaptation of rehabilitation requirements and thus the patient’s needs. Objective: The aim of this study was to propose a conceptual framework with standardized elements for the development of information systems by using a flexible and an adaptable process centered on the patient’s needs and focused on the creation of serious games for physical rehabilitation. Methods: The conceptual framework is based on 3 fundamental concepts: (1) user-centered design, which is an iterative design process focused on users and their needs at each phase of the process, (2) generic structural activities of software engineering, which guides the independent development process regardless of the complexity or size of the problem, and (3) gamification elements, which allow the transformation of obstacles into positive and fun reinforcements, thereby encouraging patients in their rehabilitation process. Results: We propose a conceptual framework to guide the development of serious games through a systematic process by using an iterative and incremental process applying the phases of context identification, user requirements, planning, design, construction of the interaction devices and video game, and evaluation. Conclusions: This proposed framework will provide developers of serious games a systematic process with standardized elements for the development of flexible and adaptable software with a high level of patient commitment, which will effectively contribute to their rehabilitation process. %M 34185003 %R 10.2196/25854 %U https://games.jmir.org/2021/2/e25854/ %U https://doi.org/10.2196/25854 %U http://www.ncbi.nlm.nih.gov/pubmed/34185003 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25522 %T A Comprehensive 6A Framework for Improving Patient Self-Management of Hypertension Using mHealth Services: Qualitative Thematic Analysis %A Song,Ting %A Liu,Fang %A Deng,Ning %A Qian,Siyu %A Cui,Tingru %A Guan,Yingping %A Arnolda,Leonard %A Zhang,Zhenyu %A Yu,Ping %+ Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia, 61 2 4221 5412, ping@uow.edu.au %K patient experience %K mHealth %K mobile phone %K mobile app %K intervention %K self-management %K high blood pressure %K chronic disease management %K qualitative research %D 2021 %7 21.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Hypertension affects over 15% of the world’s population and is a significant global public health and socioeconomic challenge. Mobile health (mHealth) services have been increasingly introduced to support hypertensive patients to improve their self-management behaviors, such as adherence to pharmacotherapy and lifestyle modifications. Objective: This study aims to explore patients’ perceptions of mHealth services and the mechanisms by which the services support them to self-manage their hypertension. Methods: A semistructured, in-depth interview study was conducted with 22 outpatients of the General Hospital of Ningxia Medical University from March to May 2019. In 2015, the hospital introduced an mHealth service to support community-dwelling outpatients with self-management of hypertension. Content analysis was conducted by following a grounded theory approach for inductive thematic extraction. Constant comparison and categorization classified the first-level codes with similar meanings into higher-level themes. Results: The patient-perceived mechanisms by which the mHealth service supported their self-management of hypertension were summarized as 6A: access, assessment, assistance, awareness, ability, and activation. With the portability of mobile phones and digitization of information, the mHealth service provided outpatients with easy access to assess their vital signs and self-management behaviors. The assessment results gave the patients real-time awareness of their health conditions and self-management performance, which activated their self-management behaviors. The mHealth service also gave outpatients access to assistance, which included health education and self-management reminders. Both types of assistance could also be activated by abnormal assessment results, that is, uncontrolled or deteriorating blood pressure values, discomfort symptoms, or not using the service for a long period. With its scalable use to handle any possible information and services, the mHealth service provided outpatients with educational materials to learn at their own pace. This led to an improvement in self-management awareness and ability, again activating their self-management behaviors. The patients would like to see further improvements in the service to provide more useful, personalized information and reliable services. Conclusions: The mHealth service extended the traditional hypertension care model beyond the hospital and clinician’s office. It provided outpatients with easy access to otherwise inaccessible hypertension management services. This led to process improvement for outpatients to access health assessment and health care assistance and improved their awareness and self-management ability, which activated their hypertension self-management behaviors. Future studies can apply the 6A framework to guide the design, implementation, and evaluation of mHealth services for outpatients to self-manage chronic conditions. %M 34152272 %R 10.2196/25522 %U https://www.jmir.org/2021/6/e25522 %U https://doi.org/10.2196/25522 %U http://www.ncbi.nlm.nih.gov/pubmed/34152272 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e23473 %T Application of the eHealth Literacy Model in Digital Health Interventions: Scoping Review %A El Benny,Mariam %A Kabakian-Khasholian,Tamar %A El-Jardali,Fadi %A Bardus,Marco %+ Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO-Box 11-0236, Riad-El-Solh, Beirut, 1107 2020, Lebanon, 961 1 350 0000 ext 4694, marco.bardus@gmail.com %K eHealth literacy %K digital health interventions %K consumer health information %K scoping review %K mHealth %K mobile phone %D 2021 %7 3.6.2021 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) are increasingly being adopted globally to address various public health issues. DHIs can be categorized according to four main types of technology: mobile based, web based, telehealth, and electronic health records. In 2006, Norman and Skinner introduced the eHealth literacy model, encompassing six domains of skills and abilities (basic, health, information, scientific, media, and computer) needed to effectively understand, process, and act on health-related information. Little is known about whether these domains are assessed or accounted for in DHIs. Objective: This study aims to explore how DHIs assess and evaluate the eHealth literacy model, describe which health conditions are addressed, and which technologies are used. Methods: We conducted a scoping review of the literature on DHIs, based on randomized controlled trial design and reporting the assessment of any domain of the eHealth literacy model. MEDLINE, CINAHL, Embase, and Cochrane Library were searched. A duplicate selection and data extraction process was performed; we charted the results according to the country of origin, health condition, technology used, and eHealth literacy domain. Results: We identified 131 unique DHIs conducted in 26 different countries between 2001 and 2020. Most DHIs were conducted in English-speaking countries (n=81, 61.8%), delivered via the web (n=68, 51.9%), and addressed issues related to noncommunicable diseases (n=57, 43.5%) or mental health (n=26, 19.8%). None of the interventions assessed all six domains of the eHealth literacy model. Most studies focused on the domain of health literacy (n=96, 73.2%), followed by digital (n=19, 14.5%), basic and media (n=4, 3%), and information and scientific literacy (n=1, 0.7%). Of the 131 studies, 7 (5.3%) studies covered both health and digital literacy. Conclusions: Although many selected DHIs assessed health or digital literacy, no studies comprehensively evaluated all domains of the eHealth literacy model; this evidence might be overlooking important factors that can mediate or moderate the effects of these interventions. Future DHIs should comprehensively assess the eHealth literacy model while developing or evaluating interventions to understand how and why interventions can be effective. %M 34081023 %R 10.2196/23473 %U https://www.jmir.org/2021/6/e23473 %U https://doi.org/10.2196/23473 %U http://www.ncbi.nlm.nih.gov/pubmed/34081023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25929 %T Evaluation Framework for Successful Artificial Intelligence–Enabled Clinical Decision Support Systems: Mixed Methods Study %A Ji,Mengting %A Genchev,Georgi Z %A Huang,Hengye %A Xu,Ting %A Lu,Hui %A Yu,Guangjun %+ Shanghai Children’s Hospital, Shanghai Jiao Tong University, No 355 Luding Road, Shanghai, 200062, China, 86 18917762998, yugj1688@shchildren.com.cn %K artificial intelligence %K AI %K clinical decision support systems %K evaluation framework %D 2021 %7 2.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical decision support systems are designed to utilize medical data, knowledge, and analysis engines and to generate patient-specific assessments or recommendations to health professionals in order to assist decision making. Artificial intelligence–enabled clinical decision support systems aid the decision-making process through an intelligent component. Well-defined evaluation methods are essential to ensure the seamless integration and contribution of these systems to clinical practice. Objective: The purpose of this study was to develop and validate a measurement instrument and test the interrelationships of evaluation variables for an artificial intelligence–enabled clinical decision support system evaluation framework. Methods: An artificial intelligence–enabled clinical decision support system evaluation framework consisting of 6 variables was developed. A Delphi process was conducted to develop the measurement instrument items. Cognitive interviews and pretesting were performed to refine the questions. Web-based survey response data were analyzed to remove irrelevant questions from the measurement instrument, to test dimensional structure, and to assess reliability and validity. The interrelationships of relevant variables were tested and verified using path analysis, and a 28-item measurement instrument was developed. Measurement instrument survey responses were collected from 156 respondents. Results: The Cronbach α of the measurement instrument was 0.963, and its content validity was 0.943. Values of average variance extracted ranged from 0.582 to 0.756, and values of the heterotrait-monotrait ratio ranged from 0.376 to 0.896. The final model had a good fit (χ262=36.984; P=.08; comparative fit index 0.991; goodness-of-fit index 0.957; root mean square error of approximation 0.052; standardized root mean square residual 0.028). Variables in the final model accounted for 89% of the variance in the user acceptance dimension. Conclusions: User acceptance is the central dimension of artificial intelligence–enabled clinical decision support system success. Acceptance was directly influenced by perceived ease of use, information quality, service quality, and perceived benefit. Acceptance was also indirectly influenced by system quality and information quality through perceived ease of use. User acceptance and perceived benefit were interrelated. %M 34076581 %R 10.2196/25929 %U https://www.jmir.org/2021/6/e25929 %U https://doi.org/10.2196/25929 %U http://www.ncbi.nlm.nih.gov/pubmed/34076581 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e18500 %T Theories Informing eHealth Implementation: Systematic Review and Typology Classification %A Heinsch,Milena %A Wyllie,Jessica %A Carlson,Jamie %A Wells,Hannah %A Tickner,Campbell %A Kay-Lambkin,Frances %+ Centre for Brain and Mental Health Priority Research Centre, The University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 0249217035, Milena.Heinsch@newcastle.edu.au %K systematic review %K eHealth %K digital health %K mHealth %K mobile phone %K technology %K implementation %K adoption %K translation %K theory %D 2021 %7 31.5.2021 %9 Review %J J Med Internet Res %G English %X Background: Theory-guided approaches to implementation science have informed translation efforts and the acceptance of eHealth (digital health) interventions in clinical care. However, there is scarce evidence on which theories are best suited to addressing the inherent complexity of eHealth implementation. Objective: The objectives of this systematic review are to identify theories that inform and explain eHealth implementation and to classify these theories using the typology by Sovacool and Hess for theories of sociotechnical change. Methods: An electronic search was conducted in the PsycINFO, MEDLINE, Embase, CINAHL, Scopus, Sociological Source Ultimate, Web of Science, ABI/INFORM, EBSCO, and ProQuest databases in June 2019. Studies were included if they were published between 2009 and June 2019; were written in English; reported on empirical research, regardless of study or publication type; reported on one or more theories in the context of eHealth implementation; and were published in a peer-reviewed journal. A total of 2 reviewers independently assessed the titles, abstracts, and full texts. Theories identified were classified using a typology for theories of sociotechnical change, which was considered a useful tool for ordering and analyzing the diverse theoretical approaches as a basis for future theory building. Results: Of the 13,101 potentially relevant titles, 119 studies were included. The review identified 36 theories used to explain implementation approaches in eHealth. The most commonly used approaches were the Technology Acceptance Model (TAM) (n=33) and the Unified Theory of Acceptance and Use of Technology (UTAUT) (n=32). These theories were primarily concerned with individual and interpersonal elements of eHealth acceptance. Less common were theories that reflect the various disorderly social processes and structural dimensions of implementation, such as the normalization process theory (n=17) and the structuration theory (n=6). Conclusions: Theories currently informing the implementation of eHealth interventions predominantly focus on predicting or explaining end-user acceptance. Theoretical perspectives that capture the dense and intricate relationships and structures required to enact sustainable change are less well represented in the eHealth literature. Given the growing acknowledgment of the inherent complexity of eHealth implementation, future research should develop and test models that recognize and reflect the multidimensional, dynamic, and relational nature of this process. %M 34057427 %R 10.2196/18500 %U https://www.jmir.org/2021/5/e18500 %U https://doi.org/10.2196/18500 %U http://www.ncbi.nlm.nih.gov/pubmed/34057427 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e22851 %T Evaluating the Consistency Between Conceptual Frameworks and Factors Influencing the Safe Behavior of Iranian Workers in the Petrochemical Industry: Mixed Methods Study %A Zahiri Harsini,Azita %A Bohle,Philip %A Matthews,Lynda R %A Ghofranipour,Fazlollah %A Sanaeinasab,Hormoz %A Amin Shokravi,Farkhondeh %A Prasad,Krishan %+ Department of Health Education, Faculty of Medical Sciences, Tarbiat Modares University, Jalal AleAhmad, Nasr, North Kargar St, Tehran, 14115-111, Iran, 98 912 250 5977, AMINSH_F@modares.ac.ir %K safe behavior %K petrochemical industry %K conceptual frameworks %K literature review %K occupational health %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Unsafe worker behavior is often identified as a major cause of dangerous incidents in the petrochemical industry. Behavioral safety models provide frameworks that may help to prevent such incidents by identifying factors promoting safe or unsafe behavior. We recently conducted a qualitative study to identify factors affecting workers' unsafe behaviors in an Iranian petrochemical company. Objective: The aims of this study were to (1) conduct a review of the relevant research literature between the years 2000 and 2019 to identify theoretical models proposed to explain and predict safe behavior in the workplace and (2) to select the model that best reflects our qualitative findings and other evidence about the factors influencing safe behaviors among petrochemical workers. Methods: This research used mixed methods. Initially, we conducted a qualitative study of factors that Iranian petrochemical workers believed affected their safety behavior. Four themes emerged from the semistructured interviews: (1) poor direct safety management and supervision; (2) unsafe workplace conditions; (3) workers’ perceptions, skills, and training; and (4) broader organizational factors. Electronic databases, including PubMed, Embase, Scopus, Google Scholar, EBSCOhost, and Science Direct, were then searched for eligible studies on models to explain and predict safe behaviors, which were published between the years 2000 and 2019. Medical subject headings were used as the primary analytical element. Medical subject headings and subheadings were then extracted from the literature. One researcher conducted the search and 3 researchers performed screening and data extraction. Then, constructs described in each study were assessed to determine which were the most consistent with themes derived from our qualitative analysis. Results: A total of 2032 publications were found using the search strategy. Of these, 142 studies were assessed and 28 studies met the inclusion criteria and were included in the review. The themes identified in the qualitative study most closely matched 3 scales included in Wu et al's model that measured safety behavior and performance, safety leadership, and safety climate in petrochemical industries. Poor direct safety management and supervision matched with safety leadership and its subscales; unsafe workplace conditions matched with safety climate and its subscales; workers' perceptions, skills, and training matched with safety performance and its subscales; and broader organizational factors matched with some subscales of the model. Conclusions: This is the first literature review to identify models intended to explain and predict safe behavior and select the model most consistent with themes elicited from a qualitative study. Our results showed that effective safety leadership and management and safety climate and culture systems are the most frequently identified factors affecting safe behaviors in the petrochemical industry. These results can further help safety researchers and professionals design effective behavior-based safety interventions, which can have a more sustainable and persistent impact on workers’ safety behaviors. Trial Registration: Iranian Registry of Clinical Trials IRCT20170515033981N2; https://www.irct.ir/trial/26107 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7126-1 %M 34042605 %R 10.2196/22851 %U https://publichealth.jmir.org/2021/5/e22851 %U https://doi.org/10.2196/22851 %U http://www.ncbi.nlm.nih.gov/pubmed/34042605 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e17240 %T Validation of 4D Components for Measuring Quality of the Public Health Data Collection Process: Elicitation Study %A Chen,Hong %A Yu,Ping %A Hailey,David %A Cui,Tingru %+ School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, 2522, Australia, 61 2 42215412, ping@uow.edu.au %K data quality %K data collection %K HIV/AIDS %K public health informatics %K health information systems %K component validation %K expert elicitation %K public health %K health informatics %D 2021 %7 10.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Identification of the essential components of the quality of the data collection process is the starting point for designing effective data quality management strategies for public health information systems. An inductive analysis of the global literature on the quality of the public health data collection process has led to the formation of a preliminary 4D component framework, that is, data collection management, data collection personnel, data collection system, and data collection environment. It is necessary to empirically validate the framework for its use in future research and practice. Objective: This study aims to obtain empirical evidence to confirm the components of the framework and, if needed, to further develop this framework. Methods: Expert elicitation was used to evaluate the preliminary framework in the context of the Chinese National HIV/AIDS Comprehensive Response Information Management System. The research processes included the development of an interview guide and data collection form, data collection, and analysis. A total of 3 public health administrators, 15 public health workers, and 10 health care practitioners participated in the elicitation session. A framework qualitative data analysis approach and a quantitative comparative analysis were followed to elicit themes from the interview transcripts and to map them to the elements of the preliminary 4D framework. Results: A total of 302 codes were extracted from interview transcripts. After iterative and recursive comparison, classification, and mapping, 46 new indicators emerged; 24.8% (37/149) of the original indicators were deleted because of a lack of evidence support and another 28.2% (42/149) were merged. The validated 4D component framework consists of 116 indicators (82 facilitators and 34 barriers). The first component, data collection management, includes data collection protocols and quality assurance. It was measured by 41 indicators, decreased from the original 49% (73/149) to 35.3% (41/116). The second component, data collection environment, was measured by 37 indicators, increased from the original 13.4% (20/149) to 31.9% (37/116). It comprised leadership, training, funding, organizational policy, high-level management support, and collaboration among parallel organizations. The third component, data collection personnel, includes the perception of data collection, skills and competence, communication, and staffing patterns. There was no change in the proportion for data collection personnel (19.5% vs 19.0%), although the number of its indicators was reduced from 29 to 22. The fourth component, the data collection system, was measured using 16 indicators, with a slight decrease in percentage points from 18.1% (27/149) to 13.8% (16/116). It comprised functions, system integration, technical support, and data collection devices. Conclusions: This expert elicitation study validated and improved the 4D framework. The framework can be useful in developing a questionnaire survey instrument for measuring the quality of the public health data collection process after validation of psychometric properties and item reduction. %M 33970112 %R 10.2196/17240 %U https://www.jmir.org/2021/5/e17240 %U https://doi.org/10.2196/17240 %U http://www.ncbi.nlm.nih.gov/pubmed/33970112 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e17127 %T Theory Integration for Lifestyle Behavior Change in the Digital Age: An Adaptive Decision-Making Framework %A Zhang,Chao %A Lakens,Daniël %A IJsselsteijn,Wijnand A %+ Human-Technology Interaction Group, Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, PO Box 513, Eindhoven, 5600 MB, Netherlands, 31 624749479, chao.zhang87@gmail.com %K behavior change %K health behavior %K digital health intervention %K decision-making %K learning %K self-control %K habits %K theoretical framework %D 2021 %7 9.4.2021 %9 Viewpoint %J J Med Internet Res %G English %X Despite the growing popularity of digital health interventions, limitations of traditional behavior change theories and a lack of theory integration hinder theory-driven behavior change applications. In this paper, we aim to review theories relevant to lifestyle behavior change from the broader psychology literature and then integrate these theories into a new theoretical framework called adaptive decision-making to address two specific problems. First, our framework represents lifestyle behaviors at two levels—one of individual daily decisions (action level) and one of larger behavioral episodes (reflection level)—to more closely match the temporal characteristics of lifestyle behaviors and their associated digital data. Second, the framework connects decision-making theories and learning theories to explain how behaviors and cognitive constructs dynamically influence each other, making it a suitable scaffold for building computational models. We map common digital intervention techniques onto the behavioral and cognitive processes in the framework and discuss possible contributions of the framework to both theory development and digital intervention design. %M 33835036 %R 10.2196/17127 %U https://www.jmir.org/2021/4/e17127 %U https://doi.org/10.2196/17127 %U http://www.ncbi.nlm.nih.gov/pubmed/33835036 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24905 %T Effort-Optimized Intervention Model: Framework for Building and Analyzing Digital Interventions That Require Minimal Effort for Health-Related Gains %A Baumel,Amit %A Muench,Frederick J %+ Partnership to End Addiction, 711 Third Avenue, New York, NY, 10017, United States, 1 9175320623, fmuench@toendaddiction.org %K behavior change %K digital health %K mental health %K addiction %K intervention %K behavioral health %K effort %K salience %K persuasive design %D 2021 %7 12.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X The majority of digital health interventions lean on the promise of bringing health and self-care into people’s homes and hands. However, these interventions are delivered while people are in their triggering environments, which places competing demands on their attention. Individuals struggling to change or learn a new behavior have to work hard to achieve even a minor change because of the automatic forces propelling them back to their habitual behaviors. We posit that effort and burden should be explored at the outset and throughout the digital intervention development process as a core therapeutic mechanism, beyond the context of design or user experience testing. In effort-focused conceptualization, it is assumed that, even though goals are rational and people want to achieve them, they are overtaken by competing cognitive, emotional, and environmental processes. We offer the term effort-optimized intervention to describe interventions that focus on user engagement in the face of competing demands. We describe design components based on a 3-step process for planning an effort-optimized intervention: (1) nurturing effortless cognitive and environmental salience to help people keep effort-related goals prominent despite competition; (2) making it as effortless as possible to complete therapeutic activities to avoid ego depletion and self-efficacy reduction; and (3) turning the necessary effortful activities into sustainable assets. We conclude by presenting an example of designing a digital health intervention based on the effort-optimized intervention model. %M 33709943 %R 10.2196/24905 %U https://www.jmir.org/2021/3/e24905 %U https://doi.org/10.2196/24905 %U http://www.ncbi.nlm.nih.gov/pubmed/33709943 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20537 %T Defining Digital Game-Based Learning for Science, Technology, Engineering, and Mathematics: A New Perspective on Design and Developmental Research %A Ishak,Shahrul Affendi %A Din,Rosseni %A Hasran,Umi Azmah %+ Science, Technology, Engineering, and Mathematics Enculturation Research Centre, Faculty of Education, Universiti Kebangsaan Malaysia, 43600 UKM, Bangi, 43600, Malaysia, 60 166656420, rosseni@ukm.edu.my %K digital game-based learning %K STEM digital game %K game development model %K game design %K design and developmental research %D 2021 %7 19.2.2021 %9 Viewpoint %J J Med Internet Res %G English %X In the modern age, digital games are widely used as informal media for Science, Technology, Engineering, and Mathematics (STEM) education and medical therapy for game-based learning. Digital games provide learners with a graphical system of interaction that enhances scientific concepts within an enjoyable environment. The vastly increasing number of digital games produced in the market affects the quality of STEM digital games while requiring multidisciplinary expertise. This paper proposes a framework for STEM digital game-based learning encompassing input-process-output stages. Several studies from the early 2000s onward were reviewed to discuss and present a new perspective on a framework for the design and development of digital games, particularly for STEM. This proposed framework consists of digital game development as input, experience as a process, and constructs as output. This simple and precise framework will generate a universal product for various types of learners. It can thus be used as a guideline for game designers, developers, and experts to develop STEM digital games and achieve better learning outcomes. %M 33605885 %R 10.2196/20537 %U http://www.jmir.org/2021/2/e20537/ %U https://doi.org/10.2196/20537 %U http://www.ncbi.nlm.nih.gov/pubmed/33605885 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e19594 %T Privacy Concerns About Health Information Disclosure in Mobile Health: Questionnaire Study Investigating the Moderation Effect of Social Support %A Dang,Yuanyuan %A Guo,Shanshan %A Guo,Xitong %A Wang,Mohan %A Xie,Kexin %+ School of Business and Management, Shanghai International Studies University, 1550 Wenxiang Road, Songjiang District, Shanghai, 201620, China, 86 18845594033, guoshanshan@shisu.edu.cn %K mobile health %K privacy concern %K disclosure benefit %K health information disclosure intention %D 2021 %7 8.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) provides a new opportunity for disease prediction and patient health self-management. However, privacy problems in mHealth have drawn significant attention to patients’ online health information disclosure and to the possibility that privacy concerns may hinder mHealth development. Objective: Privacy calculus theory (PCT) has been widely used to understand personal information disclosure behaviors with the basic assumption of a rational and linear decision-making process. However, cognitive behavior processes are complex and mutual. In an attempt to gain a fuller understanding of information disclosure behavior, we further optimize a PCT-based information disclosure model by identifying the mutual relationship between costs (privacy concerns) and benefits. Social support, which has been proven to be a distinct and significant disclosure benefit of mHealth, was chosen as the representative benefit of information disclosure. Methods: We examine a structural equation model that incorporates privacy concerns, health information disclosure intention in mHealth, and social support from mHealth, all at the individual level. Results: A validated questionnaire was completed by 253 randomly selected participants. The result indicated that perceived health information sensitivity positively enhances patients’ privacy concern (beta path coefficient 0.505, P<.001), and higher privacy concern levels will decrease their health information disclosure intention (beta path coefficient –0.338, P<.001). Various individual characteristics influence perceived health information sensitivity in different ways. One dimension of social support, informational support, negatively moderates the effect of the relationship between perceived health information sensitivity and privacy concerns (beta path coefficient –0.171, P=.092) and the effect of the relationship between privacy concerns and health information disclosure intention (beta path coefficient –0.105, P=.092). However, another dimension, emotional support, has no direct moderation effect on the relationship between privacy concerns and health information disclosure intention. Conclusions: The results indicate that social support can be regarded as a disutility reducer. That is, on the one hand, it reduces patients’ privacy concerns; on the other hand, it also reduces the negative impact of privacy concerns on information disclosure intention. Moreover, the moderation effect of social support is partially supported. Informational support, one dimension of social support, is significant (beta path coefficient –0.171, P=.092), while the other dimension, emotional support, is not significant (beta path coefficient –0.137, P=.146), in mHealth. Furthermore, the results are different among patients with different individual characteristics. This study also provides specific theoretical and practical implications to enhance the development of mHealth. %M 33555266 %R 10.2196/19594 %U https://mhealth.jmir.org/2021/2/e19594 %U https://doi.org/10.2196/19594 %U http://www.ncbi.nlm.nih.gov/pubmed/33555266 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22189 %T One Digital Health: A Unified Framework for Future Health Ecosystems %A Benis,Arriel %A Tamburis,Oscar %A Chronaki,Catherine %A Moen,Anne %+ Faculty of Technology Management, Holon Institute of Technology, Golomb St 52, PoB 305, Holon, 5810201, Israel, 972 035026892, arrielb@hit.ac.il %K One Health %K digital health %K eHealth %K medicine %K veterinary medicine %K environmental monitoring %K education %K patient engagement %K citizen science %K health care industry %K population health management %K data science %K COVID-19 %D 2021 %7 5.2.2021 %9 Viewpoint %J J Med Internet Res %G English %X One Digital Health is a proposed unified structure. The conceptual framework of the One Digital Health Steering Wheel is built around two keys (ie, One Health and digital health), three perspectives (ie, individual health and well-being, population and society, and ecosystem), and five dimensions (ie, citizens’ engagement, education, environment, human and veterinary health care, and Healthcare Industry 4.0). One Digital Health aims to digitally transform future health ecosystems, by implementing a systemic health and life sciences approach that takes into account broad digital technology perspectives on human health, animal health, and the management of the surrounding environment. This approach allows for the examination of how future generations of health informaticians can address the intrinsic complexity of novel health and care scenarios in digitally transformed health ecosystems. In the emerging hybrid landscape, citizens and their health data have been called to play a central role in the management of individual-level and population-level perspective data. The main challenges of One Digital Health include facilitating and improving interactions between One Health and digital health communities, to allow for efficient interactions and the delivery of near–real-time, data-driven contributions in systems medicine and systems ecology. However, digital health literacy; the capacity to understand and engage in health prevention activities; self-management; and collaboration in the prevention, control, and alleviation of potential problems are necessary in systemic, ecosystem-driven public health and data science research. Therefore, people in a healthy One Digital Health ecosystem must use an active and forceful approach to prevent and manage health crises and disasters, such as the COVID-19 pandemic. %M 33492240 %R 10.2196/22189 %U http://www.jmir.org/2021/2/e22189/ %U https://doi.org/10.2196/22189 %U http://www.ncbi.nlm.nih.gov/pubmed/33492240 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e20631 %T Digital Micro Interventions for Behavioral and Mental Health Gains: Core Components and Conceptualization of Digital Micro Intervention Care %A Baumel,Amit %A Fleming,Theresa %A Schueller,Stephen M %+ University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel, 972 48240111, abaumel@univ.haifa.ac.il %K micro intervention %K mental health %K mhealth %K eHealth %K engagement %K intervention %K adherence %K behavior change %K behavioral health %D 2020 %7 29.10.2020 %9 Viewpoint %J J Med Internet Res %G English %X Although many people access publicly available digital behavioral and mental health interventions, most do not invest as much effort in these interventions as hoped or intended by intervention developers, and ongoing engagement is often low. Thus, the impact of such interventions is minimized by a misalignment between intervention design and user behavior. Digital micro interventions are highly focused interventions delivered in the context of a person’s daily life with little burden on the individual. We propose that these interventions have the potential to disruptively expand the reach of beneficial therapeutics by lowering the bar for entry to an intervention and the effort needed for purposeful engagement. This paper provides a conceptualization of digital micro interventions, their component parts, and principles guiding their use as building blocks of a larger therapeutic process (ie, digital micro intervention care). The model represented provides a structure that could improve the design, delivery, and research on digital micro interventions and ultimately improve behavioral and mental health care and care delivery. %M 33118946 %R 10.2196/20631 %U http://www.jmir.org/2020/10/e20631/ %U https://doi.org/10.2196/20631 %U http://www.ncbi.nlm.nih.gov/pubmed/33118946 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19280 %T Archetypes of Gamification: Analysis of mHealth Apps %A Schmidt-Kraepelin,Manuel %A Toussaint,Philipp A %A Thiebes,Scott %A Hamari,Juho %A Sunyaev,Ali %+ Department of Economics and Management, Karlsruhe Institute of Technology, Kaiserstraße 89, Karlsruhe, D-76133, Germany, 49 72160846037, sunyaev@kit.edu %K mHealth %K smartphones %K mobile phones %K gamification %K quantified-self %K exergames, persuasive technology %D 2020 %7 19.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nowadays, numerous health-related mobile apps implement gamification in an attempt to draw on the motivational potential of video games and thereby increase user engagement or foster certain health behaviors. However, research on effective gamification is still in its infancy and researchers increasingly recognize methodological shortcomings of existing studies. What we actually know about the phenomenon today stems from fragmented pieces of knowledge, and a variety of different perspectives. Existing research primarily draws on conceptual knowledge that is gained from research prototypes, and isolated from industry best practices. We still lack knowledge on how gamification has been successfully designed and implemented within the industry and whether certain gamification approaches have shown to be particularly suitable for certain health behaviors. Objective: We address this lack of knowledge concerning best practices in the design and implementation of gamification for health-related mobile apps by identifying archetypes of gamification approaches that have emerged in pertinent health-related mobile apps and analyzing to what extent those gamification approaches are influenced by the underlying desired health-related outcomes. Methods: A 3-step research approach is employed. As a first step, a database of 143 pertinent gamified health-related mobile apps from the Apple App Store and Google Play Store is set up. Second, the gamification approach of each app within the database is classified based on an established taxonomy for gamification in health-related apps. Finally, a 2-step cluster analysis is conducted in order to identify archetypes of the most dominant gamification approaches in pertinent gamified health-related mobile apps. Results: Eight archetypes of gamification emerged from the analysis of health-related mobile apps: (1) competition and collaboration, (2) pursuing self-set goals without rewards, (3) episodical compliance tracking, (4) inherent gamification for external goals, (5) internal rewards for self-set goals, (6) continuous assistance through positive reinforcement, (7) positive and negative reinforcement without rewards, and (8) progressive gamification for health professionals. The results indicate a close relationship between the identified archetypes and the actual health behavior that is being targeted. Conclusions: By unveiling salient best practices and discussing their relationship to targeted health behaviors, this study contributes to a more profound understanding of gamification in mobile health. The results can serve as a foundation for future research that advances the knowledge on how gamification may positively influence health behavior change and guide practitioners in the design and development of highly motivating and effective health-related mobile health apps. %M 33074155 %R 10.2196/19280 %U https://mhealth.jmir.org/2020/10/e19280 %U https://doi.org/10.2196/19280 %U http://www.ncbi.nlm.nih.gov/pubmed/33074155 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22845 %T Artificial Intelligence Chatbot Behavior Change Model for Designing Artificial Intelligence Chatbots to Promote Physical Activity and a Healthy Diet: Viewpoint %A Zhang,Jingwen %A Oh,Yoo Jung %A Lange,Patrick %A Yu,Zhou %A Fukuoka,Yoshimi %+ Department of Communication, University of California, Davis, One Shields Avenue, Davis, CA, 95616, United States, 1 530 754 1472, jwzzhang@ucdavis.edu %K chatbot %K conversational agent %K artificial intelligence %K physical activity %K diet %K intervention %K behavior change %K natural language processing %K communication %D 2020 %7 30.9.2020 %9 Viewpoint %J J Med Internet Res %G English %X Background: Chatbots empowered by artificial intelligence (AI) can increasingly engage in natural conversations and build relationships with users. Applying AI chatbots to lifestyle modification programs is one of the promising areas to develop cost-effective and feasible behavior interventions to promote physical activity and a healthy diet. Objective: The purposes of this perspective paper are to present a brief literature review of chatbot use in promoting physical activity and a healthy diet, describe the AI chatbot behavior change model our research team developed based on extensive interdisciplinary research, and discuss ethical principles and considerations. Methods: We conducted a preliminary search of studies reporting chatbots for improving physical activity and/or diet in four databases in July 2020. We summarized the characteristics of the chatbot studies and reviewed recent developments in human-AI communication research and innovations in natural language processing. Based on the identified gaps and opportunities, as well as our own clinical and research experience and findings, we propose an AI chatbot behavior change model. Results: Our review found a lack of understanding around theoretical guidance and practical recommendations on designing AI chatbots for lifestyle modification programs. The proposed AI chatbot behavior change model consists of the following four components to provide such guidance: (1) designing chatbot characteristics and understanding user background; (2) building relational capacity; (3) building persuasive conversational capacity; and (4) evaluating mechanisms and outcomes. The rationale and evidence supporting the design and evaluation choices for this model are presented in this paper. Conclusions: As AI chatbots become increasingly integrated into various digital communications, our proposed theoretical framework is the first step to conceptualize the scope of utilization in health behavior change domains and to synthesize all possible dimensions of chatbot features to inform intervention design and evaluation. There is a need for more interdisciplinary work to continue developing AI techniques to improve a chatbot’s relational and persuasive capacities to change physical activity and diet behaviors with strong ethical principles. %M 32996892 %R 10.2196/22845 %U https://www.jmir.org/2020/9/e22845 %U https://doi.org/10.2196/22845 %U http://www.ncbi.nlm.nih.gov/pubmed/32996892 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 9 %P e21378 %T Detection of Behavioral Anomalies in Medication Adherence Patterns Among Patients With Serious Mental Illness Engaged With a Digital Medicine System %A Knights,Jonathan %A Heidary,Zahra %A Cochran,Jeffrey M %+ Otsuka Pharmaceutical Development & Commercialization, 508 Carnegie Center Drive, Princeton, NJ, 08540, United States, 1 6095246788, jonathan.knights@otsuka-us.com %K digital medicine %K mobile phone %K entropy rate %K Markov chains %K medication adherence %K contextual anomaly %K psychiatric disorders %D 2020 %7 10.9.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adherence to medication is often represented in the form of a success percentage over a period of time. Although noticeable changes to aggregate adherence levels may be indicative of unstable medication behavior, a lack of noticeable changes in aggregate levels over time does not necessarily indicate stability. The ability to detect developing changes in medication-taking behavior under such conditions in real time would allow patients and care teams to make more timely and informed decisions. Objective: This study aims to develop a method capable of identifying shifts in behavioral (medication) patterns at the individual level and subsequently assess the presence of such shifts in retrospective clinical trial data from patients with serious mental illness. Methods: We defined the term adherence volatility as “the degree to which medication ingestion behavior fits expected behavior based on historically observed data” and defined a contextual anomaly system around this concept, leveraging the empirical entropy rate of a stochastic process as the basis for formulating anomaly detection. For the presented methodology, each patient’s evolving behavior is used to dynamically construct the expectation bounds for each future interval, eliminating the need to rely on model training or a static reference sequence. Results: Simulations demonstrated that the presented methodology identifies anomalous behavior patterns even when aggregate adherence levels remain constant and highlight the temporal dependence inherent in these anomalies. Although a given sequence of events may present as anomalous during one period, that sequence should subsequently contribute to future expectations and may not be considered anomalous at a later period—this feature was demonstrated in retrospective clinical trial data. In the same clinical trial data, anomalous behavioral shifts were identified at both high- and low-adherence levels and were spread across the whole treatment regimen, with 77.1% (81/105) of the population demonstrating at least one behavioral anomaly at some point in their treatment. Conclusions: Digital medicine systems offer new opportunities to inform treatment decisions and provide complementary information about medication adherence. This paper introduces the concept of adherence volatility and develops a new type of contextual anomaly detection, which does not require an a priori definition of normal and allows expectations to evolve with shifting behavior, removing the need to rely on training data or static reference sequences. Retrospective analysis from clinical trial data highlights that such an approach could provide new opportunities to meaningfully engage patients about potential shifts in their ingestion behavior; however, this framework is not intended to replace clinical judgment, rather to highlight elements of data that warrant attention. The evidence provided here identifies new areas for research and seems to justify additional explorations in this area. %M 32909950 %R 10.2196/21378 %U https://mental.jmir.org/2020/9/e21378 %U https://doi.org/10.2196/21378 %U http://www.ncbi.nlm.nih.gov/pubmed/32909950 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19898 %T Assessing Digital Health Implementation for a Pediatric Chronic Pain Intervention: Comparing the RE-AIM and BIT Frameworks Against Real-World Trial Data and Recommendations for Future Studies %A de la Vega,Rocio %A Ritterband,Lee %A Palermo,Tonya M %+ Center for Child Health, Behavior and Development, Seattle Children's Research Institute, P.O. Box 5371/SCRI, M/S CW8-6, Seattle, WA, 98145-5005, United States, 1 206 884 4208, tonya.palermo@seattlechildrens.org %K mobile health %K eHealth %K mHealth %K implementation science %K chronic pain %K adolescents %K mobile phone %D 2020 %7 1.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions have demonstrated efficacy for several conditions including for pediatric chronic pain. However, the process of making interventions available to end users in an efficient and sustained way is challenging and remains a new area of research. To advance this field, comprehensive frameworks have been created. Objective: The aim of this study is to compare the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Behavior Interventions using Technology (BIT) frameworks with data collected from the web-based management of adolescent pain (WebMAP Mobile; WMM) randomized controlled trial (RCT). Methods: We conducted a hybrid effectiveness-implementation cluster RCT with a stepped wedge design in which the intervention was sequentially implemented in 8 clinics, following a usual care period. Participants were 143 youths (mean age 14.5 years, SD 1.9; 117/143, 81.8% female) with chronic pain, from which 73 were randomized to receive the active intervention. Implementation outcomes were assessed using the RE-AIM and BIT frameworks. Results: According to the RE-AIM framework, the WMM showed excellent reach, recruiting a sample 19% larger than the size originally planned and consenting 79.0% (143/181) of eligible referred adolescents. Effectiveness was limited, with only global impression of change showing significantly greater improvements in the treatment group; however, greater treatment engagement was associated with greater reductions in pain and disability. Adoption was excellent (all the invited clinics participated and referred patients). Implementation was acceptable, showing good user engagement and moderate adherence and positive attitudes of providers. Costs were similar to planned, with a 7% increase in funds needed to make the WMM publicly available. Maintenance was evidenced by 56 new patients downloading the app during the maintenance period and by all clinics agreeing to continue making referrals and all, but one, making new referrals. According to the BIT, 82% (60/73) of adolescents considered the treatment acceptable. In terms of adoption, 93% (68/73) downloaded the app, and all of them used it after their first log-in. In terms of appropriateness at the user level, 2 participants were unable to download the app. Perceptions of the appearance, navigation, and theme were positive. Providers perceived the WMM as a good fit for their clinic, beneficial, helpful, and resource efficient. In terms of feasibility, no technical issues were reported. In terms of fidelity, 40% (29/73) completed the treatment. Implementation costs were 7% above the budget. With regard to penetration, 56 new users accessed the app during the maintenance period. In terms of sustainability, 88% (7/8) of clinics continued recommending the WMM after the end of the study. Conclusions: For the first time, a real-world digital health intervention was used as a proof of concept to test all the domains in the RE-AIM and BIT frameworks, allowing for comparisons. International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2018.10.003 %M 32870158 %R 10.2196/19898 %U https://www.jmir.org/2020/9/e19898 %U https://doi.org/10.2196/19898 %U http://www.ncbi.nlm.nih.gov/pubmed/32870158 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17718 %T Exploring the Use of Evidence From the Development and Evaluation of an Electronic Health (eHealth) Trial: Case Study %A Jurkeviciute,Monika %A Eriksson,Henrik %+ Centre for Healthcare Improvement, Chalmers University of Technology, Vera Sandbergs allé 8, Gothenburg, , Sweden, 46 766061558, monika.jurkeviciute@chalmers.se %K evidence-based practice %K evidence use %K eHealth %K evaluation %K evaluation use %D 2020 %7 28.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence-based practice refers to building clinical decisions on credible research evidence, professional experience, and patient preferences. However, there is a growing concern that evidence in the context of electronic health (eHealth) is not sufficiently used when forming policies and practice of health care. In this context, using evaluation and research evidence in clinical or policy decisions dominates the discourse. However, the use of additional types of evidence, such as professional experience, is underexplored. Moreover, there might be other ways of using evidence than in clinical or policy decisions. Objective: This study aimed to analyze how different types of evidence (such as evaluation outcomes [including patient preferences], professional experiences, and existing scientific evidence from other research) obtained within the development and evaluation of an eHealth trial are used by diverse stakeholders. An additional aim was to identify barriers to the use of evidence and ways to support its use. Methods: This study was built on a case of an eHealth trial funded by the European Union. The project included 4 care centers, 2 research and development companies that provided the web-based physical exercise program and an activity monitoring device, and 2 science institutions. The qualitative data collection included 9 semistructured interviews conducted 8 months after the evaluation was concluded. The data analysis concerned (1) activities and decisions that were made based on evidence after the project ended, (2) evidence used for those activities and decisions, (3) in what way the evidence was used, and (4) barriers to the use of evidence. Results: Evidence generated from eHealth trials can be used by various stakeholders for decisions regarding clinical integration of eHealth solutions, policy making, scientific publishing, research funding applications, eHealth technology, and teaching. Evaluation evidence has less value than professional experiences to local decision making regarding eHealth integration into clinical practice. Professional experiences constitute the evidence that is valuable to the highest variety of activities and decisions in relation to eHealth trials. When using existing scientific evidence related to eHealth trials, it is important to consider contextual relevance, such as location or disease. To support the use of evidence, it is suggested to create possibilities for health care professionals to gain experience, assess a few rather than a large number of variables, and design for shorter iterative cycles of evaluation. Conclusions: Initiatives to support and standardize evidence-based practice in the context of eHealth should consider the complexities in how the evidence is used in order to achieve better uptake of evidence in practice. However, one should be aware that the assumption of fact-based decision making in organizations is misleading. In order to create better chances that the evidence produced would be used, this should be addressed through the design of eHealth trials. %M 32857057 %R 10.2196/17718 %U http://www.jmir.org/2020/8/e17718/ %U https://doi.org/10.2196/17718 %U http://www.ncbi.nlm.nih.gov/pubmed/32857057 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17459 %T Information and Communications Technology–Based Interventions Targeting Patient Empowerment: Framework Development %A Karni,Liran %A Dalal,Koustuv %A Memedi,Mevludin %A Kalra,Dipak %A Klein,Gunnar Oskar %+ Centre for Empirical Research on Information Systems, Örebro University School of Business, Fakultetsgatan 1, Örebro, 70281, Sweden, 46 19 301218, liran.karni@oru.se %K empowerment %K ICT intervention %K digital health %K eHealth %K framework model %K ICT patient empowerment model (ICT4PEM) %D 2020 %7 26.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Empowerment of patients is often an explicit goal of various information and communications technology (ICT) (electronic, digital) interventions where the patients themselves use ICT tools via the internet. Although several models of empowerment exist, a comprehensive and pragmatic framework is lacking for the development of such interventions. Objective: This study proposes a framework for digital interventions aiming to empower patients that includes a methodology that links objectives, strategies, and evaluation. Methods: This study is based on a literature review and iterated expert discussions including a focus group to formulate the proposed model. Our model is based on a review of various models of empowerment and models of technology intervention. Results: Our framework includes the core characteristics of the empowerment concept (control, psychological coping, self-efficacy, understanding, legitimacy, and support) as well as a set of empowerment consequences: expressed patient perceptions, behavior, clinical outcomes, and health systems effects. The framework for designing interventions includes strategies to achieve empowerment goals using different ICT services. Finally, the intervention model can be used to define project evaluations where the aim is to demonstrate empowerment. The study also included example indicators and associated measurement instruments. Conclusions: This framework, which includes definitions, can be useful for the design and evaluation of digital interventions targeting patient empowerment and assist in the development of methods to measure results in this dimension. Further evaluation in the form of interventional studies will be needed to assess the generalizability of the model. %M 32845245 %R 10.2196/17459 %U http://www.jmir.org/2020/8/e17459/ %U https://doi.org/10.2196/17459 %U http://www.ncbi.nlm.nih.gov/pubmed/32845245 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17774 %T Online Guide for Electronic Health Evaluation Approaches: Systematic Scoping Review and Concept Mapping Study %A Bonten,Tobias N %A Rauwerdink,Anneloek %A Wyatt,Jeremy C %A Kasteleyn,Marise J %A Witkamp,Leonard %A Riper,Heleen %A van Gemert-Pijnen,Lisette JEWC %A Cresswell,Kathrin %A Sheikh,Aziz %A Schijven,Marlies P %A Chavannes,Niels H %A , %+ Department of Public Health and Primary Care, Leiden University Medical Centre, Department of Public Health & Primary Care, Room V6-22, PO Box 9600, Leiden, 2300 RC, Netherlands, 31 715268433, t.n.bonten@lumc.nl %K eHealth %K mHealth %K digital health %K methodology %K study design %K health technology assessment %K evaluation %K scoping review %K concept mapping %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increase in use and high expectations of digital health solutions, scientific evidence about the effectiveness of electronic health (eHealth) and other aspects such as usability and accuracy is lagging behind. eHealth solutions are complex interventions, which require a wide array of evaluation approaches that are capable of answering the many different questions that arise during the consecutive study phases of eHealth development and implementation. However, evaluators seem to struggle in choosing suitable evaluation approaches in relation to a specific study phase. Objective: The objective of this project was to provide a structured overview of the existing eHealth evaluation approaches, with the aim of assisting eHealth evaluators in selecting a suitable approach for evaluating their eHealth solution at a specific evaluation study phase. Methods: Three consecutive steps were followed. Step 1 was a systematic scoping review, summarizing existing eHealth evaluation approaches. Step 2 was a concept mapping study asking eHealth researchers about approaches for evaluating eHealth. In step 3, the results of step 1 and 2 were used to develop an “eHealth evaluation cycle” and subsequently compose the online “eHealth methodology guide.” Results: The scoping review yielded 57 articles describing 50 unique evaluation approaches. The concept mapping study questioned 43 eHealth researchers, resulting in 48 unique approaches. After removing duplicates, 75 unique evaluation approaches remained. Thereafter, an “eHealth evaluation cycle” was developed, consisting of six evaluation study phases: conceptual and planning, design, development and usability, pilot (feasibility), effectiveness (impact), uptake (implementation), and all phases. Finally, the “eHealth methodology guide” was composed by assigning the 75 evaluation approaches to the specific study phases of the “eHealth evaluation cycle.” Conclusions: Seventy-five unique evaluation approaches were found in the literature and suggested by eHealth researchers, which served as content for the online “eHealth methodology guide.” By assisting evaluators in selecting a suitable evaluation approach in relation to a specific study phase of the “eHealth evaluation cycle,” the guide aims to enhance the quality, safety, and successful long-term implementation of novel eHealth solutions. %M 32784173 %R 10.2196/17774 %U https://www.jmir.org/2020/8/e17774 %U https://doi.org/10.2196/17774 %U http://www.ncbi.nlm.nih.gov/pubmed/32784173 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17696 %T Applying and Extending the FITT Framework to Identify the Challenges and Opportunities of Successful eHealth Services for Patient Self-Management: Qualitative Interview Study %A Kujala,Sari %A Ammenwerth,Elske %A Kolanen,Heta %A Ervast,Minna %+ Department of Computer Science, Aalto University, Konemiehentie 2, Espoo, Finland, 358 50 3862768, sari.kujala@aalto.fi %K interview %K implementation %K adoption %K patient self-management %K organization %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of public eHealth services that support patient self-management is rapidly increasing. However, the implementation of these eHealth services for self-management has encountered challenges. Objective: The purpose of this paper was to analyze the challenges and opportunities of implementing eHealth services for self-management by focusing on the fit between the technical solution and clinical use. Methods: We performed in-depth interviews with 10 clinical project coordinators and managers who were responsible for developing and implementing various eHealth services for self-management interventions in five university hospitals in Finland. The results were analyzed using content analysis and open coding. The Fit between Individuals, Task, and Technology (FITT) framework was used to interpret the findings. Results: The implementation of self-management services involved many challenges related to technical problems, health professional acceptance, patient motivation, and health organization and management. The implementers identified practices to manage the identified challenges, including improving the design of the technology, supporting health professionals in the adoption of the eHealth services, changing the work processes and tasks, involving patients, and collectively planning the implementation inside an organization. The findings could be mostly attributed to the dimensions of the FITT framework. Conclusions: The FITT framework helped to analyze the challenges related to the implementation, and most of them were related to poor fit. The importance of patients as stakeholders in eHealth services for patient self-management needs to be highlighted. Thus, we propose that patients should be added as a different type of individual dimension to the FITT framework. In addition, the framework could be extended to include organization and management in a new context dimension. %M 32784175 %R 10.2196/17696 %U https://www.jmir.org/2020/8/e17696 %U https://doi.org/10.2196/17696 %U http://www.ncbi.nlm.nih.gov/pubmed/32784175 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e14958 %T An Integrative Model for the Effectiveness of Biofeedback Interventions for Anxiety Regulation: Viewpoint %A Weerdmeester,Joanneke %A van Rooij,Marieke MJW %A Engels,Rutger CME %A Granic,Isabela %+ Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR, Netherlands, 31 243612076, j.weerdmeester@psych.ru.nl %K biofeedback %K neurofeedback %K anxiety %K appraisal %K mechanisms %K mental health %K eHealth %K video games %K wearable technology %K review %K mobile phone %D 2020 %7 23.7.2020 %9 Viewpoint %J J Med Internet Res %G English %X Biofeedback has shown to be a promising tool for the treatment of anxiety; however, several theoretical as well as practical limitations have prevented widespread adaptation until now. With current technological advances and the increasing interest in the use of self-monitoring technology to improve mental health, we argue that this is an ideal time to launch a new wave of biofeedback training. In this viewpoint paper, we reflect on the current state of biofeedback training, including the more traditional techniques and mechanisms that have been thought to explain the effectiveness of biofeedback such as the integration of operant learning and meditation techniques, and the changes in interoceptive awareness and physiology. Subsequently, we propose an integrative model that includes a set of cognitive appraisals as potential determinants of adaptive trajectories within biofeedback training such as growth mindset, self-efficacy, locus of control, and threat-challenge appraisals. Finally, we present a set of detailed guidelines based on the integration of our model with the mechanics and mechanisms offered by emerging interactive technology to encourage a new phase of research and implementation using biofeedback. There is a great deal of promise for future biofeedback interventions that harness the power of wearables and video games, and that adopt a user-centered approach to help people regulate their anxiety in a way that feels engaging, personal, and meaningful. %M 32706654 %R 10.2196/14958 %U https://www.jmir.org/2020/7/e14958 %U https://doi.org/10.2196/14958 %U http://www.ncbi.nlm.nih.gov/pubmed/32706654 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17996 %T The Cyclic Value-Context Reinforcement Model of Problematic Internet Use: Empirical Validation Using a Thematic Analysis of Children’s Counseling Data %A Doh,Young Yim %A Kim,Bugeun %A Lee,Seul %A Gweon,Gahgene %+ Graduate School of Convergence Science and Technology, Seoul National University, 1 Gwanakro, Seoul, Republic of Korea, 82 318889172, ggweon@snu.ac.kr %K problematic internet use %K children %K cyclic value context reinforcement model %K psychosocial value %K environmental context %K internet utility %D 2020 %7 14.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Research on problematic internet use has focused on devising diagnostic criteria or describing the factors that influence internet overuse. However, a paradigm shift is necessary in studying the phenomenon of increased internet use not just from a pathological point of view but also from a developmental point of view that considers children’s behavior of adapting to a technology-oriented society. Objective: In this paper, we propose the Cyclic Value-Context Reinforcement Model (CVCRM) to understand problematic internet use behavior. The purpose of our study was to construct a developmental process model that provides a holistic understanding of problematic internet use behavior of children and to empirically validate the proposed model by conducting a thematic analysis on actual counseling data. Methods: To validate the CVCRM, we conducted thematic analysis using the counseling data from 312 Korean children aged 7-18 years. For the coding process, 7 master’s and doctoral student researchers participated as coders, and 2 professors supervised the coding process and results. Results: This project was funded from October 2015 to September 2019 to analyze counseling data from 312 children who participated in counseling sessions during January 2012 to May 2014. Based on the data analysis, we present the CVCRM, which integrates existing theoretical approaches and encompasses the 3 interacting aspects that induce and reinforce problematic internet use in children: psychosocial value, environmental context, and internet utility. Specifically, using counseling data, we empirically ascertained that problematic internet use behavior feeds into children’s psychosocial values and environmental contexts, which in turn facilitates problematic internet use in a cyclical manner. Conclusions: Through this empirical validation, the CVCRM can provide a theoretical framework and an integrated perspective on the developmental mechanism of problematic internet use behavior of children. %M 32460233 %R 10.2196/17996 %U https://www.jmir.org/2020/7/e17996 %U https://doi.org/10.2196/17996 %U http://www.ncbi.nlm.nih.gov/pubmed/32460233 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e15770 %T Evaluating the Impact of the Grading and Assessment of Predictive Tools Framework on Clinicians and Health Care Professionals’ Decisions in Selecting Clinical Predictive Tools: Randomized Controlled Trial %A Khalifa,Mohamed %A Magrabi,Farah %A Gallego Luxan,Blanca %+ Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Rd, North Ryde, NSW 2113, Sydney, 2113, Australia, 61 438632060, mohamed.khalifa@mq.edu.au %K clinical prediction rule %K clinical decision rules %K evidence-based medicine %K evaluation study %D 2020 %7 9.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: While selecting predictive tools for implementation in clinical practice or for recommendation in clinical guidelines, clinicians and health care professionals are challenged with an overwhelming number of tools. Many of these tools have never been implemented or evaluated for comparative effectiveness. To overcome this challenge, the authors developed and validated an evidence-based framework for grading and assessment of predictive tools (the GRASP framework). This framework was based on the critical appraisal of the published evidence on such tools. Objective: The aim of the study was to examine the impact of using the GRASP framework on clinicians’ and health care professionals’ decisions in selecting clinical predictive tools. Methods: A controlled experiment was conducted through a web-based survey. Participants were randomized to either review the derivation publications, such as studies describing the development of the predictive tools, on common traumatic brain injury predictive tools (control group) or to review an evidence-based summary, where each tool had been graded and assessed using the GRASP framework (intervention group). Participants in both groups were asked to select the best tool based on the greatest validation or implementation. A wide group of international clinicians and health care professionals were invited to participate in the survey. Task completion time, rate of correct decisions, rate of objective versus subjective decisions, and level of decisional conflict were measured. Results: We received a total of 194 valid responses. In comparison with not using GRASP, using the framework significantly increased correct decisions by 64%, from 53.7% to 88.1% (88.1/53.7=1.64; t193=8.53; P<.001); increased objective decision making by 32%, from 62% (3.11/5) to 82% (4.10/5; t189=9.24; P<.001); decreased subjective decision making based on guessing by 20%, from 49% (2.48/5) to 39% (1.98/5; t188=−5.47; P<.001); and decreased prior knowledge or experience by 8%, from 71% (3.55/5) to 65% (3.27/5; t187=−2.99; P=.003). Using GRASP significantly decreased decisional conflict and increased the confidence and satisfaction of participants with their decisions by 11%, from 71% (3.55/5) to 79% (3.96/5; t188=4.27; P<.001), and by 13%, from 70% (3.54/5) to 79% (3.99/5; t188=4.89; P<.001), respectively. Using GRASP decreased the task completion time, on the 90th percentile, by 52%, from 12.4 to 6.4 min (t193=−0.87; P=.38). The average System Usability Scale of the GRASP framework was very good: 72.5% and 88% (108/122) of the participants found the GRASP useful. Conclusions: Using GRASP has positively supported and significantly improved evidence-based decision making. It has increased the accuracy and efficiency of selecting predictive tools. GRASP is not meant to be prescriptive; it represents a high-level approach and an effective, evidence-based, and comprehensive yet simple and feasible method to evaluate, compare, and select clinical predictive tools. %M 32673228 %R 10.2196/15770 %U https://www.jmir.org/2020/7/e15770 %U https://doi.org/10.2196/15770 %U http://www.ncbi.nlm.nih.gov/pubmed/32673228 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18072 %T Understanding Clinicians’ Adoption of Mobile Health Tools: A Qualitative Review of the Most Used Frameworks %A Jacob,Christine %A Sanchez-Vazquez,Antonio %A Ivory,Chris %+ Anglia Ruskin University, East Rd, Cambridge, CB1 1PT, United Kingdom, 41 798769376, christine.k.jacob@gmail.com %K telemedicine %K smartphone %K electronic health record %K workflow %K workload %K workplace %K public health practice %K technology %K perception %K health education %K mHealth %K mobile health %K telehealth %K eHealth %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although there is a push toward encouraging mobile health (mHealth) adoption to harness its potential, there are many challenges that sometimes go beyond the technology to involve other elements such as social, cultural, and organizational factors. Objective: This review aimed to explore which frameworks are used the most, to understand clinicians’ adoption of mHealth as well as to identify potential shortcomings in these frameworks. Highlighting these gaps and the main factors that were not specifically covered in the most frequently used frameworks will assist future researchers to include all relevant key factors. Methods: This review was an in-depth subanalysis of a larger systematic review that included research papers published between 2008 and 2018 and focused on the social, organizational, and technical factors impacting clinicians’ adoption of mHealth. The initial systematic review included 171 studies, of which 50 studies used a theoretical framework. These 50 studies are the subject of this qualitative review, reflecting further on the frameworks used and how these can help future researchers design studies that investigate the topic of mHealth adoption more robustly. Results: The most commonly used frameworks were different forms of extensions of the Technology Acceptance Model (TAM; 17/50, 34%), the diffusion of innovation theory (DOI; 8/50, 16%), and different forms of extensions of the unified theory of acceptance and use of technology (6/50, 12%). Some studies used a combination of the TAM and DOI frameworks (3/50, 6%), whereas others used the consolidated framework for implementation research (3/50, 6%) and sociotechnical systems (STS) theory (2/50, 4%). The factors cited by more than 20% of the studies were usefulness, output quality, ease of use, technical support, data privacy, self-efficacy, attitude, organizational inner setting, training, leadership engagement, workload, and workflow fit. Most factors could be linked to one framework or another, but there was no single framework that could adequately cover all relevant and specific factors without some expansion. Conclusions: Health care technologies are generally more complex than tools that address individual user needs as they usually support patients with comorbidities who are typically treated by multidisciplinary teams who might even work in different health care organizations. This special nature of how the health care sector operates and its highly regulated nature, the usual budget deficits, and the interdependence between health care organizations necessitate some crucial expansions to existing theoretical frameworks usually used when studying adoption. We propose a shift toward theoretical frameworks that take into account implementation challenges that factor in the complexity of the sociotechnical structure of health care organizations and the interplay between the technical, social, and organizational aspects. Our consolidated framework offers recommendations on which factors to include when investigating clinicians’ adoption of mHealth, taking into account all three aspects. %M 32442132 %R 10.2196/18072 %U https://mhealth.jmir.org/2020/7/e18072 %U https://doi.org/10.2196/18072 %U http://www.ncbi.nlm.nih.gov/pubmed/32442132 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17256 %T Technology Acceptance in Mobile Health: Scoping Review of Definitions, Models, and Measurement %A Nadal,Camille %A Sas,Corina %A Doherty,Gavin %+ School of Computer Science and Statistics, Trinity College Dublin, College Green, Dublin, D2, Ireland, 353 18963858, nadalc@tcd.ie %K Technology Acceptance Lifecycle %K patient acceptance %K mobile applications %K mHealth %K mobile phone %D 2020 %7 6.7.2020 %9 Review %J J Med Internet Res %G English %X Background: Designing technologies that users will be interested in, start using, and keep using has long been a challenge. In the health domain, the question of technology acceptance is even more important, as the possible intrusiveness of technologies could lead to patients refusing to even try them. Developers and researchers must address this question not only in the design and evaluation of new health care technologies but also across the different stages of the user’s journey. Although a range of definitions for these stages exists, many researchers conflate related terms, and the field would benefit from a coherent set of definitions and associated measurement approaches. Objective: This review aims to explore how technology acceptance is interpreted and measured in mobile health (mHealth) literature. We seek to compare the treatment of acceptance in mHealth research with existing definitions and models, identify potential gaps, and contribute to the clarification of the process of technology acceptance. Methods: We searched the PubMed database for publications indexed under the Medical Subject Headings terms “Patient Acceptance of Health Care” and “Mobile Applications.” We included publications that (1) contained at least one of the terms “acceptability,” “acceptance,” “adoption,” “accept,” or “adopt”; and (2) defined the term. The final corpus included 68 relevant studies. Results: Several interpretations are associated with technology acceptance, few consistent with existing definitions. Although the literature has influenced the interpretation of the concept, usage is not homogeneous, and models are not adapted to populations with particular needs. The prevalence of measurement by custom surveys suggests a lack of standardized measurement tools. Conclusions: Definitions from the literature were published separately, which may contribute to inconsistent usage. A definition framework would bring coherence to the reporting of results, facilitating the replication and comparison of studies. We propose the Technology Acceptance Lifecycle, consolidating existing definitions, articulating the different stages of technology acceptance, and providing an explicit terminology. Our findings illustrate the need for a common definition and measurement framework and the importance of viewing technology acceptance as a staged process, with adapted measurement methods for each stage. %M 32628122 %R 10.2196/17256 %U https://www.jmir.org/2020/7/e17256 %U https://doi.org/10.2196/17256 %U http://www.ncbi.nlm.nih.gov/pubmed/32628122 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15563 %T The Adaptive Behavioral Components (ABC) Model for Planning Longitudinal Behavioral Technology-Based Health Interventions: A Theoretical Framework %A Young,Sean D %+ Institute for Prediction Technology, Department of Informatics, University of California, Irvine, Bren School of Information and Computer Science, Irvine, CA, 92617-4022, United States, 1 650 223 5448, syoung5@hs.uci.edu %K health behavior %K risk behavior %K behavioral medicine %K public health informatics %K consumer health informatics %K psychological theory %D 2020 %7 26.6.2020 %9 Viewpoint %J J Med Internet Res %G English %X A growing number of interventions incorporate digital and social technologies (eg, social media, mobile phone apps, and wearable devices) into their design for behavior change. However, because of a number of factors, including changing trends in the use of technology over time, results on the efficacy of these interventions have been mixed. An updated framework is needed to help researchers better plan behavioral technology interventions by anticipating the needed resources and potential changes in trends that may affect interventions over time. Focusing on the domain of health interventions as a use case, we present the Adaptive Behavioral Components (ABC) model for technology-based behavioral interventions. ABC is composed of five components: basic behavior change; intervention, or problem-focused characteristics; population, social, and behavioral characteristics; individual-level and personality characteristics; and technology characteristics. ABC was designed with the goals of (1) guiding high-level development for digital technology–based interventions; (2) helping interventionists consider, plan for, and adapt to potential barriers that may arise during longitudinal interventions; and (3) providing a framework to potentially help increase the consistency of findings among digital technology intervention studies. We describe the planning of an HIV prevention intervention as a case study for how to implement ABC into intervention design. Using the ABC model to plan future interventions might help to improve the design of and adherence to longitudinal behavior change intervention protocols; allow these interventions to adapt, anticipate, and prepare for changes that may arise over time; and help to potentially improve intervention behavior change outcomes. Additional research is needed on the influence of each of ABC’s components to help improve intervention design and implementation. %M 32589152 %R 10.2196/15563 %U https://www.jmir.org/2020/6/e15563 %U https://doi.org/10.2196/15563 %U http://www.ncbi.nlm.nih.gov/pubmed/32589152 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16429 %T A Pantheoretical Framework to Optimize Adherence to Healthy Lifestyle Behaviors and Medication Adherence: The Use of Personalized Approaches to Overcome Barriers and Optimize Facilitators to Achieve Adherence %A Seixas,Azizi %A Connors,Colleen %A Chung,Alicia %A Donley,Tiffany %A Jean-Louis,Girardin %+ NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, , United States, 1 9728490862, azizi.seixas@nyumc.org %K adherence %K mHealth %K management %K chronic diseases %K prevention %K technology %D 2020 %7 24.6.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Patient nonadherence to healthy lifestyle behaviors and medical treatments (like medication adherence) accounts for a significant portion of chronic disease burden. Despite the plethora of behavioral interventions to overcome key modifiable/nonmodifiable barriers and enable facilitators to adherence, short- and long-term adherence to healthy lifestyle behaviors and medical treatments is still poor. To optimize adherence, we aimed to provide a novel mobile health solution steeped in precision and personalized population health and a pantheoretical approach that increases the likelihood of adherence. We have described the stages of a pantheoretical approach utilizing tailoring, clustering/profiling, personalizing, and optimizing interventions/strategies to obtain adherence and highlight the minimal engineering needed to build such a solution. %M 32579121 %R 10.2196/16429 %U https://mhealth.jmir.org/2020/6/e16429 %U https://doi.org/10.2196/16429 %U http://www.ncbi.nlm.nih.gov/pubmed/32579121 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15068 %T Developing and Applying a Formative Evaluation Framework for Health Information Technology Implementations: Qualitative Investigation %A Cresswell,Kathrin %A Williams,Robin %A Sheikh,Aziz %+ Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh, , United Kingdom, 44 1316508102, kathrin.beyer@ed.ac.uk %K health information technology %K evaluation %K sociotechnical %D 2020 %7 10.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: There is currently a lack of comprehensive, intuitive, and usable formative evaluation frameworks for health information technology (HIT) implementations. We therefore sought to develop and apply such a framework. This study describes the Technology, People, Organizations, and Macroenvironmental factors (TPOM) framework we developed. Objective: The aim was to develop and apply a formative evaluation framework for HIT implementations, highlighting interrelationships between identified dimensions and offering guidance for implementers. Methods: We drew on an initial prototype framework developed as part of a literature review exploring factors for the effective implementation of HIT. In addition, we used qualitative data from three national formative evaluations of different HIT interventions (electronic health record, electronic prescribing, and clinical decision support functionality). The combined data set comprised 19 case studies of primarily hospital settings, and included 703 semistructured interviews, 663 hours of observations, and 864 documents gathered from a range of care settings across National Health Service (NHS) England and NHS Scotland. Data analysis took place over a period of 10 years and was guided by a framework informed by the existing evidence base. Results: TPOM dimensions are intimately related and each include a number of subthemes that evaluators need to consider. Although technological functionalities are crucial in getting an initiative off the ground, system design needs to be cognizant of the accompanying social and organizational transformations required to ensure that technologies deliver the desired value for a variety of stakeholders. Wider structural changes, characterized by shifting policy landscapes and markets, influence technologies and the ways they are used by organizations and staff. Conclusions: The TPOM framework supports formative evaluations of HIT implementation and digitally enabled transformation efforts. There is now a need for prospective application of the TPOM framework to determine its value. %M 32519968 %R 10.2196/15068 %U http://www.jmir.org/2020/6/e15068/ %U https://doi.org/10.2196/15068 %U http://www.ncbi.nlm.nih.gov/pubmed/32519968 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e14201 %T Smart, Remote, and Targeted Health Care Facilitation Through Connected Health: Qualitative Study %A Chen,Sonia Chien-I %A Hu,Ridong %A McAdam,Rodney %+ Institute of Quantitative Economics, Huaqiao University, No. 668, Jimei Avenue, Jimei dist, Xiamen, 361021, China, 86 17750619886, j_rdhu@hqu.edu.cn %K connected health care %K smart health care %K health care quality %K access %K remote monitoring %K precision medicine %K self-management %D 2020 %7 28.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Societies around the world are aging. Widespread aging creates problems for social services and health care practices. In this light, research on connected health (CH) is becoming essential. CH refers to a variety of technological measures that allow health care to be provided remotely with the aim of increasing efficiency, cost-effectiveness, and satisfaction on the part of health care recipients. CH is reshaping health care’s direction to be more proactive, more preventive, and more precisely targeted and, thus, more effective. CH has been demonstrated to have great value in managing and preventing chronic diseases, which create huge burdens on health care and social services. In short, CH provides promising solutions to diseases and social challenges associated with aging populations. However, there are many barriers that need to be overcome before CH can be successfully and widely implemented. Objective: The research question of this study is as follows: How can CH facilitate smart, remote, and targeted health care? The objective is to identify how health care can be managed in more comprehensive ways, such as by providing timely, flexible, accessible, and personalized services to preserve continuity and offer high-quality seamless health care. Methods: A qualitative approach was used based on 60 multistage, semistructured stakeholder interviews. Results: The results can be divided into two functions of CH: ecosystem and platform. On the one hand, the interviews enabled the authors to develop a stakeholder classification and interaction diagram. These stakeholders interacted sequentially to provide technology-based content to end users. On the other hand, interviewees reflected on how CH serves as a platform to address remote monitoring and patient self-management. In the Discussion section, three innovation strategies are discussed to reflect the manner in which CH promotes smart, timely, and precise health care. Conclusions: This study indicates that it is essential to continually revise CH business models, given the ongoing and rapid changes in technology across groups of CH stakeholders. We also found that global trends toward smart, timely, and precise health care shape what individuals expect from products and services, providing firms with unique opportunities for growth. %M 32343254 %R 10.2196/14201 %U http://www.jmir.org/2020/4/e14201/ %U https://doi.org/10.2196/14201 %U http://www.ncbi.nlm.nih.gov/pubmed/32343254 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e18558 %T Rethinking Social Interaction: Empirical Model Development %A Bjornestad,Jone %A Moltu,Christian %A Veseth,Marius %A Tjora,Tore %+ Department of Social Studies, Faculty of Social Sciences, University of Stavanger, PO Box 8600 FORUS, Stavanger, 4036, Norway, 47 97141599, jone.r.bjornestad@uis.no %K social interaction %K social functioning %K social media %K model %K empirical %K adolescence %K health science %D 2020 %7 23.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media is an integral part of human social life. More than 90% of young people use social media daily. Current theories, models, and measures are primarily based on face-to-face conceptions, leaving research out of sync with current social trends. This may lead to imprecise diagnoses and predictions. Objective: To develop a theoretically based empirical model of current social interfaces to inform relevant measures. Methods: A three-stage, qualitative, data-collection approach included anonymous individual Post-it notes, three full-class discussions, and 10 focus groups to explore 82 adolescents’ relational practices. Data analysis followed a meaning-condensation procedure and a field-correspondence technique. Results: We developed an empirical model that categorizes adolescents’ social interactions into five experiential positions. Four positions result from trajectories relating to social media and face-to-face social interaction. Positions are described by match or mismatch dynamics between preferred and actual social platforms used. In matched positions, individuals prefer and use both face-to-face and social media platforms (position 1), prefer and use face-to-face platforms (position 2), or prefer and use social media platforms (position 3). In mismatched positions, individuals prefer face-to-face interactions but use social media platforms (position 4) or prefer social media but use face-to-face platforms (position 5). We propose that matched positions indicate good social functioning while mismatched positions indicate serious social challenges. Conclusions: We propose a model that will expand previous unidimensional social interaction constructs, and we hypothesize that the described match and mismatch analyses provide conceptual clarity for research and practical application. We discuss prediction value, implications, and model validation procedures. %M 32324144 %R 10.2196/18558 %U http://www.jmir.org/2020/4/e18558/ %U https://doi.org/10.2196/18558 %U http://www.ncbi.nlm.nih.gov/pubmed/32324144 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e17258 %T Exploring Patients' Intentions for Continuous Usage of mHealth Services: Elaboration-Likelihood Perspective Study %A Guo,Xitong %A Chen,Shuqing %A Zhang,Xiaofei %A Ju,Xiaofeng %A Wang,Xifu %+ School of Management, Harbin Institute of Technology, No 2, Yikuang Str, Nangang District, Harbin, 150001, China, 86 451 8641 4022, chenshuqinghit@gmail.com %K mHealth services %K health consciousness %K elaboration-likelihood model %K health behavior %K patients’ continuous usage %D 2020 %7 6.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the increasingly rapid development of Web 2.0 technologies, the application of mobile health (mHealth) care in the field of health management has become popular. Accordingly, patients are able to access consulting services and effective health information online without temporal and geographical constraints. The elaboration-likelihood model (ELM) is a dual-process persuasion theory that describes the change of attitudes and behavior. Objective: In this study, we drew on the ELM to investigate patients’ continuous usage intentions regarding mHealth services. In addition, we further examined which route—central or peripheral—has a stronger impact on a patient’s usage of health care management. Methods: To meet these objectives, five hypotheses were developed and empirically validated using a field survey to test the direct and indirect effects, via attitude, of the two routes on continuous usage intention. Results: We found that patients’ perceived mHealth information quality and perceived mHealth system quality had a positive effect on their personal attitudes. The results revealed that social media influence had a positive effect on a patient’s attitude toward mHealth services. In particular, our findings suggest that a patient’s health consciousness has a positive effect on the relationship between social media influence and attitude. Conclusions: This study contributes to the mHealth services literature by introducing the ELM as a referent theory for research, as well as by specifying the moderating role of health consciousness. For practitioners, this study introduces influence processes as policy tools that managers can employ to motivate the uptake of mHealth services within their organizations. %M 32250277 %R 10.2196/17258 %U https://mhealth.jmir.org/2020/4/e17258 %U https://doi.org/10.2196/17258 %U http://www.ncbi.nlm.nih.gov/pubmed/32250277 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e16060 %T Elements of Social Convoy Theory in Mobile Health for Palliative Care: Scoping Review %A Portz,Jennifer D %A Elsbernd,Kira %A Plys,Evan %A Ford,Kelsey Lynett %A Zhang,Xuhong %A Gore,M Odette %A Moore,Susan L %A Zhou,Shuo %A Bull,Sheana %+ General Internal Medicine, School of Medicine, University of Colorado, 13055 E 17th, F802, Aurora, CO, 80045, United States, 1 3037248856, jennifer.portz@cuanschutz.edu %K mHealth %K palliative care %K caregivers %K mobile apps %D 2020 %7 6.1.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) provides a unique modality for improving access to and awareness of palliative care among patients, families, and caregivers from diverse backgrounds. Some mHealth palliative care apps exist, both commercially available and established by academic researchers. However, the elements of family support and family caregiving tools offered by these early apps is unknown. Objective: The objective of this scoping review was to use social convoy theory to describe the inclusion and functionality of family, social relationships, and caregivers in palliative care mobile apps. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines, a systematic search of palliative care mHealth included (1) research-based mobile apps identified from academic searches published between January 1, 2010, and March 31, 2019 and (2) commercially available apps for app stores in April 2019. Two reviewers independently assessed abstracts, app titles, and descriptions against the inclusion and exclusion criteria. Abstracted data covered app name, research team or developer, palliative care element, target audience, and features for family support and caregiving functionality as defined by social convoy theory. Results: Overall, 10 articles describing 9 individual research-based apps and 22 commercially available apps were identified. Commercially available apps were most commonly designed for both patients and social convoys, whereas the majority of research apps were designed for patient use only. Conclusions: Results suggest there is an emerging presence of apps for patients and social convoys receiving palliative care; however, there are many needs for developers and researchers to address in the future. Although palliative care mHealth is a growing field, additional research is needed for apps that embrace a team approach to information sharing, target family- and caregiver-specific issues, promote access to palliative care, and are comprehensive of palliative needs. %M 31904581 %R 10.2196/16060 %U https://mhealth.jmir.org/2020/1/e16060 %U https://doi.org/10.2196/16060 %U http://www.ncbi.nlm.nih.gov/pubmed/31904581 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e16093 %T Infrastructure Revisited: An Ethnographic Case Study of how Health Information Infrastructure Shapes and Constrains Technological Innovation %A Greenhalgh,Trisha %A Wherton,Joseph %A Shaw,Sara %A Papoutsi,Chrysanthi %A Vijayaraghavan,Shanti %A Stones,Rob %+ University of Oxford, Radcliffe Primary Care Building, Oxford, OX2 6GG, United Kingdom, 44 1865289294, trish.greenhalgh@phc.ox.ac.uk %K information infrastructure %K structuration theory %K video consultations %K neo-institutional theory %K organizational ethnography %K hidden work %K actor-network theory %D 2019 %7 19.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Star defined infrastructure as something other things “run on”; it consists mainly of “boring things.” Building on her classic 1999 paper, and acknowledging contemporary developments in technologies, services, and systems, we developed a new theorization of health information infrastructure with five defining characteristics: (1) a material scaffolding, backgrounded when working and foregrounded upon breakdown; (2) embedded, relational, and emergent; (3) collectively learned, known, and practiced (through technologically-supported cooperative work and organizational routines); (4) patchworked (incrementally built and fixed) and path-dependent (influenced by technical and socio-cultural legacies); and (5) institutionally supported and sustained (eg, embodying standards negotiated and overseen by regulatory and professional bodies). Objective: Our theoretical objective was, in a health care context, to explore what information infrastructure is and how it shapes, supports, and constrains technological innovation. Our empirical objective was to examine the challenges of implementing and scaling up video consultation services. Methods: In this naturalistic case study, we collected a total of 450 hours of ethnographic observations, over 100 interviews, and about 100 local and national documents over 54 months. Sensitized by the characteristics of infrastructure, we sought examples of infrastructural challenges that had slowed implementation and scale-up. We arranged data thematically to gain familiarity before undertaking an analysis informed by strong structuration, neo-institutional, and social practice theories, together with elements taken from the actor-network theory. Results: We documented scale-up challenges at three different sites in our original case study, all of which relate to “boring things”: the selection of a platform to support video-mediated consultations, the replacement of desktop computers with virtual desktop infrastructure profiles, and problems with call quality. In a fourth subcase, configuration issues with licensed video-conferencing software limited the spread of the innovation to another UK site. In all four subcases, several features of infrastructure were evident, including: (1) intricacy and lack of dependability of the installed base; (2) interdependencies of technologies, processes, and routines, such that a fix for one problem generated problems elsewhere in the system; (3) the inertia of established routines; (4) the constraining (and, occasionally, enabling) effect of legacy systems; and (5) delays and conflicts relating to clinical quality and safety standards. Conclusions: Innovators and change agents who wish to introduce new technologies in health services and systems should: (1) attend to materiality (eg, expect bugs and breakdowns, and prioritize basic dependability over advanced functionality); (2) take a systemic and relational view of technologies (versus as an isolated tool or function); (3) remember that technology-supported work is cooperative and embedded in organizational routines, which are further embedded in other routines; (4) innovate incrementally, taking account of technological and socio-cultural legacies; (5) consider standards but also where these standards come from and what priorities and interests they represent; and (6) seek to create leeway for these standards to be adapted to different local conditions. %M 31855184 %R 10.2196/16093 %U http://www.jmir.org/2019/12/e16093/ %U https://doi.org/10.2196/16093 %U http://www.ncbi.nlm.nih.gov/pubmed/31855184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e14985 %T Understanding Drivers of Resistance Toward Implementation of Web-Based Self-Management Tools in Routine Cancer Care Among Oncology Nurses: Cross-Sectional Survey Study %A de Wit,Matthijs %A Kleijnen,Mirella %A Lissenberg-Witte,Birgit %A van Uden-Kraan,Cornelia %A Millet,Kobe %A Frambach,Ruud %A Verdonck-de Leeuw,Irma %+ Vrije Universiteit Amsterdam, Department of Clinical, Neuro- and Developmental Psychology, Van der Boechorstraat 7, Amsterdam, 1081 BT, Netherlands, 31 204440988, im.verdonck@vumc.nl %K psycho-oncology %K health-related quality of life %K self-management %K eHealth %K implementation science %K resistance to innovations %D 2019 %7 17.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Supporting patients to engage in (Web-based) self-management tools is increasingly gaining importance, but the engagement of health care professionals is lagging behind. This can partly be explained by resistance among health care professionals. Objective: The aim of this study was to investigate drivers of resistance among oncology nurses toward Web-based self-management tools in cancer care. Methods: Drawing from previous research, combining clinical and marketing perspectives, and several variables and instruments, we developed the Resistance to Innovation model (RTI-model). The RTI-model distinguishes between passive and active resistance, which can be enhanced or reduced by functional drivers (incompatibility, complexity, lack of value, and risk) and psychological drivers (role ambiguity, social pressure from the institute, peers, and patients). Both types of drivers can be moderated by staff-, organization-, patient-, and environment-related factors. We executed a survey covering all components of the RTI-model on a cross-sectional sample of nurses working in oncology in the Netherlands. Structural equation modeling was used to test the full model, using a hierarchical approach. In total, 2500 nurses were approached, out of which 285 (11.40%) nurses responded. Results: The goodness of fit statistic of the uncorrected base model of the RTI-model (n=239) was acceptable (χ21=9.2; Comparative Fit Index=0.95; Tucker Lewis index=0.21; Root Mean Square Error of Approximation=0.19; Standardized Root Mean Square=0.016). In line with the RTI-model, we found that both passive and active resistance among oncology nurses toward (Web-based) self-management tools were driven by both functional and psychological drivers. Passive resistance toward Web-based self-management tools was enhanced by complexity, lack of value, and role ambiguity, and it was reduced by institutional social pressure. Active resistance was enhanced by complexity, lack of value, and social pressure from peers, and it was reduced by social pressure from the institute and patients. In contrast to what we expected, incompatibility with current routines was not a significant driver of either passive or active resistance. This study further showed that these drivers of resistance were moderated by expertise (P=.03), managerial support (P=.004), and influence from external stakeholders (government; P=.04). Conclusions: Both passive and active resistance in oncology nurses toward Web-based self-management tools for patients with cancer are driven by functional and psychological drivers, which may be more or less strong, depending on expertise, managerial support, and governmental influence. %M 31845900 %R 10.2196/14985 %U http://www.jmir.org/2019/12/e14985/ %U https://doi.org/10.2196/14985 %U http://www.ncbi.nlm.nih.gov/pubmed/31845900 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 11 %N 4 %P e15174 %T Informational Practices of Postacute Brain Injury Patients During Personal Recovery: Qualitative Study %A Masterson,Yamini %A Brady,Erin %A Miller,Andrew %+ Department of Human-Centered Computing, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, 535 W Michigan Street, Indianapolis, IN, 46202, United States, 1 317 278 4636, ykaranam@iu.edu %K chronic illness %K brain injury %K disease management %K mental health recovery %K quality of life %K data collection %K personal health records %K patient generated health data %D 2019 %7 12.11.2019 %9 Original Paper %J J Participat Med %G English %X Background: The effects of brain injury, structural damage, or the physiological disruption of brain function last far beyond initial clinical treatment. Self-tracking and management technologies have the potential to help individuals experiencing brain injury in their personal recovery—helping them to function at their best despite ongoing symptoms of illness. However, current self-tracking technologies may be unsuited for measuring the interconnected, nonlinear ways in which brain injury manifests. Objective: This study aimed to investigate (1) the current informational practices and sensemaking processes used by postacute brain injury patients during personal recovery and (2) the potential role of quality-of-life instruments in improving patient awareness of brain injury recovery, advocacy, and involvement in care used outside the clinical context. Our objective was to explore the means of improving awareness through reflection that leads to compensatory strategies by anticipating or recognizing the occurrence of a problem caused by impairment. Methods: We conducted a qualitative study and used essentialist or realist thematic analysis to analyze the data collected through semistructured interviews and questionnaires, 2 weeks of structured data collection using brain injury–specific health-related quality of life instrument, quality of life after brain injury (QoLIBRI), and final interviews. Results: Informational practices of people with brain injury involve data collection, data synthesis, and obtaining and applying the insights to their lifestyles. Participants collected data through structured tools such as spreadsheets and wearable devices but switched to unstructured tools such as journals and blogs as changes in overall progress became more qualitative in nature. Although data collection helped participants summarize their progress better, the lack of conceptual understanding made it challenging to know what to monitor or communicate with clinicians. QoLIBRI served as an education tool in this scenario but was inadequate in facilitating reflection and sensemaking. Conclusions: Individuals with postacute brain injury found the lack of conceptual understanding of recovery and tools for making sense of their health data as major impediments for tracking and being aware of their personal recovery. There is an urgent need for a better framework for recovery and a process model for choosing patient-generated health data tools that focus on the holistic nature of recovery and improve the understanding of brain injury for all stakeholders involved throughout recovery. %R 10.2196/15174 %U https://jopm.jmir.org/2019/4/e15174 %U https://doi.org/10.2196/15174 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e13606 %T Identifying Frameworks for Validation and Monitoring of Consensual Behavioral Intervention Technologies: Narrative Review %A Carbonnel,François %A Ninot,Gregory %+ University Department of General Practice, University of Montpellier, 641 Avenue du Doyen Giraud, UFR Médecine site Nord, Montpellier, 34093, France, 33 684014834, francois.carbonnel@gmail.com %K behavioral intervention technology %K validation %K surveillance %K paradigm %K framework %K nonpharmacological interventions %D 2019 %7 16.10.2019 %9 Review %J J Med Internet Res %G English %X Background: Changing health behaviors, such as smoking, unhealthy eating, inactivity, and alcohol abuse, may have a greater impact on population health than any curative strategy. One of the suggested strategies is the use of behavioral intervention technologies (BITs). They open up new opportunities in the area of prevention and therapy and have begun to show benefits in the durable change of health behaviors in patients or those at risk. A consensual and international paradigm was adopted by health authorities for drugs 50 years ago. It guides their development from research units to their authorization and surveillance. BITs’ generalization brings into question their upstream evaluation before being placed on the market and their downstream monitoring once on the market; this is especially the case in view of the marketing information provided by manufacturers and the scarcity and methodological limits of scientific studies on these tools. Objective: This study aims to identify and categorize the frameworks for the validation and monitoring of BITs proposed in the literature. Methods: We conducted a narrative literature review using MEDLINE, PsycINFO, and Web of Science. The review items included the following: name, publication year, name of the creator (ie, first author), country, funding organization, health focus, target group, and design (ie, linear, iterative, evolutive, and/or concurrent). The frameworks were then categorized based on (1) translational research thanks to a continuum of steps and (2) the three paradigms that may have inspired the frameworks: biomedical, engineering, and/or behavioral. Results: We identified 46 frameworks besides the classic US Food and Drug Administration (FDA) five-phase drug development model. A total of 57% (26/46) of frameworks were created in the 2010s and 61% (28/46) involved the final user in an early and systematic way. A total of 4% (2/46) of frameworks had a linear-only sequence of their phases, 37% (17/46) had a linear and iterative structure, 33% (15/46) added an evolutive structure, and 24% (11/46) were associated with a parallel process. Only 12 out of 46 (26%) frameworks covered the continuum of steps and 12 (26%) relied on the three paradigms. Conclusions: To date, 46 frameworks of BIT validation and surveillance coexist, besides the classic FDA five-phase drug development model, without the predominance of one of them or convergence in a consensual model. Their number has increased exponentially in the last three decades. Three dangerous scenarios are possible: (1) anarchic continuous development of BITs that depend on companies amalgamating health benefits and usability (ie, user experience, data security, and ergonomics) and limiting implementation to several countries; (2) the movement toward the type of framework for drug evaluation centered on establishing its effectiveness before marketing authorization to guarantee its safety for users, which is heavy and costly; and (3) the implementation of a framework reliant on big data analysis based on a posteriori research and an autoregulation of a market, but that does not address the safety risk for the health user, as the market will not regulate safety or efficacy issues. This paper recommends convergence toward an international validation and surveillance framework based on the specificities of BITs, not equivalent to medical devices, to guarantee their effectiveness and safety for users. %M 31621638 %R 10.2196/13606 %U https://www.jmir.org/2019/10/e13606 %U https://doi.org/10.2196/13606 %U http://www.ncbi.nlm.nih.gov/pubmed/31621638 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e14005 %T Connected Health Services: Framework for an Impact Assessment %A Chouvarda,Ioanna %A Maramis,Christos %A Livitckaia,Kristina %A Trajkovik,Vladimir %A Burmaoglu,Serhat %A Belani,Hrvoje %A Kool,Jan %A Lewandowski,Roman %A , %+ Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Aristotle University Campus, Building 16d, Thessaloniki, 54124, Greece, 30 2310999247, ioanna@med.auth.gr %K connected health %K health impact assessment %K framework %K outcome assessment %K enablers and barriers %D 2019 %7 03.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Connected health (CH), as a new paradigm, manages individual and community health in a holistic manner by leveraging a variety of technologies and has the potential for the incorporation of telehealth and integrated care services, covering the whole spectrum of health-related services addressing healthy subjects and chronic patients. The reorganization of services around the person or citizen has been expected to bring high impact in the health care domain. There are a series of concerns (eg, contextual factors influencing the impact of care models, the cost savings associated with CH solutions, and the sustainability of the CH ecosystem) that should be better addressed for CH technologies to reach stakeholders more successfully. Overall, there is a need to effectively establish an understanding of the concepts of CH impact. As services based on CH technologies go beyond standard clinical interventions and assessments of medical devices or medical treatments, the need for standardization and for new ways of measurements and assessments emerges when studying CH impact. Objective: This study aimed to introduce the CH impact framework (CHIF) that serves as an approach to assess the impact of CH services. Methods: This study focused on the subset of CH comprising services that directly address patients and citizens on the management of disease or health and wellness. The CHIF was developed through a multistep procedure and various activities. These included, as initial steps, a literature review and workshop focusing on knowledge elicitation around CH concepts. Then followed the development of the initial version of the framework, refining of the framework with the experts as a result of the second workshop, and, finally, composition and deployment of a questionnaire for preliminary feedback from early-stage researchers in the relevant domains. Results: The framework contributes to a better understanding of what is CH impact and analyzes the factors toward achieving it. CHIF elaborates on how to assess impact in CH services. These aspects can contribute to an impact-aware design of CH services. It can also contribute to a comparison of CH services and further knowledge of the domain. The CHIF is based on 4 concepts, including CH system and service outline, CH system end users, CH outcomes, and factors toward achieving CH impact. The framework is visualized as an ontological model. Conclusions: The CHIF is an initial step toward identifying methodologies to objectively measure CH impact while recognizing its multiple dimensions and scales. %M 31482857 %R 10.2196/14005 %U https://www.jmir.org/2019/9/e14005/ %U https://doi.org/10.2196/14005 %U http://www.ncbi.nlm.nih.gov/pubmed/31482857 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e14056 %T The SMART Framework: Integration of Citizen Science, Community-Based Participatory Research, and Systems Science for Population Health Science in the Digital Age %A Katapally,Tarun Reddy %+ Johnson Shoyama Graduate School of Public Policy, University of Regina, 2155 College Ave, Regina, SK, S4P4V5, Canada, 1 3065854544, tarun.katapally@uregina.ca %K community-based participatory research %K smartphones %K mobile phones %K population health %K mHealth %K eHealth %K digital health %K big data %K evidence-based framework %K citizen science %K participatory research %K participatory surveillance %K systems science %K ubiquitous tools %D 2019 %7 30.08.2019 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Citizen science enables citizens to actively contribute to all aspects of the research process, from conceptualization and data collection, to knowledge translation and evaluation. Citizen science is gradually emerging as a pertinent approach in population health research. Given that citizen science has intrinsic links with community-based research, where participatory action drives the research agenda, these two approaches could be integrated to address complex population health issues. Community-based participatory research has a strong record of application across multiple disciplines and sectors to address health inequities. Citizen science can use the structure of community-based participatory research to take local approaches of problem solving to a global scale, because citizen science emerged through individual environmental activism that is not limited by geography. This synergy has significant implications for population health research if combined with systems science, which can offer theoretical and methodological strength to citizen science and community-based participatory research. Systems science applies a holistic perspective to understand the complex mechanisms underlying causal relationships within and between systems, as it goes beyond linear relationships by utilizing big data–driven advanced computational models. However, to truly integrate citizen science, community-based participatory research, and systems science, it is time to realize the power of ubiquitous digital tools, such as smartphones, for connecting us all and providing big data. Smartphones have the potential to not only create equity by providing a voice to disenfranchised citizens but smartphone-based apps also have the reach and power to source big data to inform policies. An imminent challenge in legitimizing citizen science is minimizing bias, which can be achieved by standardizing methods and enhancing data quality—a rigorous process that requires researchers to collaborate with citizen scientists utilizing the principles of community-based participatory research action. This study advances SMART, an evidence-based framework that integrates citizen science, community-based participatory research, and systems science through ubiquitous tools by addressing core challenges such as citizen engagement, data management, and internet inequity to legitimize this integration. %M 31471963 %R 10.2196/14056 %U http://mhealth.jmir.org/2019/8/e14056/ %U https://doi.org/10.2196/14056 %U http://www.ncbi.nlm.nih.gov/pubmed/31471963 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e14634 %T What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness %A Liu,Jing %A Hou,Shengchao %A Evans,Richard %A Xia,Chenxi %A Xia,Weidong %A Ma,Jingdong %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Qiaokou District, Wuhan,, China, 86 27 83692826, jdma@hust.edu.cn %K patient-centered care %K delivery of health care %K systematic review %K taxonomy %D 2019 %7 07.08.2019 %9 Review %J J Med Internet Res %G English %X Background: Complaints made online by patients about their health care experiences are becoming prevalent because of widespread worldwide internet connectivity. An a priori framework, based on patient centeredness, may be useful in identifying the types of issues patients complain about online across multiple settings. It may also assist in examining whether the determinants of patient-centered care (PCC) mirror the determinants of patient experiences. Objective: The objective of our study was to develop a taxonomy framework for patient complaints online based on patient centeredness and to examine whether the determinants of PCC mirror the determinants of patient experiences. Methods: First, the best fit framework synthesis technique was applied to develop the proposed a priori framework. Second, electronic databases, including Web of Science, Scopus, and PubMed, were searched for articles published between 2000 and June 2018. Studies were only included if they collected primary quantitative data on patients’ online complaints. Third, a deductive and inductive thematic analysis approach was adopted to code the themes of recognized complaints into the framework. Results: In total, 17 studies from 5 countries were included in this study. Patient complaint online taxonomies and theme terms varied. According to our framework, patients expressed most dissatisfaction with patient-centered processes (101,586/204,363, 49.71%), followed by prerequisites (appropriate skills and knowledge of physicians; 50,563, 24.74%) and the care environment (48,563/204,363, 23.76%). The least dissatisfied theme was expected outcomes (3651/204,363, 1.79%). People expressed little dissatisfaction with expanded PCC dimensions, such as involvement of family and friends (591/204,363, 0.29%). Variation in the concerns across different countries’ patients were also observed. Conclusions: Online complaints made by patients are of major value to health care providers, regulatory bodies, and patients themselves. Our PCC framework can be applied to analyze them under a wide range of conditions, treatments, and countries. This review has shown significant heterogeneity of patients’ online complaints across different countries. %M 31392961 %R 10.2196/14634 %U https://www.jmir.org/2019/8/e14634/ %U https://doi.org/10.2196/14634 %U http://www.ncbi.nlm.nih.gov/pubmed/31392961 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 3 %P e14620 %T Diagnostic Markers of User Experience, Play, and Learning for Digital Serious Games: A Conceptual Framework Study %A Tan,Jun Wen %A Zary,Nabil %+ Games for Health Innovations Centre, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore,, Singapore, 65 96945179, junwen.tan2@gmail.com %K serious games %K diagnostic criteria %K medical education %D 2019 %7 16.07.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Serious games for medical education have seen a resurgence in recent years, partly due to the growth of the video game industry and the ability of such games to support learning achievements. However, there is little consensus on what the serious and game components in a serious game are composed of. As a result, electronic learning (e-learning) and medical simulation modules are sometimes mislabeled as serious games. We hypothesize that one of the main reasons is the difficulty for a medical educator to systematically and accurately evaluate key aspects of serious games. Objective: This study aimed to identify markers that can evaluate serious games and distinguish between serious games, entertainment games, and e-learning. Methods: Jabareen’s eight-phase framework-building procedure was used to identify the core markers of a serious game. The procedure was modified slightly to elicit “diagnostic criteria” as opposed to its original purpose of a conceptual framework. Following the identification of purported markers, the newly developed markers were tested on a series of freely available health care serious games—Dr. Game Surgeon Trouble, Staying Alive, and Touch Surgery—and the results were compared to the published test validity for each game. Results: Diagnostic criteria for serious games were created, comprising the clusters of User Experience (UX), Play, and Learning. Each cluster was formed from six base markers, a minimum of four of which were required for a cluster to be considered present. These criteria were tested on the three games, and Dr. Game Surgeon Trouble and Staying Alive fit the criteria to be considered a serious game. Touch Surgery did not meet the criteria, but fit the definition of an e-learning module. Conclusions: The diagnostic criteria appear to accurately distinguish between serious games and mediums commonly misidentified as serious games, such as e-learning modules. However, the diagnostic criteria do not determine if a serious game will be efficacious; they only determine if it is a serious game. Future research should include a much larger sample of games designed specifically for health care purposes. %M 31313660 %R 10.2196/14620 %U http://games.jmir.org/2019/3/e14620/ %U https://doi.org/10.2196/14620 %U http://www.ncbi.nlm.nih.gov/pubmed/31313660 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13117 %T Theories Predicting End-User Acceptance of Telemedicine Use: Systematic Review %A Harst,Lorenz %A Lantzsch,Hendrikje %A Scheibe,Madlen %+ Research Association Public Health, Center of Evidence-based Healthcare, University Clinic Carl Gustav Carus, Technische Universität Dresden, House 106, Löscherstraße 18, Dresden, 01307, Germany, 49 351 3177 ext 223, lorenz.harst@tu-dresden.de %K systematic review %K telemedicine %K technology %K patient compliance %D 2019 %7 21.05.2019 %9 Review %J J Med Internet Res %G English %X Background: Only a few telemedicine applications have made their way into regular care. One reason is the lack of acceptance of telemedicine by potential end users. Objective: The aim of this systematic review was to identify theoretical predictors that influence the acceptance of telemedicine. Methods: An electronic search was conducted in PubMed and PsycINFO in June 2018 and supplemented by a hand search. Articles were identified using predefined inclusion and exclusion criteria. In total, two reviewers independently assessed the title, abstract, and full-text screening and then individually performed a quality assessment of all included studies. Results: Out of 5917 potentially relevant titles (duplicates excluded), 24 studies were included. The Axis Tool for quality assessment of cross-sectional studies revealed a high risk of bias for all studies except for one study. The most commonly used models were the Technology Acceptance Model (n=11) and the Unified Theory of Acceptance and Use of Technology (n=9). The main significant predictors of acceptance were perceived usefulness (n=11), social influences (n=6), and attitude (n=6). The results show a superiority of technology acceptance versus original behavioral models. Conclusions: The main finding of this review is the applicability of technology acceptance models and theories on telemedicine adoption. Characteristics of the technology, such as its usefulness, as well as attributes of the individual, such as his or her need for social support, inform end-user acceptance. Therefore, in the future, requirements of the target group and the group’s social environment should already be taken into account when planning telemedicine applications. The results support the importance of theory-guided user-centered design approaches to telemedicine development. %M 31115340 %R 10.2196/13117 %U http://www.jmir.org/2019/5/e13117/ %U https://doi.org/10.2196/13117 %U http://www.ncbi.nlm.nih.gov/pubmed/31115340 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e11565 %T Developing Theory-Driven, Evidence-Based Serious Games for Health: Framework Based on Research Community Insights %A Verschueren,Sarah %A Buffel,Connor %A Vander Stichele,Geert %+ MindBytes BVBA, Schoondreef 7, Merksplas, 2330, Belgium, 32 476753516, sarahverschueren@hotmail.com %K health %K computer games %K digital %K intervention %K review %K methodology %D 2019 %7 02.05.2019 %9 Review %J JMIR Serious Games %G English %X Background: The idea of using serious games to effectuate better outcomes in health care has gained significant traction among a growing community of researchers, developers, and health care professionals. Many now recognize the importance of creating evidence-based games that are purposefully designed to address physical and mental health challenges faced by end users. To date, no regulatory resources have been established to guide the development of serious games for health (SGH). Developers must therefore look elsewhere for guidance. Although a more robust level of evidence exists in the research literature, it is neither structured nor is there any clear consensus. Developers currently use a variety of approaches and methodologies. The establishment of a well-defined framework that represents the consensus views of the SGH research community would help developers improve the efficiency of internal development processes, as well as chances of success. A consensus framework would also enhance the credibility of SGH and help provide quality evidence of their effectiveness. Objective: This research aimed to (1) identify and evaluate the requirements, recommendations, and guidelines proposed by the SGH community in the research literature, and; (2) develop a consensus framework to guide developers, designers, researchers, and health care professionals in the development of evidence-based SGH. Methods: A critical review of the literature was performed in October to November 2018. A 3-step search strategy and a predefined set of inclusion criteria were used to identify relevant articles in PubMed, ScienceDirect, Institute of Electrical and Electronics Engineers Xplore, CiteSeerX, and Google Scholar. A supplemental search of publications from regulatory authorities was conducted to capture their specific requirements. Three researchers independently evaluated the identified articles. The evidence was coded and categorized for analysis. Results: This review identified 5 categories of high-level requirements and 20 low-level requirements suggested by the SGH community. These advocate a methodological approach that is multidisciplinary, iterative, and participatory. On the basis of the requirements identified, we propose a framework for developing theory-driven, evidence-based SGH. It comprises 5 stages that are informed by various stakeholders. It focuses on building strong scientific and design foundations that guide the creative and technical development. It includes quantitative trials to evaluate whether the SGH achieve the intended outcomes, as well as efforts to disseminate trial findings and follow-up monitoring after the SGH are rolled out for use. Conclusions: This review resulted in the formulation of a framework for developing theory-driven, evidence-based SGH that represents many of the requirements set out by SGH stakeholders in the literature. It covers all aspects of the development process (scientific, technological, and design) and is transparently described in sufficient detail to allow SGH stakeholders to implement it in a wide variety of projects, irrespective of discipline, health care segments, or focus. %M 31045496 %R 10.2196/11565 %U https://games.jmir.org/2019/2/e11565/ %U https://doi.org/10.2196/11565 %U http://www.ncbi.nlm.nih.gov/pubmed/31045496 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e10830 %T “It’s Not Just Technology, It’s People”: Constructing a Conceptual Model of Shared Health Informatics for Tracking in Chronic Illness Management %A Vizer,Lisa M %A Eschler,Jordan %A Koo,Bon Mi %A Ralston,James %A Pratt,Wanda %A Munson,Sean %+ Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Health Sciences Library, Rm 333A, CB 7110, 335 S Columbia St, Chapel Hill, NC, 27599-7110, United States, 1 4109082774, LMVizer@unc.edu %K consumer health informatics %K chronic illness %K patient generated health data %K patient reported outcomes %K workflow %K information seeking behavior %K shared decision making %D 2019 %7 29.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: For many people, tracking health indicators is central to managing a chronic illness. However, previous informatics research has largely viewed tracking as a solitary process that lacks the characteristics essential to tracking in support of chronic illness management. Objective: To inform development of effective technologies that aid tracking of health indicators to support chronic illness management, this study aimed to construct a health informatics model that accurately describes the work and social context of that tracking work. Methods: As part of a larger project, we conducted semistructured interviews with 40 adults concerning their chronic illness management practices, including tracking and communication. We also assembled transcripts of 30 publicly available videos of 24 adults discussing tracking processes for managing their own chronic illness. We used qualitative methods to analyze interviews and video transcripts through the lens of ongoing personal and health informatics research. Results: We have described the people and work involved in tracking in support of chronic illness management and contributed a Conceptual Model of Shared Health Informatics (CoMSHI). Specifically, we identified the need for a health informatics model that (1) incorporates the ongoing nature of tracking work and (2) represents the social dimension of tracking for illness management. Our model depicts communication, information, collection, integration, reflection, and action work in the social context of the person with chronic illness, informal carers, health care providers, and community members. Conclusions: The resulting CoMSHI yields a more detailed and nuanced viewpoint of tracking in support of chronic illness management and can inform technology design to improve tracking tools to support people in more confident and capable chronic illness management. %M 31033452 %R 10.2196/10830 %U http://www.jmir.org/2019/4/e10830/ %U https://doi.org/10.2196/10830 %U http://www.ncbi.nlm.nih.gov/pubmed/31033452 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e12425 %T An Ecological Approach to Smart Homes for Health Care Services: Conceptual Framework of a Smart Servicescape Wheel %A Kang,Hyo-Jin %A Han,Jieun %A Kwon,Gyu Hyun %+ Graduate School of Technology and Innovation Management, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea, 82 2 2220 2414, ghkwon@hanyang.ac.kr %K health care information management %K system analysis, smart homes for health care services %K ecological approach %K conceptual framework %K smart servicescape wheel %D 2019 %7 08.02.2019 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Background: Smart homes are considered effective solutions for home health care for the elderly, as smart home technologies can reduce care costs and improve elderly residents’ independence. To develop a greater understanding of smart homes for health care services (SHHSs), this study accentuated the necessity of ecological approaches with an emphasis on environmental constraints. This study was based on 2 rationales: (1) users are inclined to perceive the service quality and service experience from environments (ie, servicescape) owing to the intangibility of health care and the pervasiveness of smart home technologies, and (2) both service domains are complex adaptive systems in which diversified and undefined service experiences—not only a few intended service flows—can be generated by complex combinations of servicescape elements. Objective: This study proposed the conceptual framework of a Smart Servicescape Wheel (SSW) as an ecological approach delineating the extensive spectrum of environmental constraints in SHHSs. Methods: The SSW framework was established based on a literature review. Results: Generally divided by perceptible and imperceptible servicescapes, the SSW consists of the perceptible Physical scape (ie, hardware components, environmental cues, and human states) and Social scape (ie, service relationships and social relationships) as well as the imperceptible Datascape (ie, computing intelligence, databases, and communication networks). Following the ecological approach, each category of the SSW is subdivided and defined at the level of components or functions. Conclusions: The SSW’s strengths lie in the various application opportunities for SHHSs. In terms of service planning and development, the SSW can be utilized to (1) establish the requirements for SHHS development, (2) associate with work domain analysis by defining component layers, and (3) understand the real contexts of SHHSs for the enhanced prediction of diverse service experiences. Regarding service management, it can be applied to develop measurement items for the operation and evaluation of SHHSs. %M 30735145 %R 10.2196/12425 %U http://mhealth.jmir.org/2019/2/e12425/ %U https://doi.org/10.2196/12425 %U http://www.ncbi.nlm.nih.gov/pubmed/30735145 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e292 %T Measuring Engagement in eHealth and mHealth Behavior Change Interventions: Viewpoint of Methodologies %A Short,Camille E %A DeSmet,Ann %A Woods,Catherine %A Williams,Susan L %A Maher,Carol %A Middelweerd,Anouk %A Müller,Andre Matthias %A Wark,Petra A %A Vandelanotte,Corneel %A Poppe,Louise %A Hingle,Melanie D %A Crutzen,Rik %+ Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, Level 7, South Australian Health and Medical Research Institute, North Terrace, Adelaide, 5000, Australia, 61 61883130532, camille.short@adelaide.edu.au %K telemedicine %K internet %K health promotion %K evaluation studies %K treatment adherence and compliance %K outcome and process assessment (health care) %D 2018 %7 16.11.2018 %9 Viewpoint %J J Med Internet Res %G English %X Engagement in electronic health (eHealth) and mobile health (mHealth) behavior change interventions is thought to be important for intervention effectiveness, though what constitutes engagement and how it enhances efficacy has been somewhat unclear in the literature. Recently published detailed definitions and conceptual models of engagement have helped to build consensus around a definition of engagement and improve our understanding of how engagement may influence effectiveness. This work has helped to establish a clearer research agenda. However, to test the hypotheses generated by the conceptual modules, we need to know how to measure engagement in a valid and reliable way. The aim of this viewpoint is to provide an overview of engagement measurement options that can be employed in eHealth and mHealth behavior change intervention evaluations, discuss methodological considerations, and provide direction for future research. To identify measures, we used snowball sampling, starting from systematic reviews of engagement research as well as those utilized in studies known to the authors. A wide range of methods to measure engagement were identified, including qualitative measures, self-report questionnaires, ecological momentary assessments, system usage data, sensor data, social media data, and psychophysiological measures. Each measurement method is appraised and examples are provided to illustrate possible use in eHealth and mHealth behavior change research. Recommendations for future research are provided, based on the limitations of current methods and the heavy reliance on system usage data as the sole assessment of engagement. The validation and adoption of a wider range of engagement measurements and their thoughtful application to the study of engagement are encouraged. %M 30446482 %R 10.2196/jmir.9397 %U http://www.jmir.org/2018/11/e292/ %U https://doi.org/10.2196/jmir.9397 %U http://www.ncbi.nlm.nih.gov/pubmed/30446482 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e282 %T Clinical Videoconferencing as eHealth: A Critical-Realist Review and Qualitative Meta-Synthesis %A Ekeland,Anne Granstrøm %A Hansen,Anne Helen %A Bergmo,Trine Strand %+ Norwegian Centre for eHealth Research, University Hospital of North Norway, PO Box 35, University Hospital of North Norway, Tromsø, 9038, Norway, 47 95266791, anne.granstrom.ekeland@ehealthresearch.no %K videoconferencing %K clinical practice patterns %K realist review %K situated implications %K eHealth %K telemedicine %D 2018 %7 25.10.2018 %9 Review %J J Med Internet Res %G English %X Background: Earlier work has described videoconferencing technologies, peripheral equipment, organizational models, human relations, purposes, goals and roles as versatile, multifaceted, and those used differently in different clinical practices. Knowledge about benefits and challenges connected to specific characteristics of services are lacking. A 2005 systematic review of published definitions of electronic health (eHealth) identified 51 unique definitions. In addition, the “10 E’s of eHealth” was developed. In 2015, the question “What Is eHealth: Time for an Update?” was posed. Objective: Considering videoconferencing as eHealth, the objective of the paper is twofold: to demonstrate and cluster (different) clinical videoconferencing practices and their situated implications and to suggest interpretive concepts that apply to all clusters and contribute to generative learning of eHealth by discussing the concepts as add-ons to existing descriptions of eHealth in the “10 E’s of eHealth.” Methods: We performed a literature search via the National Center for Biotechnology Information, encompassing PubMed and PubMedCentral, for quality reviews and primary studies. We used the terms “videoconferencing” and “clinical practices.” The selection process was based upon clearly defined criteria. We used an electronic form to extract data. The analysis was inspired by critical and realist review types, grounded theory, and qualitative meta-synthesis. Results: The search returned 354 reviews and primary studies. This paper considered the primary studies, and 16 were included. We identified the following 4 broad clusters: videoconferencing as a controlled technological intervention within existing health care organizations for expert advice, controlled mixed interventions with experimental organizational arrangements, videoconferencing as an emerging technosocial service involving dialogue and empowerment of patients, and videoconferencing as a controlled intervention to improve administrative efficiency. The analysis across the clusters resulted in a proposal to add the following 4 D’s to the existing 10 E’s: (inter)-dependent, differentiated across services and along temporal lines, dynamic in terms of including novel elements for meeting incremental needs, and demanding in terms of making new challenges and dual results visible and needing fresh resources to meet those challenges. For a normative discussion about what eHealth should be according to authors’ conclusions, results suggested ethical, in that users interests should be respected, and not harmful in terms of increasing symptom burden. Conclusions: Services were enacted as dynamic, differentiated concerning content and considerations of quality and adaptive along temporal lines. They were made to work from an ongoing demand for fresh resources, making them interdependent. The 4 D’s—Dynamic, Differentiated, Demanding, and (inter) Dependent—serve as pragmatic add-ons to the “10 E’s of eHealth.” Questions concerning outcome of specified balances between standardization and customization in clinical settings should be addressed in future research along with the emerging dual character of outcome: services being considered both “good” and “bad.” %M 30361197 %R 10.2196/jmir.8497 %U http://www.jmir.org/2018/10/e282/ %U https://doi.org/10.2196/jmir.8497 %U http://www.ncbi.nlm.nih.gov/pubmed/30361197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e10175 %T Proposing a Transactional Model of eHealth Literacy: Concept Analysis %A Paige,Samantha R %A Stellefson,Michael %A Krieger,Janice L %A Anderson-Lewis,Charkarra %A Cheong,JeeWon %A Stopka,Christine %+ STEM Translational Communication Center, College of Journalism and Communications, University of Florida, PO Box 118400, Gainesville, FL, 32611, United States, 1 352 294 0421, paigesr190@ufl.edu %K eHealth literacy %K Transactional Model of Communication %K interpersonal communication %K social media %K mobile phone %D 2018 %7 02.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health (eHealth) literacy was conceptualized in 2006 as the ability of internet users to locate, evaluate, and act upon web-based health information. Now, advances in eHealth technology have cultivated transactional opportunities for patients to access, share, and monitor health information. However, empirical evidence shows that existing models and measures of eHealth literacy have limited theoretical underpinnings that reflect the transactional capabilities of eHealth. This paper describes a conceptual model based on the Transactional Model of Communication (TMC), in which eHealth literacy is described as an intrapersonal skillset hypothesized as being dynamic; reciprocal; and shaped by social, relational, and cultural contexts. Objective: The objective of our study was to systematically examine eHealth literacy definitions, models, and measures to propose a refined conceptual and operational definition based on the TMC. Methods: Walker and Avant’s concept analysis method was used to guide the systematic review of eHealth literacy definitions (n=10), rating scales (n=6), models (n=4), and peer-reviewed model applications (n=16). Subsequent cluster analyses showed salient themes across definitions. Dimensions, antecedents, and consequences reflected in models and measures were extracted and deductively analyzed based on codes consistent with the TMC. Results: Systematic review evidence revealed incongruity between operational eHealth literacy included in definitions compared with literacies included within models and measures. Theoretical underpinnings of eHealth literacy also remain dismal. Despite the transactional capabilities of eHealth, the role of “communication” in eHealth literacy remains underdeveloped and does not account for physical and cognitive processing abilities necessary for multiway transactions. Conclusions: The Transactional Model of eHealth Literacy and a corresponding definition are proposed. In this novel model, eHealth literacy comprises a hierarchical intrapersonal skillset that mediates the reciprocal effect of contextual factors (ie, user oriented and task oriented) on patient engagement in health care. More specifically, the intrapersonal skillset counteracts the negative effect of “noise” (or impediments) produced by social and relational contexts. Cutting across health and technology literacies, the intrapersonal skillset of eHealth literacy is operationalized through four literacies that correspond with discrete operative skills: (1) functional (ie, locate and understand); (2) communicative (ie, exchange); (3) critical (ie, evaluate); and (4) translational (ie, apply). %M 30279155 %R 10.2196/10175 %U https://www.jmir.org/2018/10/e10175/ %U https://doi.org/10.2196/10175 %U http://www.ncbi.nlm.nih.gov/pubmed/30279155 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 3 %P e11631 %T 3MD for Chronic Conditions, a Model for Motivational mHealth Design: Embedded Case Study %A Giunti,Guido %+ Salumedia Tecnologias, Av de la República Argentina, 24, Edificio Torre de Los Remedios, 5 planta modulo A, Seville, 41011, Spain, 34 717702622, drguidogiunti@gmail.com %K chronic conditions %K consumer health informatics %K gamification %K health behavioral change %K medical informatics %K mHealth %K user-centered design %K information systems %D 2018 %7 24.08.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Chronic conditions are the leading cause of death in the world. Major improvements in acute care and diagnostics have created a tendency toward the chronification of formerly terminal conditions, requiring people with these conditions to learn how to self-manage. Mobile technologies hold promise as self-management tools due to their ubiquity and cost-effectiveness. The delivery of health-related services through mobile technologies (mobile health, mHealth) has grown exponentially in recent years. However, only a fraction of these solutions take into consideration the views of relevant stakeholders such as health care professionals or even patients. The use of behavioral change models (BCMs) has proven important in developing successful health solutions, yet engaging patients remains a challenge. There is a trend in mHealth solutions called gamification that attempts to use game elements to drive user behavior and increase engagement. As it stands, designers of mHealth solutions for behavioral change in chronic conditions have no clear way of deciding what factors are relevant to consider. Objective: The goal of this work is to discover factors for the design of mHealth solutions for chronic patients using negotiations between medical knowledge, BCMs, and gamification. Methods: This study uses an embedded case study research methodology consisting of 4 embedded units: 1) cross-sectional studies of mHealth applications; 2) statistical analysis of gamification presence; 3) focus groups and interviews to relevant stakeholders; and 4) research through design of an mHealth solution. The data obtained was thematically analyzed to create a conceptual model for the design of mHealth solutions. Results: The Model for Motivational Mobile-health Design (3MD) for chronic conditions guides the design of condition-oriented gamified behavioral change mHealth solutions. The main components are (1) condition specific, which describe factors that need to be adjusted and adapted for each particular chronic condition; (2) motivation related, which are factors that address how to influence behaviors in an engaging manner; and (3) technology based, which are factors that are directly connected to the technical capabilities of mobile technologies. The 3MD also provides a series of high-level illustrative design questions for designers to use and consider during the design process. Conclusions: This work addresses a recognized gap in research and practice, and proposes a unique model that could be of use in the generation of new solutions to help chronic patients. %M 30143476 %R 10.2196/11631 %U http://games.jmir.org/2018/3/e11631/ %U https://doi.org/10.2196/11631 %U http://www.ncbi.nlm.nih.gov/pubmed/30143476 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e214 %T Tutorial for Using Control Systems Engineering to Optimize Adaptive Mobile Health Interventions %A Hekler,Eric B %A Rivera,Daniel E %A Martin,Cesar A %A Phatak,Sayali S %A Freigoun,Mohammad T %A Korinek,Elizabeth %A Klasnja,Predrag %A Adams,Marc A %A Buman,Matthew P %+ Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, Atkinson Hall (Mail Code 0811, Office 6113), La Jolla, CA, 92093-0811, United States, 1 858 822 7482, ehekler@ucsd.edu %K adaptive interventions %K mHealth %K eHealth %K digital health %K control systems engineering %K behavior change %K optimization %K multiphase optimization strategy %K physical activity %K behavioral maintenance %D 2018 %7 28.06.2018 %9 Tutorial %J J Med Internet Res %G English %X Background: Adaptive behavioral interventions are individualized interventions that vary support based on a person's evolving needs. Digital technologies enable these adaptive interventions to function at scale. Adaptive interventions show great promise for producing better results compared with static interventions related to health outcomes. Our central thesis is that adaptive interventions are more likely to succeed at helping individuals meet and maintain behavioral targets if its elements can be iteratively improved via data-driven testing (ie, optimization). Control systems engineering is a discipline focused on decision making in systems that change over time and has a wealth of methods that could be useful for optimizing adaptive interventions. Objective: The purpose of this paper was to provide an introductory tutorial on when and what to do when using control systems engineering for designing and optimizing adaptive mobile health (mHealth) behavioral interventions. Overview: We start with a review of the need for optimization, building on the multiphase optimization strategy (MOST). We then provide an overview of control systems engineering, followed by attributes of problems that are well matched to control engineering. Key steps in the development and optimization of an adaptive intervention from a control engineering perspective are then summarized, with a focus on why, what, and when to do subtasks in each step. Implications: Control engineering offers exciting opportunities for optimizing individualization and adaptation elements of adaptive interventions. Arguably, the time is now for control systems engineers and behavioral and health scientists to partner to advance interventions that can be individualized, adaptive, and scalable. This tutorial should aid in creating the bridge between these communities. %M 29954725 %R 10.2196/jmir.8622 %U http://www.jmir.org/2018/6/e214/ %U https://doi.org/10.2196/jmir.8622 %U http://www.ncbi.nlm.nih.gov/pubmed/29954725 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e189 %T The Biopsychosocial-Digital Approach to Health and Disease: Call for a Paradigm Expansion %A Ahmadvand,Alireza %A Gatchel,Robert %A Brownstein,John %A Nissen,Lisa %+ School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, 4000, Australia, 61 7 3138 4404, l.nissen@qut.edu.au %K digital health %K digital technologies %K Biopsychosocial Model to Health and Disease %K human resources for health %D 2018 %7 18.05.2018 %9 Viewpoint %J J Med Internet Res %G English %X Digital health is an advancing phenomenon in modern health care systems. Currently, numerous stakeholders in various countries are evaluating the potential benefits of digital health solutions at the individual, population, and/or organizational levels. Additionally, driving factors are being created from the customer-side of the health care systems to push health care providers, policymakers, or researchers to embrace digital health solutions. However, health care providers may differ in their approach to adopt these solutions. Health care providers are not assumed to be appropriately trained to address the requirements of integrating digital health solutions into daily everyday practices and procedures. To adapt to the changing demands of health care systems, it is necessary to expand relevant paradigms and to train human resources as required. In this article, a more comprehensive paradigm will be proposed, based on the ‘biopsychosocial model’ of assessing health and disease, originally introduced by George L Engel. The “biopsychosocial model” must be leveraged to include a “digital” component, thus suggesting a ‘biopsychosocial-digital’ approach to health and disease. Modifications to the “biopsychosocial” model and transition to the “biopsychosocial-digital” model are explained. Furthermore, the emerging implications of understanding health and disease are clarified pertaining to their relevance in training human resources for health care provision and research. %M 29776900 %R 10.2196/jmir.9732 %U http://www.jmir.org/2018/5/e189/ %U https://doi.org/10.2196/jmir.9732 %U http://www.ncbi.nlm.nih.gov/pubmed/29776900 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e107 %T The Effectiveness of Health Care Information Technologies: Evaluation of Trust, Security Beliefs, and Privacy as Determinants of Health Care Outcomes %A Kisekka,Victoria %A Giboney,Justin Scott %+ Information Security and Digital Forensics, School of Business, University at Albany, State University of New York, 1400 Wasthington Ave,, Massry Center for Business (BB) 371, Albany, NY, 12222, United States, 1 518 956 8361, vkisekka@albany.edu %K medical informatics %K privacy %K quality of health care %K trust %D 2018 %7 11.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The diffusion of health information technologies (HITs) within the health care sector continues to grow. However, there is no theory explaining how success of HITs influences patient care outcomes. With the increase in data breaches, HITs’ success now hinges on the effectiveness of data protection solutions. Still, empirical research has only addressed privacy concerns, with little regard for other factors of information assurance. Objective: The objective of this study was to study the effectiveness of HITs using the DeLone and McLean Information Systems Success Model (DMISSM). We examined the role of information assurance constructs (ie, the role of information security beliefs, privacy concerns, and trust in health information) as measures of HIT effectiveness. We also investigated the relationships between information assurance and three aspects of system success: attitude toward health information exchange (HIE), patient access to health records, and perceived patient care quality. Methods: Using structural equation modeling, we analyzed the data from a sample of 3677 cancer patients from a public dataset. We used R software (R Project for Statistical Computing) and the Lavaan package to test the hypothesized relationships. Results: Our extension of the DMISSM to health care was supported. We found that increased privacy concerns reduce the frequency of patient access to health records use, positive attitudes toward HIE, and perceptions of patient care quality. Also, belief in the effectiveness of information security increases the frequency of patient access to health records and positive attitude toward HIE. Trust in health information had a positive association with attitudes toward HIE and perceived patient care quality. Trust in health information had no direct effect on patient access to health records; however, it had an indirect relationship through privacy concerns. Conclusions: Trust in health information and belief in the effectiveness of information security safeguards increases perceptions of patient care quality. Privacy concerns reduce patients’ frequency of accessing health records, patients’ positive attitudes toward HIE exchange, and overall perceived patient care quality. Health care organizations are encouraged to implement security safeguards to increase trust, the frequency of health record use, and reduce privacy concerns, consequently increasing patient care quality. %M 29643052 %R 10.2196/jmir.9014 %U http://www.jmir.org/2018/4/e107/ %U https://doi.org/10.2196/jmir.9014 %U http://www.ncbi.nlm.nih.gov/pubmed/29643052 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e69 %T Reported Theory Use by Digital Interventions for Hazardous and Harmful Alcohol Consumption, and Association With Effectiveness: Meta-Regression %A Garnett,Claire %A Crane,David %A Brown,Jamie %A Kaner,Eileen %A Beyer,Fiona %A Muirhead,Colin %A Hickman,Matthew %A Redmore,James %A de Vocht,Frank %A Beard,Emma %A Michie,Susan %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 1742, c.garnett@ucl.ac.uk %K alcohol drinking %K behavior, addictive %K regression analysis %K meta-analysis %K randomized controlled trial %K Internet %D 2018 %7 28.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Applying theory to the design and evaluation of interventions is likely to increase effectiveness and improve the evidence base from which future interventions are developed, though few interventions report this. Objective: The aim of this paper was to assess how digital interventions to reduce hazardous and harmful alcohol consumption report the use of theory in their development and evaluation, and whether reporting of theory use is associated with intervention effectiveness. Methods: Randomized controlled trials were extracted from a Cochrane review on digital interventions for reducing hazardous and harmful alcohol consumption. Reporting of theory use within these digital interventions was investigated using the theory coding scheme (TCS). Reported theory use was analyzed by frequency counts and descriptive statistics. Associations were analyzed with meta-regression models. Results: Of 41 trials involving 42 comparisons, half did not mention theory (50% [21/42]), and only 38% (16/42) used theory to select or develop the intervention techniques. Significant heterogeneity existed between studies in the effect of interventions on alcohol reduction (I2=77.6%, P<.001). No significant associations were detected between reporting of theory use and intervention effectiveness in unadjusted models, though the meta-regression was underpowered to detect modest associations. Conclusions: Digital interventions offer a unique opportunity to refine and develop new dynamic, temporally sensitive theories, yet none of the studies reported refining or developing theory. Clearer selection, application, and reporting of theory use is needed to accurately assess how useful theory is in this field and to advance the field of behavior change theories. %M 29490895 %R 10.2196/jmir.8807 %U http://www.jmir.org/2018/2/e69/ %U https://doi.org/10.2196/jmir.8807 %U http://www.ncbi.nlm.nih.gov/pubmed/29490895 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e65 %T Integration of eHealth Tools in the Process of Workplace Health Promotion: Proposal for Design and Implementation %A Jimenez,Paulino %A Bregenzer,Anita %+ Department of Psychology, University of Graz, Universitaetsplatz 2, Graz, 8010, Austria, 43 316380 ext 5128, paul.jimenez@uni-graz.at %K eHealth %K health promotion %K mHealth %K occupational health %K workplace %D 2018 %7 23.02.2018 %9 Proposal %J J Med Internet Res %G English %X Background: Electronic health (eHealth) and mobile health (mHealth) tools can support and improve the whole process of workplace health promotion (WHP) projects. However, several challenges and opportunities have to be considered while integrating these tools in WHP projects. Currently, a large number of eHealth tools are developed for changing health behavior, but these tools can support the whole WHP process, including group administration, information flow, assessment, intervention development process, or evaluation. Objective: To support a successful implementation of eHealth tools in the whole WHP processes, we introduce a concept of WHP (life cycle model of WHP) with 7 steps and present critical and success factors for the implementation of eHealth tools in each step. Methods: We developed a life cycle model of WHP based on the World Health Organization (WHO) model of healthy workplace continual improvement process. We suggest adaptations to the WHO model to demonstrate the large number of possibilities to implement eHealth tools in WHP as well as possible critical points in the implementation process. Results: eHealth tools can enhance the efficiency of WHP in each of the 7 steps of the presented life cycle model of WHP. Specifically, eHealth tools can support by offering easier administration, providing an information and communication platform, supporting assessments, presenting and discussing assessment results in a dashboard, and offering interventions to change individual health behavior. Important success factors include the possibility to give automatic feedback about health parameters, create incentive systems, or bring together a large number of health experts in one place. Critical factors such as data security, anonymity, or lack of management involvement have to be addressed carefully to prevent nonparticipation and dropouts. Conclusions: Using eHealth tools can support WHP, but clear regulations for the usage and implementation of these tools at the workplace are needed to secure quality and reach sustainable results. %M 29475828 %R 10.2196/jmir.8769 %U http://www.jmir.org/2018/2/e65/ %U https://doi.org/10.2196/jmir.8769 %U http://www.ncbi.nlm.nih.gov/pubmed/29475828 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e2 %T Digital Health Innovation: A Toolkit to Navigate From Concept to Clinical Testing %A Marvel,Francoise Adeline %A Wang,Jane %A Martin,Seth Shay %+ Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 7th Floor, Baltimore, MD, 21287, United States, 1 4105020469, fmarvel1@jhmi.edu %K digital health innovation models %K mHealth %K innovation framework %K development of smartphone applications %K wearable technology %K healthcare transformation %D 2018 %7 18.01.2018 %9 Viewpoint %J JMIR Cardio %G English %X Digital health technologies such as smartphone apps, Web-based platforms, and wearable devices are rapidly emerging as promising interventions for acute and chronic disease management, particularly in the field of cardiovascular medicine. However, there is limited guidance on how to effectively develop and rigorously test digital health interventions (DHIs). Through our experience with innovating Corrie, a smartphone-based app paired with a smartwatch and blood pressure monitor for myocardial infarction recovery in the acute setting, we aim to provide a toolkit for navigating the digital health technology development and clinical testing processes. The toolkit consists of 6 steps: step one emphasizes concept generation by defining a specific clinical problem and the existing solutions aimed to address it; step two aims to recruit a multidisciplinary team within an academic institution; step three leverages technology accelerators and industry partnerships; step four develops the digital health technology with continuous feedback from patient and family end-users; step five solicits feedback from a diverse array of stakeholders; and step six performs a clinical study at a single site that, if successful, rapidly scales to multiple sites. DHI development is often a complex and vastly uncharted territory. By exploring the steps we took from concept to clinical testing with the first cardiology CareKit app, we hope to provide useful insights to teams that are starting out on their path to digital health innovation. We emphasize the central importance of embracing transdisciplinary work to move from silos to synergy. %M 31758761 %R 10.2196/cardio.7586 %U http://cardio.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/cardio.7586 %U http://www.ncbi.nlm.nih.gov/pubmed/31758761 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e191 %T Predictors of Playing Augmented Reality Mobile Games While Walking Based on the Theory of Planned Behavior: Web-Based Survey %A Koh,Hyeseung Elizabeth %A Oh,Jeeyun %A Mackert,Michael %+ Stan Richards School of Advertising and Public Relations, Moody College of Communication, The University of Texas at Austin, 300 West Dean Keeton, A1200, BMC 4.338, Austin, TX, 78712, United States, 1 512 471 1101, kohhye@utexas.edu %K mobile phone %K pedestrians %K safety on the street %K psychological models %K predictive value of tests %K intention %K age factors %K attitude %K social norms %K self-efficacy %K habits %K immersion %K self-report %D 2017 %7 11.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has been a sharp increase in the number of pedestrians injured while using a mobile phone, but little research has been conducted to explain how and why people use mobile devices while walking. Therefore, we conducted a survey study to explicate the motivations of mobile phone use while walking Objective: The purpose of this study was to identify the critical predictors of behavioral intention to play a popular mobile game, Pokemon Go, while walking, based on the theory of planned behavior (TPB). In addition to the three components of TPB, automaticity, immersion, and enjoyment were added to the model. This study is a theory-based investigation that explores the underlying mechanisms of mobile phone use while walking focusing on a mobile game behavior. Methods: Participants were recruited from a university (study 1; N=262) and Amazon Mechanical Turk (MTurk) (study 2; N=197) in the United States. Participants completed a Web-based questionnaire, which included measures of attitude, subjective norms, perceived behavioral control (PBC), automaticity, immersion, and enjoyment. Participants also answered questions regarding demographic items. Results: Hierarchical regression analyses were conducted to examine hypotheses. The model we tested explained about 41% (study 1) and 63% (study 2) of people’s intention to play Pokemon Go while walking. The following 3 TPB variables were significant predictors of intention to play Pokemon Go while walking in study 1 and study 2: attitude (P<.001), subjective norms (P<.001), and PBC (P=.007 in study 1; P<.001 in study 2). Automaticity tendency (P<.001), immersion (P=.02), and enjoyment (P=.04) were significant predictors in study 1, whereas enjoyment was the only significant predictor in study 2 (P=.01). Conclusions: Findings from this study demonstrated the utility of TPB in predicting a new behavioral domain—mobile use while walking. To sum up, younger users who are habitual, impulsive, and less immersed players are more likely to intend to play a mobile game while walking. %M 29229586 %R 10.2196/mhealth.8470 %U http://mhealth.jmir.org/2017/12/e191/ %U https://doi.org/10.2196/mhealth.8470 %U http://www.ncbi.nlm.nih.gov/pubmed/29229586 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e402 %T Clarifying the Concept of Adherence to eHealth Technology: Systematic Review on When Usage Becomes Adherence %A Sieverink,Floor %A Kelders,Saskia M %A van Gemert-Pijnen,Julia EWC %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, Enschede, 7500AE, Netherlands, 31 534896631, f.sieverink@utwente.nl %K adherence %K eHealth %K systematic review %D 2017 %7 06.12.2017 %9 Review %J J Med Internet Res %G English %X Background: In electronic health (eHealth) evaluations, there is increasing attention for studying the actual usage of a technology in relation to the outcomes found, often by studying the adherence to the technology. On the basis of the definition of adherence, we suggest that the following three elements are necessary to determine adherence to eHealth technology: (1) the ability to measure the usage behavior of individuals; (2) an operationalization of intended use; and (3) an empirical, theoretical, or rational justification of the intended use. However, to date, little is known on how to operationalize the intended usage of and the adherence to different types of eHealth technology. Objective: The study aimed to improve eHealth evaluations by gaining insight into when, how, and by whom the concept of adherence has been used in previous eHealth evaluations and finding a concise way to operationalize adherence to and intended use of different eHealth technologies. Methods: A systematic review of eHealth evaluations was conducted to gain insight into how the use of the technology was measured, how adherence to different types of technologies was operationalized, and if and how the intended use of the technology was justified. Differences in variables between the use of the technology and the operationalization of adherence were calculated using a chi-square test of independence. Results: In total, 62 studies were included in this review. In 34 studies, adherence was operationalized as “the more use, the better,” whereas 28 studies described a threshold for intended use of the technology as well. Out of these 28, only 6 reported a justification for the intended use. The proportion of evaluations of mental health technologies reporting a justified operationalization of intended use is lagging behind compared with evaluations of lifestyle and chronic care technologies. The results indicated that a justification of intended use does not require extra measurements to determine adherence to the technology. Conclusions: The results of this review showed that to date, justifications for intended use are often missing in evaluations of adherence. Evidently, it is not always possible to estimate the intended use of a technology. However, such measures do not meet the definition of adherence and should therefore be referred to as the actual usage of the technology. Therefore, it can be concluded that adherence to eHealth technology is an underdeveloped and often improperly used concept in the existing body of literature. When defining the intended use of a technology and selecting valid measures for adherence, the goal or the assumed working mechanisms should be leading. Adherence can then be standardized, which will improve the comparison of adherence rates to different technologies with the same goal and will provide insight into how adherence to different elements contributed to the outcomes. %M 29212630 %R 10.2196/jmir.8578 %U http://www.jmir.org/2017/12/e402/ %U https://doi.org/10.2196/jmir.8578 %U http://www.ncbi.nlm.nih.gov/pubmed/29212630 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e177 %T Patients’ Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test %A Dou,Kaili %A Yu,Ping %A Deng,Ning %A Liu,Fang %A Guan,YingPing %A Li,Zhenye %A Ji,Yumeng %A Du,Ningkai %A Lu,Xudong %A Duan,Huilong %+ The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, 38 Zheda Rd, Zhouyiqing Bldg 512, Zhejiang University, Yuquan Campus, Hangzhou, 310027, China, 86 571 2295 2693, zju.dengning@gmail.com %K smartphone %K mobile health %K patients %K hypertension %K chronic disease %K disease management %D 2017 %7 06.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. Objective: The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients’ acceptance of smartphone health technology for chronic disease management. Methods: Multiple theories and factors that may influence patients’ acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients’ acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients’ actual use of a smartphone health app. The partial least square method was used to test the theoretical model. Results: The model accounted for .412 of the variance in patients’ intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients’ smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients’ intentions to use the technology. Age and gender had no significant influence on patients’ acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use and actual use of smartphone health apps for chronic disease management. Conclusions: This study developed a theoretical model to predict patients’ acceptance of smartphone health technology for chronic disease management. Although resistance to change is a significant barrier to technology acceptance, careful management of doctor-patient relationship, and raising patients’ awareness of the negative effect of chronic disease can negate the effect of resistance and encourage acceptance and use of smartphone health technology to support chronic disease management for patients in the community. %M 29212629 %R 10.2196/mhealth.7886 %U https://mhealth.jmir.org/2017/12/e177/ %U https://doi.org/10.2196/mhealth.7886 %U http://www.ncbi.nlm.nih.gov/pubmed/29212629 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 4 %P e23 %T The Role of Transfer in Designing Games and Simulations for Health: Systematic Review %A Kuipers,Derek A %A Terlouw,Gijs %A Wartena,Bard O %A van 't Veer,Job TB %A Prins,Jelle T %A Pierie,Jean Pierre EN %+ NHL Stenden University of Applied Sciences, Rengerslaan 10, Leeuwarden, 8917 DD, Netherlands, 31 0646064240, kuipersd@nhl.nl %K transfer %K computer simulation %K video games %K serious games %K games for health %K fidelity %K abstract learning %K immersion %K metaphor %D 2017 %7 24.11.2017 %9 Review %J JMIR Serious Games %G English %X Background: The usefulness and importance of serious games and simulations in learning and behavior change for health and health-related issues are widely recognized. Studies have addressed games and simulations as interventions, mostly in comparison with their analog counterparts. Numerous complex design choices have to be made with serious games and simulations for health, including choices that directly contribute to the effects of the intervention. One of these decisions is the way an intervention is expected to lead to desirable transfer effects. Most designs adopt a first-class transfer rationale, whereas the second class of transfer types seems a rarity in serious games and simulations for health. Objective: This study sought to review the literature specifically on the second class of transfer types in the design of serious games and simulations. Focusing on game-like interventions for health and health care, this study aimed to (1) determine whether the second class of transfer is recognized as a road for transfer in game-like interventions, (2) review the application of the second class of transfer type in designing game-like interventions, and (3) assess studies that include second-class transfer types reporting transfer outcomes. Methods: A total of 6 Web-based databases were systematically searched by titles, abstracts, and keywords using the search strategy (video games OR game OR games OR gaming OR computer simulation*) AND (software design OR design) AND (fidelity OR fidelities OR transfer* OR behaviour OR behavior). The databases searched were identified as relevant to health, education, and social science. Results: A total of 15 relevant studies were included, covering a range of game-like interventions, all more or less mentioning design parameters aimed at transfer. We found 9 studies where first-class transfer was part of the design of the intervention. In total, 8 studies dealt with transfer concepts and fidelity types in game-like intervention design in general; 3 studies dealt with the concept of second-class transfer types and reported effects, and 2 of those recognized transfer as a design parameter. Conclusions: In studies on game-like interventions for health and health care, transfer is regarded as a desirable effect but not as a basic principle for design. None of the studies determined the second class of transfer or instances thereof, although in 3 cases a nonliteral transfer type was present. We also found that studies on game-like interventions for health do not elucidate design choices made and rarely provide design principles for future work. Games and simulations for health abundantly build upon the principles of first-class transfer, but the adoption of second-class transfer types proves scarce. It is likely to be worthwhile to explore the possibilities of second-class transfer types, as they may considerably influence educational objectives in terms of future serious game design for health. %M 29175812 %R 10.2196/games.7880 %U http://games.jmir.org/2017/4/e23/ %U https://doi.org/10.2196/games.7880 %U http://www.ncbi.nlm.nih.gov/pubmed/29175812 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e367 %T Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies %A Greenhalgh,Trisha %A Wherton,Joseph %A Papoutsi,Chrysanthi %A Lynch,Jennifer %A Hughes,Gemma %A A'Court,Christine %A Hinder,Susan %A Fahy,Nick %A Procter,Rob %A Shaw,Sara %+ Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, United Kingdom, 44 1865 289294, trish.greenhalgh@phc.ox.ac.uk %K diffusion of innovation %K scale-up %K program sustainability %K implementation %K complexity of innovations %K business planning %K NASSS framework %K nonadoption, abandonment, scale-up, spread, sustainability framework %K innovation adoption %D 2017 %7 01.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level. Objective: Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program. Methods: The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs—video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing—using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback. Results: The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology, the value proposition, the adopter system (comprising professional staff, patient, and lay caregivers), the organization(s), the wider (institutional and societal) context, and the interaction and mutual adaptation between all these domains over time. Our empirical case studies raised a variety of challenges across all 7 domains, each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components or issues), or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs characterized by complicatedness proved difficult but not impossible to implement. Those characterized by complexity in multiple NASSS domains rarely, if ever, became mainstreamed. The framework showed promise when applied (both prospectively and retrospectively) to other programs. Conclusions: Subject to further empirical testing, NASSS could be applied across a range of technological innovations in health and social care. It has several potential uses: (1) to inform the design of a new technology; (2) to identify technological solutions that (perhaps despite policy or industry enthusiasm) have a limited chance of achieving large-scale, sustained adoption; (3) to plan the implementation, scale-up, or rollout of a technology program; and (4) to explain and learn from program failures. %M 29092808 %R 10.2196/jmir.8775 %U http://www.jmir.org/2017/11/e367/ %U https://doi.org/10.2196/jmir.8775 %U http://www.ncbi.nlm.nih.gov/pubmed/29092808 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e324 %T What is eHealth (6)? Development of a Conceptual Model for eHealth: Qualitative Study with Key Informants %A Shaw,Tim %A McGregor,Deborah %A Brunner,Melissa %A Keep,Melanie %A Janssen,Anna %A Barnet,Stewart %+ Research in Implementation Science and eHealth, Faculty of Health Sciences, University of Sydney, Level 2, Charles Perkins Centre Building D17, Sydney, 2006, Australia, 61 2 8627 5754, tim.shaw@sydney.edu.au %K qualitative research %K interview %K health care %K eHealth %K models, theoretical %D 2017 %7 24.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite rapid growth in eHealth research, there remains a lack of consistency in defining and using terms related to eHealth. More widely cited definitions provide broad understanding of eHealth but lack sufficient conceptual clarity to operationalize eHealth and enable its implementation in health care practice, research, education, and policy. Definitions that are more detailed are often context or discipline specific, limiting ease of translation of these definitions across the breadth of eHealth perspectives and situations. A conceptual model of eHealth that adequately captures its complexity and potential overlaps is required. This model must also be sufficiently detailed to enable eHealth operationalization and hypothesis testing. Objective: This study aimed to develop a conceptual practice-based model of eHealth to support health professionals in applying eHealth to their particular professional or discipline contexts. Methods: We conducted semistructured interviews with key informants (N=25) from organizations involved in health care delivery, research, education, practice, governance, and policy to explore their perspectives on and experiences with eHealth. We used purposeful sampling for maximum diversity. Interviews were coded and thematically analyzed for emergent domains. Results: Thematic analyses revealed 3 prominent but overlapping domains of eHealth: (1) health in our hands (using eHealth technologies to monitor, track, and inform health), (2) interacting for health (using digital technologies to enable health communication among practitioners and between health professionals and clients or patients), and (3) data enabling health (collecting, managing, and using health data). These domains formed a model of eHealth that addresses the need for clear definitions and a taxonomy of eHealth while acknowledging the fluidity of this area and the strengths of initiatives that span multiple eHealth domains. Conclusions: This model extends current understanding of eHealth by providing clearly defined domains of eHealth while highlighting the benefits of using digital technologies in ways that cross several domains. It provides the depth of perspectives and examples of eHealth use that are lacking in previous research. On the basis of this model, we suggest that eHealth initiatives that are most impactful would include elements from all 3 domains. %M 29066429 %R 10.2196/jmir.8106 %U http://www.jmir.org/2017/10/e324/ %U https://doi.org/10.2196/jmir.8106 %U http://www.ncbi.nlm.nih.gov/pubmed/29066429 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e285 %T Web-Based Medical Service: Technology Attractiveness, Medical Creditability, Information Source, and Behavior Intention %A Wang,Shan Huei %+ Department and Graduate Institute of Business Administration, National Taiwan University, 9th Floor, Building I, College of Management, No. 85, Section 4, Roosevelt Road, Taipei,, Taiwan, 886 2 33661058, d98741001@ntu.edu.tw %K web-based medical service %K technology attractiveness %K medical creditability %K information source %K behavior intention %D 2017 %7 02.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based medical service (WBMS), a cooperative relationship between medical service and Internet technology, has been called one of the most innovative services of the 21st century. However, its business promotion and implementation in the medical industry have neither been expected nor executed. Few studies have explored this phenomenon from the viewpoint of inexperienced patients. Objective: The primary goal of this study was to explore whether technology attractiveness, medical creditability, and diversified medical information sources could increase users’ behavior intention. Methods: This study explored the effectiveness of web-based medical service by using three situations to manipulate sources of medical information. A total of 150 questionnaires were collected from people who had never used WBMS before. Hierarchical regression was used to examine the mediation and moderated-mediation effects. Results: Perceived ease of use (P=.002) and perceived usefulness (P=.001) significantly enhance behavior intentions. Medical credibility is a mediator (P=.03), but the relationship does not significantly differ under diverse manipulative information channels (P=.39). Conclusions: Medical credibility could explain the extra variation between technology attractiveness and behavior intention, but not significant under different moderating effect of medical information sources. %M 28768608 %R 10.2196/jmir.8114 %U http://www.jmir.org/2017/8/e285/ %U https://doi.org/10.2196/jmir.8114 %U http://www.ncbi.nlm.nih.gov/pubmed/28768608 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e244 %T Studying Scale-Up and Spread as Social Practice: Theoretical Introduction and Empirical Case Study %A Shaw,James %A Shaw,Sara %A Wherton,Joseph %A Hughes,Gemma %A Greenhalgh,Trisha %+ Women's College Hospital, Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S1B2, Canada, 1 +16473828505, jay.shaw@wchospital.ca %K sociology %K medical %K technological innovations %K telemedicine %K health policy %K mHealth %D 2017 %7 07.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Health and care technologies often succeed on a small scale but fail to achieve widespread use (scale-up) or become routine practice in other settings (spread). One reason for this is under-theorization of the process of scale-up and spread, for which a potentially fruitful theoretical approach is to consider the adoption and use of technologies as social practices. Objective: This study aimed to use an in-depth case study of assisted living to explore the feasibility and usefulness of a social practice approach to explaining the scale-up of an assisted-living technology across a local system of health and social care. Methods: This was an individual case study of the implementation of a Global Positioning System (GPS) “geo-fence” for a person living with dementia, nested in a much wider program of ethnographic research and organizational case study of technology implementation across health and social care (Studies in Co-creating Assisted Living Solutions [SCALS] in the United Kingdom). A layered sociological analysis included micro-level data on the index case, meso-level data on the organization, and macro-level data on the wider social, technological, economic, and political context. Data (interviews, ethnographic notes, and documents) were analyzed and synthesized using structuration theory. Results: A social practice lens enabled the uptake of the GPS technology to be studied in the context of what human actors found salient, meaningful, ethical, legal, materially possible, and professionally or culturally appropriate in particular social situations. Data extracts were used to illustrate three exemplar findings. First, professional practice is (and probably always will be) oriented not to “implementing technologies” but to providing excellent, ethical care to sick and vulnerable individuals. Second, in order to “work,” health and care technologies rely heavily on human relationships and situated knowledge. Third, such technologies do not just need to be adopted by individuals; they need to be incorporated into personal habits and collaborative routines (both lay and professional). Conclusions: Health and care technologies need to be embedded within sociotechnical networks and made to work through situated knowledge, personal habits, and collaborative routines. A technology that “works” for one individual in a particular set of circumstances is unlikely to work in the same way for another in a different set of circumstances. We recommend the further study of social practices and the application of co-design principles. However, our findings suggest that even if this occurs, the scale-up and spread of many health and care technologies will be neither rapid nor smooth. %M 28687532 %R 10.2196/jmir.7482 %U http://www.jmir.org/2017/7/e244/ %U https://doi.org/10.2196/jmir.7482 %U http://www.ncbi.nlm.nih.gov/pubmed/28687532 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e147 %T More Than a Text Message: Dismantling Digital Triggers to Curate Behavior Change in Patient-Centered Health Interventions %A Muench,Frederick %A Baumel,Amit %+ Psychiatry, Northwell Health, 311, 1010 Northern Blvd, Great Neck, NY, 11021, United States, 1 191 532 0623, fmuench@northwell.edu %K alerts %K digital triggers %K text messaging %K haptic triggers %K reminder systems %K push alerts %K mHealth %K mobile health %K engagement %K marketing %K behavior change %K behavioral medicine %D 2017 %7 26.05.2017 %9 Viewpoint %J J Med Internet Res %G English %X Digital triggers such as text messages, emails, and push alerts are designed to focus an individual on a desired goal by prompting an internal or external reaction at the appropriate time. Triggers therefore have an essential role in engaging individuals with digital interventions delivered outside of traditional health care settings, where other events in daily lives and fluctuating motivation to engage in effortful behavior exist. There is an emerging body of literature examining the use of digital triggers for short-term action and longer-term behavior change. However, little attention has been given to understanding the components of digital triggers. Using tailoring as an overarching framework, we separated digital triggers into 5 primary components: (1) who (sender), (2) how (stimulus type, delivery medium, heterogeneity), (3) when (delivered), (4) how much (frequency, intensity), and (5) what (trigger’s target, trigger’s structure, trigger’s narrative). We highlighted key considerations when tailoring each component and the pitfalls of ignoring common mistakes, such as alert fatigue and habituation. As evidenced throughout the paper, there is a broad literature base from which to draw when tailoring triggers to curate behavior change in health interventions. More research is needed, however, to examine differences in efficacy based on component tailoring, to best use triggers to facilitate behavior change over time, and to keep individuals engaged in physical and mental health behavior change efforts. Dismantling digital triggers into their component parts and reassembling them according to the gestalt of one’s change goals is the first step in this development work. %M 28550001 %R 10.2196/jmir.7463 %U http://www.jmir.org/2017/5/e147/ %U https://doi.org/10.2196/jmir.7463 %U http://www.ncbi.nlm.nih.gov/pubmed/28550001 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e153 %T Accelerating Digital Mental Health Research From Early Design and Creation to Successful Implementation and Sustainment %A Mohr,David C %A Lyon,Aaron R %A Lattie,Emily G %A Reddy,Madhu %A Schueller,Stephen M %+ Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, 750 N Lakeshore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 3125031403, d-mohr@northwestern.edu %K eHealth %K mHealth %K methodology %D 2017 %7 10.05.2017 %9 Viewpoint %J J Med Internet Res %G English %X Mental health problems are common and pose a tremendous societal burden in terms of cost, morbidity, quality of life, and mortality. The great majority of people experience barriers that prevent access to treatment, aggravated by a lack of mental health specialists. Digital mental health is potentially useful in meeting the treatment needs of large numbers of people. A growing number of efficacy trials have shown strong outcomes for digital mental health treatments. Yet despite their positive findings, there are very few examples of successful implementations and many failures. Although the research-to-practice gap is not unique to digital mental health, the inclusion of technology poses unique challenges. We outline some of the reasons for this gap and propose a collection of methods that can result in sustainable digital mental health interventions. These methods draw from human-computer interaction and implementation science and are integrated into an Accelerated Creation-to-Sustainment (ACTS) model. The ACTS model uses an iterative process that includes 2 basic functions (design and evaluate) across 3 general phases (Create, Trial, and Sustain). The ultimate goal in using the ACTS model is to produce a functioning technology-enabled service (TES) that is sustainable in a real-world treatment setting. We emphasize the importance of the service component because evidence from both research and practice has suggested that human touch is a critical ingredient in the most efficacious and used digital mental health treatments. The Create phase results in at least a minimally viable TES and an implementation blueprint. The Trial phase requires evaluation of both effectiveness and implementation while allowing optimization and continuous quality improvement of the TES and implementation plan. Finally, the Sustainment phase involves the withdrawal of research or donor support, while leaving a functioning, continuously improving TES in place. The ACTS model is a step toward bringing implementation and sustainment into the design and evaluation of TESs, public health into clinical research, research into clinics, and treatment into the lives of our patients. %M 28490417 %R 10.2196/jmir.7725 %U http://www.jmir.org/2017/5/e153/ %U https://doi.org/10.2196/jmir.7725 %U http://www.ncbi.nlm.nih.gov/pubmed/28490417 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 1 %P e6 %T The Epital Care Model: A New Person-Centered Model of Technology-Enabled Integrated Care for People With Long Term Conditions %A Phanareth,Klaus %A Vingtoft,Søren %A Christensen,Anders Skovbo %A Nielsen,Jakob Sylvest %A Svenstrup,Jørgen %A Berntsen,Gro Karine Rosvold %A Newman,Stanton Peter %A Kayser,Lars %+ Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1014, Denmark, 45 28757291, lk@sund.ku.dk %K integrated care %K technology enabled %K innovative care %K chronic obstructive pulmonary disease (COPD) %K frail %D 2017 %7 16.01.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: There is worldwide recognition that the future provision of health care requires a reorganization of provision of care, with increased empowerment and engagement of patients, along with skilled health professionals delivering services that are coordinated across sectors and organizations that provide health care. Technology may be a way to enable the creation of a coherent, cocreative, person-centered method to provide health care for individuals with one or more long-term conditions (LTCs). It remains to be determined how a new care model can be introduced that supports the intentions of the World Health Organization (WHO) to have integrated people-centered care. Objective: To design, pilot, and test feasibility of a model of health care for people with LTCs based on a cocreative, iterative, and stepwise process in a way that recognizes the need for person-centered care, and embraces the use of digital technology. Methods: The overall research method was inspired by action research and used an agile, iterative approach. In 2012, a living lab was established in a Danish municipality which allowed for the freedom of redesigning health care processes. As the first step, a wide group of stakeholders was gathered to create a layout for the reorganization of services and development of technology, based on established principles for innovative management of people with chronic conditions. The next three steps were (1) a proof of concept in 2012, (2) a pilot study, and (3) a feasibility study from 2013 to 2015, in which a total of 93 chronic obstructive pulmonary disease (COPD) patients were enrolled. Citizens were provided a tablet-based solution for remote follow-up and communication purposes, and access to a 24/7 response and coordination center that coordinated both virtual and face-to-face support for COPD management. In step five the initial model was extended with elements that support continuity of care. Beginning in the autumn of 2013, 1102 frail elderly individuals were included and offered two additional services: an outgoing acute medical team and a local subacute bed function. Results: Based on the findings from the iterative process, and evolving technology and workflow solutions, we propose a robust and feasible model that can provide a framework for developing solutions to support an active life with one or more LTCs. The resulting Epital Care Model (ECM) consists of six stages, and serves as a template for how a digitally-enhanced health service can be provided based on patients’ medical needs. The model is designed to be a proactive, preventive, and monitoring health care system that involves individuals in the management of their own health conditions. Conclusions: The ECM is in accordance with WHO’s framework for integrated people-centered health services, and may serve as a framework for the development of new technologies and provide a template for future reorganization. %M 28093379 %R 10.2196/resprot.6506 %U http://www.researchprotocols.org/2017/1/e6/ %U https://doi.org/10.2196/resprot.6506 %U http://www.ncbi.nlm.nih.gov/pubmed/28093379 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 12 %P e317 %T IDEAS (Integrate, Design, Assess, and Share): A Framework and Toolkit of Strategies for the Development of More Effective Digital Interventions to Change Health Behavior %A Mummah,Sarah Ann %A Robinson,Thomas N %A King,Abby C %A Gardner,Christopher D %A Sutton,Stephen %+ Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94305-5411, United States, 1 650 723 7822, sm885@cam.ac.uk %K health behavior %K design thinking %K user-centered design %K behavioral theory %K behavior change techniques %K digital interventions %K mobile phones %K digital health %K telemedicine %K diet %K exercise %K weight loss %K smoking cessation %K medication adherence %K sleep %K obesity %D 2016 %7 16.12.2016 %9 Viewpoint %J J Med Internet Res %G English %X Developing effective digital interventions to change health behavior has been a challenging goal for academics and industry players alike. Guiding intervention design using the best combination of approaches available is necessary if effective technologies are to be developed. Behavioral theory, design thinking, user-centered design, rigorous evaluation, and dissemination each have widely acknowledged merits in their application to digital health interventions. This paper introduces IDEAS, a step-by-step process for integrating these approaches to guide the development and evaluation of more effective digital interventions. IDEAS is comprised of 10 phases (empathize, specify, ground, ideate, prototype, gather, build, pilot, evaluate, and share), grouped into 4 overarching stages: Integrate, Design, Assess, and Share (IDEAS). Each of these phases is described and a summary of theory-based behavioral strategies that may inform intervention design is provided. The IDEAS framework strives to provide sufficient detail without being overly prescriptive so that it may be useful and readily applied by both investigators and industry partners in the development of their own mHealth, eHealth, and other digital health behavior change interventions. %M 27986647 %R 10.2196/jmir.5927 %U http://www.jmir.org/2016/12/e317/ %U https://doi.org/10.2196/jmir.5927 %U http://www.ncbi.nlm.nih.gov/pubmed/27986647 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e79 %T Deriving Requirements for Pervasive Well-Being Technology From Work Stress and Intervention Theory: Framework and Case Study %A Koldijk,Saskia %A Kraaij,Wessel %A Neerincx,Mark A %+ Delft University of Technology, Interactive Intelligence, Mekelweg 4, Delft,, Netherlands, 31 888665875, M.A.Neerincx@tudelft.nl %K psychological stress %K professional burn-out %K behavioral symptoms %K self-management %K health technology %K early medical intervention %D 2016 %7 05.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stress in office environments is a big concern, often leading to burn-out. New technologies are emerging, such as easily available sensors, contextual reasoning, and electronic coaching (e-coaching) apps. In the Smart Reasoning for Well-being at Home and at Work (SWELL) project, we explore the potential of using such new pervasive technologies to provide support for the self-management of well-being, with a focus on individuals' stress-coping. Ideally, these new pervasive systems should be grounded in existing work stress and intervention theory. However, there is a large diversity of theories and they hardly provide explicit directions for technology design. Objective: The aim of this paper is to present a comprehensive and concise framework that can be used to design pervasive technologies that support knowledge workers to decrease stress. Methods: Based on a literature study we identify concepts relevant to well-being at work and select different work stress models to find causes of work stress that can be addressed. From a technical perspective, we then describe how sensors can be used to infer stress and the context in which it appears, and use intervention theory to further specify interventions that can be provided by means of pervasive technology. Results: The resulting general framework relates several relevant theories: we relate “engagement and burn-out” to “stress”, and describe how relevant aspects can be quantified by means of sensors. We also outline underlying causes of work stress and how these can be addressed with interventions, in particular utilizing new technologies integrating behavioral change theory. Based upon this framework we were able to derive requirements for our case study, the pervasive SWELL system, and we implemented two prototypes. Small-scale user studies proved the value of the derived technology-supported interventions. Conclusions: The presented framework can be used to systematically develop theory-based technology-supported interventions to address work stress. In the area of pervasive systems for well-being, we identified the following six key research challenges and opportunities: (1) performing multi-disciplinary research, (2) interpreting personal sensor data, (3) relating measurable aspects to burn-out, (4) combining strengths of human and technology, (5) privacy, and (6) ethics. %M 27380749 %R 10.2196/mhealth.5341 %U http://mhealth.jmir.org/2016/3/e79/ %U https://doi.org/10.2196/mhealth.5341 %U http://www.ncbi.nlm.nih.gov/pubmed/27380749 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e176 %T How a Fully Automated eHealth Program Simulates Three Therapeutic Processes: A Case Study %A Holter,Marianne T. S %A Johansen,Ayna %A Brendryen,Håvar %+ The Norwegian Centre for Addiction Research, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1039 Blindern, Oslo, 0315, Norway, 47 93 62 30 61, m.t.s.holter@medisin.uio.no %K Internet %K eHealth %K telemedicine %K behavior therapy %K motivational interviewing %K working alliance %K intervention mapping %K smoking cessation %K cell phones %K text messaging %D 2016 %7 28.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth programs may be better understood by breaking down the components of one particular program and discussing its potential for interactivity and tailoring in regard to concepts from face-to-face counseling. In the search for the efficacious elements within eHealth programs, it is important to understand how a program using lapse management may simultaneously support working alliance, internalization of motivation, and behavior maintenance. These processes have been applied to fully automated eHealth programs individually. However, given their significance in face-to-face counseling, it may be important to simulate the processes simultaneously in interactive, tailored programs. Objective: We propose a theoretical model for how fully automated behavior change eHealth programs may be more effective by simulating a therapist’s support of a working alliance, internalization of motivation, and managing lapses. Methods: We show how the model is derived from theory and its application to Endre, a fully automated smoking cessation program that engages the user in several “counseling sessions” about quitting. A descriptive case study based on tools from the intervention mapping protocol shows how each therapeutic process is simulated. Results: The program supports the user’s working alliance through alliance factors, the nonembodied relational agent Endre and computerized motivational interviewing. Computerized motivational interviewing also supports internalized motivation to quit, whereas a lapse management component responds to lapses. The description operationalizes working alliance, internalization of motivation, and managing lapses, in terms of eHealth support of smoking cessation. Conclusions: A program may simulate working alliance, internalization of motivation, and lapse management through interactivity and individual tailoring, potentially making fully automated eHealth behavior change programs more effective. %M 27354373 %R 10.2196/jmir.5415 %U http://www.jmir.org/2016/6/e176/ %U https://doi.org/10.2196/jmir.5415 %U http://www.ncbi.nlm.nih.gov/pubmed/27354373 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 5 %P e131 %T Activity Theory as a Theoretical Framework for Health Self-Quantification: A Systematic Review of Empirical Studies %A Almalki,Manal %A Gray,Kathleen %A Martin-Sanchez,Fernando %+ Health and Biomedical Informatics Centre, Melbourne Medical School, The University of Melbourne, Room 106, Level 1, 202 Berkeley Street, Melbourne, 3010, Australia, 61 3 8344 8936, manal_almalki@hotmail.com %K activities of daily living %K diagnostic self-evaluation %K patient activation %K patient participation %K self-care %K self-experimentation %K self-management %K user-computer interface %K activity theory %K human-computer interaction %K self-quantification %K self-tracking %K personal informatics %K quantified self %K self-monitoring %D 2016 %7 27.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-quantification (SQ) is a way of working in which, by using tracking tools, people aim to collect, manage, and reflect on personal health data to gain a better understanding of their own body, health behavior, and interaction with the world around them. However, health SQ lacks a formal framework for describing the self-quantifiers’ activities and their contextual components or constructs to pursue these health related goals. Establishing such framework is important because it is the first step to operationalize health SQ fully. This may in turn help to achieve the aims of health professionals and researchers who seek to make or study changes in the self-quantifiers’ health systematically. Objective: The aim of this study was to review studies on health SQ in order to answer the following questions: What are the general features of the work and the particular activities that self-quantifiers perform to achieve their health objectives? What constructs of health SQ have been identified in the scientific literature? How have these studies described such constructs? How would it be possible to model these constructs theoretically to characterize the work of health SQ? Methods: A systematic review of peer-reviewed literature was conducted. A total of 26 empirical studies were included. The content of these studies was thematically analyzed using Activity Theory as an organizing framework. Results: The literature provided varying descriptions of health SQ as data-driven and objective-oriented work mediated by SQ tools. From the literature, we identified two types of SQ work: work on data (ie, data management activities) and work with data (ie, health management activities). Using Activity Theory, these activities could be characterized into 6 constructs: users, tracking tools, health objectives, division of work, community or group setting, and SQ plan and rules. We could not find a reference to any single study that accounted for all these activities and constructs of health SQ activity. Conclusions: A Health Self-Quantification Activity Framework is presented, which shows SQ tool use in context, in relation to the goals, plans, and competence of the user. This makes it easier to analyze issues affecting SQ activity, and thereby makes it more feasible to address them. This review makes two significant contributions to research in this field: it explores health SQ work and its constructs thoroughly and it adapts Activity Theory to describe health SQ activity systematically. %M 27234343 %R 10.2196/jmir.5000 %U http://www.jmir.org/2016/5/e131/ %U https://doi.org/10.2196/jmir.5000 %U http://www.ncbi.nlm.nih.gov/pubmed/27234343 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 4 %N 2 %P e17 %T A Legal Framework to Support Development and Assessment of Digital Health Services %A Garell,Cecilia %A Svedberg,Petra %A Nygren,Jens M %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 35167863, jens.nygren@hh.se %K digital health %K legal aspects %K technological innovations %D 2016 %7 25.05.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: Digital health services empower people to track, manage, and improve their own health and quality of life while delivering a more personalized and precise health care, at a lower cost and with higher efficiency and availability. Essential for the use of digital health services is that the treatment of any personal data is compatible with the Patient Data Act, Personal Data Act, and other applicable privacy laws. Objective: The aim of this study was to develop a framework for legal challenges to support designers in development and assessment of digital health services. Methods: A purposive sampling, together with snowball recruitment, was used to identify stakeholders and information sources for organizing, extending, and prioritizing the different concepts, actors, and regulations in relation to digital health and health-promoting digital systems. The data were collected through structured interviewing and iteration, and 3 different cases were used for face validation of the framework. Results: A framework for assessing the legal challenges in developing digital health services (Legal Challenges in Digital Health [LCDH] Framework) was created and consists of 6 key questions to be used to evaluate a digital health service according to current legislation. Conclusions: Structured discussion about legal challenges in relation to health-promoting digital services can be enabled by a constructive framework to investigate, assess, and verify the digital service according to current legislation. The LCDH Framework developed in this study proposes such a framework and can be used in prospective evaluation of the relationship of a potential health-promoting digital service with the existing laws and regulations %M 27226391 %R 10.2196/medinform.5401 %U http://medinform.jmir.org/2016/2/e17/ %U https://doi.org/10.2196/medinform.5401 %U http://www.ncbi.nlm.nih.gov/pubmed/27226391 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e42 %T Collective-Intelligence Recommender Systems: Advancing Computer Tailoring for Health Behavior Change Into the 21st Century %A Sadasivam,Rajani Shankar %A Cutrona,Sarah L %A Kinney,Rebecca L %A Marlin,Benjamin M %A Mazor,Kathleen M %A Lemon,Stephenie C %A Houston,Thomas K %+ Division of Health Informatics and Implementation Science, Department of Quantitative Health Science, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, , United States, 1 5088568924, rajani.sadasivam@umassmed.edu %K computer-tailored health communication %K machine learning %K recommender systems %D 2016 %7 07.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: What is the next frontier for computer-tailored health communication (CTHC) research? In current CTHC systems, study designers who have expertise in behavioral theory and mapping theory into CTHC systems select the variables and develop the rules that specify how the content should be tailored, based on their knowledge of the targeted population, the literature, and health behavior theories. In collective-intelligence recommender systems (hereafter recommender systems) used by Web 2.0 companies (eg, Netflix and Amazon), machine learning algorithms combine user profiles and continuous feedback ratings of content (from themselves and other users) to empirically tailor content. Augmenting current theory-based CTHC with empirical recommender systems could be evaluated as the next frontier for CTHC. Objective: The objective of our study was to uncover barriers and challenges to using recommender systems in health promotion. Methods: We conducted a focused literature review, interviewed subject experts (n=8), and synthesized the results. Results: We describe (1) limitations of current CTHC systems, (2) advantages of incorporating recommender systems to move CTHC forward, and (3) challenges to incorporating recommender systems into CTHC. Based on the evidence presented, we propose a future research agenda for CTHC systems. Conclusions: We promote discussion of ways to move CTHC into the 21st century by incorporation of recommender systems. %M 26952574 %R 10.2196/jmir.4448 %U http://www.jmir.org/2016/3/e42/ %U https://doi.org/10.2196/jmir.4448 %U http://www.ncbi.nlm.nih.gov/pubmed/26952574 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e49 %T Electronic Health Record Patient Portal Adoption by Health Care Consumers: An Acceptance Model and Survey %A Tavares,Jorge %A Oliveira,Tiago %+ NOVA Information Management School (IMS), Universidade Nova de Lisboa, Campus de Campolide, Lisboa, 1070-312, Portugal, 351 917330943, d2012072@novaims.unl.pt %K UTAUT2 %K technology adoption %K eHealth %K health care consumers %K electronic health records %K technology acceptance %D 2016 %7 02.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The future of health care delivery is becoming more citizen centered, as today’s user is more active, better informed, and more demanding. Worldwide governments are promoting online health services, such as electronic health record (EHR) patient portals and, as a result, the deployment and use of these services. Overall, this makes the adoption of patient-accessible EHR portals an important field to study and understand. Objective: The aim of this study is to understand the factors that drive individuals to adopt EHR portals. Methods: We applied a new adoption model using, as a starting point, Ventkatesh's Unified Theory of Acceptance and Use of Technology in a consumer context (UTAUT2) by integrating a new construct specific to health care, a new moderator, and new relationships. To test the research model, we used the partial least squares (PLS) causal modelling approach. An online questionnaire was administrated. We collected 360 valid responses. Results: The statistically significant drivers of behavioral intention are performance expectancy (beta=.200; t=3.619), effort expectancy (beta=.185; t=2.907), habit (beta=.388; t=7.320), and self-perception (beta=.098; t=2.285). The predictors of use behavior are habit (beta=0.206; t=2.752) and behavioral intention (beta=0.258; t=4.036). The model explained 49.7% of the variance in behavioral intention and 26.8% of the variance in use behavior. Conclusions: Our research helps to understand the desired technology characteristics of EHR portals. By testing an information technology acceptance model, we are able to determine what is more valued by patients when it comes to deciding whether to adopt EHR portals or not. The inclusion of specific constructs and relationships related to the health care consumer area also had a significant impact on understanding the adoption of EHR portals. %M 26935646 %R 10.2196/jmir.5069 %U http://www.jmir.org/2016/3/e49/ %U https://doi.org/10.2196/jmir.5069 %U http://www.ncbi.nlm.nih.gov/pubmed/26935646 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 4 %N 1 %P e7 %T Conceptual Models in Health Informatics Research: A Literature Review and Suggestions for Development %A Gray,Kathleen %A Sockolow,Paulina %+ Health and Biomedical Informatics Centre, University of Melbourne, Level 1, 202 Berkeley Street, Melbourne, 3010, Australia, 61 3 8344 8936, kgray@unimelb.edu.au %K medical informatics %K theoretical models %K conceptual framework %K conceptual model %K design-based research %K implementation research %K evaluation research %K health informatics %K research design %K research training %D 2016 %7 24.02.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: Contributing to health informatics research means using conceptual models that are integrative and explain the research in terms of the two broad domains of health science and information science. However, it can be hard for novice health informatics researchers to find exemplars and guidelines in working with integrative conceptual models. Objectives: The aim of this paper is to support the use of integrative conceptual models in research on information and communication technologies in the health sector, and to encourage discussion of these conceptual models in scholarly forums. Methods: A two-part method was used to summarize and structure ideas about how to work effectively with conceptual models in health informatics research that included (1) a selective review and summary of the literature of conceptual models; and (2) the construction of a step-by-step approach to developing a conceptual model. Results: The seven-step methodology for developing conceptual models in health informatics research explained in this paper involves (1) acknowledging the limitations of health science and information science conceptual models; (2) giving a rationale for one’s choice of integrative conceptual model; (3) explicating a conceptual model verbally and graphically; (4) seeking feedback about the conceptual model from stakeholders in both the health science and information science domains; (5) aligning a conceptual model with an appropriate research plan; (6) adapting a conceptual model in response to new knowledge over time; and (7) disseminating conceptual models in scholarly and scientific forums. Conclusions: Making explicit the conceptual model that underpins a health informatics research project can contribute to increasing the number of well-formed and strongly grounded health informatics research projects. This explication has distinct benefits for researchers in training, research teams, and researchers and practitioners in information, health, and other disciplines. %M 26912288 %R 10.2196/medinform.5021 %U http://medinform.jmir.org/2016/1/e7/ %U https://doi.org/10.2196/medinform.5021 %U http://www.ncbi.nlm.nih.gov/pubmed/26912288 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e25 %T Evidence-Based mHealth Chronic Disease Mobile App Intervention Design: Development of a Framework %A Wilhide III,Calvin C %A Peeples,Malinda M %A Anthony Kouyaté,Robin C %+ WellDoc Inc, 1501 St Paul Street, Baltimore, MD, 21202, United States, 1 443 797 2126, ccwilhide@verizon.net %K mHealth %K mobile applications %K mobile app design %K chronic disease %K diabetes %K mHealth framework %K behavioral intervention %K intervention design %K mHealth implementation %K telemedicine %D 2016 %7 16.02.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Mobile technology offers new capabilities that can help to drive important aspects of chronic disease management at both an individual and population level, including the ability to deliver real-time interventions that can be connected to a health care team. A framework that supports both development and evaluation is needed to understand the aspects of mHealth that work for specific diseases, populations, and in the achievement of specific outcomes in real-world settings. This framework should incorporate design structure and process, which are important to translate clinical and behavioral evidence, user interface, experience design and technical capabilities into scalable, replicable, and evidence-based mobile health (mHealth) solutions to drive outcomes. Objective: The purpose of this paper is to discuss the identification and development of an app intervention design framework, and its subsequent refinement through development of various types of mHealth apps for chronic disease. Methods: The process of developing the framework was conducted between June 2012 and June 2014. Informed by clinical guidelines, standards of care, clinical practice recommendations, evidence-based research, best practices, and translated by subject matter experts, a framework for mobile app design was developed and the refinement of the framework across seven chronic disease states and three different product types is described. Results: The result was the development of the Chronic Disease mHealth App Intervention Design Framework. This framework allowed for the integration of clinical and behavioral evidence for intervention and feature design. The application to different diseases and implementation models guided the design of mHealth solutions for varying levels of chronic disease management. Conclusions: The framework and its design elements enable replicable product development for mHealth apps and may provide a foundation for the digital health industry to systematically expand mobile health interventions and validate their effectiveness across multiple implementation settings and chronic diseases. %M 26883135 %R 10.2196/resprot.4838 %U http://www.researchprotocols.org/2016/1/e25/ %U https://doi.org/10.2196/resprot.4838 %U http://www.ncbi.nlm.nih.gov/pubmed/26883135 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e120 %T An Internet-Based Intervention (Mamma Mia) for Postpartum Depression: Mapping the Development from Theory to Practice %A Drozd,Filip %A Haga,Silje Marie %A Brendryen,Håvar %A Slinning,Kari %+ National Network for Infant Mental Health, Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, PO Box 4623 Nydalen, Oslo, N-0405, Norway, 47 975 16 188, filip.drozd@r-bup.no %K early intervention %K Internet %K intervention mapping %K Mamma Mia %K postpartum depression %K pregnancy %K well-being %D 2015 %7 12.10.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: As much as 10-15% of new mothers experience depression postpartum. An Internet-based intervention (Mamma Mia) was developed with the primary aims of preventing depressive symptoms and enhancing subjective well-being among pregnant and postpartum women. A secondary aim of Mamma Mia was to ease the transition of becoming a mother by providing knowledge, techniques, and support during pregnancy and after birth. Objective: The aim of the paper is to provide a systematic and comprehensive description of the intervention rationale and the development of Mamma Mia. Methods: For this purpose, we used the intervention mapping (IM) protocol as descriptive tool, which consists of the following 6 steps: (1) a needs assessment, (2) definition of change objectives, (3) selection of theoretical methods and practical strategies, (4) development of program components, (5) planning adoption and implementation, and (6) planning evaluation. Results: Mamma Mia is a fully automated Internet intervention available for computers, tablets, and smartphones, intended for individual use by the mother. It starts in gestational week 18-24 and lasts up to when the baby becomes 6 months old. This intervention applies a tunneled design to guide the woman through the program in a step-by-step fashion in accordance with the psychological preparations of becoming a mother. The intervention is delivered by email and interactive websites, combining text, pictures, prerecorded audio files, and user input. It targets risk and protective factors for postpartum depression such as prepartum and postpartum attachment, couple satisfaction, social support, and subjective well-being, as identified in the needs assessment. The plan is to implement Mamma Mia directly to users and as part of ordinary services at well-baby clinics, and to evaluate the effectiveness of Mamma Mia in a randomized controlled trial and assess users’ experiences with the program. Conclusions: The IM of Mamma Mia has made clear the rationale for the intervention, and linked theories and empirical evidence to the contents and materials of the program. This meets the recent calls for intervention descriptions and may inform future studies, development of interventions, and systematic reviews. %M 26476481 %R 10.2196/resprot.4858 %U http://www.researchprotocols.org/2015/4/e120/ %U https://doi.org/10.2196/resprot.4858 %U http://www.ncbi.nlm.nih.gov/pubmed/26476481 %0 Journal Article %@ 2369-3762 %I JMIR Publications Inc. %V 1 %N 2 %P e10 %T Design of Mobile Augmented Reality in Health Care Education: A Theory-Driven Framework %A Zhu,Egui %A Lilienthal,Anneliese %A Shluzas,Lauren Aquino %A Masiello,Italo %A Zary,Nabil %+ Centre for Learning and Knowledge, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 3th Floor, Tomtebodavägen 18a, Stockholm, 171 77, Sweden, 46 8 524 83711, egui.zhu@ki.se %K augmented reality %K health care education %K antibiotics %K general practitioners %K learning environment %K learning theory %K mobile technology %D 2015 %7 18.09.2015 %9 Original Paper %J JMIR Medical Education %G English %X Background: Augmented reality (AR) is increasingly used across a range of subject areas in health care education as health care settings partner to bridge the gap between knowledge and practice. As the first contact with patients, general practitioners (GPs) are important in the battle against a global health threat, the spread of antibiotic resistance. AR has potential as a practical tool for GPs to combine learning and practice in the rational use of antibiotics. Objective: This paper was driven by learning theory to develop a mobile augmented reality education (MARE) design framework. The primary goal of the framework is to guide the development of AR educational apps. This study focuses on (1) identifying suitable learning theories for guiding the design of AR education apps, (2) integrating learning outcomes and learning theories to support health care education through AR, and (3) applying the design framework in the context of improving GPs’ rational use of antibiotics. Methods: The design framework was first constructed with the conceptual framework analysis method. Data were collected from multidisciplinary publications and reference materials and were analyzed with directed content analysis to identify key concepts and their relationships. Then the design framework was applied to a health care educational challenge. Results: The proposed MARE framework consists of three hierarchical layers: the foundation, function, and outcome layers. Three learning theories—situated, experiential, and transformative learning—provide foundational support based on differing views of the relationships among learning, practice, and the environment. The function layer depends upon the learners’ personal paradigms and indicates how health care learning could be achieved with MARE. The outcome layer analyzes different learning abilities, from knowledge to the practice level, to clarify learning objectives and expectations and to avoid teaching pitched at the wrong level. Suggestions for learning activities and the requirements of the learning environment form the foundation for AR to fill the gap between learning outcomes and medical learners’ personal paradigms. With the design framework, the expected rational use of antibiotics by GPs is described and is easy to execute and evaluate. The comparison of specific expected abilities with the GP personal paradigm helps solidify the GP practical learning objectives and helps design the learning environment and activities. The learning environment and activities were supported by learning theories. Conclusions: This paper describes a framework for guiding the design, development, and application of mobile AR for medical education in the health care setting. The framework is theory driven with an understanding of the characteristics of AR and specific medical disciplines toward helping medical education improve professional development from knowledge to practice. Future research will use the framework as a guide for developing AR apps in practice to validate and improve the design framework. %M 27731839 %R 10.2196/mededu.4443 %U http://mededu.jmir.org/2015/2/e10/ %U https://doi.org/10.2196/mededu.4443 %U http://www.ncbi.nlm.nih.gov/pubmed/27731839 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e166 %T Trials of Intervention Principles: Evaluation Methods for Evolving Behavioral Intervention Technologies %A Mohr,David C %A Schueller,Stephen M %A Riley,William T %A Brown,C Hendricks %A Cuijpers,Pim %A Duan,Naihua %A Kwasny,Mary J %A Stiles-Shields,Colleen %A Cheung,Ken %+ Center for Behavioral Intervention Technologies (CBITs), Northwestern University, 750 N. Lakeshore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 1403, d-mohr@northwestern.edu %K mHealth %K eHealth %K clinical trials %K methodology %D 2015 %7 08.07.2015 %9 Viewpoint %J J Med Internet Res %G English %X In recent years, there has been increasing discussion of the limitations of traditional randomized controlled trial (RCT) methodologies for the evaluation of eHealth and mHealth interventions, and in particular, the requirement that these interventions be locked down during evaluation. Locking down these interventions locks in defects and eliminates the opportunities for quality improvement and adaptation to the changing technological environment, often leading to validation of tools that are outdated by the time that trial results are published. Furthermore, because behavioral intervention technologies change frequently during real-world deployment, even if a tested intervention were deployed in the real world, its shelf life would be limited. We argue that RCTs will have greater scientific and public health value if they focus on the evaluation of intervention principles (rather than a specific locked-down version of the intervention), allowing for ongoing quality improvement modifications to the behavioral intervention technology based on the core intervention principles, while continuously improving the functionality and maintaining technological currency. This paper is an initial proposal of a framework and methodology for the conduct of trials of intervention principles (TIPs) aimed at minimizing the risks of in-trial changes to intervention technologies and maximizing the potential for knowledge acquisition. The focus on evaluation of intervention principles using clinical and usage outcomes has the potential to provide more generalizable and durable information than trials focused on a single intervention technology. %M 26155878 %R 10.2196/jmir.4391 %U http://www.jmir.org/2015/7/e166/ %U https://doi.org/10.2196/jmir.4391 %U http://www.ncbi.nlm.nih.gov/pubmed/26155878 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e62 %T Integrating mHealth and Systems Science: A Combination Approach to Prevent and Treat Chronic Health Conditions %A Oreskovic,Nicolas Michel %A Huang,Terry T %A Moon,Jon %+ Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, 100 Cambridge Street, 5th Fl., Boston, MA, 02116, United States, 1 617 726 0593, noreskovic@mgh.harvard.edu %K mHealth %K systems science %K chronic health conditions %K obesity %K physical activity %D 2015 %7 02.06.2015 %9 Viewpoint %J JMIR mHealth uHealth %G English %X Chronic health conditions are a growing global health concern and account for over half of all deaths worldwide. Finding ways to decrease the burden of and resources allotted to chronic health conditions is of primary importance. Recent advances in technology and insights into modeling techniques offer promising approaches, which if combined, represent a novel direction that would further advance the prevention and treatment of chronic health conditions. %M 26036753 %R 10.2196/mhealth.4150 %U http://mhealth.jmir.org/2015/2/e62/ %U https://doi.org/10.2196/mhealth.4150 %U http://www.ncbi.nlm.nih.gov/pubmed/26036753 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 2 %N 1 %P e9 %T Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users' Needs %A Kayser,Lars %A Kushniruk,Andre %A Osborne,Richard H %A Norgaard,Ole %A Turner,Paul %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1014, Denmark, 45 28757291, lk@sund.ku.dk %K eHealth literacy %K requirements %K user involvement %D 2015 %7 20.05.2015 %9 Original Paper %J JMIR Human Factors %G English %X Background: eHealth systems and applications are increasingly focused on supporting consumers to directly engage with and use health care services. Involving end users in the design of these systems is critical to ensure a generation of usable and effective eHealth products and systems. Often the end users engaged for these participatory design processes are not actual representatives of the general population, and developers may have limited understanding about how well they might represent the full range of intended users of the eHealth products. As a consequence, resulting information technology (IT) designs may not accommodate the needs, skills, cognitive capacities, and/or contexts of use of the intended broader population of health consumers. This may result in challenges for consumers who use the health IT systems, and could lead to limitations in adoption if the diversity of user attributes has not been adequately considered by health IT designers. Objective: The objective of this paper is to propose how users’ needs and competences can be taken into account when designing new information and communications technology solutions in health care by expanding the user-task-context matrix model with the domains of a new concept of eHealth literacy. Methods: This approach expands an existing method for supporting health IT system development, which advocates use of a three-dimensional user-task-context matrix to comprehensively identify the users of health IT systems, and what their needs and requirements are under differing contexts of use. The extension of this model involved including knowledge about users’ competences within the seven domains of eHealth literacy, which had been identified based on systematic engagement with computer scientists, academics, health professionals, and patients recruited from various patient organizations and primary care. A concept map was constructed based on a structured brainstorm procedure, card sorting, and computational analysis. Results: The new eHealth literacy concept (based on 7 domains) was incorporated as a key factor in expanding the user-task-context matrix to describe and qualify user requirements and understanding related to eHealth literacy. This resulted in an expanded framework and a five-step process, which can support health IT designers in understanding and more accurately addressing end-users’ needs, capabilities, and contexts to improve effectiveness and broader applicability of consumer-focused health IT systems. It is anticipated that the framework will also be useful for policy makers involved in the planning, procuring, and funding of eHealth infrastructure, applications, and services. Conclusions: Developing effective eHealth products requires complete understanding of the end-users’ needs from multiple perspectives. In this paper, we have proposed and detailed a framework for modeling users’ needs for designing eHealth systems that merges prior work in development of a user-task-context matrix with the emerging area of eHealth literacy. This framework is intended to be used to guide design of eHealth technologies and to make requirements explicitly related to eHealth literacy, enabling a generation of well-targeted, fit-for-purpose, equitable, and effective products and systems. %M 27025228 %R 10.2196/humanfactors.3696 %U http://humanfactors.jmir.org/2015/1/e9/ %U https://doi.org/10.2196/humanfactors.3696 %U http://www.ncbi.nlm.nih.gov/pubmed/27025228 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e118 %T Behavior Change Techniques in Popular Alcohol Reduction Apps: Content Analysis %A Crane,David %A Garnett,Claire %A Brown,James %A West,Robert %A Michie,Susan %+ Department of Clinical, Educational and Health Psychology, University College London, 1 -19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7687 0723, david.crane.13@ucl.ac.uk %K alcohol %K behaviour change %K mHealth %K smartphone %K iPhone %K android %K apps %K digital %K intervention %D 2015 %7 14.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone apps have the potential to reduce excessive alcohol consumption cost-effectively. Although hundreds of alcohol-related apps are available, there is little information about the behavior change techniques (BCTs) they contain, or the extent to which they are based on evidence or theory and how this relates to their popularity and user ratings. Objective: Our aim was to assess the proportion of popular alcohol-related apps available in the United Kingdom that focus on alcohol reduction, identify the BCTs they contain, and explore whether BCTs or the mention of theory or evidence is associated with app popularity and user ratings. Methods: We searched the iTunes and Google Play stores with the terms “alcohol” and “drink”, and the first 800 results were classified into alcohol reduction, entertainment, or blood alcohol content measurement. Of those classified as alcohol reduction, all free apps and the top 10 paid apps were coded for BCTs and for reference to evidence or theory. Measures of popularity and user ratings were extracted. Results: Of the 800 apps identified, 662 were unique. Of these, 13.7% (91/662) were classified as alcohol reduction (95% CI 11.3-16.6), 53.9% (357/662) entertainment (95% CI 50.1-57.7), 18.9% (125/662) blood alcohol content measurement (95% CI 16.1-22.0) and 13.4% (89/662) other (95% CI 11.1-16.3). The 51 free alcohol reduction apps and the top 10 paid apps contained a mean of 3.6 BCTs (SD 3.4), with approximately 12% (7/61) not including any BCTs. The BCTs used most often were “facilitate self-recording” (54%, 33/61), “provide information on consequences of excessive alcohol use and drinking cessation” (43%, 26/61), “provide feedback on performance” (41%, 25/61), “give options for additional and later support” (25%, 15/61) and “offer/direct towards appropriate written materials” (23%, 14/61). These apps also rarely included any of the 22 BCTs frequently used in other health behavior change interventions (mean 2.46, SD 2.06). Evidence was mentioned by 16.4% of apps, and theory was not mentioned by any app. Multivariable regression showed that apps including advice on environmental restructuring were associated with lower user ratings (Β=-46.61, P=.04, 95% CI -91.77 to -1.45) and that both the techniques of “advise on/facilitate the use of social support” (Β=2549.21, P=.04, 95% CI 96.75-5001.67) and the mention of evidence (Β=1376.74, P=.02, 95%, CI 208.62-2544.86) were associated with the popularity of the app. Conclusions: Only a minority of alcohol-related apps promoted health while the majority implicitly or explicitly promoted the use of alcohol. Alcohol-related apps that promoted health contained few BCTs and none referred to theory. The mention of evidence was associated with more popular apps, but popularity and user ratings were only weakly associated with the BCT content. %M 25977135 %R 10.2196/jmir.4060 %U http://www.jmir.org/2015/5/e118/ %U https://doi.org/10.2196/jmir.4060 %U http://www.ncbi.nlm.nih.gov/pubmed/25977135 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 2 %P e11 %T Integrating Health Behavior Theory and Design Elements in Serious Games %A Cheek,Colleen %A Fleming,Theresa %A Lucassen,Mathijs FG %A Bridgman,Heather %A Stasiak,Karolina %A Shepherd,Matthew %A Orpin,Peter %+ Rural Clinical School, School of Medicine, University of Tasmania, Private Bag 3513, Burnie, , Australia, 61 3 6430 5922, Colleen.Cheek@utas.edu.au %K depression %K adolescent %K cognitive behavior therapy %K online intervention %K user-centered %K self-efficacy %K motivation %K adherence %K SPARX %D 2015 %7 21.04.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: Internet interventions for improving health and well-being have the potential to reach many people and fill gaps in service provision. Serious gaming interfaces provide opportunities to optimize user adherence and impact. Health interventions based in theory and evidence and tailored to psychological constructs have been found to be more effective to promote behavior change. Defining the design elements which engage users and help them to meet their goals can contribute to better informed serious games. Objective: To elucidate design elements important in SPARX, a serious game for adolescents with depression, from a user-centered perspective. Methods: We proposed a model based on an established theory of health behavior change and practical features of serious game design to organize ideas and rationale. We analyzed data from 5 studies comprising a total of 22 focus groups and 66 semistructured interviews conducted with youth and families in New Zealand and Australia who had viewed or used SPARX. User perceptions of the game were applied to this framework. Results: A coherent framework was established using the three constructs of self-determination theory (SDT), autonomy, competence, and relatedness, to organize user perceptions and design elements within four areas important in design: computer game, accessibility, working alliance, and learning in immersion. User perceptions mapped well to the framework, which may assist developers in understanding the context of user needs. By mapping these elements against the constructs of SDT, we were able to propose a sound theoretical base for the model. Conclusions: This study’s method allowed for the articulation of design elements in a serious game from a user-centered perspective within a coherent overarching framework. The framework can be used to deliberately incorporate serious game design elements that support a user’s sense of autonomy, competence, and relatedness, key constructs which have been found to mediate motivation at all stages of the change process. The resulting model introduces promising avenues for future exploration. Involving users in program design remains an imperative if serious games are to be fit for purpose. %M 26543916 %R 10.2196/mental.4133 %U http://mental.jmir.org/2015/2/e11/ %U https://doi.org/10.2196/mental.4133 %U http://www.ncbi.nlm.nih.gov/pubmed/26543916 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 4 %P e89 %T The Use of Behavior Change Theory in Internet-Based Asthma Self-Management Interventions: A Systematic Review %A Al-Durra,Mustafa %A Torio,Monika-Bianca %A Cafazzo,Joseph A %+ Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto General Hospital, R Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 4765, maldurra@ehealthinnovation.org %K asthma %K self-care %K self-management %K eHealth, mHealth %K mobile health %K telehealth %K telemedicine %K Internet %K review %D 2015 %7 02.04.2015 %9 Review %J J Med Internet Res %G English %X Background: The high prevalence rate of asthma represents a major societal burden. Advancements in information technology continue to affect the delivery of patient care in all areas of medicine. Internet-based solutions, social media, and mobile technology could address some of the problems associated with increasing asthma prevalence. Objective: This review evaluates Internet-based asthma interventions that were published between 2004 and October 2014 with respect to the use of behavioral change theoretical frameworks, applied clinical guidelines, and assessment tools. Methods: The search term (Asthma AND [Online or Internet or Mobile or Application or eHealth or App]) was applied to six bibliographic databases (Ovid MEDLINE, PubMed, BioMed Central, ProQuest Computing, Web of Knowledge, and ACM Digital Library) including only English-language articles published between 2004 and October 2014. In total, 3932 articles matched the priori search terms and were reviewed by the primary reviewer based on their titles, index terms, and abstracts. The matching articles were then screened by the primary reviewer for inclusion or exclusion based on their abstract, study type, and intervention objectives with respect to the full set of priori inclusion and exclusion criteria; 331 duplicates were identified and removed. A total of 85 articles were included for in-depth review and the remaining 3516 articles were excluded. The primary and secondary reviewer independently reviewed the complete content of the 85 included articles to identify the applied behavioral change theories, clinical guidelines, and assessment tools. Findings and any disagreement between reviewers were resolved by in-depth discussion and through a consolidation process for each of the included articles. Results: The reviewers identified 17 out of 85 interventions (20%) where at least one model, framework, and/or construct of a behavioral change theory were applied. The review identified six clinical guidelines that were applied across 30 of the 85 interventions (35%) as well as a total of 21 assessment tools that were applied across 32 of the 85 interventions (38%). Conclusions: The findings of this literature review indicate that the majority of published Internet-based interventions do not use any documented behavioral change theory, clinical guidelines, and/or assessment tools to inform their design. Further, it was found that the application of clinical guidelines and assessment tools were more salient across the reviewed interventions. A consequence, as such, is that many Internet-based asthma interventions are designed in an ad hoc manner, without the use of any notable evidence-based theoretical frameworks, clinical guidelines, and/or assessment tools. %M 25835564 %R 10.2196/jmir.4110 %U http://www.jmir.org/2015/4/e89/ %U https://doi.org/10.2196/jmir.4110 %U http://www.ncbi.nlm.nih.gov/pubmed/25835564 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 4 %P e86 %T The eHealth Enhanced Chronic Care Model: A Theory Derivation Approach %A Gee,Perry M %A Greenwood,Deborah A %A Paterniti,Debora A %A Ward,Deborah %A Miller,Lisa M Soederberg %+ School of Nursing, Division of Health Sciences, Idaho State University, 921 South 8th Avenue, Pocatello, ID, 83209, United States, 1 208 282 2182, geeperr@isu.edu %K chronic disease %K mobile health %K eHealth %K telemedicine %K personal health records %K social networks %K education of patients %D 2015 %7 01.04.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools. Objective: The first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses. Methods: Using Theory Derivation processes, we identified a “parent theory”, the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms “CCM or Chronic Care Model” AND “eHealth” or the specific identified components of eHealth. Additionally, “Chronic Illness Self-management support” AND “Technology” AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM. Results: We identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be placed within the context of community and enhanced with the benefits of the eCommunity or virtual communities, and (3) a complete feedback loop is needed to assure productive technology-based interactions between the patient and provider. Conclusions: The revised model, eCCM, offers insight into the role of eHealth tools in self-management support for people with chronic conditions. Additional research and testing of the eCCM are the logical next steps. %M 25842005 %R 10.2196/jmir.4067 %U http://www.jmir.org/2015/4/e86/ %U https://doi.org/10.2196/jmir.4067 %U http://www.ncbi.nlm.nih.gov/pubmed/25842005 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e31 %T Apps Seeking Theories: Results of a Study on the Use of Health Behavior Change Theories in Cancer Survivorship Mobile Apps %A Vollmer Dahlke,Deborah %A Fair,Kayla %A Hong,Y Alicia %A Beaudoin,Christopher E %A Pulczinski,Jairus %A Ory,Marcia G %+ Texas A&M School of Public Health, Health Promotion and Community Health Sciences, Texas A&M University, 1266 TAMU, College Station, TX, TX, 77843, United States, 1 512 699 4493, Deborahvd@gmail.com %K mobile apps %K health behavior %K survivorship %K health promotion %K eHealth %K mobile health %D 2015 %7 27.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Thousands of mobile health apps are now available for use on mobile phones for a variety of uses and conditions, including cancer survivorship. Many of these apps appear to deliver health behavior interventions but may fail to consider design considerations based in human computer interface and health behavior change theories. Objective: This study is designed to assess the presence of and manner in which health behavior change and health communication theories are applied in mobile phone cancer survivorship apps. Methods: The research team selected a set of criteria-based health apps for mobile phones and assessed each app using qualitative coding methods to assess the application of health behavior change and communication theories. Each app was assessed using a coding derived from the taxonomy of 26 health behavior change techniques by Abraham and Michie with a few important changes based on the characteristics of mHealth apps that are specific to information processing and human computer interaction such as control theory and feedback systems. Results: A total of 68 mobile phone apps and games built on the iOS and Android platforms were coded, with 65 being unique. Using a Cohen’s kappa analysis statistic, the inter-rater reliability for the iOS apps was 86.1 (P<.001) and for the Android apps, 77.4 (P<.001). For the most part, the scores for inclusion of theory-based health behavior change characteristics in the iOS platform cancer survivorship apps were consistently higher than those of the Android platform apps. For personalization and tailoring, 67% of the iOS apps (24/36) had these elements as compared to 38% of the Android apps (12/32). In the area of prompting for intention formation, 67% of the iOS apps (34/36) indicated these elements as compared to 16% (5/32) of the Android apps. Conclusions: Mobile apps are rapidly emerging as a way to deliver health behavior change interventions that can be tailored or personalized for individuals. As these apps and games continue to evolve and include interactive and adaptive sensors and other forms of dynamic feedback, their content and interventional elements need to be grounded in human computer interface design and health behavior and communication theory and practice. %M 25830810 %R 10.2196/mhealth.3861 %U http://mhealth.jmir.org/2015/1/e31/ %U https://doi.org/10.2196/mhealth.3861 %U http://www.ncbi.nlm.nih.gov/pubmed/25830810 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e32 %T Care Models of eHealth Services: A Case Study on the Design of a Business Model for an Online Precare Service %A van Meeuwen,Dorine PD %A van Walt Meijer,Quirine J %A Simonse,Lianne WL %+ Product Innovation Management department, Faculty of Industrial Design Engineering, Delft University of Technology, Building 32 B-4-160, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 15 27 89054, L.W.L.Simonse@tudelft.nl %K eHealth %K business model innovation %K strategic design %K precare %K service design %K visual modeling method %K care model %D 2015 %7 24.03.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: With a growing population of health care clients in the future, the organization of high-quality and cost-effective service providing becomes an increasing challenge. New online eHealth services are proposed as innovative options for the future. Yet, a major barrier to these services appears to be the lack of new business model designs. Although design efforts generally result in visual models, no such artifacts have been found in the literature on business model design. This paper investigates business model design in eHealth service practices from a design perspective. It adopts a research by design approach and seeks to unravel what characteristics of business models determine an online service and what are important value exchanges between health professionals and clients. Objective: The objective of the study was to analyze the construction of care models in-depth, framing the essential elements of a business model, and design a new care model that structures these elements for the particular context of an online pre-care service in practice. Methods: This research employs a qualitative method of an in-depth case study in which different perspectives on constructing a care model are investigated. Data are collected by using the visual business modeling toolkit, designed to cocreate and visualize the business model. The cocreated models are transcribed and analyzed per actor perspective, transactions, and value attributes. Results: We revealed eight new actors in the business model for providing the service. Essential actors are: the intermediary network coordinator connecting companies, the service dedicated information technology specialists, and the service dedicated health specialist. In the transactions for every service providing we found a certain type of contract, such as a license contract and service contracts for precare services and software products. In addition to the efficiency, quality, and convenience, important value attributes appeared to be: timelines, privacy and credibility, availability, pleasantness, and social interaction. Based on the in-depth insights from the actor perspectives, the business model for online precare services is modeled with a visual design. A new care model of the online precare service is designed and compiled of building blocks for the business model. Conclusions: For the construction of a care model, actors, transactions, and value attributes are essential elements. The design of a care model structures these elements in a visual way. Guided by the business modeling toolkit, the care model design artifact is visualized in the context of an online precare service. Important building blocks include: provision of an online flow of information with regular interactions to the client stimulates self-management of personal health and service-dedicated health expert ensure an increase of the perceived quality of the eHealth service. %M 25831094 %R 10.2196/resprot.3501 %U http://www.researchprotocols.org/2015/1/e32/ %U https://doi.org/10.2196/resprot.3501 %U http://www.ncbi.nlm.nih.gov/pubmed/25831094 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e45 %T Integrating Health Belief Model and Technology Acceptance Model: An Investigation of Health-Related Internet Use %A Ahadzadeh,Ashraf Sadat %A Pahlevan Sharif,Saeed %A Ong,Fon Sim %A Khong,Kok Wei %+ Universiti Putra Malaysia, Faculty of Modern Languages and Communication, UPM, Serdang, 43400, Selangor, Malaysia, Kuala Lumpur, , Malaysia, 60 172824392, ahadzadeh1980@gmail.com %K health beliefs %K Technology Acceptance Model %K health-related Internet use behavior %K mediation effect %D 2015 %7 19.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Today, people use the Internet to satisfy health-related information and communication needs. In Malaysia, Internet use for health management has become increasingly significant due to the increase in the incidence of chronic diseases, in particular among urban women and their desire to stay healthy. Past studies adopted the Technology Acceptance Model (TAM) and Health Belief Model (HBM) independently to explain Internet use for health-related purposes. Although both the TAM and HBM have their own merits, independently they lack the ability to explain the cognition and the related mechanism in which individuals use the Internet for health purposes. Objective: This study aimed to examine the influence of perceived health risk and health consciousness on health-related Internet use based on the HBM. Drawing on the TAM, it also tested the mediating effects of perceived usefulness of the Internet for health information and attitude toward Internet use for health purposes for the relationship between health-related factors, namely perceived health risk and health consciousness on health-related Internet use. Methods: Data obtained for the current study were collected using purposive sampling; the sample consisted of women in Malaysia who had Internet access. The partial least squares structural equation modeling method was used to test the research hypotheses developed. Results: Perceived health risk (β=.135, t1999=2.676) and health consciousness (β=.447, t1999=9.168) had a positive influence on health-related Internet use. Moreover, perceived usefulness of the Internet and attitude toward Internet use for health-related purposes partially mediated the influence of health consciousness on health-related Internet use (β=.025, t1999=3.234), whereas the effect of perceived health risk on health-related Internet use was fully mediated by perceived usefulness of the Internet and attitude (β=.029, t1999=3.609). These results suggest the central role of perceived usefulness of the Internet and attitude toward Internet use for health purposes for women who were health conscious and who perceived their health to be at risk. Conclusions: The integrated model proposed and tested in this study shows that the HBM, when combined with the TAM, is able to predict Internet use for health purposes. For women who subjectively evaluate their health as vulnerable to diseases and are concerned about their health, cognition beliefs in and positive affective feelings about the Internet come into play in determining the use of health-related Internet use. Furthermore, this study shows that engaging in health-related Internet use is a proactive behavior rather than a reactive behavior, suggesting that TAM dimensions have a significant mediating role in Internet health management. %M 25700481 %R 10.2196/jmir.3564 %U http://www.jmir.org/2015/2/e45/ %U https://doi.org/10.2196/jmir.3564 %U http://www.ncbi.nlm.nih.gov/pubmed/25700481 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e25 %T The Chronic Care Model and Technological Research and Innovation: A Scoping Review at the Crossroads %A Gammon,Deede %A Berntsen,Gro Karine Rosvold %A Koricho,Absera Teshome %A Sygna,Karin %A Ruland,Cornelia %+ Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, P.O Box 4950, N-0424, Oslo, , Norway, 47 90977963, deede.gammon@telemed.no %K chronic care model %K chronic disease management %K information and communication technology %K telemedicine %K ehealth %K computer science %K medical informatics %K scoping review %D 2015 %7 06.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Information and communication technologies (ICT) are key to optimizing the outcomes of the Chronic Care Model (CCM), currently acknowledged as the best synthesis of available evidence for chronic illness prevention and management. At the same time, CCM can offer a needed framework for increasing the relevance and feasibility of ICT innovation and research in health care. Little is known about how and to what extent CCM and ICT research inform each other to leverage mutual strengths. The current study examines: What characterizes work being done at the crossroads of CCM and ICT research and innovation? Objective: Our aim is identify the gaps and potential that lie between the research domains CCM and ICT, thus enabling more substantive questions and opportunities for accelerating improvements in ICT-supported chronic care. Methods: Using a scoping study approach, we developed a search strategy applied to medical and technical databases resulting in 1054 titles and abstracts that address CCM and ICT. After iteratively adapting our inclusion/exclusion criteria to balance between breadth and feasibility, 26 publications from 20 studies were found to fulfill our criteria. Following initial coding of each article according to predefined categories (eg, type of article, CCM component, ICT, health issue), a 1st level analysis was conducted resulting in a broad range of categories. These were gradually reduced by constantly comparing them for underlying commonalities and discrepancies. Results: None of the studies included were from technical databases and interventions relied mostly on “old-fashioned” technologies. Technologies supporting “productive interactions” were often one-way (provider to patient), and it was sometimes difficult to decipher how CCM was guiding intervention design. In particular, the major focus on ICT to support providers did not appear unique to the challenges of chronic care. Challenges in facilitating CCM components through ICT included poorly designed user interfaces, digital divide issues, and lack of integration with existing infrastructure. Conclusions: The CCM is a highly influential guide for health care development, which recognizes the need for alignment of system tools such as ICT. Yet, there seem to be alarmingly few touch points between the subject fields of “health service development” and “ICT-innovation”. Bridging these gaps needs explicit and urgent attention as the synergies between these domains have enormous potential. Policy makers and funding agencies need to facilitate the joining of forces between high-tech innovative expertise and experts in the chronic care system redesign that is required for tackling the current epidemic of long-term multiple conditions. %M 25677200 %R 10.2196/jmir.3547 %U http://www.jmir.org/2015/2/e25/ %U https://doi.org/10.2196/jmir.3547 %U http://www.ncbi.nlm.nih.gov/pubmed/25677200 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 1 %P e30 %T The Person-Based Approach to Intervention Development: Application to Digital Health-Related Behavior Change Interventions %A Yardley,Lucy %A Morrison,Leanne %A Bradbury,Katherine %A Muller,Ingrid %+ Department of Psychology, Faculty of Social and Human Sciences, University of Southampton, Department of Psychology, Highfield campus, Southampton, SO17 1BJ, United Kingdom, 44 2380 594581, L.Yardley@soton.ac.uk %K person-based approach %K Internet %K qualitative research %K evaluation studies %K feasibility studies %K health promotion %K patient education %K professional education %K behavior change. %D 2015 %7 30.01.2015 %9 Viewpoint %J J Med Internet Res %G English %X This paper describes an approach that we have evolved for developing successful digital interventions to help people manage their health or illness. We refer to this as the “person-based” approach to highlight the focus on understanding and accommodating the perspectives of the people who will use the intervention. While all intervention designers seek to elicit and incorporate the views of target users in a variety of ways, the person-based approach offers a distinctive and systematic means of addressing the user experience of intended behavior change techniques in particular and can enhance the use of theory-based and evidence-based approaches to intervention development. There are two key elements to the person-based approach. The first is a developmental process involving qualitative research with a wide range of people from the target user populations, carried out at every stage of intervention development, from planning to feasibility testing and implementation. This process goes beyond assessing acceptability, usability, and satisfaction, allowing the intervention designers to build a deep understanding of the psychosocial context of users and their views of the behavioral elements of the intervention. Insights from this process can be used to anticipate and interpret intervention usage and outcomes, and most importantly to modify the intervention to make it more persuasive, feasible, and relevant to users. The second element of the person-based approach is to identify “guiding principles” that can inspire and inform the intervention development by highlighting the distinctive ways that the intervention will address key context-specific behavioral issues. This paper describes how to implement the person-based approach, illustrating the process with examples of the insights gained from our experience of carrying out over a thousand interviews with users, while developing public health and illness management interventions that have proven effective in trials involving tens of thousands of users. %M 25639757 %R 10.2196/jmir.4055 %U http://www.jmir.org/2015/1/e30/ %U https://doi.org/10.2196/jmir.4055 %U http://www.ncbi.nlm.nih.gov/pubmed/25639757 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 8 %P e188 %T The Behavioral Intervention Technology Model and Intervention Mapping: The Best of Both Worlds %A Crutzen,Rik %+ CAPHRI, Department of Health Promotion, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433882828, rik.crutzen@maastrichtuniversity.nl %K mHealth %K eHealth %K behavioral intervention technology %K intervention mapping %D 2014 %7 05.08.2014 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 25095730 %R 10.2196/jmir.3620 %U http://www.jmir.org/2014/8/e188/ %U https://doi.org/10.2196/jmir.3620 %U http://www.ncbi.nlm.nih.gov/pubmed/25095730 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 6 %P e146 %T The Behavioral Intervention Technology Model: An Integrated Conceptual and Technological Framework for eHealth and mHealth Interventions %A Mohr,David C %A Schueller,Stephen M %A Montague,Enid %A Burns,Michelle Nicole %A Rashidi,Parisa %+ Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 1403, d-mohr@northwestern.edu %K mhealth %K ehealth %K behavioral intervention technology %D 2014 %7 05.06.2014 %9 Viewpoint %J J Med Internet Res %G English %X A growing number of investigators have commented on the lack of models to inform the design of behavioral intervention technologies (BITs). BITs, which include a subset of mHealth and eHealth interventions, employ a broad range of technologies, such as mobile phones, the Web, and sensors, to support users in changing behaviors and cognitions related to health, mental health, and wellness. We propose a model that conceptually defines BITs, from the clinical aim to the technological delivery framework. The BIT model defines both the conceptual and technological architecture of a BIT. Conceptually, a BIT model should answer the questions why, what, how (conceptual and technical), and when. While BITs generally have a larger treatment goal, such goals generally consist of smaller intervention aims (the "why") such as promotion or reduction of specific behaviors, and behavior change strategies (the conceptual "how"), such as education, goal setting, and monitoring. Behavior change strategies are instantiated with specific intervention components or “elements” (the "what"). The characteristics of intervention elements may be further defined or modified (the technical "how") to meet the needs, capabilities, and preferences of a user. Finally, many BITs require specification of a workflow that defines when an intervention component will be delivered. The BIT model includes a technological framework (BIT-Tech) that can integrate and implement the intervention elements, characteristics, and workflow to deliver the entire BIT to users over time. This implementation may be either predefined or include adaptive systems that can tailor the intervention based on data from the user and the user’s environment. The BIT model provides a step towards formalizing the translation of developer aims into intervention components, larger treatments, and methods of delivery in a manner that supports research and communication between investigators on how to design, develop, and deploy BITs. %M 24905070 %R 10.2196/jmir.3077 %U http://www.jmir.org/2014/6/e146/ %U https://doi.org/10.2196/jmir.3077 %U http://www.ncbi.nlm.nih.gov/pubmed/24905070 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e76 %T Tailored and Integrated Web-Based Tools for Improving Psychosocial Outcomes of Cancer Patients: The DoTTI Development Framework %A Smits,Rochelle %A Bryant,Jamie %A Sanson-Fisher,Rob %A Tzelepis,Flora %A Henskens,Frans %A Paul,Christine %A Stevenson,William %+ Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, 2308, Australia, 61 2 4042 0700, Rochelle.Smits@newcastle.edu.au %K Internet %K consumer health information %K health literacy %K medical informatics %K neoplasms %K communication %D 2014 %7 14.03.2014 %9 Viewpoint %J J Med Internet Res %G English %X Background: Effective communication with cancer patients and their families about their disease, treatment options, and possible outcomes may improve psychosocial outcomes. However, traditional approaches to providing information to patients, including verbal information and written booklets, have a number of shortcomings centered on their limited ability to meet patient preferences and literacy levels. New-generation Web-based technologies offer an innovative and pragmatic solution for overcoming these limitations by providing a platform for interactive information seeking, information sharing, and user-centered tailoring. Objective: The primary goal of this paper is to discuss the advantages of comprehensive and iterative Web-based technologies for health information provision and propose a four-phase framework for the development of Web-based information tools. Methods: The proposed framework draws on our experience of constructing a Web-based information tool for hematological cancer patients and their families. The framework is based on principles for the development and evaluation of complex interventions and draws on the Agile methodology of software programming that emphasizes collaboration and iteration throughout the development process. Results: The DoTTI framework provides a model for a comprehensive and iterative approach to the development of Web-based informational tools for patients. The process involves 4 phases of development: (1) Design and development, (2) Testing early iterations, (3) Testing for effectiveness, and (4) Integration and implementation. At each step, stakeholders (including researchers, clinicians, consumers, and programmers) are engaged in consultations to review progress, provide feedback on versions of the Web-based tool, and based on feedback, determine the appropriate next steps in development. Conclusions: This 4-phase framework is evidence-informed and consumer-centered and could be applied widely to develop Web-based programs for a diverse range of diseases. %M 24641991 %R 10.2196/jmir.2849 %U http://www.jmir.org/2014/3/e76/ %U https://doi.org/10.2196/jmir.2849 %U http://www.ncbi.nlm.nih.gov/pubmed/24641991 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 7 %P e155 %T Principles and Framework for eHealth Strategy Development %A Scott,Richard E %A Mars,Maurice %+ Nelson R Mandela School of Medicine, Department of TeleHealth, University of KwaZulu-Natal, Private Bag 7, Congella 4013, Durban, , South Africa, 27 31 260 4543, rscott@ukzn.ac.za %K eHealth strategy %K eHealth strategy development framework %K eHealth %K telehealth %K telemedicine %K e-learning %D 2013 %7 30.07.2013 %9 Viewpoint %J J Med Internet Res %G English %X Significant investment in eHealth solutions is being made in nearly every country of the world. How do we know that these investments and the foregone opportunity costs are the correct ones? Absent, poor, or vague eHealth strategy is a significant barrier to effective investment in, and implementation of, sustainable eHealth solutions and establishment of an eHealth favorable policy environment. Strategy is the driving force, the first essential ingredient, that can place countries in charge of their own eHealth destiny and inform them of the policy necessary to achieve it. In the last 2 years, there has been renewed interest in eHealth strategy from the World Health Organization (WHO), International Telecommunications Union (ITU), Pan American Health Organization (PAHO), the African Union, and the Commonwealth; yet overall, the literature lacks clear guidance to inform countries why and how to develop their own complementary but locally specific eHealth strategy. To address this gap, this paper further develops an eHealth Strategy Development Framework, basing it upon a conceptual framework and relevant theories of strategy and complex system analysis available from the literature. We present here the rationale, theories, and final eHealth strategy development framework by which a systematic and methodical approach can be applied by institutions, subnational regions, and countries to create holistic, needs- and evidence-based, and defensible eHealth strategy and to ensure wise investment in eHealth. %M 23900066 %R 10.2196/jmir.2250 %U http://www.jmir.org/2013/7/e155/ %U https://doi.org/10.2196/jmir.2250 %U http://www.ncbi.nlm.nih.gov/pubmed/23900066 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e124 %T Why Business Modeling is Crucial in the Development of eHealth Technologies %A van Limburg,Maarten %A van Gemert-Pijnen,Julia EWC %A Nijland,Nicol %A Ossebaard,Hans C %A Hendrix,Ron MG %A Seydel,Erwin R %+ Center for eHealth Research and Disease Management, Department of Psychology, Health and Technology, Faculty of Behavioural Sciences, University of Twente, Drienerlolaan 5, Enschede, 7500AE, Netherlands, 31 534896070, a.h.m.vanlimburg@utwente.nl %K Business model %K cocreation %K collaboration %K eHealth %K implementation %K multidisciplinary %K stakeholder %K sustainability %K value creation %D 2011 %7 28.12.2011 %9 Viewpoint %J J Med Internet Res %G English %X The impact and uptake of information and communication technologies that support health care are rather low. Current frameworks for eHealth development suffer from a lack of fitting infrastructures, inability to find funding, complications with scalability, and uncertainties regarding effectiveness and sustainability. These issues can be addressed by defining a better implementation strategy early in the development of eHealth technologies. A business model, and thus business modeling, help to determine such an implementation strategy by involving all important stakeholders in a value-driven dialogue on what the technology should accomplish. This idea also seems promising to eHealth, as it can contribute to the whole development of eHealth technology. We therefore suggest that business modeling can be used as an effective approach to supporting holistic development of eHealth technologies. The contribution of business modeling is elaborated in this paper through a literature review that covers the latest business model research, concepts from the latest eHealth and persuasive technology research, evaluation and insights from our prior eHealth research, as well as the review conducted in the first paper of this series. Business modeling focuses on generating a collaborative effort of value cocreation in which all stakeholders reflect on the value needs of the others. The resulting business model acts as the basis for implementation. The development of eHealth technology should focus more on the context by emphasizing what this technology should contribute in practice to the needs of all involved stakeholders. Incorporating the idea of business modeling helps to cocreate and formulate a set of critical success factors that will influence the sustainability and effectiveness of eHealth technology. %M 22204896 %R 10.2196/jmir.1674 %U http://www.jmir.org/2011/4/e124/ %U https://doi.org/10.2196/jmir.1674 %U http://www.ncbi.nlm.nih.gov/pubmed/22204896 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e125 %T eHealth Literacy 2.0: Problems and Opportunities With an Evolving Concept %A Norman,Cameron %+ CENSE Research + Design, 757-155 Dalhousie Street, Toronto, ON, M5B2P7, Canada, 1 4168543805, cameron.norman@utoronto.ca %K eHealth literacy, measurement, consumer eHealth, social media %D 2011 %7 23.12.2011 %9 Guest Editorial %J J Med Internet Res %G English %X As the use of eHealth grows and diversifies globally, the concept of eHealth literacy – a foundational skill set that underpins the use of information and communication technologies (ICT) for health – becomes more important than ever to understand and advance. EHealth literacy draws our collective attention to the knowledge and complex skill set that is often taken for granted when people interact with technology to address information, focusing our attention on learning and usability issues from the clinical through to population health level. Just as the field of eHealth is dynamic and evolving, so too is the context where eHealth literacy is applied and understood. The original Lily Model of eHealth literacy and scale used to assess it were developed at a time when the first generation of web tools gained prominence before the rise of social media. The rapid shifts in the informational landscape created by Web 2.0 tools and environments suggests it might be time to revisit the concept of eHealth Literacy and consider what a second release might look like. %M 22193243 %R 10.2196/jmir.2035 %U http://www.jmir.org/2011/4/e125/ %U https://doi.org/10.2196/jmir.2035 %U http://www.ncbi.nlm.nih.gov/pubmed/22193243 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e111 %T A Holistic Framework to Improve the Uptake and Impact of eHealth Technologies %A van Gemert-Pijnen,Julia EWC %A Nijland,Nicol %A van Limburg,Maarten %A Ossebaard,Hans C %A Kelders,Saskia M %A Eysenbach,Gunther %A Seydel,Erwin R %+ Department of Psychology, Health and Technology/Center for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Drienerlolaan 5, PO Box 217, Enschede, 7500 AE, Netherlands, 31 534896050, j.e.w.c.vangemert-pijnen@utwente.nl %K eHealth %K design %K participation %K implementation %K evaluation %K multidisciplinary approach %K Health 2.0 %K Wiki %K e-collaboration %D 2011 %7 13.12.2011 %9 Viewpoint %J J Med Internet Res %G English %X Background: Many eHealth technologies are not successful in realizing sustainable innovations in health care practices. One of the reasons for this is that the current development of eHealth technology often disregards the interdependencies between technology, human characteristics, and the socioeconomic environment, resulting in technology that has a low impact in health care practices. To overcome the hurdles with eHealth design and implementation, a new, holistic approach to the development of eHealth technologies is needed, one that takes into account the complexity of health care and the rituals and habits of patients and other stakeholders. Objective: The aim of this viewpoint paper is to improve the uptake and impact of eHealth technologies by advocating a holistic approach toward their development and eventual integration in the health sector. Methods: To identify the potential and limitations of current eHealth frameworks (1999–2009), we carried out a literature search in the following electronic databases: PubMed, ScienceDirect, Web of Knowledge, PiCarta, and Google Scholar. Of the 60 papers that were identified, 44 were selected for full review. We excluded those papers that did not describe hands-on guidelines or quality criteria for the design, implementation, and evaluation of eHealth technologies (28 papers). From the results retrieved, we identified 16 eHealth frameworks that matched the inclusion criteria. The outcomes were used to posit strategies and principles for a holistic approach toward the development of eHealth technologies; these principles underpin our holistic eHealth framework. Results: A total of 16 frameworks qualified for a final analysis, based on their theoretical backgrounds and visions on eHealth, and the strategies and conditions for the research and development of eHealth technologies. Despite their potential, the relationship between the visions on eHealth, proposed strategies, and research methods is obscure, perhaps due to a rather conceptual approach that focuses on the rationale behind the frameworks rather than on practical guidelines. In addition, the Web 2.0 technologies that call for a more stakeholder-driven approach are beyond the scope of current frameworks. To overcome these limitations, we composed a holistic framework based on a participatory development approach, persuasive design techniques, and business modeling. Conclusions: To demonstrate the impact of eHealth technologies more effectively, a fresh way of thinking is required about how technology can be used to innovate health care. It also requires new concepts and instruments to develop and implement technologies in practice. The proposed framework serves as an evidence-based roadmap. %M 22155738 %R 10.2196/jmir.1672 %U http://www.jmir.org/2011/4/e111/ %U https://doi.org/10.2196/jmir.1672 %U http://www.ncbi.nlm.nih.gov/pubmed/22155738