%0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e1 %T Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability %A Levesque,Deborah %A Umanzor,Cindy %A de Aguiar,Emma %+ Pro-Change Behavior Systems, Inc, 1174 Kingstown Road, Suite 101, South Kingstown, RI, 02879, United States, 1 401 360 2975, dlevesque@prochange.com %K pilot projects %K substance use disorders %K primary care %K behavioral medicine %K expert system %D 2018 %7 02.01.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: In 2016, 21 million Americans aged 12 years and older needed treatment for a substance use disorder (SUD). However, only 10% to 11% of individuals requiring SUD treatment received it. Given their access to patients, primary care providers are in a unique position to perform universal Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify individuals at risk, fill gaps in services, and make referrals to specialty treatment when indicated. Major barriers to SBIRT include limited time among providers and low motivation to change among many patients. Objective: The objective of this study was to develop and test the acceptability of a prototype of a mobile-delivered substance use risk intervention (SURI) for primary care patients and a clinical dashboard for providers that can address major barriers to SBIRT for risky drug use. The SURI delivers screening and feedback on SUD risk via mobile tools to patients at home or in the waiting room; for patients at risk, it also delivers a brief intervention based on the transtheoretical model of behavior change (TTM) to facilitate progress through the stages of change for quitting the most problematic drug and for seeking treatment if indicated. The prototype also delivers 30 days of stage-matched text messages and 4 Web-based activities addressing key topics. For providers, the clinical dashboard summarizes the patient’s SUD risk scores and stage of change data, and provides stage-matched scripts to guide in-person sessions. Methods: A total of 4 providers from 2 federally qualified health centers (FQHCs) were recruited for the pilot test, and they in turn recruited 5 patients with a known SUD. Furthermore, 3 providers delivered dashboard-guided SBIRT sessions and completed a brief acceptability survey. A total of 4 patients completed a Web-based SURI session and in-person SBIRT session, accessed other program components, and completed 3 acceptability surveys over 30 days. Questions in the surveys were adapted from the National Cancer Institute’s Education Materials Review Form. Response options ranged from 1=strongly disagree to 5=strongly agree. The criterion for establishing acceptability was an overall rating of 4.0 or higher across items. Results: For providers, the overall mean acceptability rating was 4.4 (standard deviation [SD] 0.4). Notably, all providers gave a rating of 5.0 for the item, “The program can give me helpful information about my patient.” For patients, the overall mean acceptability rating was 4.5 (SD 0.3) for the mobile- and provider-delivered SBIRT sessions and 4.0 (SD 0.4) for the text messages and Web-based activities. One highly rated item was “The program could help me make some positive changes” (4.5). Conclusions: The SURI program and clinical dashboard, developed to reduce barriers to SBIRT in primary care, were well received by providers and patients. %M 29295811 %R 10.2196/medinform.7355 %U http://medinform.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/medinform.7355 %U http://www.ncbi.nlm.nih.gov/pubmed/29295811 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 2 %P e13 %T A Web-Based Graphical Food Frequency Assessment System: Design, Development and Usability Metrics %A Franco,Rodrigo Zenun %A Alawadhi,Balqees %A Fallaize,Rosalind %A Lovegrove,Julie A %A Hwang,Faustina %+ Biomedical Engineering, School of Biological Sciences, University of Reading, Whiteknights Campus, Reading,, United Kingdom, 44 118 378 7668, rodrigo.zenun.franco@pgr.reading.ac.uk %K nutrition assessment %K FFQ %K food frequency questionnaire %K personalized nutrition %K nutrition informatics %K dietary intake %K usability %K SUS %D 2017 %7 08.05.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Food frequency questionnaires (FFQs) are well established in the nutrition field, but there remain important questions around how to develop online tools in a way that can facilitate wider uptake. Also, FFQ user acceptance and evaluation have not been investigated extensively. Objective: This paper presents a Web-based graphical food frequency assessment system that addresses challenges of reproducibility, scalability, mobile friendliness, security, and usability and also presents the utilization metrics and user feedback from a deployment study. Methods: The application design employs a single-page application Web architecture with back-end services (database, authentication, and authorization) provided by Google Firebase’s free plan. Its design and responsiveness take advantage of the Bootstrap framework. The FFQ was deployed in Kuwait as part of the EatWellQ8 study during 2016. The EatWellQ8 FFQ contains 146 food items (including drinks). Participants were recruited in Kuwait without financial incentive. Completion time was based on browser timestamps and usability was measured using the System Usability Scale (SUS), scoring between 0 and 100. Products with a SUS higher than 70 are considered to be good. Results: A total of 235 participants created accounts in the system, and 163 completed the FFQ. Of those 163 participants, 142 reported their gender (93 female, 49 male) and 144 reported their date of birth (mean age of 35 years, range from 18-65 years). The mean completion time for all FFQs (n=163), excluding periods of interruption, was 14.2 minutes (95% CI 13.3-15.1 minutes). Female participants (n=93) completed in 14.1 minutes (95% CI 12.9-15.3 minutes) and male participants (n=49) completed in 14.3 minutes (95% CI 12.6-15.9 minutes). Participants using laptops or desktops (n=69) completed the FFQ in an average of 13.9 minutes (95% CI 12.6-15.1 minutes) and participants using smartphones or tablets (n=91) completed in an average of 14.5 minutes (95% CI 13.2-15.8 minutes). The median SUS score (n=141) was 75.0 (interquartile range [IQR] 12.5), and 84% of the participants who completed the SUS classified the system either “good” (n=50) or “excellent” (n=69). Considering only participants using smartphones or tablets (n=80), the median score was 72.5 (IQR 12.5), slightly below the SUS median for desktops and laptops (n=58), which was 75.0 (IQR 12.5). No significant differences were found between genders or age groups (below and above the median) for the SUS or completion time. Conclusions: Taking into account all the requirements, the deployment used professional cloud computing at no cost, and the resulting system had good user acceptance. The results for smartphones/tablets were comparable with desktops/laptops. This work has potential to promote wider uptake of online tools that can assess dietary intake at scale. %M 28483746 %R 10.2196/humanfactors.7287 %U http://humanfactors.jmir.org/2017/2/e13/ %U https://doi.org/10.2196/humanfactors.7287 %U http://www.ncbi.nlm.nih.gov/pubmed/28483746 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 2 %P e10 %T Personal Communication Device Use by Nurses Providing In-Patient Care: Survey of Prevalence, Patterns, and Distraction Potential %A McBride,Deborah L %A LeVasseur,Sandra A %+ Samuel Merritt University, 1720 S Amphlett Blvd #300, San Mateo, CA, 94402, United States, 1 510 848 1721, dmcbride@samuelmerritt.edu %K distraction %K mobile devices %K nurses %D 2017 %7 13.04.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Coincident with the proliferation of employer-provided mobile communication devices, personal communication devices, including basic and enhanced mobile phones (smartphones) and tablet computers that are owned by the user, have become ubiquitous among registered nurses working in hospitals. While there are numerous benefits of personal communication device use by nurses at work, little is known about the impact of these devices on in-patient care. Objective: Our aim was to examine how hospital-registered nurses use their personal communication devices while doing both work-related and non‒work-related activities and to assess the impact of these devices on in-patient care. Methods: A previously validated survey was emailed to 14,797 members of two national nursing organizations. Participants were asked about personal communication device use and their opinions about the impact of these devices on their own and their colleagues’ work. Results: Of the 1268 respondents (8.57% response rate), only 5.65% (70/1237) never used their personal communication device at work (excluding lunch and breaks). Respondents self-reported using their personal communication devices at work for work-related activities including checking or sending text messages or emails to health care team members (29.02%, 363/1251), as a calculator (25.34%, 316/1247), and to access work-related medical information (20.13%, 251/1247). Fewer nurses reported using their devices for non‒work-related activities including checking or sending text messages or emails to friends and family (18.75%, 235/1253), shopping (5.14%, 64/1244), or playing games (2.73%, 34/1249). A minority of respondents believe that their personal device use at work had a positive effect on their work including reducing stress (29.88%, 369/1235), benefiting patient care (28.74%, 357/1242), improving coordination of patient care among the health care team (25.34%, 315/1243), or increasing unit teamwork (17.70%, 220/1243). A majority (69.06%, 848/1228) of respondents believe that on average personal communication devices have a more negative than positive impact on patient care and 39.07% (481/1231) reported that personal communication devices were always or often a distraction while working. Respondents acknowledged their own device use negatively affected their work performance (7.56%, 94/1243), or caused them to miss important clinical information (3.83%, 47/1225) or make a medical error (0.90%, 11/1218). Respondents reported witnessing another nurse’s use of devices negatively affect their work performance (69.41%, 860/1239), or cause them to miss important clinical information (30.61%, 378/1235) or make a medical error (12.51%, 155/1239). Younger respondents reported greater device use while at work than older respondents and generally had more positive opinions about the impact of personal communication devices on their work. Conclusions: The majority of registered nurses believe that the use of personal communication devices on hospital units raises significant safety issues. The high rate of respondents who saw colleagues distracted by their devices compared to the rate who acknowledged their own distraction may be an indication that nurses are unaware of their own attention deficits while using their devices. There were clear generational differences in personal communication device use at work and opinions about the impact of these devices on patient care. Professional codes of conduct for personal communication device use by hospital nurses need to be developed that maximize the benefits of personal communication device use, while reducing the potential for distraction and adverse outcomes. %M 28408359 %R 10.2196/humanfactors.5110 %U http://humanfactors.jmir.org/2017/2/e10/ %U https://doi.org/10.2196/humanfactors.5110 %U http://www.ncbi.nlm.nih.gov/pubmed/28408359 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 2 %P e6 %T A Blended Web-Based Gaming Intervention on Changes in Physical Activity for Overweight and Obese Employees: Influence and Usage in an Experimental Pilot Study %A Kouwenhoven-Pasmooij,Tessa A %A Robroek,Suzan JW %A Ling,Sui Wai %A van Rosmalen,Joost %A van Rossum,Elisabeth FC %A Burdorf,Alex %A Hunink,MG Myriam %+ Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Na2818, Postbus 2040, Rotterdam, 3000CA, Netherlands, 31 107043489, t.kouwenhoven@erasmusmc.nl %K eHealth %K gamification %K physical activity %K fitness tracker %K body mass index %K engagement %K social support %K blended care %D 2017 %7 03.04.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: Addressing the obesity epidemic requires the development of effective interventions aimed at increasing physical activity (PA). eHealth interventions with the use of accelerometers and gaming elements, such as rewarding or social bonding, seem promising. These eHealth elements, blended with face-to-face contacts, have the potential to help people adopt and maintain a physically active lifestyle. Objective: The aim of this study was to assess the influence and usage of a blended Web-based gaming intervention on PA, body mass index (BMI), and waist circumference among overweight and obese employees. Methods: In an uncontrolled before-after study, we observed 52 health care employees with BMI more than 25 kg/m2, who were recruited via the company’s intranet and who voluntarily participated in a 23-week Web-based gaming intervention, supplemented (blended) with non-eHealth components. These non-eHealth components were an individual session with an occupational health physician involving motivational interviewing and 5 multidisciplinary group sessions. The game was played by teams in 5 time periods, aiming to gain points by being physically active, as measured by an accelerometer. Data were collected in 2014 and 2015. Primary outcome was PA, defined as length of time at MET (metabolic equivalent task) ≥3, as measured by the accelerometer during the game. Secondary outcomes were reductions in BMI and waist circumference, measured at baseline and 10 and 23 weeks after the start of the program. Gaming elements such as “compliance” with the game (ie, days of accelerometer wear), “engagement” with the game (ie, frequency of reaching a personal monthly target), and “eHealth teams” (ie, social influence of eHealth teams) were measured as potential determinants of the outcomes. Linear mixed models were used to evaluate the effects on all outcome measures. Results: The mean age of participants was 48.1 years; most participants were female (42/51, 82%). The mean PA was 86 minutes per day, ranging from 6.5 to 223 minutes, which was on average 26.2 minutes per day more than self-reported PA at baseline and remained fairly constant during the game. Mean BMI was reduced by 1.87 kg/m2 (5.6%) and waist circumference by 5.6 cm (4.8%). The univariable model showed that compliance, engagement, and eHealth team were significantly associated with more PA, which remained significant for eHealth team in the multivariable model. Conclusions: This blended Web-based gaming intervention was beneficial for overweight workers in becoming physically active above the recommended activity levels during the entire intervention period, and a favorable influence on BMI and waist circumference was observed. Promising components in the intervention, and thus targets for upscaling, are eHealth teams and engagement with the game. Broader implementation and long-term follow-up can provide insights into the sustainable effects on PA and weight loss and into who benefits the most from this approach. %M 28373157 %R 10.2196/games.6421 %U http://games.jmir.org/2017/2/e6/ %U https://doi.org/10.2196/games.6421 %U http://www.ncbi.nlm.nih.gov/pubmed/28373157 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 1 %P e5 %T Can Gaming Increase Antibiotic Awareness in Children? A Mixed-Methods Approach %A Hale,Alexander R %A Young,Vicki Louise %A Grand,Ann %A McNulty,Cliodna Ann Miriam %+ Public Health England, Primary Care Unit, Gloucestershire Royal Hospital, Gloucester, GL1 3NN, United Kingdom, 44 300 422 5062, vicki.young@phe.gov.uk %K antibiotic resistance %K computer games %K children %K education %K e-Bug %D 2017 %7 24.03.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: e-Bug is a pan-European educational resource for junior and senior school children, which contains activities covering prudent antibiotic use and the spread, treatment, and prevention of infection. Teaching resources for children aged 7-15 years are complemented by a student website that hosts games and interactive activities for the children to continue their learning at home. Objective: The aim of this study was to appraise young people’s opinions of 3 antibiotic games on the e-Bug student website, exploring children’s views and suggestions for improvements, and analyzing change in their knowledge around the learning outcomes covered. The 3 games selected for evaluation all contained elements and learning outcomes relating to antibiotics, the correct use of antibiotics, and bacteria and viruses. Methods: A mixed methodological approach was undertaken, wherein 153 pupils aged 9-11 years in primary schools and summer schools in the Bristol and Gloucestershire area completed a questionnaire with antibiotic and microbe questions, before and after playing 3 e-Bug games for a total of 15 minutes. The after questionnaire also contained open-ended and Likert scale questions. In addition, 6 focus groups with 48 students and think-aloud sessions with 4 students who had all played the games were performed. Results: The questionnaire data showed a significant increase in knowledge for 2 out of 7 questions (P=.01 and P<.001), whereas all questions showed a small level of increase. The two areas of significant knowledge improvement focused around the use of antibiotics for bacterial versus viral infections and ensuring the course of antibiotics is completed. Qualitative data showed that the e-Bug game “Body Busters” was the most popular, closely followed by “Doctor Doctor,” and “Microbe Mania” the least popular. Conclusions: This study shows that 2 of the e-Bug antibiotic educational games are valuable. “Body Busters” effectively increased antibiotic knowledge in children and had the greatest flow and enjoyment. “Doctor Doctor” also resulted in increased knowledge, but was less enjoyable. “Microbe Mania” had neither flow nor knowledge gain and therefore needs much modification and review. The results from the qualitative part of this study will be very important to inform future modifications and improvements to the e-Bug games. %M 28341618 %R 10.2196/games.6420 %U http://games.jmir.org/2017/1/e5/ %U https://doi.org/10.2196/games.6420 %U http://www.ncbi.nlm.nih.gov/pubmed/28341618 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e8 %T A Human-Centered Design Methodology to Enhance the Usability, Human Factors, and User Experience of Connected Health Systems: A Three-Phase Methodology %A Harte,Richard %A Glynn,Liam %A Rodríguez-Molinero,Alejandro %A Baker,Paul MA %A Scharf,Thomas %A Quinlan,Leo R %A ÓLaighin,Gearóid %+ Physiology, School of Medicine, NUI Galway, University Road, Galway, IRL, Ireland, 353 91493710, leo.quinlan@nuigalway.ie %K human-centered design %K user-centered design %K usability testing %K user interface design %K connected health %K human factors %K mHealth %D 2017 %7 16.03.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Design processes such as human-centered design, which involve the end user throughout the product development and testing process, can be crucial in ensuring that the product meets the needs and capabilities of the user, particularly in terms of safety and user experience. The structured and iterative nature of human-centered design can often present a challenge when design teams are faced with the necessary, rapid, product development life cycles associated with the competitive connected health industry. Objective: We wanted to derive a structured methodology that followed the principles of human-centered design that would allow designers and developers to ensure that the needs of the user are taken into account throughout the design process, while maintaining a rapid pace of development. In this paper, we present the methodology and its rationale before outlining how it was applied to assess and enhance the usability, human factors, and user experience of a connected health system known as the Wireless Insole for Independent and Safe Elderly Living (WIISEL) system, a system designed to continuously assess fall risk by measuring gait and balance parameters associated with fall risk. Methods: We derived a three-phase methodology. In Phase 1 we emphasized the construction of a use case document. This document can be used to detail the context of use of the system by utilizing storyboarding, paper prototypes, and mock-ups in conjunction with user interviews to gather insightful user feedback on different proposed concepts. In Phase 2 we emphasized the use of expert usability inspections such as heuristic evaluations and cognitive walkthroughs with small multidisciplinary groups to review the prototypes born out of the Phase 1 feedback. Finally, in Phase 3 we emphasized classical user testing with target end users, using various metrics to measure the user experience and improve the final prototypes. Results: We report a successful implementation of the methodology for the design and development of a system for detecting and predicting falls in older adults. We describe in detail what testing and evaluation activities we carried out to effectively test the system and overcome usability and human factors problems. Conclusions: We feel this methodology can be applied to a wide variety of connected health devices and systems. We consider this a methodology that can be scaled to different-sized projects accordingly. %M 28302594 %R 10.2196/humanfactors.5443 %U http://humanfactors.jmir.org/2017/1/e8/ %U https://doi.org/10.2196/humanfactors.5443 %U http://www.ncbi.nlm.nih.gov/pubmed/28302594 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 1 %P e4 %T A Mobile, Avatar-Based App for Improving Body Perceptions Among Adolescents: A Pilot Test %A Lyles,Annmarie A %A Amresh,Ashish %A Huberty,Jennifer %A Todd,Michael %A Lee,Rebecca E %+ College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, United States, 1 602 496 2196, Annmarie.Lyles@asu.edu %K adolescents %K avatars %K eHealth %K mHealth %K perceptions %K Web-based %K usability testing %D 2017 %7 02.03.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: One barrier to effectively treating weight issues among adolescents is that they tend to use social comparison instead of objective measures to evaluate their own health status. When adolescents correctly perceive themselves as overweight, they are more likely to adopt healthy lifestyle behaviors. Objective: The purpose of this pilot test was to develop and assess acceptability and usability of an avatar-based, theoretically derived mobile app entitled Monitor Your Avatar (MYA). Methods: The MYA app was engineered for high school adolescents to identify, using avatars, what they thought they looked like, what they wanted to look like, and what they actually looked like based on body measurements. Results: The MYA app was pilot-tested with male and female adolescents aged 15-18 years to assess for acceptability and usability. A total of 42 students created and viewed their avatars. The majority of the adolescents were female (28/42, 67%), age 16 years (16/42, 38%), white (35/42, 83%), non-Hispanic (36/42, 86%), in grade 10 (20/42, 48%), healthy weight for females (23/28, 82%), and obese for males (7/14, 50%). The adolescents had positive reactions to the avatar app and being able to view avatars that represented them. All but one student (41/42, 98%) indicated some level of comfort viewing the avatars and would use the app in the future to see how their bodies change over time. Conclusions: Avatar-based mobile apps, such as the MYA app, provide immediate feedback and allow users to engage with images that are personalized to represent their perceptions and actual body images. This pilot study adds to the increasing but limited research of using games to improve health outcomes among high school adolescents. There is a need to further adapt the MYA app and gather feedback from a larger number of high school adolescents, including those from diverse backgrounds. %M 28254737 %R 10.2196/games.6354 %U http://games.jmir.org/2017/1/e4/ %U https://doi.org/10.2196/games.6354 %U http://www.ncbi.nlm.nih.gov/pubmed/28254737 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e6 %T Negotiating Tensions Between Theory and Design in the Development of Mailings for People Recovering From Acute Coronary Syndrome %A Witteman,Holly O %A Presseau,Justin %A Nicholas Angl,Emily %A Jokhio,Iffat %A Schwalm,JD %A Grimshaw,Jeremy M %A Bosiak,Beth %A Natarajan,Madhu K %A Ivers,Noah M %+ Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada, 1 418 656 2131 ext 3981, holly.witteman@fmed.ulaval.ca %K user-centered design %K codesign %K medication adherence %K health behavior %K health education %K myocardial infarction %K secondary prevention %K stents %D 2017 %7 01.03.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Taking all recommended secondary prevention cardiac medications and fully participating in a formal cardiac rehabilitation program significantly reduces mortality and morbidity in the year following a heart attack. However, many people who have had a heart attack stop taking some or all of their recommended medications prematurely and many do not complete a formal cardiac rehabilitation program. Objective: The objective of our study was to develop a user-centered, theory-based, scalable intervention of printed educational materials to encourage and support people who have had a heart attack to use recommended secondary prevention cardiac treatments. Methods: Prior to the design process, we conducted theory-based interviews and surveys with patients who had had a heart attack to identify key determinants of secondary prevention behaviors. Our interdisciplinary research team then partnered with a patient advisor and design firm to undertake an iterative, theory-informed, user-centered design process to operationalize techniques to address these determinants. User-centered design requires considering users’ needs, goals, strengths, limitations, context, and intuitive processes; designing prototypes adapted to users accordingly; observing how potential users respond to the prototype; and using those data to refine the design. To accomplish these tasks, we conducted user research to develop personas (archetypes of potential users), developed a preliminary prototype using behavior change theory to map behavior change techniques to identified determinants of medication adherence, and conducted 2 design cycles, testing materials via think-aloud and semistructured interviews with a total of 11 users (10 patients who had experienced a heart attack and 1 caregiver). We recruited participants at a single cardiac clinic using purposive sampling informed by our personas. We recorded sessions with users and extracted key themes from transcripts. We held interdisciplinary team discussions to interpret findings in the context of relevant theory-based evidence and iteratively adapted the intervention accordingly. Results: Through our iterative development and testing, we identified 3 key tensions: (1) evidence from theory-based studies versus users’ feelings, (2) informative versus persuasive communication, and (3) logistical constraints for the intervention versus users’ desires or preferences. We addressed these by (1) identifying root causes for users’ feelings and addressing those to better incorporate theory- and evidence-based features, (2) accepting that our intervention was ethically justified in being persuasive, and (3) making changes to the intervention where possible, such as attempting to match imagery in the materials to patients’ self-images. Conclusions: Theory-informed interventions must be operationalized in ways that fit with user needs. Tensions between users’ desires or preferences and health care system goals and constraints must be identified and addressed to the greatest extent possible. A cluster randomized controlled trial of the final intervention is currently underway. %M 28249831 %R 10.2196/humanfactors.6502 %U http://humanfactors.jmir.org/2017/1/e6/ %U https://doi.org/10.2196/humanfactors.6502 %U http://www.ncbi.nlm.nih.gov/pubmed/28249831 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e237 %T Can a Free Wearable Activity Tracker Change Behavior? The Impact of Trackers on Adults in a Physician-Led Wellness Group %A Gualtieri,Lisa %A Rosenbluth,Sandra %A Phillips,Jeffrey %+ Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, United States, 1 617 636 0438, lisa.gualtieri@tufts.edu %K wearable activity trackers %K fitness trackers %K trackers %K physical activity %K chronic disease %K behavior change %K wellness group %K wellness %K older adults %K digital health %D 2016 %7 30.11.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Wearable activity trackers (trackers) are increasingly popular devices used to track step count and other health indicators. Trackers have the potential to benefit those in need of increased physical activity, such as adults who are older and face significant health challenges. These populations are least likely to purchase trackers and most likely to face challenges in using them, yet may derive educational, motivational, and health benefits from their use once these barriers are removed. Objective: The aim of this pilot research is to investigate the use of trackers by adults with chronic medical conditions who have never used trackers previously. Specifically, we aim to determine (1) if participants would accept and use trackers to increase their physical activity; (2) if there were barriers to use besides cost and training; (3) if trackers would educate participants on their baseline and ongoing activity levels and support behavior change; and (4) if clinical outcomes would show improvements in participants’ health. Methods: This study was conducted with patients (N=10) in a 12-week physician-led wellness group offered by Family Doctors, LLC. Patients were given trackers in the second week of The Wellness Group and were interviewed 2 to 4 weeks after it ended. The study investigators analyzed the interview notes to extract themes about the participants’ attitudes and behavior changes and collected and analyzed participants’ clinical data, including weight and low-density lipoprotein (LDL) cholesterol over the course of the study. Results: Over the 12 to 14 weeks of tracker use, improvements were seen in clinical outcomes, attitudes towards the trackers, and physical activity behaviors. Participants lost an average of 0.5 lbs per week (SD 0.4), with a mean total weight loss of 5.97 lbs (P=.004). Other short-term clinical outcomes included a 9.2% decrease in LDL levels (P=.038). All participants reported an increase in well-being and confidence in their ability to lead more active lives. We identified the following 6 major attitudinal themes from our qualitative analysis of the interview notes: (1) barriers to tracker purchase included cost, perceived value, and choice confusion; (2) attitudes towards the trackers shifted for many, from half of the participants expressing excitement and hope and half expressing hesitation or trepidation, to all participants feeling positive towards their tracker at the time of the interviews; (3) trackers served as educational tools for baseline activity levels; (4) trackers provided concrete feedback on physical activity, which motivated behavior change; (5) tracker use reinforced wellness group activities and goals; and (6) although commitment to tracker use did not waver, external circumstances influenced some participants’ ongoing use. Conclusions: Our findings suggest that adding trackers to wellness groups comprising primarily older adults with chronic medical conditions can support education and behavior change to be more physically active. The trackers increased participant self-efficacy by providing a tangible, visible reminder of a commitment to increasing activity and immediate feedback on step count and progress towards a daily step goal. While acceptance was high and attitudes ultimately positive, training and support are needed and short-term drop-off in participant use is to be expected. Future research will further consider the potential of trackers in older adults with chronic medical conditions who are unlikely to purchase them, and studies will use larger samples, continue over a longer period of time, and evaluate outcomes independent of a wellness group. %M 27903490 %R 10.2196/resprot.6534 %U http://www.researchprotocols.org/2016/4/e237/ %U https://doi.org/10.2196/resprot.6534 %U http://www.ncbi.nlm.nih.gov/pubmed/27903490